From: bagg@ellis.uchicago.edu (matthew john baggott)
Subject: How to argue that alcoholism is a disease
Reply-To: bagg@midway.uchicago.edu
Organization: University of Chicago
Date: Tue, 5 Jan 1993 00:03:31 GMT


In article <1993Jan2.154837.1@pomona.claremont.edu> cblanc@pomona.claremont.edu (Malevolessence) responds to my statements by writing:

(Note to reader all >> quoted statements were bagg's (mine).)

>>The claim that alcoholics are always going to be alcoholics puzzles me.
>
>	You understand nothing of the problem, then.
>
>> It sounds like something an objectivist would say.  Or like something
>> Wittgenstein attacked in his _Tractatus_.  If it means that former
>> chronic drinkers have a higher chance of engaging in disfunctional heavy 
>> drinking than the general population, then I can happily go along with
>> it.  Otherwise, it sounds like dogma.  Now, if you find such dogma useful
>> in your attempts to understand/control your own behavior, fine.  Just
>
>	You're confusing drinking and alcoholism, which leads me to doubt your
>claim to being a 'scientist.'  

I am not confusing the two.  I am using a description ("chronic drinker")
which describes the phenomenon while avoiding the theoretical baggage with
which you weigh down the term "alcoholic."  Similar terms, like "heavy 
drinker," have appeared in the literature numerous times.  I am surprised 
that such a knowledgable person as yourself should be unfamiliar with this 
practice.

>> From what I understand, there has recently been success curing
>> phobias with beta blockers.  For example, giving a dose of propranolol
>> immediately before the stress-producing situation allegedly prevents
>> panic from occuring and once the phobic finds they can calmly act in
>> those circumstances, the phobia is allegedly gone (and no further
>> drug intervention is necessary).  This seems to be an example of a
>> single drug intervention curing a chronic behavioral problem.
>> In what ways would treating alcoholics with MDMA be different?
>> There are some who maintain that alcoholism is partly motivated by
>> feelings of inadequacy in social situations and that alcohol is used
>> to lower one's own and others' expectations.  Under such a model
>> of alcoholism, MDMA therapy might seem particularly appropriate.

>	There are some who feel that way, doubtless, and there are some who
>would attribute it to a vengeful deity.  Neither theory is correct.

Those who attribute alcoholism to vengeful deities are not published in
reputable journals.  Those who assert that alcoholism is partly motivated
by feelings of inadequacy in social situations are.  In order to get
published, these researchers submit their work to their peers who
evaluate it based upon professional and scientific standards.  Among other
things, their work has to provide scientific evidence for the claims
it makes.  Perhaps you could model your behavior after these
researchers, rather than after those who simply assert alcoholism is
caused by deities.

>	Alcoholism as a disease is the addiction to alcohol, which comes in
>many forms and is not the simple emotional lack you portray it as.

I did not portray alcoholism as an emotional lack, I said that others have
argued that emotional/cognitive factors motivate alcoholic behavior.  

So you believe that addictions in general are all diseases?  This is
interesting.  From your previous remark about "addictive personalities,"
I suspect that you think that all addictions are manifestations of a
single disease.  Is this so?

>> Perhaps anything can play the central role(s) in someone's life which 
>
>	Sophomore:  Anything sensual can have psychological
>addiction-engendering qualities.  Anything.  I have seen people make
>nonaddictive drugs 'addictive' by using them until they became not a central
>focus but a necessity in their lives.  Anything.

My point is made below.  Anything may be possible, but possibility can
be measured.  We do not normally consider things addictive unless there
is a high chance of addiction.  This, of course, is not directly relevant.
I only mentioned it to point out that vague claims such as the one you make
above are not very useful.  When we find someone who appears to be addicted
to something with very little addictive potential, like banannas, then we do 
not "localize" the addictive potential in the fruit, but in some 
psychological/physiological aspect of the "addict."  On the other hand,
when we find someone who is addicted to something which is very
reinforcing and has high addictive potential, then we tend to explain the
addiction by referring to the drug's characteristics.  Both of these
tactics can be useful.  However, both have their shortcomings.
Most significantly, they downplay the importance of environmental
variables.  This is important since there is a substantial body of
animal data which demonstrates how social and physical environments
influence both drug taking and drug effects.  Your talk of alcoholism
as a disease makes me think that you don't believe environmental and
substance variables are particularly significant in addiction.  Or,
rather, you seem to believe that environment and drug characteristics
merely enable the individual's addictive disease status to be expressed.  

What I would like from you is a description of how the presence or
degree of this disease is measurable aside from measuring the addict's drug
consumption itself.  If the "disease" is cognitive or psychological,
then addicts should be different from control subjects before they
begin drug taking and after they stop.  If the "disease" is physio-
logical or genetic, then, again, there should be some mark of an addict
which can be distinguished from the effects of chronic drug taking.
In all cases, we need to be able to rule out the effects of environmental 
differences between our addicts and controls since normal use of the word 
"disease" doesn't include problems caused by being poor etc.  If your only
justification for calling alcoholism a disease comes from the
behavior of the addicts, then I wonder why you don't call every
suboptimal behavior a "disease."   



>> addictive drugs play in addicts' lives.  However, there are several
>> standardized ways of measuring the addictive potential of a drug.  For
>> example, we can look at patterns of self-administration in animals.  Or
>> we can look at patterns of use in human users (such as percent of first-time 
>> users who continue to become frequent users).  Any single measurement will
>> have systematic flaws and will measure a slightly different aspect of the
>> 'addictive qualitites' of a drug.  However, taken together, these measurements
>> can give us a pretty good idea about how addictive a drug is. This sort of 
>> thing can be done for non-drugs as well.  While further experimentation is
>> necessary, it currently appears that MDMA has low addictive potential.
>> 
>>    --Matt Baggott

>Bucko Gizm


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