Unhelpful

The following is an excerpt from the introduction of “DRINK: A Social History of America” by Andrew Barr. Barr has a knack for debunking a lot of what are accepted as truths about alcohol (and nonalcoholic drink) in America. This book is a heavy, well-needed dose of common sense as well as thoroughly enjoyable reading.

[Included in its entirety in the extension for your convenience.]

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Many others do not drink at all. Approximately one third of Americans (according to opinion polls) abstain from alcohol, fearing that this, too, will cause them to lose control. They believe that alcohol is an addictive drug, just like heroin and cocaine. It cannot be consumed in moderation. Only if you do not drink can you be sure of being safe. One drink, and you risk becoming an alcoholic. This notion has been encouraged by health campaigners. The former surgeon general, Dr. C. Everett Koop, has written in his memoirs that “Alcohol is a toxic, potentially addictive drug.” Betty Ford, in a rare appearance in Washington, D.C., in 1991, criticized the Bush administration for ignoring alcohol in its “war on drugs,” pointing out that alcohol was “the number one drug of addiction in this country.”
An addictive drug is one that creates dependency in the user, who comes to rely on that drug to improve or maintain his sense of mental or physical well-being. This reliance amounts to a compulsion, and if the person tries to do without the drug he has do confront not only these feelings of compulsion, but also withdrawal symptoms, which cause him sufficient discomfort to induce him to return to the drug. It is hard to see how alcohol can be described as an addictive drug when the vast majority of people who use it suffer neither from feelings of compulsion nor from symptoms of withdrawal. Even the minority of drinkers who abuse alcohol — those defined as alcoholics — often fail to develop withdrawal symptoms; even those who do suffer from withdrawal symptoms (such as hand tremors) are able to resist the supposed compulsion to drink while suffering from them. Alcohol can harldy be a very addictive drug when even alcoholics do not experience feelings of compulsion when they try to do without the substance on which they supposedly depend.
Alcohol is certainly a drug, which is a substance that affects the body in some way, but it is a less addictive one than caffeine. According to a report in the Journal of the American Medical Association for October 1994, researchers at Johns Hopkins University have found that the caffeine in coffee, tea, and cola produces the full range of characteristics associated with classic psychoactive dependence, including persistent, unsuccessful attempts to reduce consumption; continued use despite side effects such as sleeplessness, anxiety, and gastrointestinal problems; tolerance, that is the need for ever-higher doses to achieve the same effect; as well as withdrawal symptoms, in the form of headaches, lethargy, and depression when use is stopped.
Do the health campaigners who describe alcohol as an addictive drug really believe what they say? or are they making their statements for propaganda purposes? By associating alcohol with drugs, they have persuaded both the government and the public to take alcohol-related problems seriously. The psychiatrist Morris Chafetz became involved in alcohol problems because, as a Jew in Massachusetts in the 1950s, few hospital staff jobs were available to him. Other psychiatrists were not interested in alcoholics at the time, so this was one area where he was able to find employment. In 1971 he was appointed the first director of the National Institute on Alcohol Abuse and Alcoholism. It was his job to see to it that alcohol-related problems were taken seriously, so he started calling alcohol a drug.
It has also suited antidrug campaigners to make the connection with alcohol. In order to sustain the idea that America is suffering from a drug crisis that demands greater investment in antidrug agencies and harsher antidrug laws, campaigners have lumped together all substances that can conceivably be called drugs. This enables them to exaggerate the number of people who are dependent on drugs or are suffering from drug-related problems. It also permits them to shift attention from one drug to another without having to answer awkward questions about the extent to which they have manufactured stories about particular “drug crises” in order to gain money and exposure.22

22 Although health and antidrug campaigners still seek to promote the idea that alcohol is a drug, government agencies, having taken in the late 1980s and early 1990s to referring to “alcohol and other drugs,” have now retreated from this position and come to accept the evidence in favor of the health benefits of moderate drinking. The official term for excessive drinking and drug taking is no longer “drug addiction” but “substance abuse.” The “drug war” is discussed in Chapter 5 and the health benefits of moderate drinking in Chapter 4.

