Exploring the Disease of Alcoholism:
A Scientific Approach
Michael Galke
St. Joseph’s College
There are many more volatile topics in our present-day 2015 culture, than whether or not alcoholism is a disease. Despite its place in today’s dialogue of current affairs, this discussion needs to be had. Every attempt will also be made to fortify both ‘pro’ and ‘con’ positions with objective, science-based sources of data. My conclusion is that alcoholism is in fact, a disease; it is progressive, and it is fatal.
To Merriam-Webster’s Dictionary, the word disease is defined as:
(1) An illness that affects a person, animal, or plant; a condition that prevents the body or mind from working normally. (2) A problem that a person, group, organization, or society has and cannot stop”. (Britannica)
What is Merriam-Webster’s definition of “alcoholic”?
(1) Affected with alcoholism. (2) A person who frequently drinks too much alcohol and is unable to live a normal and healthy life:a person who is affected with alcoholism.
In reality, there seem to be as many unofficial definitions of what an alcoholic is, as there are alcoholics. Some claim that an alcoholic is someone who can’t hold their liquor. Others suggest that an alcoholic is a weak-willed individual that simply lacks discipline. Still others may cite a deficit in one’s moral code, or perhaps they are simply wounded souls with fragile psyches, and this is how they cope… using alcohol as a crutch.
Real alcoholics—not social drinkers—have an allergy, a physical allergy to the substance of alcohol. One could accurately and simply say, “An alcoholic is allergic to alcohol”. Social drinkers, moderate drinkers—or even heavy drinkers do not have this allergy.
If someone has Hay Fever—if they are allergic to pollen and mold spores, and ingest that substance into their system, the manifestation of that allergy is sneezing, runny-nose, and watery eyes, etc. If the person is allergic to strawberries, and they ingest strawberries into their system, the manifestation of that allergy is usually substantial itching, a rash and hives.
If a person is allergic to alcohol (in other words, if they are alcoholic) and they take alcohol into their system, the manifestation of this allergy is not a runny-nose and sneezing, or hives and rash. Rather, the manifestation of this allergy is what is called the “phenomenon of craving”. (Silkworth, 1939) Once the real alcoholic takes as little as one drink into his or her system, the phenomenon of craving kicks in. At this juncture, willpower is no longer a factor. Neither is a better code of morals or self-discipline. A determined, sincere and genuine resolve likewise has nothing to do with it. Literally, the alcoholic now physically needs, albeit unconsciously, more alcohol in his or her body. One of the plethora of clichés that is often said amongst members of Alcoholics Anonymous is, “The next time you have diarrhea, try willpower “.
Are there no exceptions to this rule? Is it absolutely impossible for some to successfully implement what is called “controlled drinking”? Perhaps the best possible aggregate of data to best answer this question would be to consult the consistently largest gathering of assembled alcoholics on any given day or night—AA meetings.
The consensus from virtually all of the AA members consulted, was along the lines of, “Sure—there are some alcoholics that can get away with controlled drinking for perhaps a few days, or weeks or maybe even months”. But it is usually just a matter of time before the alcoholic who relapses reports, “Yeah, we pulled it off for a while, but ‘controlled drinking is like trying to have one cornflake for breakfast’, and just a matter of time before we drank the way we wanted—or needed, to drink… to make up for that lost time.”
It has been said that no one understands an alcoholic—like another alcoholic. The exception to this rule might be a doctor who, in 1939 was a well-known, chief physician at a prominent hospital—Charles B. Townes Hospital in New York, specializing in alcoholism and drug addiction. Of all of the research performed for this paper, perhaps Dr. William D. Silkworth was the best, or most articulate in explaining this idea of a physical allergy. The writer’s of the book, Alcoholics Anonymous (affectionately dubbed The Big Book by AA members), first introduced Dr. Silkworth, and his ideas with the following quote,
“In this statement he confirms what we who have suffered alcoholic torture must believe—that the body of the alcoholic is quite as abnormal as his mind. It did not satisfy us to be told that we could not control our drinking just because we were maladjusted to life, that we were in full flight from reality, or were outright mental defectives. These things were true to some extent, in fact, to a considerable extent with some of us. But we are sure that our bodies were sickened as well. In our belief, any picture of the alcoholic which leaves out this physical factor is incomplete. (Alcoholics Anonymous, 1939).
