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Disease of Addiction

Old 05-26-2011, 08:38 PM
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Disease of Addiction

I went back and forth on whether or not to post this - I didn't want to step on any toes or bring about controversy, though I'm not entirely sure my view is all that controversial. I certainly don't want to start some great disease/non-disease debate but I do have very strong views about this and when a statement was made on a blog I frequently read, I had to comment. I wanted to share my opinion with all of you about addiction the disease. I don't regard myself an expert in any sense, though I do study the addicted brain (by study, I mean I'm finishing my PhD in behavioral neuroscience focusing on the process of addiction and work with people who have studied this for years so I do base my views on what science currently has to say on the topic - for what it's worth). Ultimately, though, this is just how I feel about it. This is just my opinion on why addiction is a disease. Just a point of view to consider... (also, sorry - this is kind of long...) (also, also, sorry if I seem overly apologetic...my mother always says I stop just short of apologizing for living)

"Addiction isn't a disease. That's just an excuse people use to keep from having to take responsibility for their actions."

It absolutely is. And that is absolutely not true.

I am absolutely willing to take responsibility for my actions. I am not using addiction as a disease to excuse any poor decision I have made. I have never done so. Do I understand why some might feel this way? Sure. And in some cases, I'm sure it's completely true. But to discount the disease of addiction on account of a few is irresponsible and incorrect. Yes, I made poor decisions and yes, I did so as an ultimate result of a condition I have. But my poor decisions were made because I was high (or drunk). I made poor decisions because I made them. That's that. Because I have a disease that did I not have, I likely would not have made those decisions doesn't make the decisions the disease's responsibility. It was a contributing factor. It created situations in my brain that were not aligned with reality. But when the day is done and all the cards are on the table, I did it. And I will never not take responsibility for that.

However, I have a disease. One may not fully be able to understand what saying addiction is a disease actually, really means. What it means is that, in the simplest terms I can find, my brain is different than a non-addict's brain. My body is different than a non-addict's body. When a substance such as alcohol enters my body, my reactions are not the same as a non-addict's. The physiological and mental processes that are kick-started are not the same. I am unable to describe and you who have not experienced it are unable to empathize the feeling that occurs when your body and mind are consumed by a pattern of thinking that is ultimately designed to kill you. In the face of all consequences - jail, death, disease, homelessness, poverty, starvation, isolation - you continue to do that which is the root of all your failings because you are unable, actually physically and mentally INCAPABLE, of not doing it (without the proper tools). You despise the very thought of it; you no longer experience pleasurable effects from it; when physical pain would be preferable; when it is no longer doing anything that is in the remotest sense positive - you have a disease.

A disease is a medical condition associated with specific symptoms. It is either caused by some external factor, such as a virus or some internal factor, such as a genetic disorder. The word "disease" is generally used to describe any condition that impairs normal function of the body and causes pain, dysfunction or death. Impairs normal function? Yes. Causes pain? Oh, absolutely. Dysfunction? Right here, sister. Death? Most definitely. Most importantly, it is TREATABLE. Addiction is a disease - it is chronic, and left to its own devices, terminal - but it is treatable. It is one of the most difficult diseases to treat and it is the ONLY disease that you have to convince people they have. I believe it can be beaten. Not cured - it is always present - but controlled.

The American Medical Association (AMA) has recognized addiction as a disease since 1956. The illness can be described - it has specific symptoms - and it is predictable and progressive. Addiction causes changes in the brain that then drive behaviors.

Our brains work differently. Our bodies do not respond as others' do to the entrance of substances. I, for example, cannot understand why anyone would have just one drink if that one drink did not get you absolutely smashed. I can recognize that it is absolutely true that some people enjoy, perhaps, the taste of a nice drink and may just enjoy one with dinner - but I cannot understand the idea that one might drink alcohol for any other reason than the express purpose of getting drunk. I know that that is true. And I know that that is how my brain is different and that abstaining from alcohol is much easier than trying to pretend as though I "get" drinking socially. Because when I take a sip of alcohol (or a hit of weed or a bump of coke), my brain says "doasmuchasyoucanasfastasyoucangethighhighhighnown ownow." And my first and best line of defense is to avoid introducing that substance altogether. Abstinence is the only option because moderation is a nonexistent concept. I can pretend and fight through it and struggle and seem successful, but it's just much easier to not start than to try to stop. And that is because my brain does not work the same way as a non-addict's. In fact, a non-addict may not even understand this idea much like I cannot understand "social drinking."

