Definitions of 'alcoholism'
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Definitions of 'alcoholism'
In Addiction, Change, & Choice: The New View of Alcoholism (Sharp Press, Tucson, AZ, 1993), Vince Fox provides no fewer than 18 definitions of the term alcoholism, out of 40 he found. He groups them as Traditional, Nontraditional, and Exploratory. The following is quoted verbatim; parenthetical and bracketed notations are by Fox, not me.
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1-A) Traditional: By the National Council on Alcoholism and Drug Dependence:
Part 1 (Initial statement, 1971). Alcoholism is a chronic, progressive and potentially fatal disease characterized by tolerance and physical dependency or pathological organ changes, or both--all the direct or indirect consequences of the alcohol ingested.
Part 2 (1990): (Written jointly by the NCADD and ASAM--the American Society of Addiction Medicine.) Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. (Note departure from the 1972 statement relative to qualification of the progressive nature of alcoholism and the inclusion of denial as a symptom of the define disease.)
1-B) Nontraditional: By Claude Steiner and Eric Berne: Alcoholism is neither incurable nor a disease.
1-C) Exploratory: By the World Health Organization (WHO): Alcoholics are those excessive drinkers whose dependence upon alcohol has attained such a degree that it shows a noticeable mental disturbance or an interference with their bodily and mental health, their interpersonal relations, and their smooth social and economic functioning; or [those] who show the prodromal (warning) signs of such developments.
2-A) Traditional: By the American Medical Association: (1956, December 29): The medical treatment of alcoholism is rapidly becoming more important in accomplishing recovery for this disease.
(1966, November 28 - 30): A reaffirmation of the 1956 resolution.
(1987, June 21-25): RESOLVED, That the American Medical Association endorses the proposition that drug dependencies, including alcoholism, are diseases.
2-B) Nontraditional: By Black's Law Dictionary, 5th Ed., 1979: The pathological effect (as distinguished from physiological effect) of excessive indulgence in alcoholic liquors. [Pathological: that is, the diseased condition or structural and functional effects produced as a result of "excessive consumption"].
2-C): Exploratory: By Webster's New World Dictionary of the American Language; Second College Edition:
The habitual drinking of alcoholic liquor to excess, or a diseased condition caused by this.
3-A) Traditional: By Jim Christopher: Science has established that alcoholism is a physiological disease predetermined by heredity. Alcohol is a selectively physically addictive drug…
3-B) Nontraditional: By Jack Trimpey: [The words] "alcoholism" and "alcoholic" are folk expressions…. I will use the term "alcoholic" to refer to people who believe they are powerless over their addictions and act accordingly, and to those who call themselves "alcoholics." They are practicing the philosophy of alcoholism, just as Catholics practice the philosophy of Catholicism. I prefer the correct term "alcohol dependence" to describe the problem of persistent, heavy drinking…
3-C) Exploratory: By Charles Bufe: [Of Alcoholic, Alcoholism]: Since the terms were invented over 100 years ago, a great variety of definitions have been offered, and there is still no uniformity of opinion among the "experts" about what constitutes alcoholism nor about what constitutes an alcoholic. The safest thing that can be said is that definitions are largely arbitrary and can (and do) change over time.
4-A) Traditional: By Claudia Black: The alcoholic is a person who, in his drinking, has developed a psychological dependency on the drug alcohol coupled with a physiological addiction…. They are people who neither have the ability to consistently control their drinking, nor who can predict their behavior once they start to drink.
4-B) Nontraditional: by the American Psychiatric Association (ASA) (DSM-III-R): Note: The word alcoholism is no longer used as a subject heading in the third edition of the familiar DSM-III-R (Diagnostic Statistical Manual, Revised). It lists Alcohol Dependence (Section 303.90, p. 173) and Alcohol Abuse (Section 305.00, p. 173) in its stead. It observes that abuse can lead to dependence.
Patterns of use. There are three main patterns of Alcohol Abuse or Dependence. The first consists of regular daily intake of large amounts; the second, of periods of sobriety interspersed with binges of daily heavy drinking lasting for weeks or months. It is a mistake to associate one of these particular patterns exclusively with "alcoholism." Some investigators divide alcoholism into "species"…[such as the] so-called gamma alcoholism…that is common in the United States and conforms to the stereotype of the alcoholism seen in people who are active in Alcoholics Anonymous…[and that] involves problems with "control."