Not only do many people abstain from alcohol because they have been told that it is an addictive drug, but others who have drunk it to excess at some point in their lives are convinced that they must henceforth abstain altogether because they have been infected with the disease of alcoholism. They believe that the ingestion of alcohol biochemically triggers an irresistible craving for the substance, and that if they take a single drink they will be set inexorably on a downward course.
It is generally imagined that the concept of alcoholism as a disease was invented by Alcoholics Anonymous. This is not the case. The idea that alcoholism was an illness rather than a failure of the will had been widespread among the medical community in the nineteenth century. But it was not communicated to the general public. Instead, people were told by temperance campaigners that habitual drunkenness was a moral failing. These campaigners would hardly have promulgated the disease theory of alcoholism, as it contradicted the message they wanted to spread: that alcohol and the people who made and sold it were evil, and that its manufacture and trade should be banned.
The population at large came to hear that alcoholism was a disease only following the creation of Alcoholics Anonymous in 1935. The founders of AA, WIlliam Wilson and Dr. Robert Smith, adopted the disease theory because it helped them to persuade potential recruits that they were indeed “powerless over alcohol.” They publicized the idea through a group they helped set up, the National Council for Education on Alcohol (NCEA),23

23 Now the NCADD, the National Council on Alcoholism and Drug Dependence.

which devoted itself to communicating to the public the “monumentous discovery” that alcoholism was a sickness. In the late 1940s and 1950s, a large number of articles in mass-circulation magazines presented the statement that “alcoholism is a disease” as an established fact. Whereas public opinion surveys in the late 1940s found only one fifth of interviewees willing to agree that an alcoholic was sick and that alcoholism was an illness, by the early 1960s nearly two thirds of the respondents accepted these propositions. As a result of the publicity given to the disease concept by the NCEA, membership in AA soared.
The disease concept was widely accepted not only by members of the public but also by professionals working with alcohol and alcohol problems. The drinks industry looked favorably upon a theory that did not blame it for the harm caused by drink, as Prohibition had done. The disease concept was also accepted by doctors, because they thought it would encourage hospitals to accept alcoholic patients. In the first half of the twentieth century, general hospitals had normally refused to admit habitual drunkards for treatment on the grounds that they were uncooperative, especially when it came to paying their bills. The hospitals changed their attitude once they accepted that alcoholism was a disease rather than a bad habit. Doctors also believed that by calling alcoholism a disease they would make it easier for alcoholics to seek treatment. It is likely that fewer people by far would have been prepared to admit to being alcoholics if they also had to admit that they were not suffering from a disease but merely from a failure of personality.
The benefits of treating alcoholism as a disease can be demonstrated by the example of the military, which has never accepted the idea and regards the abuse of alcohol as willful misconduct. Within the armed forces the consumption of alcoholic beverages is officially regarded as “a personal choice that makes everyone personally responsible for their [sic] conduct.” Although military personnel are officially encouraged to seek assistance for alcohol or drug problems, they rarely do so for fear that disciplinary action would be taken against them. Yet there is more abuse of alcohol among the armed forces than in the general population, enough to damage their effectiveness in combat. In 1980, more than one in six military personnel reported having experienced serious consequences in work performance, health, or social relationships as a result of heavy drinking during the previous year. If the armed forces were prepared to adopt the disease theory of alcoholism, more of their members would be prepared to seek treatment.
The disease theory might seem helpful, but there is no evidence that treating alcoholics on this basis helps them to break the habit. The few scientifically reliable studies that have been carried out show that attending AA works no better than no treatment at all. It is true that drinkers who persist in AA remain abstinent. But this does not mean that it is AA that keeps them so. Drinkers remain in AA only if they are able to remain reasonably abstinent and accept the AA way of life. The vast majority of heavy drinkers never try AA, and most who do join drop out.
It has even been suggested that attending AA is less effective than allowing the abusive drinker to get over his problem on his own. Those who join AA are told that they can never drink again. This prohibition encourages many AA members to switch their fixation from alcohol to cigarettes, coffee, and high-calorie desserts without dealing with the underlying problem that led to the abusive drinking in the first place.
Nor is it necessary for alcoholics to give up drinking for life, as AA and other proponents of the disease theory insist. This view, which prevails in America, has found little favor in Europe, where a great deal of effort is put into teaching alcoholics how to drink responsibly. Books that argue in favor of controlled drinking therapy (teaching alcoholics how to drink in moderation) are quickly knocked down in America; no treatment center in the country pursues this as its official policy. In Britain, three quarters of alcohol treatment units offer it. Research conducted by psychologists in Britain has shown that hospitalized alcoholics who believe that alcoholism is a disease are more likely to drink excessively after having a single drink than those who do not subscribe to the disease theory. The belief that alcoholism is a disease makes it hard for recovering alcoholics to develop a pattern of moderate drinking.
Telling alcoholics that they can never drink again produces the same unhealthy consequences as national Prohibition in the 1920s and the prohibition of alcoholic drink to young people today. This approach makes it more likely that people will develop the habit of alternating sobriety with occasional lapses into binges, rather than learning how to drink in a controlled and civilized manner.24

