prschuster wrote:Addiction medicine is one of the most pervasive scams in medicine today which, unlike alternative treatments, is fully incorporated into the mainstream. I won't touch on controversies about 12-step recovery here, but I do want to comment on the disease model of addiction, which is closely associated with 12-step methods. Both NCADD and ASAM have have put forth a definition of alcoholism which states:
"Alcoholism is a primary disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial."

It sounds like a legitimate set of physical and psychological criteria at first glance, but as one who has learned to abstain from alcohol without any so called "recovery program", I see no validity to this medical model. First of all, two terms are of special significance here. The first is "disease" which they define as "an involuntary disability". This is important to note. I will grant that once an alcoholic takes the first drink it is virtually impossible to be sure that moderation can be maintained. But this is common sense and doesn't require the disease model to explain. Alcohol pollutes your brain and no one can make rational decision when under the influence. Some people are more severely affected by this intoxication and ought to quit drinking altogether. This so called disease is no more than a temporary intoxication caused by the substance itself and hardly counts as a progressive chronic medical condition in itself.

The second term is "denial" which is said to "reduce awareness of the fact that alcohol use is the cause of an individual's
problems rather than a solution to those problems". No lie. This is what we commonly call rationalizing, or more to the point, lying to yourself. Now why would the act of drinking alcoholically and then rationalizing your bad compulsive habit, be called a disease? It would be safe to say that voluntary behavior in itself would not be considered a disease unless you make a case that one acts out of some state of delusion or else is so compelled that they have lost all rational thought processes. Paranoid schizophrenia may be an example of the former, and blind rage may be an example of the latter. I don't think alcoholism fits either of those, especially since I can cite my own experiences with alcohol for reference. The out of control behavior and compulsive use of alcohol becomes beyond one's control only when a person is already under the influence - not before. So this disease is no more than a temporary, alcohol induced state.

But wait... I'm not done yet. The whole disease theory of alcoholism and addiction really rests on the assumption that it is a "brain disease" with a consequent "thought disorder". This model would never hold up without some claim that altered brain chemistry or irreversible neural connections, resulting from use, make the alcoholic/addict forever changed in some fundamental way which can never be undone, but only maintained. Hence the notion of a disease which is never cured but only relieved by remissions. This sets the stage for a lifetime of rehabilitation which is supposed to be followed in order to prevent "relapse". It's very convenient for the recovery industry that the disease model helps to provide the rationale for endless treament. I find this all very disturbing that I am expected to go through the rest of my life acting as if I had a biochemically induced thought disorder which required constant monitoring. This is just too Orwellian for me to swallow.

But wait... I'm not done yet. The whole disease theory of alcoholism and addiction really rests on the assumption that it is a "brain disease" with a consequent "thought disorder". This model would never hold up without some claim that altered brain chemistry or irreversible neural connections, resulting from use, make the alcoholic/addict forever changed in some fundamental way which can never be undone, but only maintained. Hence the notion of a disease which is never cured but only relieved by remissions. This sets the stage for a lifetime of rehabilitation which is supposed to be followed in order to prevent "relapse". It's very convenient for the recovery industry that the disease model helps to provide the rationale for endless treament. I find this all very disturbing that I am expected to go through the rest of my life acting as if I had a biochemically induced thought disorder which required constant monitoring. This is just too Orwellian for me to swallow.

Agrippina wrote:bookmarking

Disease: Illness or sickness often characterized by typical patient problems (symptoms) and physical findings (signs).

Agrippina wrote:What I find so strange is that when I was young we used to simply call the uncles and aunts who drank too much "drunks" and refuse to invite them to parties because they always started fights, or else we'd invite them to tea and say that there was no alcohol in the house (in the olden days you didn't bring food to someone else's party). Anyway, nowadays everyone has a "disease." In those days even if we said so-so-so was an "alcoholic" everyone else would say that they wouldn't go so far because "he just drinks too much!" or "can't hold his liquor" now you get addictions to everything, if you're a little too fond of chocolate, people tell you that "You're a chocoholic, maybe you need help!" Or maybe we just have too many substances around today that cause people to become addicted to them. But then I don't know. When I was young men walked around with pipes that always burned and inhaled "snuff" and before "drugs" there was cough syrup and of course alcoholic and Turkish cigarettes that smelled funny.

prschuster wrote:This definition of disease (posted by Tbickle) implies a physical organic pathology, which is responsible for the clinical signs & symptoms of disease. Let's look at this closer. Inebriation has definite signs & symptoms ranging from euphoria to a high BAC & loss of motor control.
Withdrawal from alcohol may include the "jitters", DTs, siezures etc. Cirrhosis of the liver can be diagnosed by assessing liver enzymes, detecting bilirubin in the blood & urine, and observing jaundice. Wernicke-Korsikoff syndrome ("wet brain") can be diagnosed by observing general deterioration of mental function along with skew deviation of the eyes. Then there are other conditions like esophageal varices and alcoholic panceatitis. These are the medical conditions associated with long term excessive alcohol intake. If anyone shows these signs & symptoms, they are most likely alcoholic.

Now the real question is whether alcoholism itself is a disease or whether it is a behavior that causes actual diseases. And then there is the possibility that the biochemical makeup or wiring of the brain may predispose a person to alcohol or drug abuse. In either case, the real diseases associated with substance abuse are better described as predispositions to, or complications of, the addiction. So I would describe addiction to alcohol or drugs as a compulsive, but voluntary, behavior which is associated with several medical diseases. The addiction itself does not rise to the level of a disease.

prschuster wrote:Tbickle asks if I consider depression a disease. I definitely consider it a mental illness. Whether it can be called a medical condition has to do with whether a particular person is depressed because of an inherited brain chemistry imbalance (serotonin deficeincy) or whether it is just a reaction to one's circumstances in life. Nor being a psychiatrist, I can't comment on anything more specific then this. But the feeling itself is not totally within a person's control. It may actually be a predisposing factor in subsatance abuse, in which case addiction can best be described as an attempt at self medication. I do make a distinction between bona fide medical conditions (normally called diseases), mental illness and addictive behavior. I know in real life people may have a combination of all three at one time which may work together. I just want to be clear about distinguishing between these terms and guard against conflating one with the other. Now for the short answer to your question... I would refer to depression as a mental illness which may or may not be associated with a real medical disease depending on whether it was caused by brain chemistry imbalances.

prschuster wrote:Tbickle asks if I consider depression a disease. I definitely consider it a mental illness. Whether it can be called a medical condition has to do with whether a particular person is depressed because of an inherited brain chemistry imbalance (serotonin deficeincy) or whether it is just a reaction to one's circumstances in life.

Nor being a psychiatrist, I can't comment on anything more specific then this. But the feeling itself is not totally within a person's control. It may actually be a predisposing factor in subsatance abuse, in which case addiction can best be described as an attempt at self medication. I do make a distinction between bona fide medical conditions (normally called diseases), mental illness and addictive behavior. I know in real life people may have a combination of all three at one time which may work together. I just want to be clear about distinguishing between these terms and guard against conflating one with the other. Now for the short answer to your question... I would refer to depression as a mental illness which may or may not be associated with a real medical disease depending on whether it was caused by brain chemistry imbalances.

prschuster wrote:Now the real question is whether alcoholism itself is a disease or whether it is a behavior that causes actual diseases.