4-C) Exploratory: By The Encyclopedia Britannica: [The] repetitive intake of alcoholic beverages to such an extent that repeated or continued harm to the drinker occurs….Alcoholism may be viewed as a disease, a drug addiction, a learned response to crisis, a symptom of an underlying psychological or physical disorder, or a combination of these facts. The cause of alcoholism is equally uncertain. It has been viewed as a hereditary defect, a physical malfunction, a psychological disorder, a response to economic or social stress, or sin.
5-A) Traditional: By Mark Keller: I think [alcoholism] is a disease because the alcoholic can't consistently choose whether or not he shall engage in self-injurious behavior--that is, any of the alcoholism drinking patterns. I think of it as a psychological disablement.
5-B) Nontraditional: By Herbert Fingarette: Heavy drinkers [alcoholics] are people who have over time made a long and complex series of decisions, judgments, and choices of commission and omission that have coalesced into a central activity…. Instead of viewing heavy drinkers as the helpless victims of a disease, we come to see their drinking as a meaningful, however destructive, part of their struggle to live their lives.
5-C) Exploratory: By the United States Supreme Court (1988): …apparently nobody understands alcoholism…it appears to be willful misbehavior.
6-A) Traditional: By Alcoholics Anonymous and Bill Wilson (delivered at the National Clerical Conference on Alcoholism convention, April 21, 1960): We have never called alcoholism a disease because, technically speaking, it is not a disease entity. (emphasis added) For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore we did not with to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always called it an illness, or a malady--a far safer term for us to use.
6-B) Nontraditional: by Morris Chavetz: Alcoholism is drinking too much too often. It is permitting alcohol to play an inordinately powerful role in a person's life.
6-C) Exploratory: By Arnold Ludwig: There is no general agreement about the nature, cause, or treatment of alcoholism. What is an alcoholic? Where does one draw the line between problem drinking and alcoholism, between alcohol abuse and alcohol dependence? Is alcoholism one disorder or a collection of different disorders? Is it a moral failing, a bad habit, or a disease? Do alcoholics have distinctive personality features? Is alcoholism hereditary or learned? Does excessive drinking represent a symptomatic expressing of an underlying conflict or is it the primary problem itself? Which treatment approach, if any, is most effective? Who is best qualified to help? … In the absence of facts, opinions and beliefs tend to prevail.
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From Fox's copious footnotes, here are two that might be of interest. Portions that I have snipped are indicated with "…."
1. Many people assume that what is termed a disease is scientifically determined within set parameters and through laboratory testing. This is not always the case. The determination is often made by voice vote within a committee designated by the American Medical Association, as in the case of "alcoholism" as a disease….
16. Wilson's statement will come as a shock to many. It stands, however, as written. I found it in a footnote on pp. 22-23 of Not-God by Ernest Kurtz…. Is it possible that Wilson was a nontraditionalist? Yes, but only in the narrow sense of not viewing alcoholism as a physiological disease. In most other areas he was the quintessential traditionalist; he promoted the loss-of-control notion, for example, and he postulated that alcoholism was an incurable but arrestable "malady" or "illness." …. His fundamental conviction…was that alcoholism is a spiritual disease in the metaphorical sense. On page 44 (1976 ed.) of the Big Book he describes alcoholism as "…an illness which only a spiritual experience will conquer"…. Throughout the Big Book he refers to alcoholism as an illness, malady, sickness, allergy, and craving. A.A. literature generally refers to alcoholism as a "physical, mental (or emotional), and spiritual disease," and shares with Wilson the conviction that the defining issue is spiritual.
--------------------
1-A) Traditional: By the National Council on Alcoholism and Drug Dependence:
Part 1 (Initial statement, 1971). Alcoholism is a chronic, progressive and potentially fatal disease characterized by tolerance and physical dependency or pathological organ changes, or both--all the direct or indirect consequences of the alcohol ingested.
