Thursday, May 6, 2010

Is Alcoholism a Disease?

About a week ago, a friend on Facebook posted a news story about a study that found Alcoholics Anonymous to be more dangerous to alcoholics and addicts than it is helpful. It's an argument that's been put forth over and over again, probably since AA was first founded. The main complaint is the whole idea of alcoholism being a disease. People also take issue with AA's insistence on a Higher Power. The basic reasoning against AA goes something like this: if you accept that you have some genetic disease that makes you an alcoholic, then you can't really help yourself, can you? You're going to fail at quitting drinking over and over again, because you can't help it. Accepting the disease concept of alcoholism gives you a great big loophole for falling off the wagon, an excuse to relapse. The whole idea is self-defeating.

It's true. Some alcoholics do indeed give up, throw in the towel, say "I can't help it," and go back out.

I'm not even sure I fully buy into the disease concept. When I think "disease," I think cancer or diabetes, things that physically you cannot will away. Yet finally even I had to agree that I couldn't "will away" my alcoholism. I can't tell you how many times I tried to quit on my own, or to control my drinking. I'd switch to beer only, wine only, weekends only, once a month, stopping at just two, and the list goes on. None of it worked, even total abstinence, and I am not a weak-willed person. I quit smoking cold turkey after fifteen years of smoking. I was definitely physically addicted to nicotine; it was uncomfortable to quit. Sheer will power did it. But I couldn't give up drinking. I think it's because by the time a person has developed full-blown alcoholism, they are both physically and psychologically addicted to the drug.

It happens so slowly and subtly that you're addicted before you're even aware you are. And the nature of the disease is denial; so even when you have that sneaking suspicion that something is wrong, your brain (which you THINK is rational) convinces you that the problem is only a "little problem."

Yeah, yeah, people will say, but how can we call, say, sex an addiction? That's not a disease!

I'm not saying that addictions equal disease. Some addictions are solely psychological ones--they're compulsions. Your body doesn't go into withdrawals if you abstain. But psychologically, you can suffer almost as badly: you're anxious, you're agitated, you NEED this "thing." You feel like you'll go apeshit if you don't get this "thing!" If a compulsion is that bad for you--be it sex, drinking, eating, smoking, stealing, lying, whatever--that's a clear sign you've got a problem and you need to arrest the compulsion, put it to bed.

Easier said than done.

But alcoholism or being addicted to, say, pain medication, is a different ball of wax. Not only do you have the mental compulsion, you have a physical compulsion. In fact, somebody who is addicted to alcohol cannot safely just stop without medical supervision. Delirium tremens and seizures, even death, are real and can happen to people who just up and quit. (Once I walked out of an AA meeting, and there lay a man on the ground, having a seizure.) The severity of your withdrawal totally depends on how long you've been abusing the drug and how much you were taking in every time. I was lucky. My withdrawal wasn't too bad. The most I ever experienced was severe anxiety (and in rehab I couldn't have my Ativan because it's a narcotic), tremors, sweating, some sleeplessness, and a severe case of Bad Mood.

It is pretty darn offensive for someone to say to an alcoholic like me: "Just stop! Put on your Woman Panties and buck up! Find some will power."

How smug! If only it were that easy.

I think of the disease of alcoholism as being more like a medical condition akin to an allergy. Some of us were just born with a genetic propensity towards addiction. I don't know why that's so, but look at how many of us yield from families where there are several alcoholics. I think I may have read somewhere once that "addictive personalities" are people who seem to get more pleasure out of a particular substance than normal people do. You'll often hear alcoholics telling their stories that the minute they tried booze, they loved it. They KNEW they'd found "home." That's true for me. The first time I ever got a buzz, I was fifteen, and it was as if I'd drenched myself in holy waters. I felt uplifted; personable; clever; I just felt better than I'd ever felt. My point is, we don't react to alcohol the same way as normies. That part seems hardwired into us. So the intensity of our compulsions is not surprising.

But then we're back to, well, if it's hardwired into us, then we can't help ourselves. We're doomed to fail. Not so. It is so only if we take the first drink. (Then forget it, we've lost control already until we've sobered up.) If we can resist the first drink, then we're okay. Will power can do it temporarily, but not over the long term. I've found I need something else I can trust or rely on because I know my own will power will fail, as it has failed me so many times. AA suggests that a Higher Power can be that "something else." It doesn't have to be GOD, as in some entity in the sky judging your every move. For me, God is more like love, the good force, the life of the universe. Nature. Everything. For those AAers who aren't spiritually inclined, their "something else" can be the AA group itself (Group of Drunks) or even rationality (Good Orderly Direction). The point is to get out of your own head and find some faith that yes, you CAN stop drinking. And there's this whole support group of friends who can offer suggestions about how to do that. But don't depend on your own will power, baby, 'cause that is going to eventually let you down.

One thing I like to add to this whole discussion is this. Hey, the insurance industry is not about to pay for anything that hasn't been clearly established as needing medical intervention. It took forever for that industry to even toss us back some pennies for chiropractic or acupuncture. Insurance companies treat alcoholism as a disease and offer coverage for it. Companies and educational institutions like mine grant sick leave for it, often paid (mine was, thankfully). If it's good enough for them, it ought to be good enough for the rest of us.

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