24 The unintended consequences of prohibitions are discussed in Chapter 5, and binge drinking in the Conclusion.

As Stanton Peele, a leading expert on addiction and a staunch opponent of the disease theory, has argued, “The devaluation of moderate drinking as a treatment goal, and a social norm, is dangerous … When we promote the belief that many people cannot taste alcohol without catastrophic results, we may be fulfilling our own prophecy.”
The disease theory is unhelpful, and it is wrong. The idea gained acceptance without any serious examination. Alcoholism does not display specific symptoms, follow a particular course, or respond to treatment in the same way as infectious diseases. It lacks a pathogen, an agent that causes the disease. Some people have argued that the alcohol itself is a pathogen, just like, say, the tuberculosis bacillus. How so? Most people are not caused any problems by alcohol. Are we supposed to accept that they have somehow developed an immunity to it?
Only a minority of people who are supposed to know professionally about disease — doctors — believe that alcoholism is one. According to two opinion polls carried out in the early 1980s, 79 percent of the general population believed that alcohol was a disease, but only 21 percent of doctors did so. Doctors have adopted the disease theory largely for policy reasons, in order to get alcoholics into treatment, not because they believe in it.
The disease theory can be compared to the emperor’s new clothes. It suits people to believe it, so they believe it, even though it isn’t really there. Rather than accepting blindly that alcoholism is a disease, it makes more sense to follow the observation of medical theorist Thomas Szasz that “the misuse of alcohol, whatever the reason for it, is no more an illness than is the misuse of any other product of human inventiveness, from language to nuclear energy.”
The disease concept of alcoholism is destroyed by its own internal contradiction. Any alcoholic who seeks treatment is told that by drinking alcohol he sets off an irrepressible desire for the substance and that he must therefore agree as a condition of his treatment to abstain from drinking. Yet if he does as he is told and abstains during treatment, he is disproving the theory that alcoholism is a disease that causes an inability to abstain from drinking.
The disease concept of alcoholism is based on the idea that the alcoholic loses all control over his drinking. This is untrue. Scientific research shows that the amount alcoholics drink depends on the benefits they think they receive from alcohol and the effort they have to make to obtain it. They don’t just go on drinking until they pass out. In this respect, alcohol differs from drugs: It is not a case of taking a single dose in order to obtain the desired effect, but taking a whole sequence of doses in order to achieve a whole range of effects. Conscious choice comes into it at every stage.25

25 Because alcohol gives the user a greater degree of control than do drugs, many people take it in preference to tranquilizers to treat stress or depression. Unlike Prozac, which must be taken in a prescribed amount and requires several days to achieve its effect, alcohol acts quickly and can be taken when the person thinks he needs it; since it is dose respondent, it can be taken in the quantity he thinks he needs. This is not a recommendation, but it is often done.

The disease theory has also been debunked by placebo tests. In one such test in the 1970s, psychologists at the University of Wisconsin selected sixty-four people, of whom half were social drinkers and half had been diagnosed as alcoholics. Some were given alcohol in the form of vodka and tonic, and told that they were being given alcohol, while others were given alcohol but told that they were being given a placebo, plain tonic water. Still others were given a placebo but told that they were being given alcohol, while a fourth group received a placebo and were told as much. According to the disease theory of alcoholism, any time that an alcoholic takes a drink he will be seized by an irresistible craving and will be unable to stop, while an alcoholic who is deprived of drink will suffer from painful withdrawal symptoms, such as the “shakes.” Yet, in this test, one of the men who had been expecting to receive alcohol but had been given tonic water began acting in an intoxicated manner, whereas several of the men who had been told that they would be drinking tonic water but were actually drinking alcohol continued to suffer from withdrawal symptoms, even after consuming the equivalent of double vodkas. This and other tests indicate that someone’s reaction to alcohol, far from being biochemically determined, depends on how he expects it to affect him.
To a substantial extent, the way in which we respond to alcohol is a learned behavior, a psychological rather than a chemical reaction.26