Dr. Silkworth had worked with several hundred active alcoholics, over several years, in various stages of their progression. The doctor writes:
“We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit and found they cannot break it, once having lost their self-confidence, their reliance upon things human, their problems pile up on them and become astonishingly difficult to solve.” (Silkworth, 1939)
Having established the allergy concept, it follows there is no cure for alcoholism. There is however, a way to treat / arrest this affliction, which is total and complete abstinence. However, these early pioneers of AA soon learned another aspect of this disease; specifically, that though different bodily as well as mentally, that the main problem of the alcoholic centers in his mind, rather than in his body. In chapter two of the book Alcoholics Anonymous entitled, “There Is A Solution”, it reads:
“These observations would be academic and pointless if our friend never took the first drink, thereby setting the terrible cycle in motion. Therefore, the main problem of the alcoholic centers in his mind, rather than in his body.” So physically, will power has proven ineffective, once the alcoholic takes one drink. But the Big Book goes on to say, “The fact is that most alcoholics, for reasons yet obscure, have lost the power of choice in drink. Our so-called will power becomes practically nonexistent. We are unable, at certain times, to bring into our consciousness with sufficient force the memory of the suffering and humiliation of even a week or a month ago. We are without defense against the first drink.” (Alcoholics Anonymous, 1939)
Alcoholics basically deal with a physical compulsion, combined with a mental obsession. As stated in the last paragraph of the Big Book’s third chapter, “More About Alcoholism”:
“Once more: The alcoholic at certain times has no effective mental defense against the first drink. Except in a few rare cases, neither he nor any other human being can provide such a defense. That defense must come from a power greater than himself.”
The temptation here is to elaborate more about the suggested course of action that follows next, as a program of recovery—The Twelve Steps, because it is through the practice of these steps that seems to be the most effective and convincing means of addressing the “mental obsession” aspect. AA members will tell of how they realized not long after a period of abstinence, that they were not just powerless over alcohol… but powerless also, over their thoughts, or their thinking. In the practice of incorporating the principles of the Twelve Steps into their lives, that fundamental and essentially needed change (what Carl Jung called a ‘psychic change, huge emotional displacement, or spiritual awakening) takes place (essentially how this ‘mental obsession’ aspect is resolved. But as mentioned, though the temptation to continue along this thread is enticing, this part moves outside of the scope of this paper. Suffice it to say, an alcoholic—not social, moderate—or even heavy drinker, but an alcoholic… cannot safely take alcohol into their system, without the resulting manifestation of the phenomenon of craving. The phenomenon of craving all but guarantees his self-destruction each time he takes one drink. Will power, a solid moral code, resolve and determination are certainly good attributes to demonstrate with respect to all other areas of life. But for alcoholics, once the alcohol is in the alcoholic’s system, these otherwise decent, noble character assets are rendered irrelevant.
One of the most reputable, non-biased and apolitical institutions in the American medical community, and perhaps the world is the Mayo Clinic. A Google search revealed several articles written on the subject, but brevity being a virtue, the most verbally economical version reads:
“Alcoholism is a chronic and often progressive disease that includes problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect (physical dependence), or having withdrawal symptoms when you rapidly decrease or stop drinking. If you have alcoholism, you can’t consistently predict how much you’ll drink, how long you’ll drink, or what consequences will occur from your drinking.” (Staff, Mayo Clinic; 2014).
The American Medical Association officially proclaimed alcoholism as a disease in 1956. The AMA officially ratified this the Journal of the American Medical Association. Frankly, this most compelling explanation, argument, or position, whatever one may call it… was mainly the words and writings of Dr. William D. Silkworth, in 1939.
