Ten Industry Experts Discuss Alcoholism & Addiction Treatment

We recently got in touch with a variety of industry professionals to ask their opinion on alcoholism. From whether or not alcoholism is a disease to methods of recovery, we touched on a variety of topics.

Everybody has their own opinion when it comes to alcoholism, however, those who work in this industry, day in and day out, have a strong understanding of the impact on society as well as those who abuse this substance.

Overview of Questions

We interviewed 10 industry professionals, asking each one the following eight questions:

1. Is alcoholism a disease? Why?

2. Is alcoholism a behavioral issue? Why?

3. Is alcoholism a moral failing? Why?

4. Are there varieties (Jellinek, Phases of addiction) of alcohol/drug abusers? In other words how does one explain the potential contradictions in levels of addiction or abuse?

5. Are the Twelve Steps the only reliable modality for recovery? Why?

6. By categorizing alcoholism/addiction as a medical condition or a disease, are we creating a sense of anything is excusable for the abuser/addicted? Why?

7. In your own words what is alcoholism?

8. Comment on this statement. The difference between coming to terms with the concept of alcoholism vs. addiction is simple, alcohol is legal and drug use is not, therefore if you are an alcohol abuser it is more difficult to recognize your addiction especially if you are nor physically dependent on alcohol. Whereas, if you are using drugs such as heroin there is no doubt you are an addict.

Who Said What?

As you can imagine, every person we interviewed had a different take on each question. For this reason, no two answers were the same.

For example, when asked if alcoholism is a disease, there were a variety of responses.

Ashley Kopaniasz said, “Yes, alcoholism/ addiction is a disease. It has been recognized by the following entities as such : American Psychiatry Association, American Society of Addiction Medicine, and the American Medical Association have all defined alcoholism/addiction as a disease.”

On the other hand, Rich Dowling noted the following: I do not use the term “alcoholism”, the scientific terms as per DSM are ABUSE and DEPENDENCE identified as maladaptive behave, no mention of disease.”

This is just one example of how every industry professional has his or her own opinion on alcoholism, including but not limited to how it is classified and treated.

Alcoholism vs Addiction

One of the most interesting questions in our survey was the last one, asking people to comment on a statement touching on the “concept of alcoholism vs. addiction.” This elicited some powerful opinions, such as the following from Don Thomas:

“One of the difficulties in diagnosing alcoholism or addiction as a disease is it just plain doesn’t seem like one. It doesn’t look, sound, smell and it certainly doesn’t act like a disease. To make matters worse, generally it denies it exists and resists treatment. The DSM-5 and ASAM Criteria plus all the questionnaires are used to determine Substance Use Disorders.”

Our survey on alcoholism is sure to open your eyes, as it shows that everybody, including industry professionals, have a strong opinion on this subject. Be sure to read over the answers provided by all 10 people, as these will help you better understand this topic while shaping your personal stance.

John Johnston of Serenity Lane Treatment Center

1. Is alcoholism a disease? Why?

Alcoholism is a brain disease recognized by the World Health Organization that effects  millions of people worldwide. There are physiological differences in the way the brain of a true alcoholic(picture the stereo typical skid row bum) and that of a so-called normal person. A person with an alcoholic brain will experience euphoria when alcohol is entered into the system primarily due to the way that the brain metabolizes the drug.  There also tends to be a strong genetic predisposition for alcoholism. It can be debated that the trauma of alcoholism in a family perpetuates the behavioral cycle and this very well may be true but the strong physiological evidence cannot be denied. The reality is the two work hand in hand to allow the disease to establish a strong foothold that it can be identified generational.

2. Is alcoholism a behavioral issue? Why?

Alcoholism is a physiological, behavioral , emotional and social disease. The successful treatment of Alcoholism will address all four areas alcoholism runs in family’s for the individual. There has been strong correlation between addiction and the genes identified in individual with risk taking behaviors. The fact that family and behaviors and coping skills are learned from our family of origins cannot be overlooked.

3. Is alcoholism a moral failing? Why?

There are defiantly cognitive thinking errors that play a role in the manifestation of addiction in an individual’s life however to call addiction a moral dilemma is one of the biggest issues that keeps individuals from seeking treatment. The stigma, bias  and shame associated with addiction in one of the biggest barriers that keeps individuals from seeking treatment for their disease.

4. Are there varieties (Jellinek, Phases of addiction) of alcohol/drug abusers? In other words how does one explain the potential contradictions in levels of addiction or abuse?

I do believe there are different manifestations of addiction , however the end result often looks the same. We see an ever increasing amount of individuals seeking treatment for chemical dependency as a result of becoming addicted to prescription drugs from the physicians. These drugs are prescribed for pain management but the individual ends developing an emotional and or physical dependency to the drugs. Pain management drugs often work effectively for a short period of time but eventually they lead to the individual requiring more and more of the drug for diminished results. I also believe that there are individuals who experience what I refer to as a situational addiction where they maybe experiences a traumatic life event and find relief in substance abuse and or dependency. Where these individuals are not the classic definition of addict their lives are just as dramatically affected. Financial, social, emotional and physical wreckage occurs and their lives may ultimately be threatened.

5. Are the Twelve Steps the only reliable modality for recovery? Why?

No .The 12 steps of recover work best for the overwhelming majority of people suffering from addiction but there are other avenues such as rational recovery or a medical model accompanied by working with an individual therapists. The 12 steps of A.A. and N.A. has provided millions of individuals with a path to life free of addiction.

6. By categorizing alcoholism/addiction as a medical condition or a disease, are we creating a sense of anything is excusable for the abuser/addicted? Why?

