…
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 untru
