Colorado Drug Rehab Addresses the Alcohol Disease Model

Is Alcholism a Disease?

In the other pages related to alcohol and alcoholism, we have seen that there are certainly some serious mental delusions that accompany drinking, even at the mildest of levels. For instance:

Many people will report that they have had only one to two drinks, which they proport that their doctor recommends, but when one examins others that know the level that the person actually drinks, we find that they many times they will confuse one to two drinks with 4 to 5 drinks.

But what actually constitutes a disease and does alcoholism fit in that difination.

The About.com answer is: Yes. Alcoholism is a chronic, often progressive disease with symptoms that include a strong need to drink despite negative consequences, such as serious job or health problems. Like many other diseases, it has a generally predictable course, has recognized symptoms, and is influenced by both genetic and environmental factors that are being increasingly well defined.

One can examine the diagnostic cratieria used to determine if alcoholism is a disease:

Early Criteria

At least 39 diagnostic systems had been identified before 1940 (2). In 1941 Jlinek first published what is considered a groundbreaking theory of subtypes of what was, until 1980, termed alcoholism (2,8). Jellinek associated these subtypes with different degrees of physical, psychological, social, and occupational impairment (2,9).

Formulations of diagnostic criteria continued with the American Psychiatric Association's publication of the Diagnostic and Statistical Manual of Mental Disorders, First Edition (DSM-I), and Second Edition (DSM-II) (10,11). Alcoholism was categorized in both editions as a subset of personality disorders, homosexuality, and neuroses (2,12).

In response to perceived deficiencies in DSM-I and DSM-II, the Feighner criteria were developed in the 1970's to establish a research base for the diagnostic criteria of alcoholism (5,13). These criteria were the first to be based on research rather than on subjective judgment and clinical experience alone (5). Though designed for use in clinical practice, they were primarily developed to stimulate continued research for the development of even more useful diagnostic criteria (5). Several years later, Edwards and Gross focused solely on alcohol dependence (8). They considered essential elements of dependence to be a narrowing of the drinking repertoire, drink-seeking behavior, tolerance, withdrawal, drinking to relieve or avoid withdrawal symptoms, subjective awareness of the compulsion to drink, and a return to drinking after a period of abstinence (8)

The DSM Criteria

Researchers and clinicians in the United States usually rely on the DSM diagnostic criteria. The evolution of diagnostic criteria for behavioral disorders involving alcohol reached a turning point in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (14). In DSM-III, for the first time, the term "alcoholism" was dropped in favor of two distinct categories labeled "alcohol abuse" and "alcohol dependence" (1,2,12,15). In a further break from the past, DSM-III included alcohol abuse and dependence in the category "substance use disorders" rather than as subsets of personality disorders (1,2,12).

The DSM was revised again in 1987 (DSM-III-R) (16). In DSM-III-R, the category of dependence was expanded to include some criteria that in DSM-III were considered symptoms of abuse. For example, the DSM-III-R described dependence as including both physiological symptoms, such as tolerance and withdrawal, and behavioral symptoms, such as impaired control over drinking (17). In DSM-III-R, abuse became a residual category for diagnosing those who never met the criteria for dependence, but who drank despite alcohol-related physical, social, psychological, or occupational problems, or who drank in dangerous situations, such as in conjunction with driving (17). According to Babor, this conceptualization allowed the clinician to classify meaningful aspects of a patient's behavior even when that behavior was not clearly associated with dependence (18).

The DSM was revised again in 1994 and was published as the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (6). The section on substance-related disorders was revised in a coordinated effort involving a working group of researchers and clinicians as well as a multitude of advisers representing the fields of psychiatry, psychology, and the addictions (2). The latest edition of the DSM represents the culmination of their years of reviewing the literature; analyzing data sets, such as those collected during the Epidemiologic Catchment Area Study; conducting field trials of two potential versions of DSM-IV; communicating the results of these processes; and reaching consensus on the criteria to be included in the new edition (2,19).

DSM-IV, like its predecessors, includes nonoverlapping criteria for dependence and abuse. However, in a departure from earlier editions, DSM-IV provides for the subtyping of dependence based on the presence or absence of tolerance and withdrawal (6). The criteria for abuse in DSM-IV were expanded to include drinking despite recurrent social, interpersonal, and legal problems as a result of alcohol use (2,4). In addition, DSM-IV highlights the fact that symptoms of certain disorders, such as anxiety or depression, may be related to an individual's use of alcohol or other drugs (2).

Information furnished by:
National Institute on Alcohol Abuse and Alcoholism

You can find more on this subject and the referrences related to the (numbers) above at this site: http://alcoholism.about.com/cs/alerts/l/blnaa30.htm

After analyzing this information and after years of research in this field, Colorado Drug Rehab can tell you that the "disease model" has done very little to help the person with an addiction, whether it be to alcohol or other drugs, but the model has allowed many practitioners to assign fault to the mysterious severety of the disease, relieving them and the addict of the personal responsibility to change one's conditions.

Our belief is that only the truth will set us free and that alcohol and drugs add delusion to a world that isn't, necessarily, always operating on true data.

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