Heavy Drinking: The Myth of Alcoholism as a Disease

Fingarette's main position is that alcoholism is not a disease resulting from a biological vulnerability to drink uncontrollably and continuously that can only be cured by abstinence. He argues heavy drinkers drink for various reasons and that drinking has become a destructive but central part or activity in their personal life. He states their heavy drinking arises from many different causes and problems and produces many different patterns of usage and problems. He argues against Alcohol Anonymous (A.A) concept that alcoholism is a disease. Fingarette states those heavy drinkers that are the majority of what A.A. would call alcoholics would not consider themselves alcoholics and would not seek treatment programs from A.A. nor would they be accepted by A.A. because of their denial. His research focuses on chronic heavy drinkers and the difficulties of understanding and helping the persistent long-term drinker.

Research has shown that there is more than a simple treatment program required for these heavy drinkers. Instead of one disease and one cure based on A.A ideology, Fingarette sees it as a multitude of patterns, behaviors, issues involved with heavy drinking and many ways of treating or curing the individual. According to Fingarette, A.A. has perpetuated this "disease" myth mainly to further their cause. The "disease" myth came about due to early Nineteenth Century's way of thinking that moral and social ills were perceived as diseases or sicknesses of the individual. A.A. believes there is a specific group of heavy drinkers that due to some biological vulnerability suffer from a disease where they have an intense urge or craving to drink uncontrollably and continuously and can only be cured from this disease by abstinence.

Furthermore, the person will not be able to start drinking again normally due to this biological uncontrollable urge that forces them to drink heavily. The heavy drinker experiences uncontrollable urges or cravings not allowing them to refrain or control their drinking and they continue to drink until they hit bottom or die from this disease. According to A.A, the only way for a person to be cured is to go through their treatment program. The various meetings involve a person to publicly confess that he/she has an incurable disease and will only be cured by way of their "treatment" programs that lead to abstinence.

According to Fingarette, A.A counselors, most of who are recovering alcoholics, have adopted the belief that alcoholism is a disease and they tend to perceive any challenges to the disease concept as a challenge to the fact that they have overcome the disease. Those who become active participants in A.A.'s program have adopted the A.A. disease concept; those who don't adopt it drop out of the program. Fingarette believes A.A. has created this disease idea to further their cause and to receive federal funds for their treatment programs. Active lobbyists for A.A. make sure the disease concept reaches the general public based on the fact that the general public will go along with this myth because we don't want to accept the reality that there is no single remedy to heavy drinking.

Fingarette makes several arguments and explains why the disease concept is a myth. According to Fingarette, the disease concept is a hindrance because most heavy drinkers do not think of themselves as alcoholics and would not be diagnosed as alcoholics. He states A.A. believes that labeling alcoholism as a disease allows abusers not to feel guilty or ashamed and makes it easier for them to seek treatment. However, many heavy drinkers will view the disease label as stigmatizing and will refuse any treatment. Also, the belief that this disease makes the drinker lose control may be seen to some drinkers as hopelessness, that they will never be cured. Another argument is that some drinkers will not seek treatment if they believe that abstinence is the only cure, the thought of never being able to drink again is very discouraging.

Research done by E.M. Jellinek redefined the disease myth by publicizing various books about the subject. He basically stated or reaffirmed A.A's belief that alcoholism was a disease based on research studies; however, his findings were found to be biased. Other national research surveys contradicted Jellinek's findings and some of these surveys suggested many drinkers do not lose control and that there is no single pattern in the lives of heavy drinkers that connect them to having symptoms of this disease. Another point Fingarette makes is that when the word disease is used people automatically assume there is scientific evidence to justify it being called a disease.

Fingarette states there is no scientific data or research that shows alcoholism as a disease and that the public has been deceived or misled. There are no medical facts that contribute a set of symptoms causing this disease. Treatment programs offered to individuals are not based on any medical facts or knowledge and are not medically based. The only time medicine plays a part in the alcohol treatment is when the person is receiving medical treatment for some physical effect caused by alcohol. No medical treatment addresses the pattern of heavy drinking or why the person drinks.
Also, alcohol treatment programs do not have any specific treatment they use as in the case of treating a disease.

