The World Health Organization, the American Medical Association, the American Osteopathic Association, the American Hospital Association, to mention a few, all have acknowledged alcoholism as a disease. It is my opinion that the man in the street thinks this is just so much baloney, and, if put to a test, I’m sure he could come up with a more descriptive and colorful phrase.
“Hell, if a guy wants to stop drinking, all he has to do is give it up!” says Mr. Joe Blow as he sits there in his chair, 40 pounds overweight, smoking cigarette after cigarette. I ask Joe Blow why he can’t eat sensibly and why he can’t give up cigarettes – both of which are infinitely easier than the alcoholic giving up booze. O.K., so let’s see if we can convince Joe Blow that alcoholism is a disease. What is a disease? What set of criteria do you have to meet to call something a disease? What are the Benefits of Our Alumni Program?
Webster’s Dictionary says that a disease is “the converse of health.” (You’d think such a large book could give a better definition.) Does an alcoholic exhibit good health? Not so. One of the ways of spotting an alcoholic is by examining his health record. An alcoholic is “sick” much more than the average. He misses more work; he’s in and out of the hospital; nothing seems to go right for him. Major insurance companies have gradually come to realize this. Most of the first-class insurance companies now recognize alcoholism as a disease and will pay for hospitalization and treatment. Some honest citizens whispered into their ears that many doctors have been treating their alcoholic patients for years, calling the problem anything but alcoholism; and this has been costing the insurance companies tons of money. Now, at least, a doctor can call a spade, a spade – if he has the guts. Any disagreement on this point? I hope not.
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Let us proceed to more exacting criteria. To call something a disease, you should have:
1) an etiology (cause);
2) clinical manifestation;
3) pathogenesis;
4) treatment of choice.
Not all diseases, as we know them, meet these criteria, but let’s run alcoholism through the list. Why can one person drink like a fish all his life and never develop into an alcoholic, while his buddy comes down the same road, crosses the line and hits rock bottom?
We flunk the test. The cause of alcoholism is not known. There are many causes proposed, but none proven. As research progresses, we may indeed come up with a physical or chemical cause. We like to think that the alcoholic is missing an enzyme or has too much of some other chemical so that alcohol does peculiar things to him. Physiological disturbances, psychological problems, and social disintegration are often suggested as etiology, but they may be the result, not the cause. The fact is that we simply do not know. The best we can do is say that excessive drinking may be genetically, constitutionally, or develop mentally acquired.
Clinical manifestations are myriad among alcoholics. The preceding chapters have enumerated some of the physical defects. We’ll get into the symptoms later on. Pathogenesis refers to the development of the end product. The liver is a prime example. It is not impossible to trace step by step the physical and moral degeneration in the pathogenesis of this disease. There is nothing to dispute here.
The treatment of choice: There are many effective treatments, but none “of choice.” The most successful try to touch all the bases. They involve the family, the boss, Alcoholics Anonymous, the family doctor, the clergy, social services, etc. The one most successful entity is Alcoholics Anonymous. Here’s something to ponder. Alcoholism is a disease, and yet a totally nonprofessional, non medical group has the most success in treatment. Interesting, isn’t it?
