Alcoholism: Disease or "Dis-ease"?

For several years now, whether alcoholism and substance abuse is a disease or simply "dis-ease" has been a question of great debate. There are those who believe alcoholics are simply a product of their environment or choose to abuse. I tend to subscribe to the "Diathesis-Stress Model" approach to this question. I believe alcoholism, absolutely is a disease with biological origins. Yet, it is triggered by external factors. Therefore, it is both a disease and "dis-ease", but neither one exclusively.

The "diathesis-stress" approach takes the standpoint that a person has a genetic predisposition to become an alcoholic. Alcoholics have the "gene", so to speak, for this disease. Yet, without the right circumstances present, the disease will never develop. For example, an individual may be biologically predisposed to become an alcoholic. The potential is certainly there. Yet, if the never take a drink, this will obviously not occur. Conversely, of one is predisposed and the right combination of events occurs, such as encountering life stress en then consuming a drink, the disease will inevitably surface.

Although, the disease theory of alcoholism is nowadays becoming widely accepted, it was not always so. As a matter of fact, there are a handful of those who still strongly oppose these findings. However, the idea of its biological roots actually started to emerge many, many years ago. "References to chronic drunkenness as a sickness of the body and soul...can be found in the civilizations of ancient Egypt and Greece" (Vegso, 2000). In America, a Dr. Benjamin Rush introduced this topic in his Inquiry into the Effects of Ardent Spirits on the Human Mind and Body. Using medical-like terminology, he declared that "chronic drunkenness was an odious disease and a disease induced by vice" (Vegso, 2000). He even continued on to offer speculation on a medical cause for this disease. In 1888, one Dr. Joseph Parrish furthered this cause by stating that "it is the internal craving for alcoholic liquors, and for their intoxicating effect, that constitutes the disease, and not the fact of drunkenness" (Vegso, 2000). In support of this, Dr. T.D. Crothers added some definition in stating that it was "the constitutional proclivity of neurosis" (Vegso, 2000) that was the cause of excessive alcohol use. One of the most prominent organizations that adopted the disease theory is Alcoholics Anonymous. Their perspective is strongly based on E.M. Jellinek's assumption in the 1960's that "alcoholism was a permanent, irreversible condition. Once a person who develops alcoholism takes a drink, the biochemical effects of the drug on the brain create an irresistible physical craving for more" (Vegso, 2000).

Today, there is remarkable and compounding evidence supporting the biological roots of alcoholism. We now have an idea of how alcohol affects the chemical in our brains. Although, much of this is yet to be discovered and not yet fully understood, there is confirmed evidence on the effect alcohol has on dopamine and an understanding of how this contributes to addiction. The Annual Editions article Addiction and The Brain, discusses how addictive drugs enhance dopamine transmission, producing the pleasurable effect these drugs can cause. However, "as the brain adapts to the excess of dopamine, natural production declines...tolerance rises and eventually pleasure is almost absent. But addicts still want the drug and still use it, because most other experiences have become less rewarding. They need the drug just to feel normal" (Wilson, 2000). Thus, we see the "catch 22" of addiction. Use of the drug increases as tolerance increases; and tolerance increases as usage increases.

As well, there have risen many studies that support the genetics of alcoholism. "Researchers have linked alcoholism...to genes involved in determining the structure of dopamine receptors on the brain" (Nevid, 2000). However, this disease is not quite so simplistic as to likely have one causal gene. Instead, evidence suggests that "a set of genes that interact with each other (are responsible for alcoholism)" (Nevid, 2000). Other studies involving twins suggest a genetic linkage. Monozygotic twins who have identical genes have higher concordance rates of alcoholism than dizygotic twins who share only half their genes (Nevid, 2000). In addition, "consistent with a genetic contribution, studies who that male adoptees whose biological parents suffered from alcoholism have an increased risk of developing alcoholism, even if they are raised in non-drinking homes" (Nevid, 2000).

However, now that we have established the support for alcoholism as a disease, we must revisit my other belief that was stated previously. This was that although alcoholism is a disease, it cannot surface without the contribution of external factors. As said prior, one cannot become an alcoholic without first taking a drink, and there are many external factors that precipitate this act. These predecessors can be numerous kinds of stress, derived from various life circumstances. As well, it could be learned behavior that causes one to take the first drink, such as growing up in an environment with parents who frequently consume alcohol. Enoch Gordis, director of NIHAA, states exactly this point: "there is no doubt that genetics play a role (in alcoholism)...we know that some people are loaded genetically, but obviously they can't become alcoholics unless they take a drink. The genes are for risk, not for destiny" (Wilson, 2000). And, vice versa: "environment may increase exposure to alcohol, but the actual process that results in addiction is biochemical and involuntary" (Wilson, 2000). Similarly, the Harvard Mental Health Letter also states that "the capacity of drugs to disturb the balance of the brain does not depend ton their chemical properties, alone...there are also striking individual differences in susceptibility that arise from heredity, culture, social circumstances, and good or ill fortune" (Wilson, 2000).

In concluding this question, the National Cormorbidity Survey reports in 194 "lifetime prevalence rates of 14% for alcohol dependence and 9% for alcohol abuse without dependence" (Nevid, 2000). Therefore, we can conclude that there can be abuse or "dis-ease" without dependence. Yet, when dependence occurs, it definitely constitutes the disease known as alcoholism-a disease that is biologically-based and genetically linked. Yet, this disease will not be triggered without the presence of certain external factors. Therefore: the question of whether alcoholism is a disease or" dis-ease" can almost be considered a "trick" question. For, in reality, it is actually both: it is a disease that is dependent upon the presence and element of "dis-ease' to exist.

WORKS CITED

Morrow, W. (1990). Mayo Clinic Family Health Book. New York: Mayo Clinic Press.

Nevid, J. (2000). Abnormal Psychology in a Changing World. New Jersey: Dell

Vegso, P. (publisher). (2000). Counselor Magazine, vol. 1 (1). Florida.

Wilson, H. T. (editor) (2000). Annual Editions Drugs, Society, and Behavior. Connecticut.