I would hope not, my hope is that it opens the door to people giving them hope that addiction is a treatable disease. There has been many advances made in the treatment of addiction primarily through medications use for addressing the pain of detoxification and for addressing craving that have benefited those seeking craving.

7. In your own words what is alcoholism?

An insidious disease that effects the individual, family and community of all that suffer from it. Addiction a disease of perception, as an alcoholic the way I view, interpret and respond to the world is always going to .slightly askew. Even in recovery I require individual and the 12 steps to help me interpret, navigate and behave in a manner that different than my immediate response left to my own accord.

8. Finally comment on this statement. The difference between coming to terms with the concept of alcoholism vs. addiction is simple, alcohol is legal and drug use is not, therefore if you are an alcohol abuser it is more difficult to recognize your addiction especially if you are nor physically dependent on alcohol. Whereas, if you are using drugs such as heroin there is no doubt you are an addict.

There is absolutely no difference between a legal drug and an illegal drug in terms of addiction. The desolation destruction and pain is absolutely the same. As an addict I can obsess on anything and if that obsession goes unchecked then that obsession can become self destructive.

Cathy Doran of YFA Connections:

1. Is alcoholism a disease? Why?

I believe that the evidence is overwhelming in favor of the disease theory of alcoholism – addiction is a brain disease.   Why?  Research clearly indicates a difference in the way an addicted brain processes certain neurochemicals compared to a non-addicted brain The clinical studies using MRI in Oregon clearly map these differences. This is what withdrawal and tolerance is about – a change in the biological/neurochemical function of the brain.

2. Is alcoholism a behavioral issue? Why?

I believe that there are behavioral aspects of alcoholism that one can point to – DUI arrests, staggering, slurring speech, loss of control over one’s life, loss of job, loss of family etc.  These things can be caused by the behaviors associated with alcoholism but I don’t believe that alcoholism itself can be boiled down into a “behavior”. Diabetics also demonstrate certain behaviors associated with diabetes – blood sugar lows causing fainting, insulin lows causing coma, staggering, slurring, etc. – but diabetes is not a behavioral issue –it is a disease of the pancreas.

3. Is alcoholism a moral failing? Why?

No Why?  Is failing to adequately control one’s blood sugar a moral failing for a diabetic?  Is failing to control seizures a moral failing for an epileptic?  Is failing to shrink your own cancerous tumor a moral failing?  Behaviors associated with alcoholism are visible to the public and drunk drivers kill people.  People can see staggering, slurring, drunkenness – what if that behavior can be attributed to a sugar low – the behaviors can look identical.  People love to talk about “lack of willpower” in the case of alcoholism.  If we concentrate really hard maybe we can also produce more insulin from our broken pancreas?  Sorry – that was a rant….

4. Are there varieties (Jellinek, Phases of addiction) of alcohol/drug abusers? In other words how does one explain the potential contradictions in levels of addiction or abuse?

Sorry- hate to keep coming back to diabetes – but it’s just so similar in it’s progression. There are “levels” or diabetes and different causes. It can be genetically linked in Type 2, for example. Type 1 has been shown to be primarily caused by a virus but more often in people who have a genetic pre-disposition. The levels of intervention in this disease depend on the level of severity – diet and exercise will work in the beginning stages – or pre-diabetes. Then we move to using metformin to enhance glucose absorption – if we get to “late stage” – then we are using insulin injections – and that is now your life. Alcoholism is also progressive – we can intervene when behaviors get out of control and prior to physical dependence using abstinence. When someone is unable to maintain abstinence – the disease continues to progress much like diabetes. Then the level’s of intervention change…..outpatient – inpatient – detox – antabuse – etc. I don’t think there is any contradiction in the concept of “levels” – it’s just levels of severity of the disease – or where you are on the continuum of the disease. I also believe that if you “catch it” early – prior to moving into physiological dependence – then you haven’t moved into actual addiction yet – that only happens when there is tolerance and dependence (brain chemical shifts). I believe you can be an abuser of alcohol – stop before you fall over the fence – and never progress to the full disease. Same with diabetes – if your blood sugar hits the pre-diabetic value and you are serious about avoiding the disease – then diet and exercise can work for you – forever – and you never progress beyond that into full blown insulin-dependent diabetes.

5. Are the Twelve Steps the only reliable modality for recovery? Why?

Absolutely not.Why? Again – I go back to the research – here is the link –  http://www.commed.uchc.edu/match/default.htm

I believe that successful treatment of any behavioral health issue has to do mainly with the relationship between the addicted person and the person providing the treatment or support.  People need to be “matched” to treatment professionals – or recovery groups – that they believe in and feel supported by.  When you add “willingness” to this mix then you have a better recipe for success.

And – 12 step programs  – or some kind of self help group – are critical for people in recovery because it helps to not feel like you are the only person struggling with this disease – and it helps manage the guilt and shame – which more often than not – if what leads a person back to using.

Sadly – you don’t see diabetics crowding into smoky church basements and wringing their hands in guilt and shame about eating a snickers and knocking them off their blood sugar goal – why?  Because there is no moral stigma attached to “real diseases”.  If the public really understood addiction the way medical professional do – and guilt and shame vanished – imagine how empowered people would feel – show supported?  It’s only been in the past year that addiction has attained “parity” with other medical issues regarding insurance coverage for treatment.

6. By categorizing alcoholism/addiction as a medical condition or a disease, are we creating a sense of anything is excusable for the abuser/addicted? Why?

