It reached its zenith in the 1950s and 1960s in Canada. However, over the past two decades, the disease concept of alcohol problems has been seriously called to question by public health agencies and epidemiologists in Canada. Alcoholism is only one of many health and social problems associated with alcohol use. It has been demonstrated that alcohol consumption well below that of clinical alcoholics can greatly elevate the risk of cirrhosis and other health problems. There is no magic threshold at which a person suddenly becomes an alcoholic or becomes likely to experience an alcohol-related health or social problem.
Drugs can similarly have adverse effects among nondependent users.
Most illicit drug users never become addicted, and those who do tend to drift in and out of dependence, depending on their social and economic circumstances. All of these findings challenge the disease concept of alcohol and drug problems. It has been severely challenged by public health authorities in Canada, many of whom would prefer a health promotion approach with a greater emphasis an prevention and early intervention. Although still influential in both Canada and the United States, the disease concept of alcohol and drug problems was always more widely held in the U.S. and it represents the conceptual basis for many American residential treatment programmes. This is not to say that medical treatment should not be provided to persons suffering from dependence or other physical problems associated with the use of alcohol and drugs.