26 The same is true of many drugs, such as tobacco — which Europeans interpreted very differently from Amerindians.

Indian tribes in the colonial period believed that alcohol had magical powers, and that drunkenness was a sacred state; a man was not responsible for the acts he committed while drunk. Tribal leaders, who normally punished violent actions with great strictness, exonerated those who had behaved violently when intoxicated. Many Indians took advantage of this state of affairs. As one French missionary in Montreal pointed out, “It is a somewhat common custom amongst them when they have enemies to get drunk and afterwards go and break their heads or stab them to death, so as to be able to say afterwards that they committed the wicked act when they were not in their senses.” It was also suggested that some Indians feigned drunkenness in order to be able to attack others and avoid the consequences.
As these Indians had realized, it is not alcohol that causes men to become violent, but rather the belief that it will have this effect. The alcohol was not in itself any more responsible for their behavior than it is today for husbands who beat wives or young men who commit crimes of violence. Indeed, one researcher at Brown University discovered that just like Indians in the past, many prisoners had been stone-cold sober when they committed their crimes but had told the judge that they had been drunk, in the hope of obtaining a lighter sentence.
There is no doubt that spousal abuse is linked with abuse of alcohol. But this does not mean that husbands are induced by the consumption of alcohol to beat their wives, nor that they would necessarily refrain if they remained sober. If husbands drink before beating their wives, it is party because this is expected of them. Society associates alcohol with violence, so they do too. The statistical connection between drunkenness and wife beating exists principally because households predisposed to violence are also predisposed to the abuse of alcohol, as well as the abuse of drugs and many other social problems. In one test, blood samples were taken from a group of men who had been arrested for assaulting their wives. According to verbal reports, half of them had been drinking excessively at the time. Yet the results showed that fewer than one in five had sufficient alcohol in their bloodstream to be regarded as unfit to drive. According to sociology professors Richard Gelles and Murray Straus, leading experts on the subject, “Drinking (or claiming to be drunk) provides the perfect excuse for instances of domestic violence. ‘I didn’t know what I was doing when I was drunk’ is the most frequently heard excuse by those who counsel violent families. When women claim their husbands are like ‘Dr. Jekyll and Mr. Hyde,’ they are actually providing the excuse their husbands need to justify their violent behavior. In the end, violent parents and partners learn that if they do not want to be held responsible for their violence, they should drink and hit, or at least say they were drunk.”
In these circumstances, it is hardly surprising that alcohol has been accused of causing so many ills in American history. No scapegoat could be more convenient than one that relies for its effect on the expectation of the drinker, and that can therefore be blamed for almost any social problem one might want to choose.

The disease theory of alcoholism is not merely wrong, but harmful. If alcoholism is a disease, then it needs to be treated, but many people who are infected with it do not recognize the fact. Hence the concept of “denial”: that denying you are suffering from the disease of alcoholism is one manifestation of the illness.
Denial is based on the reasonable notion that people do not realize they are relying on mood modifiers (such as alcohol) in order to remedy their bad feelings about their failure to cope with their lives. But this is very different from saying that denial is part of the disease of alcoholism: that it results from seeking solace in drink. In fact, denial is a precondition for such behavior. People who try to hide from reality are the sort who become alcoholics; it is not alcohol that causes them to avoid the truth. Denial is not caused by the disease of alcoholism; it is the denial of reality that causes people to become alcoholics.
Although the concept of denial is misconceived, it leads to people being forced into treatment on the grounds that the denial is part of their disease and that they have to be treated for their own good. Many of the people who attend AA meetings and associated treatments for alcoholism have been coerced into doing so. Some are threatened by their employers with dismissal unless they undergo AA-style therapy; others have been convicted by the courts of driving under the influence of alcohol and agree to undergo treatment as an alternative to more severe penalties, such as losing their license.
Having been coerced into therapy, people who attend AA meetings find they are forced to participate in a religious ritual, redolent of fundamentalist revivalist Christianity. “God” and a “higher power” are mentioned in six of the twelve steps of AA, which arose out of the Oxford Group, an early-twentieth-century evangelical movement that sought to return to the ways of primitive Christianity, including surrender to a higher power as a means of changing one’s life. Many people are shocked to discover this aspect of AA therapy. As one woman, who had been convicted of driving under the influence, wrote in her diary about the treatment she felt pressured into entering as an alternative to having her license suspended for a year, “I keep reminding myself that this is America. I find it unconscionable that the criminal justice system has the power to coerce American citizens to accept ideas that are anathema to them. It is as if I were a citizen of a totalitarian regime being punished for political dissent.” Most so-called alcoholism treatment in America is not medical treatment, it is brainwashing.
The disease theory of alcoholism also corrupts the wider community because it panders to a common psychological inadequacy: the tendency to blame one’s problems on an external cause rather than to accept that they arise from an inability effectively to deal with the outside world.27