It sounds as though perhaps I believe addicts are in a sense "damned" to their addictions for the rest of their lives...that's not what I intend. I do believe addicts can live in recovery for the rest of their full, happy lives. But I believe that that takes learning how to "talk over" your deepest drives. It takes learning a new way of thinking and living. You have to learn over deeply ingrained patterns of behavior - patterns that are wired in. 12-step programs teach us that, rehab teaches us that, supportive recovering addict friends teach us that, addiction therapists teach us that, other forms of recovery that I've forgotten/unaware of teach us that. By implementing a structured treatment plan (whatever it may be) each and every day, addicts conquer their disease. By not using or drinking just for this one day, each day at a time, addicts treat their disease. By rehabilitating the mind and doing emotional and mental work to develop healthy and effective coping strategies, addicts stay sober.

Make no mistake about it - addiction is a disease. And it kills. But it doesn't have to.
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Old 05-26-2011, 08:48 PM
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Old 05-26-2011, 08:55 PM
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Disease

Originally Posted by defyinggravity View Post
Make no mistake about it - addiction is a disease. And it kills. But it doesn't have to.
Great Post!
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Old 05-27-2011, 12:13 AM
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I agree. The disease is addiction. The symptom is substance abuse.

The treatment of the disease is abstinence and "rewiring" - to fill the void or vaccuum created by abstinence.

Thank you for your post - well thought out.
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Old 05-27-2011, 12:42 AM
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I believe addiction is the symptom of whatever causes a person to need to numb out. That may be depression, anxiety, low self esteem, abuse, emotional pain....the list can be long.
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Old 05-27-2011, 04:32 AM
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Originally Posted by defyinggravity View Post
... I certainly don't want to start some great disease/non-disease debate but I do have very strong views about this and when a statement was made on a blog I frequently read, I had to comment. I wanted to share my opinion with all of you about addiction the disease.
Posts like this pop up about every 30 days around here. Probably that is how long it takes them to fall of the top 20 list.

IMHO what you choose to call it is an adjunct issue. I choose to call it an affliction because it struck me like a bolt of lightning. The real issue is whether there is a solution/remedy/way out that is reliable to last a person for the rest of their life.

IMNSHO there is a pinnacle in recovery. A Spiritual Awakening which will remove the obsession to drink "root and branch". For me it is no longer one-arduous-day-at-a-time. I stay spiritually fit ODAAT and thoughts of it stay of my radar screen ODAAT.
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Old 05-27-2011, 10:23 AM
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Thank you for your insights (and for your work in this field). I'm grateful that alcoholism (and addiction in general) is recognized as a disease condition by the AMA/World Health Organization because it allows insurance coverage and allows doctors and professionals to develop clinical models and treatment plans as well as research. Otherwise, we are left with the thinking of the past: that we are lazy, weak and morally inferior.

Most of us are baffled by our condition, having shown discipline and intelligence in the other areas of our lives. Without the disease model, we (along with those who love us) think everything would be solved if we could "just cut down," - just be normal. It's like telling someone with depression or bipolar to "snap out of it."

In order to treat alcoholism, we have to have something to treat. If it's not recognized as a disease state, we're left without the resources to save lives, the education of professionals, and the opportunity to further understand the complexities of humanity.

Thanks again for a great post!
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Old 05-27-2011, 11:23 AM
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[SIZE="2"]I think it might be helpful to make a few distinctions.

1. It is important to see that, as you say, even if alcoholism is viewed as a "disease" this does not remove a patient's responsibility for bringing it under control. Diabetes is a fine example. If a patient, despite the knowledge that he/she has diabetes, continues to ingest large amounts of sugar, then that person lacks responsibility for bringing the condition under control.