There is no set pattern A.A follows to medically cure a person from this disease. In addition, A.A's paraprofessionals do not administer any medical treatment and there is little evidence that one type of treatment is better than the other. Also, paraprofessionals or counselors often see scientific data or research as obscure, irrelevant and contradictory to their own personal experience with alcoholism. Once faced with the lack of scientific knowledge of the disease concept they usually are close-minded and refuse to believe any scientific evidence or lack of evidence. Most evidence has shown that people improve not because of the treatment they receive but because of social factors surrounding them change or motivates them to stop drinking.

One study of alcoholics in treatment programs found that 71 percent attended A.A. at some point but at 18 month follow-ups only 14-18 percent were still attending. Only 22 percent maintained abstention and over 33 percent had returned to drinking. A.A. is not a treatment but a new way of life for those who choose to become involved. Research has shown that over the long term, treatment has had little effect on the individual the belief that the barrier here for the most drinkers is the concept that the only cure is abstinence. Fingarette believes this is where A.A. fails, instead of focusing on why the person drinks; what's going on in their life and working to change their behavior patterns or their decisions regarding their central activities, A.A. focuses on the need for the person to use self control to stop drinking altogether, in other words, to control the uncontrollable urges or cravings somehow.

Instead of seeing alcoholism as one disease with one cure, abstinence, researchers have come up with new concepts stating there are psychological and social issues that can cause heavy drinking. Economics, politics, norms, and stereotypes also play a significant role in understanding why people drink heavily. Fingarette suggests not looking at heavy drinkers as victims of some biological abnormality; we should look at them as a diverse group of people who for various reasons are caught up in a destructive way of life. Based on research studies, Fingarette believes that alcoholics can control their drinking and that the craving the disease myth suggests needs to be redefine by either mild or severe.

Heavy drinkers are not one group that suffers from a single disease, rather, they are a diverse group and their drinking is based on individual motives, patterns, issues and ways of living that affects their drinking. Fingarette notes that craving does not explain why a drinker doesn't drink or why some drinkers can control this urge even while experiencing strong withdrawals. A.A. believes alcoholics cannot control their drinking that they suffer from an uncontrollable urge to continue drinking and the only hope is for the person to refrain from the first drink. Research has found that people do not drink continuously, they tend to stop and start and were able to drink in moderation. They basically control their drinking through various methods of reasoning. The person's patterns of drinking seem to be associated with the costs and benefits of drinking.

According to Fingarette, each drinker weighs the motivations to drink based on negative and positive costs, rewards or benefits, not some uncontrollable urge or craving to drink excessively. Some were even able to resist their cravings to drink or drink excessively, therefore, the myth that people suffer from an uncontrollable craving does not seem to exist with many heavy drinkers. The best evidence shows that heavy drinkers are people that have made drinking a central activity in their way of life for various social and psychological reasons. For heavy drinkers, life has come to center around and on drinking. Drinking is the central activity in their life and their friends and activities all center around drinking. There are many reasons why people become heavy drinkers and Fingarette suggests we must start to look at heavy drinkers as people who are living with decisions - wrong or right - that they have made in their lives that they are living with the consequences of one of their central activities.

Instead of seeing heavy drinkers as a small group of victims of a disease we need to start seeing them as a large group who struggle with decisions made in their lives and are struggling with a part of their life. They chose to drink, to stop drinking, and to drink in moderation all for various reasons, weighing pros and cons, rewards, benefits and the negative consequences of drinking. He suggests for a heavy drinker to control his drinking they need to make major changes in their lives. They must reconstruct and develop new values, norms, physical and social settings, and new ways of behaving to their situations. Through individualized treatment they must learn to take personal responsibility for their actions and reorganize their lives and learn to live differently. Treatment programs need to be based on the individual's problems and may involve a host of various treatments.