There are surely voices of dissent against this theory that alcoholism is a disease. The most commonly heard attitude is, “That’s just a loser’s excuse for copping out”; and “It’s also probably so that doctors can get paid through insurance companies for the time they have to invest with their patients.” As mentioned earlier in the first paragraph, “Every attempt will also be made to fortify both pro and con positions with objective, science-based sources of data.” But the unanticipated problem which came to light while writing this paper is simply this: While there are perhaps other rebuttals and opinions to the contrary—literally NONE of these, could be found during research to assert while maintaining the paradigm of, “…. with objective, science-based sources of data.” In other words, the author began to research this part of the paper—assuming that not only would there be no shortage of various arguments, but that most surely these opinions would be buttressed by objective, science-based data—but only the former was true, and only partially at that. Point being, while the author attempted to shift gears for the dissenting opinion part of this paper, an assumption was in place that both the (a) number of arguments existed, and that (b) these would surely be rooted in objective, science-based data. Though perhaps quantitative attitudes exist (those mentioned above), there actually was no scientific data behind those dissenting opinions. There is scientific, objective and empirical data that supports that alcoholism is in fact, a disease, and if there is any science-based objective and empirical data to argue the counterpoint, it did not exist. Just some of the sources consulted were Google, Lexus-Nexus, Journal of American Medical Association, The American Medical Association, Mayo Clinic, and New England Journal of Medicine.
In an excerpt from a letter published in The Grapevine—A.A.’s “meeting in print” in 1958 by A.A.’s co-founder Bill Wilson, reads,
“The answer to the problem of alcoholism is education—education in school rooms, in medical colleges, among clergymen and employers, in families, and in the public at large. From cradle to grave, the drunk and the potential alcoholic will have to be completely surrounded by a true and deep understanding and by a continuous barrage of information. This means factual education, properly presented. Heretofore, much of this education has attached the immorality of drinking rather than the illness of alcoholism.” (Wilson, 1958)
As mentioned, Bill Wilson was one co-founder of A.A. The other co-founder was Robert Smith, affectionately known as “Dr. Bob”. Dr. Bob considered himself an A.A. member first, and everything else (a medical doctor) second. In observance of A.A.’s Twelve Traditions, Dr. Bob never wanted to engage in any controversies as a member of A.A., and also a doctor. Therefore he needed to tread a fine-line of sorts, on this debate of alcoholism as a disease.
It is extremely important to clarify one very important point, which will require a brief return to a “first-person” narrative: Alcoholics Anonymous does not have an official spokesperson. Nor does the author of this paper speak for A.A. The ideas expressed in this research paper are solely that of the author’s—not of A.A.
In closing—the decision to choose this topic was driven by the life and death nature of this disease, and the ramifications that any misinformation may have on the alcoholic who finally has that “moment of clarity” and realizes he is in serious trouble. What is critical for an alcoholic that realizes the fatal nature of his situation and wants help, is to understand is that they are in fact allergic to alcohol—that they cannot take even one drink without the phenomenon of craving manifesting. When people make the ill-informed, opinion-based remarks referenced earlier, it can cast the shadow of ignorance, where a much-needed light of reason must shine for these people that need to hear this message the most—chronic alcoholics. As mentioned earlier, no one understands an alcoholic like another alcoholic. And this is also why A.A. is as successful as it is, because it usually takes a recovered alcoholic to earn the trust of the still suffering alcoholic. This is achieved most effectively when the recovered alcoholic implants in the mind of the sufferer, the truly fatal nature of his / her situation. This happens usually and only after the alcoholic has truly hit bottom. Then and only then is the chronic, suffering alcoholic as open to conviction and willing to listen—as only the dying can be.
“We are not cured of alcoholism. What we really have is a daily reprieve contingent on the maintenance of our spiritual condition.” — Bill Wilson
A.A. Preamble
Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.
The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are self- supporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.
— Copyright © The AA Grapevine, Inc. Reprinted with permission
Works Cited
Alcoholics Anonymous. (1939). There Is A Solution. In Alcoholics Anonymous (p.24). New York, NY: AA World Services, Inc.
Britannica, E. (n.d.). Retrieved April 12, 2015, from http://www.merriam-webster.com: http://www.merriam-webster.com/dictionary/disease
Silkworth, W. D. (1939). The Doctor’s Opinion. In I. Alcoholics Anonymous World Services, Alcoholics Anonymous. New York, NY.
Staff, Mayo Clinic;. (2014, December). mayoclinic.org/diseases-conditions. Retrieved April 20, 2015, from http://www.mayoclinic.org: http://www.mayoclinic.org/diseases conditions/alcoholism/basics/definition/con- 20020866
Wilson, B. (1958). A Community Problem. The Grapevine, Inc.