2. When you say that an alcoholic's body may react differently to alcohol, this may be because that person has atypical genetic characteristics.I agree with you on that.
But also over the course of time, due to continued drinking, an alcoholic's body, metabolism, chemistry, neuron interceptors, etc. will no doubt change so as to accommodate themselves to the alcohol. This results in tolerance, dependence and addiction.

The end result is that, as the "disease" progresses, an alcoholic is doubly disadvantaged: he/she continues to have those troublesome genetic characteristics, and secondly he/she has developed additional physical and chemical alterations as a result of persistent drinking.

But the "disease" concept does not exhaust the list of causal factors in this very complex situation. No doubt there are others, such as personality characteristics (e.g. shyness, compulsiveness, perfectionism, self centeredness, proneness to risk taking), socio cultural ones, such as a family history of drinking, college drinking, peer pressures. And some alcoholics have suffered from child abuse, mental and physical or suffer from bipolar imbalances.

So maybe it might be more accurate to refer to alcoholism as a "disease plus", a condition which requires not only medical care but an especially strong amount of patient responsibility, determination and cooperation. My experience has been that I could not do it alone. I had to have help, often from doctors who weren't really that skilled in providing that, and finally from one who encouraged me to get help from a group of fellow alcoholics. I'm very thankful for that.

W.

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Old 05-27-2011, 03:56 PM
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Originally Posted by defyinggravity View Post
The American Medical Association (AMA) has recognized addiction as a disease since 1956.
The AMA recognized alcoholism as an illness in 1956, not a disease. It was recognized as a disease by the AMA in 1966

Make no mistake about it
That is your opinion. I disagree along with others. Take a look at the history of the disease concept. It was pushed by Marty Mann, the first woman in AA. She funded Dr. Jellinik who played an early and vital role in the disease concept. However, it turned out the Dr. Jellinik was a cheat who fabricated his degrees and education. During his time at Yale University, the University asked Jellinik to refute his own finding in his "The Stages of Alcoholism" since it didn't stand up to scientific scrutiny.

However, that didn't stop Mann and Jellinik to keep pushing their disease theory. They later formed a clandestine relationship with the head of the NIAAA, R. Brinkley Smithers, who would promoted and funded the disease concept. This is the same man who lobbied for and was responsible for gaining insurance coverage for patients in treatment (hence the 28 day program).

The disease concept mushroomed into a mutli-billion a year industry. As the industry grows and treats more people of their diseases, one would expect that this disease would have diminished overtime. Instead, more people have this disease than ever before. Clearly, something is fundamentally wrong here.

I am not arguing with you, but I wholeheartedly disagree with you.

At the end of the day, I really don't care what you call addiction. It is real. It is deadly. It is destructive, not only to the person who suffers from the addiction, but many others who cross paths with the addict.

I also have no problem using the "disease" concept as an analogy, as they did back in the old days of AA before the rehab speak of using a "diseases" was infiltrated during the 70's and 80's.
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Old 05-27-2011, 05:31 PM
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Antiderivative:
I agree that it really doesn't matter what you call it. Or even what "causes" it, except as the answer to that might reflect on the major concern, namely, "now that you have it, whatever it is, what are you going to do about it?" If the "disease" concept implies just sitting back and letting the doctors take care of it, like measles or mumps, then my own experience is that I spent forty years doing just that until I finally hit a doctor who said, "We're going to help you but you've got to help us if you ever want to get out of this and, to do that, we strongly suggest that you seek the help of other alcoholics." So I tried AA and had many problems with it, finally ending up in an agnostics group, although I'm not an agnostic or atheist. This really helped me and I haven't had a drink in nearly 24 years. So my experience is that whatever "it" is, or whatever its "cause" or "causes", the primary way out is to seek the help of other alcoholics, whether through AA or some other support program.
Finally, I don't have any problem with doctors classifying this so that it is covered by insurance. The first and only time I ever went to a rehab it was covered by insurance, and that paid out $15,000 by the time the dust settled. For the first time I had an excellent doctor and fine staff advice. I have no problem with that at all. I only wish that folks today could get the equivalent of $15,000 insurance coverage to go to a rehab. But the sorry thing is that so much of this is today done on an outpatient basis. I talked with one nurse and she said that, "unless a person is about to have DT's or a seizure, we give them 30 Xanax, send them home and tell them "not to drink"." If they keep them in the hospital for a few days and then release them that's called in the trade a "spin dry". That was my speciality in the old days, the "spin dry". It spun me around and got me nowhere.
Popping them out the door with thirty Xanax is a little like saying to the guy who comes in with a revolver, "here are some more bullets but be careful, don't shoot yourself!" Reminds me of the doctor who gave me an open (perpetually refillable) prescription for chloral hydrate (in liquid form, possibly a suspension with alcoholic content) (that was in 1958) or the one who prescribed me for seconal (to get to sleep) and sodium amytal (to stay asleep)(that was in 1962). That was outpatient treatment in the old days!