No Why?  Back to diabetes – my brother is type 1 and doesn’t manage his sugar well – consequently he ends up passed out in parking lots not knowing how he got there.  He drops over in the halls in the school where is teaches – he drives the wrong way on the freeway absolutely unaware of what he’s doing.  He has diabetes – does that excuse his dangerous and stupid behaviors – absolutely not.  People have a responsibility to do what is right, follow the laws, be good and kind people –whatever it is we expect of each other in this world.

7. In your own words what is alcoholism?

It is a progressive and potentially fatal disease process that impacts every organ in your body and every aspect of your life.

8. Finally comment on this statement. The difference between coming to terms with the concept of alcoholism vs. addiction is simple, alcohol is legal and drug use is not, therefore if you are an alcohol abuser it is more difficult to recognize your addiction especially if you are nor physically dependent on alcohol. Whereas, if you are using drugs such as heroin there is no doubt you are an addict.

A person is not addicted to alcohol unless they are physically dependent (tolerance/withdrawal).    If a person is using heroin, cocaine, pot, meth, etc. does that mean they are addicted?  No – a person still needs to meet diagnostic criteria to be labeled “addicted”.

Personally – I believe that if someone is “socially” using an illegal drug there is already a problem – law breaking behavior is an indication of something…..but not addiction per se.

I believe that the legality or illegality of something doesn’t “cause” addition or make it any harder or easier to become addicted.

I also believe that alcohol is the most harmful of all the drugs we treat.  It is probably easier to “write it off” as social drinking or abuse rather than addiction because it’s legal and “everyone does it”.  As long as the government can figure out how to profit (taxes) from the misery of those who are addicted to alcohol and tobacco (and now pot) then the battle will always be uphill.

Jennifer Ouellette of York County Shelter Programs

1. Is alcoholism a disease? Why?

Yes, it is.  In the most basic definition of the word disease, we find that it is a medical condition, with signs and symptoms, that not only plague the physical body but also emotional and behavioral components of a person.  Just like cancer, diabetes, and Parkinson’s most diseases come about with no known cause, no known ability to prevent no matter what someone does.  It is often connected to a genetic disposition, although, not always.  I have never, in my 23 years in the field of addiction, met an alcoholic or drug addict who says they intended to become such.  Similar to a diabetic, cancer survivor, or an individual with MS, people don’t ask for the illness, they didn’t actively go out and try to get the illness, and yet, are not stereotyped about their illness (like they can use willpower and make it go away, or just stop drinking) in the same way someone with chemical dependency is.

2. Is alcoholism a behavioral issue? Why?

I think alcoholism creates behavioral issues, but itself is not a behavioral issue.  As the disease progresses, as with others, we find deterioration in the essence of “who” the person is or was.  The components of the disease change the individual, whether it is “real life” biological changes, or simply changes in response to dealing with the illness.  As people get sick and suffer from the symptoms there is no option other than to respond to it in a changed way.  People then behave differently.

3. Is alcoholism a moral failing? Why?

No, I don’t believe it is.  There is no more moral failing for the victim of alcoholism than there is for the victim of diabetes or cancer or any other disease.  It is not necessarily something you chose to have to deal with or suffer from.  It is not a life choice, or something you can wish to go away.  It has nothing to do with morals or the implication if they were a better person they wouldn’t have this problem.  I have met highly moral individuals who are chemically dependent.

4. Are there varieties (Jellinek, Phases of addiction) of alcohol/drug abusers? In other words how does one explain the potential contradictions in levels of addiction or abuse?

I am not sure what you are implying or asking here.  I assume when you speak of contradictions, you are speaking about why one person appears to suffer more than another person with the same disease.  This is not easy to answer.

I do believe there are phases of addiction, when someone crosses that invisible line from abuse into dependency.  I have seen early, middle, and late stages of dependency.  Typically, at the later stage, we see more consequences, far less enjoyment, and almost a total consumption of the individual as they drink to maintain and get by.  There are health issues, legal involvement, mental health issues, and relationship problems.

In the early stages of addiction you can see some of these issues as well, but they are not as chronic. Two individuals with alcohol dependency can look very different to the casual observer-one may be living on a park bench, with no friends, and no family, and panhandling, while another is working full time living with their partner.  However, when we look at the disease itself, it looks very much the same (tolerance, withdrawal, consequences) but one has more resources available or their individual situation permits things to stay somewhat in tact.  This then becomes the standard all are judged by, instead of looking at the symptoms of the actual illness.  This is where the “moral” question comes in and judgement about a person’s character take place.

5. Are the Twelve Steps the only reliable modality for recovery? Why?

I will answer this as I do with recipients of our services-AA/NA and other twelve step models are not for everyone, however, you cannot dispute that they help millions of people.  My belief about 12 step programming is the sense of community, engagement, and belonging with others is what makes it work.  That is the key to recovery in my mind. If you feel as though others understand you, and can also explain why you feel so badly, you find yourself in a place that provides some guidance and comfort.  Some people get thoroughly involved in “working the steps” and others do not.  I don’t believe it is necessary to follow a prescribed method (i.e. do step one before step two) but rather to “take what you need and leave the rest.”

I have seen SMART recovery work for some, Cognitive Behavioral Therapy work for some, and “just saying no” work for some.  I have never seen harm reduction work, and I don’t prescribe to believing that someone with alcohol (or drug) dependency can really cut back and maintain that indefinitely.  I do believe abstinence is the only way.