Fingarette doesn't present any competing explanations other than the position of A.A., which I have already discussed.
I agree with Fingarette that there is no scientific evidence that alcoholism is a disease. In my opinion, a disease is a condition that takes place within the body or a breakdown in the body chemistry and there is no evidence of this with alcoholism. The fact that drinking is acceptable in this society and that the majority of people do drink or have drank alcohol is part of the reason why alcoholism is labeled a disease. Cigarette smoking is not labeled a disease, nor is any other drug use, however, our society accepts alcohol so the so-called "disease" concept is more likely to be accepted.

I disagree with Fingarette on some points because I believe there is a physiological aspect to consider just like heroin and cocaine affects the brain chemistry I believe alcohol affects it also. Heavy drinkers choose alcohol as a central activity in their life to address problems or situations they are facing but the fact that they don't use heroin, cocaine or some other drug or use some other method to face situations and turn to alcohol may suggest some sort of physiological dependency. If there is a physiological factor cutting back or trying to return to what Fingarette suggest is "normal" drinking, could eventually lead to the same pattern of heavy drinking.

Fingarette doesn't consider other factors, like genetic or biological factors, and how these play an important role. Genetic or physiological factors may prevent the person from being able to reorganize their lives or make proper decisions or what some would consider proper decisions. Also, some people have a high tolerance that makes them more likely to drink heavy, so I believe there is a biological/genetic factor that makes them susceptible to becoming a heavy drinker.

Again, the fact that they turn to alcohol instead of some other drug or activity may mean they have some genetic or physiological tendency to be drawn to alcohol when situations come up against them. I also disagree with Fingarette's suggestions that heavy drinkers don't have a craving or can control their craving. Heavy drinkers are heavy drinkers because they crave; in other words, they have an urge to drink in certain situations.

Just because the individual can control this craving, even drinking in moderation, does not mean there is not an initial craving. Whether it is mild or severe craving should be of little concern. I agree with Fingarette that the craving is not an uncontrollable urge, as suggested by A.A. but the fact that they "seek" alcohol to escape their problems suggests there is some sort of craving. I believe A.A.'s motive is to help those who are heavy drinkers to stop destroying their lives and the only way for some to do this is to stop drinking altogether. The best solution for some heavy drinkers is to abstain. I believe A.A does offer individuals a new way of life and a new way of thinking, which Fingarette says is needed for the heavy drinker and I agree with Fingarette that situations surrounding these individuals can lead them to drink and make drinking a central activity in their life.

One point Fingarette suggested and agree with is that with A.A the person attending the treatment programs continuously admits he/she is an alcoholic. This method is suppose to always remind the person of their "disease" but to always think of yourself as suffering from a disease can be detrimental. It can keep them in the "victim" mindset; even cancer survivors don't go around mentioning they are cancer victims but survivors. The mentality to continually be an alcoholic doesn't give the person a hopeful outlook or defeating their disease if circumstances in their personal life become overwhelming. It can show that their drinking controls them as opposed to them controlling their drinking as suggested by Fingarette to be the idea recovery. Fingarette did mention the emphasis on society and culture's acceptance of drinking and economic issues relating to alcoholism. This factor can be argued against A.A and Fingarettes' viewpoints.

If societal and economic factors are considered, a heavy drinker may not be able to maintain abstinence nor be able to return to a state of normal drinking. I believe Fingarette should have done more research regarding genetic and physiological factors regarding heavy drinking and what happens within the brain chemistry after one starts drinking. Could genetic factors influence any sort of brain chemistry? What goes on within the brain that could keep a heavy drinker seeking alcohol as a central activity in their life even when it becomes destructive and disruptive no matter what degree of craving? What causes the craving?

I believe Fingarette has presented a very good argument in support of his position. Even though I believe there are some genetic and physiological factors to consider, I believe individuals drink or become heavy drinkers due to their social environment, beliefs, and norms. It has become a way of life for them and a way for them to address any situation or problem that arises. Plus genetic factors only add to the onset of heavy drinking. How much, when and where they drink is weighed based on evaluations they have considered; the negative and positive consequences they have weighed.

He suggests once we stop focusing on involuntary symptoms of a disease and start focusing on the individual's personal concerns, activities and social environment than we can help heavy drinkers reorganize their lives and their central activities.