For more than 100 years, alcoholism has been viewed as a disease; however, this framing has created barriers to diagnosing, treating and even understanding the condition, one psychologist argues.
"By adhering so strictly to the disease model…I think that we miss the opportunity to frame alcoholism in ways that could help some people," said Lance Brendan Young, a postdoctoral research fellow with the Department of Veterans Affairs’ Center for Comprehensive Access & Delivery Research and Evaluation in Iowa City, Iowa.
Thinking of the condition as a disease diminishes the moral stigma of it. However, this framing introduces the stigma of disease, Young said.
"It introduces the stigma of abnormality — of being permanently deviant in body and mind," Young said.
While the disease model may be useful for treating people who consider themselves alcoholics, it may be harmful to people trying to determine whether their drinking is problematic, Young said. To be diagnosed with alcoholism means a person has to give up their identity as a "normal" person, and take on the identity of someone with a disease, Young said.
"Individuals are faced with this identity-threatening choice they have to make," Young said. As a consequence, some people change their behavior so they can continue to think of themselves as normal. For instance, a person might believe "alcoholics" only drink alone, so he will try to get his friends to go drinking with him frequently. This way, he can continue consume alcohol excessively without needing to believe he is an "alcoholic," or seeking treatment.
Young said he is not advocating eliminating the disease model, but hopes instead to move beyond it. The medical community should find away to frame the condition so it is less threatening to people's identify, perhaps by using different words to describe it, Young said. And more research should investigate social and cultural influences on alcoholism, rather than focusing on biological causes of it, he argued.
Young published his views in the September issue of the journal Culture & Psychology.
Who is an 'alcoholic?'
Alcoholism is a physical addiction to alcohol in which people continue to drink even though the drinking causes physical, mental and social problems, including problems with job responsibilities and relationships, according to the National Institutes of Health. As is the case with other addictions, alcoholism is considered a disease by many in the medical community, including the American Medical Association.
A drawback to framing alcoholism as a disease is that we tend to think of diseases as something that needs to be diagnosed by a professional, Young said. However, physicians often only meet with patients for a short time and cannot possibility have the same insight into an individual's habits as she herself.
"I know of addicts who have been able to get a professional to tell them they are not addicted," and then use that as justification to continue their excessive drinking, Young said.
The disease model also gives the false impression that alcoholism is solely a biological disorder, Young said, leading some researchers tend to adopt a narrow view, focusing on particular chemicals or brain cells that might be involved.
"We tend to look at smaller and smaller parts of the human body, and the human mind and the human brain," to find the cause of something, Young said. In doing so, we lose sight of the bigger picture, including social and cultural influences that may play a role in alcoholism development. Factors including who you spend time with, how many liquor stores are near you and your religious affiliation all are linked with how much you drink, Young said.
Young said he prefers to use the word "allergy" to describe alcoholism.
"It is less threatening to consider the idea that one might have an allergy than to consider the idea that one might be permanently diseased," Young said.
"With alcoholism, there's a dichotomy — you either are [an alcoholic] or you're not. And that sort of marks you as an individual — you're either normal or you're deviant." Young said. "With allergies, the deviance is much less significant."
In addition, drinkers should not feel they have to leave their diagnosis to a physician. People should give weight to their own experiences, including what they perceive their drinking is doing to their lives, Young said.
Other experts point out that the problem of disease stigmatization or identity crisis is not unique to alcoholism.
"It really doesn't matter what illness you have; people have a sense of loss," said Dr. Ihsan Salloum, chief of the Division of Alcohol and Drug abuse at the University of Miami Miller School of Medicine; who also called the Young's article "more philosophical than scientific."
The disease model has helped us understand alcoholism and develop drugs for the condition, Salloum said.
However, Salloum agreed there is a need to take into account subjectivity when diagnosing and treating the condition.
"When somebody is suffering, it's not only the organ that's suffering, it's the whole person," Salloum said.
If doctors want to help patients accept their diagnosis as an alcoholic, they should work to understand how the patient is processing what's happening to him or her, Salloum said.
Pass it on: Viewing alcoholism as a disease may create problems in terms of diagnosing, treating and understanding the condition.