I believe that recovery is more than just not drinking, but includes an establishment of healthier alternatives, getting to know ones’ self, rebuilding broken relationships, learning to live life on life’s terms, and connecting with others.  Recovery includes feeling connected to a community, finding those with something in common, and healing whatever broken pieces there are.  Recovery is about walking through the fear and pain and sadness.  It is about confronting our inner demons, and learning they have no power over us.  Many find this acceptance in the halls of AA or NA.  Professionals are also a potential resource, however, no one can go to therapy or counseling for their entire life.  It is not designed to provide that, nor should it.  Professional help is meant to intervene and help build a foundation that can be supported through community resources like AA.

 

6. By categorizing alcoholism/addiction as a medical condition or a disease, are we creating a sense of anything is excusable for the abuser/addicted? Why?

No more so than for a cancer patient or someone with another disease.  If you have diabetes, you know sugar is the enemy, and if you chose to eat a piece of cake that it will potentially cause you harm.  Yet, the societal views about doing such carry far less stigma and judgement than those attempting to get clean and sober.  A medical disease, no matter what is at the root of it or what we believe to be at the root of it, is still a disease.  The individual living with the disease must learn how to manage it or they will suffer from it.  Being chemically dependent doesn’t permit anyone to get away with anything, in fact, they suffer more judgement than any other individual or group in my opinion.

7. In your own words what is alcoholism?

Alcoholism is a disease that creates physical, behavioral, and emotional consequences.  It is not something that can be “cured,” but is something that can be managed successfully.  Individuals with this illness are often plagued by trauma histories, family dysfunction while growing up, and a need to alleviate painful struggles.  From the innocent teenager who begins alcohol use along with friends to fit in and finds himself feeling more social when under the influence, to the lawyer who has struggled with a high profile case that has riddled him with anxiety and alcohol levels that feeling, to the late stage alcoholic who is also a Vietnam veteran with constant nightmares, alcohol at one time was a friend.  However, once dependency is established, the need for consumption is overwhelming, despite the loss of home, friends, and family.  Alcohol (or drugs) becomes the only focus. An alcohol dependent person is not bad, they are suffering.  They do not intend to break the promise of quitting, they simply cannot figure out how to go on without using.  They are lost, and continue to spiral downwards.  They will lose everything or have everything taken from them as this is the expense of addiction.

8. Finally comment on this statement. The difference between coming to terms with the concept of alcoholism vs. addiction is simple, alcohol is legal and drug use is not, therefore if you are an alcohol abuser it is more difficult to recognize your addiction especially if you are nor physically dependent on alcohol. Whereas, if you are using drugs such as heroin there is no doubt you are an addict.

Well, for one, I don’t believe this statement.  If you use heroin, that does not automatically mean you are addicted.  People can recreationally use heroin.  There is a difference between a legal drug and an illegal drug, but just because you use an illegal drug does not equate to you being addicted to it.  Now it is true that some drugs have a higher potential for addiction than others.  However, alcohol, despite being legal, is one of the most addictive drugs there is.  And yes, it is considered a drug.  Marijuana, still currently considered illegal as a recreational drug is not as habit forming as alcohol  and does not create the physical and social problems alcohol does.  Some research still questions whether you can actually become dependent on marijuana.  Prescription medications, specifically opiates and benzodiazepines, are heavily addictive, and yet considered “ok” because they are legally prescribed.  This question could result in me going on and on!

Secondly, if you are an alcohol abuser (as stated above) this does not mean you are dependent, either.  It means you are teetering on the verge of crossing over, or at least that there are danger signs indicating you are heading towards dependency.  However, I have met many who meet alcohol abuse criteria, and then change their behaviors, resulting in no dependency being formed.

Finally, it seems all too often, the last person to know they have an addiction issue is the individual them self.  Addiction and the desire to continue use changes people.  It changes brain chemistry.  People don’t recognize the problems because it has established itself slowly and the individual has compensated for that over time.  They figure out how to leave work early or how to work with a hangover.  They hang with friends who drink as much as they do.  It is socially acceptable to consume in excess in late teens, early twenties.  It is also common place to attend social functions where alcohol is constantly present.  Not that long ago, I went to a preschool graduation party for a 4 year old.  Alcohol was served!  I am not anti-alcohol, but in a society that permits and expects the availability of alcohol, one of the most damaging drugs there is, at every social function, it is easy to overlook danger signs.  I don’t know anyone I went to college with who didn’t drink to excess, black out, and do “stupid” things.  Society views it as a right of passage and overlooks it saying “oh, he had a few too many.”  A few too many often results in car accidents, aggressive and sometimes violent behaviors and personality changes.

Charles J. Esposito of Seastone of Delray

1. Is alcoholism a disease? Why? 2. Is alcoholism a behavioral issue? Why?

Addiction has both mental and physical health components.  The mental health component leads people to believe that addiction is not really a disease.

An addict can become physically addicted to their drug of choice.  Take for instance an alcoholic who drinks a liter of vodka every day for weeks.  He physically cannot just stop drinking alcohol, or the withdrawal symptoms may kill him. In this sense alcoholism is a disease that can kill, just like many other diseases.  The correct treatment for alcoholism at this level is to enter into detox so that your body may physically recover.  Once a person is no longer “physically” addicted to their drug of choice, addiction ceases to act like a garden variety disease where you take medicine and get better.

The mental component of addiction truly is a mental health problem that can be treated through therapy and support groups, like 12 step programs, along with some non-narcotic medications.  The mental health component of addiction is a much graver problem than the physical component.  The mental addiction is an obsession of the mind that is a phenomenon of craving that cannot be controlled or subdued by willpower alone.  Addicts abuse substances as a form of self-medication to treat their mental health problems.  Some of these mental health issues could be bi-polar disorder, schizophrenia, or other illnesses.  More often, however, addicts suffer from low self-esteem, post-traumatic stress, depression and other less tangible problems.  It is difficult to quantify many mental health issues, and this leads people to believe that the mental health component of addiction is not truly a disease.