W.
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Old 05-27-2011, 05:50 PM
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Dr. Kevin McCauley discusses the disease model of addiction. It's 72 min. long but he explains it better than anything else I have found.


Dr. Kevin McCauley Meth Keynote on Vimeo
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Old 05-27-2011, 10:12 PM
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Originally Posted by wpainterw
I agree that it really doesn't matter what you call it. Or even what "causes" it, except as the answer to that might reflect on the major concern, namely, "now that you have it, whatever it is, what are you going to do about it?"
I wholeheartedly agree with you and also share the OP's sentiments about this.

Originally Posted by wpainterw View Post
Finally, I don't have any problem with doctors classifying this so that it is covered by insurance.
I don't necessarily have a problem with insurance paying for treatment or even spending more tax payer's money on it by diverting away resources from the failed War on Drugs, non-violent drug criminals in our overcrowded prisons, and treating the consequences of addiction and moving them to treating the problem.

Smithers was a great man and great philanthropist and Marty Mann had good intentions to get alcoholism labeled as a "disease" because she wanted to reduce the stigma associated with it. I have nothing against these two. Jellinek, though, was shady.

Good intentions do not make something true. Most of the funding and lobbying, particularly during the Kennedy and Nixon administrations of the medical disease concept of addiction came from Smithers. Over the years, the medical community has failed to significantly reduce the number of "diseased" addicts, despite blossoming into a multi-billion dollar a year industry.

As some critics point out, the "diseasing" of addiction may have backfired. Good intentions can have negative consequences. However, I don't expect a reversal of the "disease" concept anytime soon.
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Old 05-28-2011, 04:47 AM
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Google "Addiction Interaction Disorder"
The disease of addiction is primary in the spiritual aspect of a human.
The lack of will, emotional, mental, behavioral, and physical are just secondary signs and symptoms of the primary disease.
The disease of addiction does not care what you feed it, it just does not want you to treat it.
The disease of addiction can be fed alcohol, drugs, food, sex, money, exercize, power, religion, administrating and controlling others.
The disease of addiction in USA has mutated from alcohol and drugs and sex manifestattions into food and money.
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Old 05-28-2011, 08:53 AM
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Slugger: Interesting that you would view exercise as a disease or addiction. There may be some truth in this for those who exercise in a compulsive or obsessive way. Compulsive dieting can lead to the "disease" of anorexia nervosa. Compulsive eating to bulimia and obesity. Compulsive religiosity to cult behavior.
In any event, alcoholism remains elusive and problems persist with how to describe it or what causes it. The important thing, maybe the "only thing", as Yogi Berra would have said, is what to do about it when you have it. Excessive or obsessive focus on what it is or what causes it may prevent a person from focussing on what to do about it. Some alcoholics often read all they can find about the "disease" and keep on drinking nonetheless. They become experts at everything except how to get well. Fortunately doing something about it can be described in fairly simple terms. It is only denial which makes it complicated. And of course the body, once used to alcohol, does not want to give it up. It will then convince the mind that there is really nothing wrong or that progress is being made when that is not the case.

W.
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Old 05-28-2011, 06:14 PM
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I'm not particularly concerned with the history of the disease concept of alcoholism or the charge made by some of its critics that it was put forth and promoted for ulterior motives, largely financial. In this I am reminded of T.S. Eliot's opener in his early poem, "The Love Song of Alfred J. Prufrock":

Streets that follow like a tedious argument
Of insidious intent
To lead you to an overwhelming question. . .
Oh, do not ask, "What is it?"
Let us go and make our visit.