27 This “victim culture” has created an absurd state of affairs in people who confess to having allowed alcohol or drugs to impair their professional and personal lives are shown sympathy, while others who have been strong enough to carry on in spite of their habit are condemned.

In 1976, Jules Masserman, a former president of the American Psychiatric Association, stated that “addiction to drink is a ‘disease’ only in the sense that excessive eating, sleeping, smoking, wandering or lechery can also be classified.” This was intended as a reductio ad absurdum to ridicule the notion that a behavior could be regarded as an illness. But within a few years disease treatments were developed not only for all of the things Masserman had listed but for much else as well.
The disease of alcoholism is primarily defined by a loss of control over one’s drinking. Loss of control is a subjective experience. It might just as well be applied to shopping. Certainly people can feel out of control of their spending. If alcoholism is a disease, so, too, is shopaholism. So, too, according to this criterion, are over- and undereating, anxiety and depression, obsessive-compulsive disorder, and even intimate relationships. The claim is commonly made that some women are biologically driven to form inappropriate and destructive relationships; men (including presidents of the United States) are more often said to be addicted to sex. With “love addiction” and “sex addiction” we have arrived at a ridiculous situation in which the problems of conducting everyday relationships are described as a disease. People never have the chance to develop; they are never given the opportunity to grow up.28

28 The concept of behavior as a disease represents the abandonment of responsibility for one’s own life in a similar way to “repressed memory syndrome.” People go to therapists and are encouraged by them to “discover” that the root cause of their lack of fulfillment lies in childhood sexual abuse. They are attracted to this idea because it places them at the center of their own world, just as they were when they were children. But in most cases there is no evidence that the abuse ever happened, and it certainly does not help the “victims” to come to terms with their own lives.

So widely has it become accepted that we can abrogate personal responsibility for our actions by claiming that we are suffering from a disease that defendants charged with murder, rape, and robbery have used, and sometimes succeeded with the defense that they had been overcome by a compulsion beyond their control. As Peele points out, “These defenses seem to describe a completely self-gratifying universe. … The hallmark of a civilized society is that people learn to restrain their impulses in line with the needs of their communities, neighbors, and families.”
Today we blame our own failings on an external compulsion, which we call a “disease.” In medieval Europe, and in early modern America, the specter of witches was summoned for the same purpose. The Salem witch trials of 1692 centered on young girls who suffered from fits in which they seemed to lose control over their own words and actions: They uttered blasphemies; they interrupted church meetings; they refused to pray. The girls claimed to be tormented by witches, or, rather, devils whom Satan had delegated to take on the likeness of witches. The girls’ irreligious behavior while under diabolical influence suggests that they were using the latter as an excuse for improper conduct. During the previous winter, several of the girls who later became possessed had experimented with divination. They must have realized this was illicit. By claiming to have been possessed, they were able to shift responsibility for their wickedness to demons within them. Adults were inclined to believe that the devil was at work, and to accuse their neighbors of witchcraft, as it offered an explanation of their recent suffering as a result of raids by Indians (whom in any case they linked with witchcraft and the devil on account of their mysterious shamanistic rituals). Psychologically, it is difficult to accept that one has suffered as a random act of chance. It is easier to attribute responsibility to someone or something else. The modern habit of blaming our wrongdoings on some power beyond our control, which we call a disease, is no different from the pre-modern habit of blaming it on witches.

I found this book after a conversation in which I started to question the accuracy of calling alcoholism a “disease”, and it came highly recommended by someone who had a (in my view) justifiably critical view of American attitudes toward alcohol and alcoholism. The book covers a lot more ground than that, mind you, and offers countless fascinating insights into American drinking: what we drink and when, how drinking has changed, how American and European drinking tastes have influenced one another, the social price of prohibition, and so forth.

Get it now.