3. Is alcoholism a moral failing? Why?

In some sense, the result of addiction is a moral failing.  Most, but not all, addicts use several ego defense mechanisms that many would call a “lack of morals.”  At Seastone we treat clients who deny, distort, project, and split.  When addicts use these defenses it looks a lot like disrespect, talking back or other moral failings.  It’s important to understand, however, that these defenses are symptoms of their disease and not the disease itself.  For example, if an addict has low self-esteem because they feel intimidated by having to share their feelings about an issue they’re having, they may try to act like an alpha or try to control the situation by showing disrespect.  This diverts the attention from them and on to whoever is causing their dilemma.  In reality, the moral failing is the symptom of the addict not being able to cope with their reality, but it is not the cause of their illness.

4. Are there varieties (Jellinek, Phases of addiction) of alcohol/drug abusers? In other words how does one explain the potential contradictions in levels of addiction or abuse?

You’ve probably heard before the saying “an addict is an addict is an addict.”  This usually means that no matter where an addict is in life, whether or not in active addiction, that person is still an addict.

Addiction is a three part disease with mental, physical and spiritual components. The mental component is characterized by a mental obsession of craving, the physical component is characterized by physical addiction and the spiritual component is characterized by a disconnect from society brought on by a lack of morality and self-respect. Believe it or not, the standard for addiction is fairly high.

At Seastone, we ask whether an individual has lost control of their substance use, and that loss of control affects their daily life in a negative manner.  We look to see whether our client has lost their job because of their substance (ab)use, whether they have alienated their family and friends, and whether or not their addiction prevents them from functioning in the real world, and whether or not their addiction has caused them to have physical health problems.

Is a person who goes on vacation several weeks a year and uses large quantities of cocaine and alcohol an addict? The answer really depends on a lot of things.  If that person is able to go back home, raise a family, and not let drug use interfere with everyday life, then we would not categorize that person as an addict.  That person might be a drug abuser, but they aren’t an addict.

Defining addiction is still somewhat subjective, however.  Each individual is different.  There are some addicts who say they are only addicted to one substance and that they can control others.  That may be the case.  It’s not something we advocate during treatment, however

5. Are the Twelve Steps the only reliable modality for recovery? Why?

No, the 12 steps are not the only reliable modality for recovery, but they have proven to be the most successful.  At Seastone, we believe that treatment modalities, such as relapse prevention, substance abuse education, along with life skills training and other forms of clinical therapy combined with support groups like AA, NA and CA provide the most effective way to engage recovery.

When it comes down to it, someone who is actively engaged and fully committed to getting sober will be able to do so in a variety of ways.  However, the 12 steps outline a very efficient way to quit using and also offer a way of life that will help prevent relapse.

That being said, there are plenty of “dry drunks” who actively engage in 12 step programs.  This is not the fault of these fellowships, but sometimes those “dry” individuals are touted for their “clean time.”  At Seastone, we believe that it’s not the number of days you have, it’s how you live each day.  The goal of sobriety is not just to remain dry, but to become a better individual and to live each day with purpose.

6. By categorizing alcoholism/addiction as a medical condition or a disease, are we creating a sense of anything is excusable for the abuser/addicted? Why?

Addicts cannot be punished for being addicts.  If a sick person at the hospital vomits, the nurses don’t yell at them.  Much the same way, when an addict relapses or even just uses ego-defenses to act out, it is important to remember that the individual is sick and trying to cope with their illness.  That being said, many enablers of this disease refuse to put their foot down and hold addicts responsible for their actions.  This allows the addict to live in their alternate reality in which they have no responsibility or consequences for their actions.

If an addict is not held responsible for their actions, such as committing crimes, it may result in them using more.  However, being an addict is not in itself a crime.  Addicts should not be punished for using drugs because they are self-medicating their problems, but at the same time they need to be held accountable for their actions so that they can see the consequences of their drug use.

7. In your own words what is alcoholism?

Addiction is a three part disease with mental, physical and spiritual components. The mental component is characterized by a mental obsession of craving, the physical component is characterized by physical addiction and the spiritual component is characterized by a disconnect from society brought on by a lack of morality and self-respect.

Alcoholism is an attempt by an individual to self-medicate for a mental health problems.  These problems may stem from child abuse, lack of nurturing, inability to cope with feelings or reality, depression, etc.

8. Finally comment on this statement. The difference between coming to terms with the concept of alcoholism vs. addiction is simple, alcohol is legal and drug use is not, therefore if you are an alcohol abuser it is more difficult to recognize your addiction especially if you are nor physically dependent on alcohol. Whereas, if you are using drugs such as heroin there is no doubt you are an addict.

Alcoholism and addiction are the same disease.  Simply because alcohol is legal and heroin is not does not make an alcoholic any different from a heroin addict.  Both individuals are using a drug to self-medicate.

It may be harder to determine if someone is an alcoholic rather than a heroin addict because alcohol is so widely available.  It is also easier to become physically addicted to heroin.  Again, I refer back to Seastone’s definition of an addict.  Is the drug or alcohol use preventing the individual from living a fulfilling life?

David Lisonbee of Twin Town Treatment Centers

1. Is alcoholism a disease? Why?

According to the World Health Organization and the American Medical Association, alcoholism does qualify under commonly accepted and official definition of “disease”. Due to biological markers and centuries of observation/ study, “alcoholism” has been given the term of “disease” by physicians- specialists who we give legal/ cultural authority over such matters.