Part 2 (1990): (Written jointly by the NCADD and ASAM--the American Society of Addiction Medicine.) Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. (Note departure from the 1972 statement relative to qualification of the progressive nature of alcoholism and the inclusion of denial as a symptom of the define disease.)
1-B) Nontraditional: By Claude Steiner and Eric Berne: Alcoholism is neither incurable nor a disease.
1-C) Exploratory: By the World Health Organization (WHO): Alcoholics are those excessive drinkers whose dependence upon alcohol has attained such a degree that it shows a noticeable mental disturbance or an interference with their bodily and mental health, their interpersonal relations, and their smooth social and economic functioning; or [those] who show the prodromal (warning) signs of such developments.
2-A) Traditional: By the American Medical Association: (1956, December 29): The medical treatment of alcoholism is rapidly becoming more important in accomplishing recovery for this disease.
(1966, November 28 - 30): A reaffirmation of the 1956 resolution.
(1987, June 21-25): RESOLVED, That the American Medical Association endorses the proposition that drug dependencies, including alcoholism, are diseases.
2-B) Nontraditional: By Black's Law Dictionary, 5th Ed., 1979: The pathological effect (as distinguished from physiological effect) of excessive indulgence in alcoholic liquors. [Pathological: that is, the diseased condition or structural and functional effects produced as a result of "excessive consumption"].
2-C): Exploratory: By Webster's New World Dictionary of the American Language; Second College Edition:
The habitual drinking of alcoholic liquor to excess, or a diseased condition caused by this.
3-A) Traditional: By Jim Christopher: Science has established that alcoholism is a physiological disease predetermined by heredity. Alcohol is a selectively physically addictive drug…
3-B) Nontraditional: By Jack Trimpey: [The words] "alcoholism" and "alcoholic" are folk expressions…. I will use the term "alcoholic" to refer to people who believe they are powerless over their addictions and act accordingly, and to those who call themselves "alcoholics." They are practicing the philosophy of alcoholism, just as Catholics practice the philosophy of Catholicism. I prefer the correct term "alcohol dependence" to describe the problem of persistent, heavy drinking…
3-C) Exploratory: By Charles Bufe: [Of Alcoholic, Alcoholism]: Since the terms were invented over 100 years ago, a great variety of definitions have been offered, and there is still no uniformity of opinion among the "experts" about what constitutes alcoholism nor about what constitutes an alcoholic. The safest thing that can be said is that definitions are largely arbitrary and can (and do) change over time.
4-A) Traditional: By Claudia Black: The alcoholic is a person who, in his drinking, has developed a psychological dependency on the drug alcohol coupled with a physiological addiction…. They are people who neither have the ability to consistently control their drinking, nor who can predict their behavior once they start to drink.
4-B) Nontraditional: by the American Psychiatric Association (ASA) (DSM-III-R): Note: The word alcoholism is no longer used as a subject heading in the third edition of the familiar DSM-III-R (Diagnostic Statistical Manual, Revised). It lists Alcohol Dependence (Section 303.90, p. 173) and Alcohol Abuse (Section 305.00, p. 173) in its stead. It observes that abuse can lead to dependence.
Patterns of use. There are three main patterns of Alcohol Abuse or Dependence. The first consists of regular daily intake of large amounts; the second, of periods of sobriety interspersed with binges of daily heavy drinking lasting for weeks or months. It is a mistake to associate one of these particular patterns exclusively with "alcoholism." Some investigators divide alcoholism into "species"…[such as the] so-called gamma alcoholism…that is common in the United States and conforms to the stereotype of the alcoholism seen in people who are active in Alcoholics Anonymous…[and that] involves problems with "control."
4-C) Exploratory: By The Encyclopedia Britannica: [The] repetitive intake of alcoholic beverages to such an extent that repeated or continued harm to the drinker occurs….Alcoholism may be viewed as a disease, a drug addiction, a learned response to crisis, a symptom of an underlying psychological or physical disorder, or a combination of these facts. The cause of alcoholism is equally uncertain. It has been viewed as a hereditary defect, a physical malfunction, a psychological disorder, a response to economic or social stress, or sin.
