The Problematic Disease
Photo by Thibault Penin on Unsplash
From the first public health school in the United States that was established in 1916 at Johns Hopkins University, sanitation was one of the main competencies taught. From this school, more schools would be developed and throughout the 1900s specific public health concepts were standardized. These concepts included: communicable diseases control, environmental sanitation, child health services, health education, industrial hygiene, nutrition, and medical care. One of the largest changes that occurred was teaching the public to be clean and treat foods properly in order to avoid disease. Simply speaking, having a clean environment and clean body eliminates the ability for diseases to for.
Looking at alcoholism (which is a special case) the disease model has completely failed in its ability to deal with this social issue. One of the major failings with alcoholism is the direct result of its definition as a disease and its treatment approach. Amazingly enough, Alcoholism is defined as a disease but the modern medical establishment has had little to do with writing that definition. Alcoholics Anonymous is the group responsible for defining the disease of alcoholism. Alcoholism when defined as a disease makes very little sense. There is something rationally unsound when defining alcoholism in this way. Here is the definition of alcoholism as defined by the Mayo Clinic.
Alcoholism is a chronic and often progressive disease that includes problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect (physical dependence), or having withdrawal symptoms when you rapidly decrease or stop drinking. If you have alcoholism, you can’t consistently predict how much you’ll drink, how long you’ll drink, or what consequences will occur from your drinking (Mayo Clinic, 2012). Update: Since the time of this article’s original publishing in 2012, the Mayo Clinic updated its definition, now referring to Alcoholism as Alcohol use disorder: “a pattern of alcohol use that involves problems controlling your drinking” (Mayo Clinic, 2021). This change highlights the growing movement away from defining alcoholism as a disease.
The disease definition superficially sounds good but when examined critically the error in its definition becomes apparent. Watch what happens when alcoholism is substituted for another addiction:
Smoking is a chronic and often progressive disease that includes problems controlling your smoking, being preoccupied with smoking, continuing to use tobacco even when it causes problems, having to smoke more to get the same effect (physical dependence), or having withdrawal symptoms when you rapidly decrease or stop smoking. If you have tobacco dependence, you can’t consistently predict how much you’ll smoke, how long you’ll smoke, or what consequences will occur from your smoking.
When you define smoking in the same manner as drinking there is a logical problem. The claim that alcoholism is a chronic disease that makes your body dependent on alcohol; if this were true it would mean that a person who has never drank alcohol could contract the disease of alcoholism. Without ever drinking, one would begin suddenly craving to drink out of control. This is not possible since one cannot become an alcoholic without ingesting alcohol.
The point of this exercise is to show how the disease model fails and why it should be questioned constantly. From the point of social conflict, I find it amusing that the group (Alcoholics Anonymous) who wrote the definition of the disease is also the group that benefits the most from the medical community and government adopting this definition. What is even more revealing is the fact that Alcoholics Anonymous has a failure rate of 95% (Vaillant, 1995). Studies have shown that in many instances no treatment would have been preferable to the AA program. AA has shown through its own research that the program raises the death rate amongst group participants by 3% (Vaillant, 1995). I am critical of the disease model because of this situation.
Mayo Clinic (2012) Diseases and Conditions Alcoholism Old URL http://www.mayoclinic.org/diseases- conditions/alcoholism/basics definition/CON-20020866?p=1&DSECTION=all New 2020 URL https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243
Vaillant, G.E. (1995). The natural history of alcoholism revisited. Cambridge, MA: Harvard University Press.
Vincent Triola. Tue, Jan 19, 2021. Alcoholism: Problems with the medical model of disease. Retrieved from https://vincenttriola.com/blogs/ten-years-of-academic-writing/alcoholism-problems-with-the-medical-model-of-disease