2. Is alcoholism a behavioral issue? Why?

“Alcoholism” arises from and gives rise to common behavioral problems- see the Diagnostic and Statistical Manual of Mental Disorders.

3. Is alcoholism a moral failing? Why?

“Alcoholism” commonly results in conflicts and failings between an individual’s behavior versus their internally held and socially imposed moral standards.

4. Are there varieties (Jellinek, Phases of addiction) of alcohol/drug abusers? In other words how does one explain the potential contradictions in levels of addiction or abuse?

Each individual behaves and responds to chemicals in unique ways. The progression of the disease of addiction often manifests predictable landmarks, though individual differences always exist in matters of development, behavior, emotion and personality.

5. Are the Twelve Steps the only reliable modality for recovery? Why?

For many, Twelve Step participation or facilitation therapy is effective. Many people do not have the capacity or come from a context leading toward benefit from this approach.

6. By categorizing alcoholism/addiction as a medical condition or a disease, are we creating a sense of anything is excusable for the abuser/addicted? Why?

A common personality characteristic/ defense used by the addict is rationalization. Rationale can be found in all things. Whether one’s condition is termed as “sinful”, “criminal”, “deviant”, “ill”, “diseased”, “crazy” or “bad”, rationalization, hopelessness, or defeat can arise. The difference is individual and perceptual.

7. In your own words what is alcoholism?

Alcoholism is a condition where ones behavioral, cognitive and biological locus of control has evolved closer to alcohol.

8. Finally comment on this statement. The difference between coming to terms with the concept of alcoholism vs. addiction is simple, alcohol is legal and drug use is not, therefore if you are an alcohol abuser it is more difficult to recognize your addiction especially if you are nor physically dependent on alcohol. Whereas, if you are using drugs such as heroin there is no doubt you are an addict.

I understand your point about alcohol vs. drug addiction though “coming to terms” with a personal condition often pertains to more than cultural, social or legal sanctions. “Coming to terms” often arises from personal failure, pain, loss, and alcohol results in these consequences as effectively as any drug. Alcohol creates a much greater number of adverse events and consequences in today’s society than any other drug with the exception of nicotine.

Robyn McGregor of Willamette Family

1. Is alcoholism a disease? Why?

Because one person could use in the same pattern as another and not experience a progression of addiction, and another one will, and because it can be in remission, and relapse can happen.  It is chronic, because if the alcohol or drug is re-introduced, the brain will recognize it, and cravings can begin again, and it may be very difficult to get back on track.

2. Is alcoholism a behavioral issue? Why?

Behavior is a big part of the problem, but the behavior changes go hand in hand with the progression of the disease of addiction.  The behaviors may become habit after a long battle with addiction, so thinking errors and behaviors that have developed while using need to be addressed as part of their treatment.

3. Is alcoholism a moral failing? Why?

No.  Because the person cannot predict that they will experience a loss of control prior to experiencing it as part of their initial drug or alcohol use.  Two people can try alcohol or a drug for the first time and have a totally different outcome.  Legal issues can be a behavior issue, or they can be part of the symptom of the disease, loss of control.  A person who may experience a  “moral failing” while under the influence may never have had that issue until they are under the influence.

4. Are there varieties (Jellinek, Phases of addiction) of alcohol/drug abusers? In other words how does one explain the potential contradictions in levels of addiction or abuse?

Yes.  It’s called Progression.  Most people don’t start IV Heroin use the first time they try an illicit drug.  They start with a lesser potency of drug, and continue until they reach a much more unhealthy level of risk with their use.

5. Are the Twelve Steps the only reliable modality for recovery? Why?

Of course not.  The largest reason for attendance there can be to get introduced to other recovering addicts and alcoholics in your area.  It does have a behavior approach built into the steps of the program that can help an addict or alcoholic  take accountability  for their actions while using or drinking.

6. By categorizing alcoholism/addiction as a medical condition or a disease, are we creating a sense of anything is excusable for the abuser/addicted? Why?

No.  Because every program, treatment center, style of support group had one thing in common.  That is to take responsibility for your actions while under the influence.  I can’t think of one modality that says that the addict is excused for his behavior by virtue of having the “disease.”

7. In your own words what is alcoholism?

It is the compulsive use of drugs or alcohol, despite legal, health, loss of employment, guilt & shame due to your actions, financial problems and relationship consequences.  With help, it can go into remission, but the addict or alcoholic must maintain positive practices in order to avoid a relapse.

8. Finally comment on this statement. The difference between coming to terms with the concept of alcoholism vs. addiction is simple, alcohol is legal and drug use is not, therefore if you are an alcohol abuser it is more difficult to recognize your addiction especially if you are nor physically dependent on alcohol. Whereas, if you are using drugs such as heroin there is no doubt you are an addict.

Defining addiction is not that simple.  One of the symptoms of an addiction to alcohol is that you are a daily drinker.  That is what creates another symptom, withdrawals.  I don’t believe that being legal or not has much to do with addiction.  Alcohol and cigarettes are legal, and pain pills and Marijuana are legal by prescription.  Addiction can still exist, no matter what the legality is.  You can be a daily alcohol user an enlarged liver, an estranged family, lost jobs, and still be within the law.  You can be a Heroin user that doesn’t use daily, and still not be addicted.

Loss of control is the hallmark of addiction.  So, loss of control in the non-daily Heroin user may be that risk they are taking when they do use, that they might get arrested.

Rich Dowling of The Thought Exchange

1. Is alcoholism a disease? Why?

I do not use the term “alcoholism”, the scientific terms as per DSM are ABUSE and DEPENDENCE identified as maladaptive behave, no mention of disease. As I understand it this issue does not meet the definition of a medical disease. If you look at the history of “alcoholism you will find that the “disease concept” was made up to take the stigma off, medical profession picked up on it and created a multi-billion dollar industry.