5-A) Traditional: By Mark Keller: I think [alcoholism] is a disease because the alcoholic can't consistently choose whether or not he shall engage in self-injurious behavior--that is, any of the alcoholism drinking patterns. I think of it as a psychological disablement.
5-B) Nontraditional: By Herbert Fingarette: Heavy drinkers [alcoholics] are people who have over time made a long and complex series of decisions, judgments, and choices of commission and omission that have coalesced into a central activity…. Instead of viewing heavy drinkers as the helpless victims of a disease, we come to see their drinking as a meaningful, however destructive, part of their struggle to live their lives.
5-C) Exploratory: By the United States Supreme Court (1988): …apparently nobody understands alcoholism…it appears to be willful misbehavior.
6-A) Traditional: By Alcoholics Anonymous and Bill Wilson (delivered at the National Clerical Conference on Alcoholism convention, April 21, 1960): We have never called alcoholism a disease because, technically speaking, it is not a disease entity. (emphasis added) For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore we did not with to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always called it an illness, or a malady--a far safer term for us to use.
6-B) Nontraditional: by Morris Chavetz: Alcoholism is drinking too much too often. It is permitting alcohol to play an inordinately powerful role in a person's life.
6-C) Exploratory: By Arnold Ludwig: There is no general agreement about the nature, cause, or treatment of alcoholism. What is an alcoholic? Where does one draw the line between problem drinking and alcoholism, between alcohol abuse and alcohol dependence? Is alcoholism one disorder or a collection of different disorders? Is it a moral failing, a bad habit, or a disease? Do alcoholics have distinctive personality features? Is alcoholism hereditary or learned? Does excessive drinking represent a symptomatic expressing of an underlying conflict or is it the primary problem itself? Which treatment approach, if any, is most effective? Who is best qualified to help? … In the absence of facts, opinions and beliefs tend to prevail.
---------------------------
From Fox's copious footnotes, here are two that might be of interest. Portions that I have snipped are indicated with "…."
1. Many people assume that what is termed a disease is scientifically determined within set parameters and through laboratory testing. This is not always the case. The determination is often made by voice vote within a committee designated by the American Medical Association, as in the case of "alcoholism" as a disease….
16. Wilson's statement will come as a shock to many. It stands, however, as written. I found it in a footnote on pp. 22-23 of Not-God by Ernest Kurtz…. Is it possible that Wilson was a nontraditionalist? Yes, but only in the narrow sense of not viewing alcoholism as a physiological disease. In most other areas he was the quintessential traditionalist; he promoted the loss-of-control notion, for example, and he postulated that alcoholism was an incurable but arrestable "malady" or "illness." …. His fundamental conviction…was that alcoholism is a spiritual disease in the metaphorical sense. On page 44 (1976 ed.) of the Big Book he describes alcoholism as "…an illness which only a spiritual experience will conquer"…. Throughout the Big Book he refers to alcoholism as an illness, malady, sickness, allergy, and craving. A.A. literature generally refers to alcoholism as a "physical, mental (or emotional), and spiritual disease," and shares with Wilson the conviction that the defining issue is spiritual.
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NCADD was cited on another thread as a source for a definition of alcoholism, and is also listed above. This is a private organization which was founded by an early AA member, Marty Mann, using the studies of E.M. Jellinek to 'establish scientific legitimacy for the disease concept'. Jellinek has been widely discredited.
NCADD is not an impartial group when it comes to defining alcoholism. Here is a link from Stanton Peele's web site; he has clashed with NCADD members, and of course is not impartial either.
http://www.peele.net/lib/nca.html
NCADD has lots of interesting facts and links at their web site:
http://www.ncadd.org/facts/index.html
NCADD should not be confused with NIAAA, a government institute:
http://www.niaaa.nih.gov/
Don S
NCADD is not an impartial group when it comes to defining alcoholism. Here is a link from Stanton Peele's web site; he has clashed with NCADD members, and of course is not impartial either.
http://www.peele.net/lib/nca.html
NCADD has lots of interesting facts and links at their web site:
http://www.ncadd.org/facts/index.html
NCADD should not be confused with NIAAA, a government institute:
http://www.niaaa.nih.gov/
Don S
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