Alcoholism as Disease
The problem in classifying alcoholism as a disease is that it does not demonstrate the classical signs of disease. It does not originate, as far as we know, from an infection or an injury and the usual methods of treatment have no lasting effect on it. Nevertheless, it is a chronic, progressive and sometimes fatal disease. There are a wide variety of definitions of alcoholism reflecting the fact that it is a unique illness and not easily classified or defined. It is generally agreed that to be called “alcoholism” it must involve social and/or economic impairment. Social impairment means relationships with friends and/or family. Economic impairment implies a degradation of the individual’s ability to work and produce in the arena of earning a living. There are different patterns involved in alcoholism ranging from daily continuous drinking in private of what would be reasonable amounts if they were not daily all the way to rare episodes of extreme drinking in public involving
violent behavior and/or amnesia and/or blackouts and/or resultant legal problems. If any of these patterns are identifiable and repeat themselves and if there is impairment of social and/or economic stability, then the diagnosis of the disease of alcoholism is definitive. The effects on the body are not limited to those well appreciated by the public at large (the brain and liver), but are ubiquitous through the body including the heart (alcoholic cardiomyopathy) and skeletal muscles (degenerative weakness) and actually all organs. The most outstanding psychological feature of alcoholism, at least in the early stages, is denial. Because the disease has so many ways of presenting itself it is easy for the alcoholic to list the ways he is not alcoholic and conveniently overlook the certain evidence that he is in fact alcoholic. In additon to all this, there is a distinct repulsive odor to the alcoholic, at least during the drinking stages and the few days after that, which reflects the breakdown of cells in the body, particularly of the liver. Once experienced, this odor is unmistakable.
Because alcohol is widely available and because treatment involves complete voluntary abstinence, medical treatment is only secondarily important. The treatment is simple: cessation of alcohol consumption, period, point. There is a drug (Antabuse or disulfiram) which diverts the breakdown of alcohol in the liver to acetaldehyde and if taken with alcohol the resultant acetaldehyde results in a violent and totally painful illness and can even result in death. The considerations behind this drug is that it gives the alcoholic time to reconsider a decision to drink at least until the drug is out of the system which can take up to two weeks. The most effective treatment of alcoholism is carried out by Alcoholics Anonymous (AA) which employs friendship, support, confrontation, and most important a forum in which denial can be given up without shame and in fact with pride. It would be safe to say that AA is a place where people love each other and have compassion for each other, conditions we all need in our lives. Bill Wilson and Bob Smith, two “hopeless alcoholics” founded AA in 1935 and developed the now famous 12 step program. It is said that when a person can stand up and admit the truth of these 12 “steps,” then alcoholism can be overcome. Here are the 12 steps in the words of Bill and Bob: