“The concept of disease is fast replacing the concept of responsibility. With increasing zeal Americans use and interpret the assertion “I am sick” as equivalent to the assertion “I am not responsible”: Smokers say they are not responsible for smoking, drinkers that they are not responsible for drinking, gamblers that they are not responsible for gambling, and mothers who murder their infants that they are not responsible for killing. To prove their point — and to capitalize on their self-destructive and destructive behavior — smokers, drinkers, gamblers, and insanity acquitees are suing tobacco companies, liquor companies, gambling casinos, and physicians.” ―
Addiction does not meet the criteria specified for a core disease entity
“Addiction does not meet the criteria specified for a core disease entity, namely the presence of a primary measurable deviation from physiologic or anatomical norm. Addiction is self-acquired and is not transmissible, contagious, autoimmune, hereditary, degenerative or traumatic. Treatment consists of little more than stopping a given behaviour. True diseases worsen if left untreated. A patient with cancer is not cured if locked in a cell, whereas an alcoholic is automatically cured. No access to alcohol means no alcoholism. A person with schizophrenia will not remit if secluded. Sepsis will spread and Parkinson disease will worsen if left untreated. Criminal courts do not hand down verdicts of “not guilty by virtue of mental illness” to drunk drivers who kill pedestrians.” (2012. Tim Holden. Accessed, Dec. 20, 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314045/)
Moreover, the “disease model of addiction” advocates for “epiphenomenalism which posits that “our thoughts and our behaviour are caused by brain activity, BUT what we think has no effect on our behaviour or on the activity of the brain. Essentially, this philosophy completely rejects free-will at both the level of thought and action. From this view, brain activity simply happens as part of a fully physically determined chain of cause and effect—the brain develops in certain ways according to genetics and conditioning, and just reacts chemically, producing thoughts and behaviours over which we have only an illusion of control. Or, as researcher Edwin Locke put it: A more common ‘soft’ materialist view of thought is that, although thoughts exist, they are epiphenomena of physical events, that is, by-products of the physical having no causal efficacy. The doctrine of epiphenomenalism, of course, is a version of determinism, or more precisely, psychological determinism. This doctrine holds that with respect to his beliefs, thoughts, decisions and actions, human beings have no choice. Given the conditions of his environment and his genes at any given time, only one alternative is possible. In sum, human beings have no control over their destiny; they are totally controlled by conditioning and physiology. (Locke, 1995) (2014. STEVEN SLATE. Accessed Dec. 20, 2017 http://www.thecleanslate.org/philosophical-brain-disease-addiction-epiphenomenalism/).
By medicalizing addiction, addicts have been turned into political, social and economic fodder for policy makers
In the 1940’s, if you were an alcoholic, you could go to a hospital and safely detox, however you were required to pay a bill for your stay, which was approximately 5 to 7 days. There was no money in the procedure of “drying out” drunks and addicts. BUT, by medicalizing addiction and defining it as a disease has opened the door for social policy makers to justify a huge infrastructure of social services and, of course a whole army of social workers, addiction counsellors, and harm-reduction specialists to work on the growing problem of addiction. Furthermore, medicalizing addictions has given rise to the multi-billion dollar treatment centre industry. It has also spawned the further rise of “Big Pharma” and their plethora of pharmaceutical interventions to augment the addict’s plight. And let us no forget Government sponsored methadone programs and safe-injection sites for heroine addicts. Sadly, talk with any heroine addict and ask them about the horrors of trying to detox from methadone addiction, all courtesy of our enabling government sanctioned social services agencies.
“Medicalizing addiction has not led to any management advances at the individual level. The need for helping or treating people with addictions is not in doubt, but a social problem requires social interventions.” (2012. Tim Holden. Accessed, Dec. 20, 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3314045/)
Twelve Step Program describes alcoholism/addiction as an allergy of the body, an obsession of the mind, — a spiritual malady
Nowhere in the “Big Book,” Alcoholics Anonymous (2001, 4th ed.), the Twelve Step basic recovery text does it subscribe to the notion of alcoholism as a “disease”
However the “Big Book” of Alcoholics Anonymous does state:
“The doctor’s theory that we have an allergy to alcohol interests us. As laymen, our opinion as to its soundness may, of course, mean little. But as exproblem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account.” (2001. A.A. 4th ed. p.xxvi)
“An illness of this sort and we have come to believe it an illness involves those about us in a way no other human sickness can. (2001. A.A. 4th ed. p.18)
“Men and women drink essentially because they like the effect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks–drinks which they see others taking with impunity. After they have succumbed to the desire again, as so many do, and the phenomenon of craving develops, they pass through the well-known stages of a spree, emerging remorseful, with a firm resolution not to drink again. This is repeated over and over, and unless this person can experience an entire psychic change there is very little hope of his recovery.” (2001. A.A. 4th ed. p.xxviii)
“…there was always the curious mental phenomenon that parallel with our sound reasoning there inevitably ran some insanely trivial excuse for taking the first drink. Our sound reasoning failed to hold us in check. The insane idea won out. Next day we would ask ourselves, in all earnestness and sincerity, how it could have happened.” (2001. A.A. 4th ed. p.37)
The untreated alcoholic/addict is a manifestation of varying degrees of irresponsibility.
“Selfishness, self-centeredness! That, we (Alcoholics Anonymous) think, is the root of the alcoholic’s troubles…So our troubles, we think, are basically of our own making. They arise out of ourselves, and the alcoholic is an extreme example of self-will run riot, though he usually doesn’t think so.” (2001. A.A. 4th ed. p.62).