*Mr. Dowling choose to only respond to one of the 8 questions we asked.

Ashley Kopaniasz of Unison Behavioral Health Group

1. Is alcoholism a disease? Why?

Yes, alcoholism/ addiction is a disease. It has been recognized by the following entities as such : American Psychiatry Association, American Society of Addiction Medicine, and the American Medical Association have all defined alcoholism/addiction as a disease.

There are many approaches to addressing addiction, however the disease model is widely accepted and scientifically proven to reflect the chemical changes that occur not only in the brain but in the body during addiction.  The American Society of Addiction Medicine defines as “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.” (http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/the-definition-of-addiction).

2. Is alcoholism a behavioral issue? Why?

There are behavioral components to alcoholism/addiction that are important to address if the individual is to achieve ongoing recovery. These behavioral components have manifested as ways to support the active addiction.

3. Is alcoholism a moral failing? Why?

Absolutely not. Alcoholism is a disease. As with any disease diagnosis the individual should not be viewed as having a moral failing, however the individual is charged with treating the symptoms of their disease. Addiction as with most diseases is an equal opportunity afflicter.

http://www.asam.org/magazine/read/article/2014/03/13/addiction-character-defect-or-chronic-disease

4. Are there varieties (Jellinek, Phases of addiction) of alcohol/drug abusers? In other words how does one explain the potential contradictions in levels of addiction or abuse?

Jellinek breaks down the phases of addiction in a way that gives valuable information to professionals in terms of course of treatment. The phases of addiction could be compared to stages of progression as in any other disease diagnosis rendering prognosis and course of care. Examples of this are in asthma diagnoses are mild, moderate and severe; in cancer stages are issues ie stage 1, stage 4.

5. Are the Twelve Steps the only reliable modality for recovery? Why?

Absolutely not. The twelve steps are widely accepted as a modality of recovery and as ongoing maintenance. To expand , some individuals will achieve recovery in Twelve Step programs alone, others requiring more interventions that may include: detoxification, inpatient, intensive outpatient, and aftercare. In almost all instances you will find that following the additional interventions individuals are strongly encouraged to engage or remain engaged in Twelve Step Programs in order to keep sobriety. Addiction is a disease but may enter into remission, like with any disease diagnosis individuals follow a maintenance course of treatment that varies from medications to lifestyle changes. There are a number of evidenced based treatment modalities for addiction.

6. By categorizing alcoholism/addiction as a medical condition or a disease, are we creating a sense of anything is excusable for the abuser/addicted? Why?

No more than any other disease diagnosis. Individuals are responsible for the treatment of their symptoms/disease.

7. In your own words what is alcoholism?

Addiction is a crippling disease of the mind and body, however with treatment recovery is possible.

8. Finally comment on this statement. The difference between coming to terms with the concept of alcoholism vs. addiction is simple, alcohol is legal and drug use is not, therefore if you are an alcohol abuser it is more difficult to recognize your addiction especially if you are nor physically dependent on alcohol. Whereas, if you are using drugs such as heroin there is no doubt you are an addict.

Denial is just as strong for either, those using heroin may rationalize that use began as a prescription for opiates, which is legal. Often coming to terms is a result in accumulation of consequences that become impossible to ignore.

Jim Bradford of Maryland’s Department of Mental Health and Hygiene

1. Is alcoholism a disease? Why?

Alcoholism is a disease.  It is an abnormal condition that is characterized by identifiable signs and symptoms.  Features of the disease are that it is chronic, the course is progressive, and the outcome is potentially fatal.  ( These are the characteristics that comprise a disease ).

2. Is alcoholism a behavioral issue? Why?

Alcoholism is not a behavioral issue as people from all walks of life may have alcoholism ( Yale to Jail ).  Behavioral issues from alcoholism have more to do with the effect of the drug on behavior ( drug effected behavior ) and the progression of the disease process.  As a person becomes more dependent, the addicted person may engage in anti social activities to secure the supply or protect self.

3. Is alcoholism a moral failing? Why?

Alcoholism is not a moral failing.  Again the immoral behavior has more to do with the effect of the drug on behavior or the progression of the disease process.  Alcohol tends to knock reason out of the brain early and consequently people will engage in behaviors impulsively while actively intoxicated.  People from all walks of life are impacted by alcoholism and this includes clergy, judges and others who may be of great moral standing.

4. Are there varieties (Jellinek, Phases of addiction) of alcohol/drug abusers? In other words how does one explain the potential contradictions in levels of addiction or abuse?

Levels of addiction do exist and it has more to do with the progression of the disease process.  DSM V guidelines indicate them as mild, moderate, severe.  Since alcoholism is progressive this usually progressively gets worse.  There also also different types of alcoholics, in its simple form it would be maintenance and binge use patterns.  Both patterns are characterized by loss of control after consuming one on a consistent basis.  I think we see more patterns now as ” bottoms” of alcoholics have lessened due to increased interventions and treatment.

5. Are the Twelve Steps the only reliable modality for recovery? Why?

The 12 steps are not the only reliable modality for recovery, however the 12 steps work best for most.  The real concept is that it is critical for persons to understand the chronic nature of alcoholism and that some type of ongoing treatment is important to maintain abstinence.  It is easy to stop use, it is hard to stay stopped.  Other resources may be ongoing counseling, church, rational support groups ( SMART, Rational Recovery).

