From: met48546@uxa.cso.uiuc.edu (Marc E. Talbot)
Subject: Re: Addiction a disease? (not)
Organization: University of Illinois at Urbana
Date: Sun, 26 Jul 1992 02:43:49 GMT

carnes@sparky.eecs.umich.edu (Richard Carnes) writes:

>>[re: alcoholism]
>>Uh, define disease?  The AMA certainly thinks it is.  Has for many
>>years.  There are certain criteria something has to meet before it is
>>labeled a disease.  The AMA will tell you that alcoholism certainly
>>meets the criteria.

>I don't know what the AMA says, but I suggest that alcoholism is an
>ADDICTION, and that an addiction is neither a disease nor a
>consequence of moral inferiority or "weakness".  As I understand it,
>an addiction is a dependency on a substance or activity for
>experiencing good feelings (like confidence, control, joy, etc.) and
>for avoiding painful feelings (like hopelessness, emptiness,
>loneliness, etc.).

>Some problems with considering an addiction as a disease:

>* So far as I know, no biological cause has been discovered that
>explains addictive behavior.  (Including a gene, contrary to popular
>belief: see A.M. Bolos et al., "Population and pedigree studies reveal
>a lack of association between the dopamine D_2 receptor gene and
>alcoholism," _Journal of the AMA_ 264 (1990): 3156-60.)

Hmmm....maybe we're just having a definition problem here.  Why does there
have to be a definite biological root for something to be a disease?
I don't have AMA facts handy, so I can't say for sure what qualifications
something has to meet to be a disease, but I am quite sure that alcohol/
drug addiction HAS met the AMA qualifications.  Anyone else?

>* It is not true that all addicts always lose control when they come
>into contact with the substance to which they are addicted.  (For
>example, I understand that experiments have shown that many alcoholics
>frequently control their drinking when it is in their interest to do
>so.)

I don't understand your point.  Speaking from personal experience, I can
say that on a number of occasions I "regulated" my drinking/using when it
was in my best interests to do so.  There were also many occasions when
I used/drank much MORE than was in my best interests.  I think the latter
far outways the former.  I think the "always" is a silly criterion to
use.

>* Addiction is usually not a lifetime condition.  For example, I think
>that there are more ex-smokers than smokers in the US, and 90+ percent
>of them quit on their own, without medical treatment.

Here we need to differentiate between drug (read MIND ALTERING)/alcohol
abuse and addiction.  Yes, alcoholism is an addiction.  Yes, smoking is
also an addiction.  Can we compare the two?  Maybe.  A goldfish is an
animal.  A hampster is an animal.  Why can't a hamster live under water?
Why can't the alcoholic just quit like the smoker does? :-)

>* Addiction is not inevitably progressive.  Most people with addictive
>habits eventually moderate them or give them up.  There are many
>people who used to drink excessively but now drink moderately, and
>many people who were frequent users of illicit drugs but who are not
>now chemically dependent.

You were good about naming studies elsewhere in the post.  I'd really
like to see a study that shows that any significant portion of alcoholics
can drink socially again.  I don't belive it.  Maybe one in a hundred, but
I've never met one.  Also, I think we need to differentiate between
the alcoholic and the excessive drinker.  Just because someone drinks
heavily does not make them an alcoholic; a more important criteria is
how much control alcohol drug abuse has over your life (IMHO).  In
my using days, met a lot of people who could keep up with me in terms
of drug/alcohol intake, but then would have no desire to do so again the
next day.  Use in excess might be a sign of alcoholism, but it certainly
doesn't tell the whole story.

>* Treatment for addiction is frequently no more effective than letting
>the person outgrow the addictive habit on their own.  Some treatments
>are more effective than others, but the more effective ones are not
>the ones that are popular in the United States such as AA (which is
>not to deny that many people have found AA very valuable -- but many
>others have found it to be unhelpful and occasionally harmful).  (See
>W.R. Miller and R.K. Hester, "The effectiveness of alcoholism
>treatment: what research reveals," in _Treating Addictive Behaviors_
>(ed. by the same authors), New York: Plenum, 1986.)

The only place I would have outgrown my habits on my own would be my
grave.

>All this is MHO, of course.  I apologize if this topic has alreadly
>been argued to death here; I'm a relatively new reader of this group.
>Greetings to all and take care,

>Richard Carnes