Alcoholics Anonymous advocates a spiritual-moral solution to the problem of alcoholism and addiction.
Through the Step Four process, the alcoholic uncovers their short-comings, their character defects. Examples of those defects can be found throughout the first 164 pages of the “Big Book,” here are some that are cited: “pride, vanity, egotistical, self-pity, morbidness, jealousy, suspicion, envy, selfishness, self-seeking, self-centeredness, self-justification, insincerity, dishonesty, lying, exaggeration, unthinking, callousness, cruelty, anger, rancor, bitterness, hate, antipathy, lethargy, impatience, fear, cowardice, worry, intolerance, lust, infidelity, inconsideration, anti-social, slander, gossip, prejudice, diffidence, servility, scraping, irresponsibility, unreasonableness, apathy, martyrdom, squandering, and obstinacy.”
These character defects are the underlying root causes and conditions that produce symptoms of this spiritual malady recognized as restless, irritable and discontented, boredom, depression, anxiety, etc.
These symptoms produce a mental mind-set in the alcoholic to causes them to seek a sense of ease and comfort which comes at once from alcohol/drugs and leads, thus them to picking up the first drink (even when they don’t really want to) which, when coupled with their physical allergy to alcohol, leads to the “alcoholic spree,” whereby they seemingly have no control over their consumption.
The Alcoholics Anonymous program states, “There is a solution.” “When the spiritual malady is overcome, we straighten out mentally and physically.” (2001. A.A. 4th ed. p.64)
A key tenet to the Twelve Step solution is Step Three: “Made a decision to turn our will (our thinking) and our lives (our actions) over to the care of God (the ‘Great Reality’ we find deep down within ourselves) as we understood Him.” (2001. A.A. 4th ed. p.59)
This essentially means that the alcoholic is going think and live by a new set of spiritual principles. Character defects are correlated with the spiritual malady which produces and general disposition of restlessness, discontentedness, irritability, boredom, etc. and leads to the mental obsession which inevitably leads to the first drink and subsequent spree. Spiritual principles are correlated with arresting the symptoms of the malady, thus allowing the alcoholic’s mind and body to straighten out and recover from a seemingly hopeless state of mind and body. This is all accomplished by the alcoholic working all Twelve Steps which facilitates a spiritual experience or awakening.
A Daily Plan of Action
“On awakening let us think about the twenty-four hours ahead. We consider our plans for the day. Before we begin, we ask God to direct our thinking, especially asking that it be divorced from self-pity, dishonest or self-seeking motives (character defects). Under these conditions we can employ our mental faculties with assurance, for after all God gave us brains to use. Our thought- life will be placed on a much higher plane when our thinking is cleared of wrong motives.” (2001. A.A. 4th ed. p.86)
“When we retire at night, we constructively review our day. Were we resentful, selfish, dishonest or afraid? Do we owe an apology? Have we kept something to ourselves which should be discussed with another person at once? Were we kind and loving toward all? What could we have done better? Were we thinking of ourselves most of the time? Or were we thinking of what we could do for others, of what we could pack into the stream of life? But we must be careful not to drift into worry, remorse or morbid reflection, for that would diminish our usefulness to others. After making our review we ask God’s forgiveness and inquire what corrective measures should be taken.” (2001. A.A. 4th ed. p.86)
“We are not cured of alcoholism. What we really have is a daily reprieve contingent on the maintenance of our spiritual condition. Every day is a day when we must carry the vision of God’s will into all of our activities. “How can I best serve Thee, Thy will (not mine) be done.” These are thoughts which must go with us constantly. We can exercise our will power along this line all we wish. It is the proper use of the will.” (2001. A.A. 4th ed. p.85)
The efficacy of the Twelve Step Program
“On the other hand–and strange as this may seem to those who do not understand–once a psychic change has occurred, the very same person who seemed doomed, who had so many problems he despaired of ever solving them, suddenly finds himself easily able to control his desire for alcohol, the only effort necessary being that required to follow a few simple rules.” (2001. A.A. 4th ed. p. xxix).
“Life will take on new meaning. To watch people recover, to see them help others, to watch loneliness vanish, to see a fellowship grow up about you, to have a host of friends — this is an experience you must not miss. We know you will not want to miss it. Frequent contact with newcomers and with each other is the bright spot of our lives.” (2001. A.A. 4th ed. p.89)
Lastly, tens of thousands of recoveries throughout the decades, since 1939, in the rooms of A.A., C.A., N.A. and so many other Twelve Step oriented fellowships, bares witness to the efficacy of the Twelve Step Program.
In conclusion, we find that alcoholism/addiction is not a disease but a spiritual malady. A malady that can be remedied with a simple, moral-spiritual approach, as instructed in the text of the Big Book of Alcoholics Anonymous.
Disease is something that needs to be cured. Illness is something that needs to be managed.
Traditionally trained medical doctors are trained to treat diseases. They are trained basically in surgery and medicine which is aimed at curing some abnormal condition in a bodily organ or tissue.
Comparison Table Between Illness and Disease
|Parameters of Comparison||Illness||Disease|
|Definition||Illness is an inability to function in a healthy way for prolonged periods.||The Disease is a condition or disorder of any body structure and function.|
|Manifestation||It does not cause any specific manifestation of a known cause.||It causes specific manifestation and has a known cause.|
|Remedy||It can be cured by an individual on their own.||Requires professional care and medicaments.|
|Death-Dealing||The Illness is not death-dealing.||The Disease can be death-dealing.|
|Illustration||Bacterial infection, depression, inflammation, stress, and anxiety.||Hepatitis A, Salmonella poisoning, Lyme disease, cancer, and AIDS.|