6. By categorizing alcoholism/addiction as a medical condition or a disease, are we creating a sense of anything is excusable for the abuser/addicted? Why?

Characterizing alcoholism as a disease does not give an addicted person a green light on their behavior.  Individuals are responsible for their behavior as any judge will let them know.  More importantly the addicted person is responsible for their recovery which is a point that appears to be often missed.  Other diseases impact behavior as well, such as mood disorders, and schizophrenia.

7. In your own words what is alcoholism?

Alcoholism is  a disease process characterized by loss of control of alcohol.

8. Finally comment on this statement. The difference between coming to terms with the concept of alcoholism vs. addiction is simple, alcohol is legal and drug use is not, therefore if you are an alcohol abuser it is more difficult to recognize your addiction especially if you are nor physically dependent on alcohol. Whereas, if you are using drugs such as heroin there is no doubt you are an addict.

Coming to terms with alcohol addiction as compared to addiction to other substances can be difficult because alcohol is legal and more socially acceptable.  However alcohol is a drug like heroin or other substances.  The use of alcohol by an alcoholic is not going to be acceptable in terms of society’s norms.  This is interesting because tobacco is legal and it has fallen out of favor in terms of society and is looked down on.  cannabis on the other hand is illegal and has gained more approval from society.  The bottom line is an addicted person will justify whatever drug they are using and will make their use appear perfectly logical and will also try to get others on board with them.

Don Thomas of Square One Treatment

1. Is alcoholism a disease? Why?

Yes. Addiction to alcohol; a progressive disease characterized by loss of control over use, obsession with use, continued use despite adverse consequences, denial that there is a problem and a powerful tendency to relapse. After saying that in 1956 the American Medical Association (AMA) declared that alcoholism was an illness and in 1991, the AMA further endorsed the dual classification
of alcoholism by the International Classification of Diseases under both psychiatric and medical sections. In 1994 the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) and then the DSM-IV-TR listed alcohol abuse and alcohol dependence under
Substance Abuse and Substance Dependence (Alcohol-Related Disorders). In 2013 DSM-5 replaced Substance Abuse and Dependence diagnostic category with Addiction and Related Disorders, i.e., Alcohol Use Disorder- Mild, Moderate or Severe. Also in 2013 The ASAM Criteria third edition listed the word “Alcoholism” as a general but not diagnostic term, usually used to describe alcohol use disorder, but sometimes used more broadly to describe a variety of problems related to the use of beverage alcohol.

2. Is alcoholism a behavioral issue? Why?

Yes and No. Behavioral addictions include compulsive gambling, shopping and sexual behavior, internet addiction and eating  disorders. Where as compulsive behaviors include compulsive gambling, anorexia, bulimia, overeating, sexual addiction, compulsive shopping and co-dependency. Drug addiction is a compulsive behavior and obviously alcohol effects a person’s behavior.

3. Is alcoholism a moral failing? Why?

No. Despite volumes of research on alcoholism and drug dependence and scientific evidence to the contrary, alcoholism and addiction is viewed by many as a moral failing or weakness. Addiction is one of the few diseases that carries such a negative emotional charge and that is a source of shame or embarrassment.

4. Are there varieties (Jellinek, Phases of addiction) of alcohol/drug abusers? In other words how does one explain the potential contradictions in levels of addiction or abuse?

Yes. The Diagnostic and Statistical Manual of Mental Disorders fifth edition describes substance use disorders.

5. Are the Twelve Steps the only reliable modality for recovery? Why?

No, however Alcoholics Anonymous is the only program in the 10,000 years of drinking history of the human race that has any kind of respectable tract record. No other recovery program can match their success rate.

6. By categorizing alcoholism/addiction as a medical condition or a disease, are we creating a sense of anything is excusable for the abuser/addicted? Why?

No. Washington State RCW 70.96A.10 – Declaration of policy. It is the policy of this state that alcoholics and intoxicated persons may not be subjected to criminal prosecution solely because of their consumption of alcoholic beverages but rather should be afforded a continuum of treatment in order that they may lead normal lives as productive members of society. In other words they are held responsible for their actions and afforded a continuum of treatment.

7. In your own words what is alcoholism?

Me – Don Thomas, I am an alcoholic with the disease of alcoholism. Alcoholism/chemical dependency/addiction is a primary disease, it has specific symptoms and is not to be confused with stress, poor relationships or unmanageable work demands.  Alcoholism / addiction is progressive, if left untreated, the symptoms of the disease worsens. Alcoholism/addiction is a chronic relapsing disease and it can not be cured. Like many other disease, the symptoms of alcoholism/addiction can be temporarily stopped, but without significant lifestyle changes and continued maintenance, the symptoms will reoccur. The disease can be arrested.

8. Finally comment on this statement. The difference between coming to terms with the concept of alcoholism vs. addiction is simple, alcohol is legal and drug use is not, therefore if you are an alcohol abuser it is more difficult to recognize your addiction especially if you are nor physically dependent on alcohol. Whereas, if you are using drugs such as heroin there is no doubt you are an addict.

One of the difficulties in diagnosing alcoholism or addiction as a disease is it just plain doesn’t seem like one. It doesn’t look, sound, smell and it certainly doesn’t act like a disease. To make matters worse, generally it denies it exists and resists treatment. The DSM-5 and ASAM Criteria plus all the questionnaires are used to determine Substance Use Disorders.

Interview Statistics:

stats

  1. Percentage of interviewees who believed alcoholism was a disease: 90%
  2. Percentage of interviewees who believed alcoholism was a moral failing: 20%
  3. Percentage of interviewees who think the Twelve Steps are the only reliable modality for recovery: 20%

 

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