Disease theory of alcoholism

A Disease theory of alcoholism is a theory based on the concept that alcoholism is a disease process. The disease theory is generally accepted by the medical community which argues that genetic, neurological and behavioral studies distinguish those with alcohol dependence from problem drinkers.

Theory
The term "disease" refers to a disorder of structure or function. The term can refer to a physical disorder, such as diabetes, or to a mental disorder, such as schizophrenia. Diseases can be short-lived, such as the common cold, or life-long, as in sickle cell anemia.

In the case of alcoholism, research has demonstrated both genetic and environmental contributors to the development of a condition that carries significant physical morbidity. Such factors as a typical course and well-described epidemiology (the incidence and prevalence of the condition) also contribute to the establishment of a disease entity.

History
The disease theory of alcoholism was first proposed in the early 1800s by Dr. Benjamin Rush of Philadelphia, and independently by Thomas Trotter. The modern theory of alcoholism as a disease was put forth by E. Morton Jellinek. Controversy over Jellinek's claim that he received a doctoral degree has contributed to criticisms of the disease theory.

The first challenge to the disease model came with the publication of D.L. Davies' (1962) follow up of seven alcohol abusers which found that some of them were able to revert to "controlled drinking." Although the data have subsequently been challenged, it caused a storm at the time by asking how someone suffering a disease which reputedly leads to uncontrollable drinking can manage to drink controllably. Subsequent studies also found similar results.

Between 1980 and 1991, medical organizations worked together to establish policies regarding their positions on the disease theory. These policies were developed in 1987 in part due to the lack of parity between addictive disease and other chronic disease states with respect to third-party reimbursement. The policies of the American Medical Association, formed through consensus of the federation of state and specialty medical societies within their House of Delegates, state, in part: "The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice." In 1991, The AMA further endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections. In 1980, the AMA's Council on Scientific Affairs (now the Council on Science and Public Health) noted that "alcoholism is in and of itself a disabling and handicapping condition."

In a 1988 US Supreme Court decision on whether alcohol dependence is a condition for which the US Veterans Administration should provide benefits, Justice Byron R. White's statement echoed the District of Columbia Circuit's finding that "a substantial body of medical literature that even contests the proposition that alcoholism is a disease, much less that it is a disease for which the victim bears no responsibility." He also wrote, "Indeed, even among many who consider alcoholism a "disease" to which its victims are genetically predisposed, the consumption of alcohol is not regarded as wholly involuntary."

Current acceptance
The American Society of Addiction Medicine and the American Medical Association both maintain extensive policy regarding alcoholism. The American Psychiatric Association recognizes the existence of "alcoholism" as the equivalent of alcohol dependence. The American Hospital Association, the American Public Health Association, the National Association of Social Workers, and the American College of Physicians classify "alcoholism" as a disease.

Opponents
Outside the medical community, there is debate over whether or not alcoholism should be considered a disease. Opponents cite the inability to pin down the behavioral issues to a physical cause as a reason for avoiding classification. Programs such as Rational Recovery and a psychotherapist, Stanton Peele, reject the "disease model".

The US Social Security Administration no longer makes disability payments to individuals for whom substance use disorders are a material aspect of their disability.

Medical evidence
The results of medical research have been used both in support of and against the disease theory of alcoholism. Current scientific and medical opinions favour the concept that alcoholism is a disease; however, debate still remains on the subject: http://www.bhrm.org/papers/Counselor3.pdf and http://www.indiana.edu/~engs/cbook/chap6.html

Supporting evidence
Certain medications including opioid antagonists such as naltrexone have been shown to be effective in the treatment of alcoholism, although research has not yet demonstrated long-term efficacy.

Current evidence indicates that in both men and women, alcoholism is 50-60% genetically determined, leaving 40-50% for environmental influences.

Research shows that frequency and quantity of alcohol use are not related to the presence of the condition ; that is, people can drink a great deal without necessarily being alcoholic and alcoholics may drink minimally and/or infrequently.

Dissenting evidence
Research has shown that some recovered alcohol abusers can resume "controlled drinking." However, the data in this study have been challenged.