Thus it seems to me best not to dwell on what alcoholism really "is", at least if that prevents addressing the main question, namely "Now that I have it, what am I going to do about it?" If so, it may be appropriate to "make a visit", e.g to a rehab, a detox and/or a support group. There comes a time when it is wise to put down the books, the history, end the debate and get busy finding how to "get out of this place" (as the popular song goes).

W.

Last edited by wpainterw; 05-28-2011 at 06:16 PM. Reason: typos
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Old 05-28-2011, 07:58 PM
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Originally Posted by defyinggravity View Post
(...I'm finishing my PhD in behavioral neuroscience focusing on the process of addiction...)

...I do believe addicts can live in recovery for the rest of their full, happy lives. But I believe that that takes learning how to "talk over" your deepest drives. It takes learning a new way of thinking and living. You have to learn over deeply ingrained patterns of behavior - patterns that are wired in. 12-step programs teach us that, rehab teaches us that, supportive recovering addict friends teach us that, addiction therapists teach us that, other forms of recovery that I've forgotten/unaware of teach us that. By implementing a structured treatment plan (whatever it may be) each and every day, addicts conquer their disease. By not using or drinking just for this one day, each day at a time, addicts treat their disease. By rehabilitating the mind and doing emotional and mental work to develop healthy and effective coping strategies, addicts stay sober.
In Behavioral Neuroscience do you learn the neurobiology or neuro anatomy/physiology aspects of addiction? I'm an RN and the part of rehab that fascinated me was the pathways of the addicted brain. What happens physically and physiologically. Our brain literally changes shape and we lose mass (happens with nicotine addiction as well).

In recovery we must build new brain pathways or as you say, "learn over deeply ingrained patterns of behavior."

The more practice one gets by doing things sober the stronger and more prominent those new pathways become. For example, when I first got sober I didn't know how to be social without my drug or drink. Being social over and over again sober, and over time I have learned that it can be done and quite successfully! This is my brain building a new pathway. I choose to use this pathway.

I was paralyzed mentally at first until I got active in my recovery and started doing everything sober (I used to think I couldn't do anything sober because I used every waking moment for years and years).

The catch is that the formerly active addict brain pathways will ALWAYS be there. Falling into "old behaviors" is very dangerous - it reignites those old pathways and frequently leads to relapse. But it doesn't have to....just what ever I do, I don't pick up and use or drink. I do something recovery related instead. It gets easier and easier over time because those new pathways are now prominent and readily available to me.

Also, when in active addiction, the active pathways are...get the drug or drink, use the drug or drink, get more, lie to get it, steal to get it, hide it, hide me (isolate), etc etc...which creates all kinds of emotional problems. This is why it is absolutely 100% necessary to address the mental/emotional side of addiction (psychiatry, therapy, sober networks (12 step, etc) to deal with the shame and guilt of the old behaviors and the damage done to oneself and others.

Only the last two paragraphs are my opinion. The rest is pretty well studied and documented.

Thanks for you post.

p.s. would love a conversation about specific neurotransmitters!
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Old 05-28-2011, 09:18 PM
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Originally Posted by Antiderivative View Post
Take a look at the history of the disease concept. It was pushed by Marty Mann, the first woman in AA. She funded Dr. Jellinik who played an early and vital role in the disease concept.
You seem to imply that the disease concept is a fabrication that started with AA, is that correct?
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Old 05-28-2011, 11:25 PM
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Originally Posted by BadCompany View Post
You seem to imply that the disease concept is a fabrication that started with AA, is that correct?
No, but I see that we need to try this again.

One early member in AA pushed the disease theory as an outside issue. Her name was Marty Mann. I never said that the current disease concept was a fabrication started by AA as a whole. I also said Smithers was a philanthropist. Does that mean that every philanthropist pushed the modern day disease theory? Using your reasoning, you could have easily ask the same question, but you did not. Instead, you thought I was attacking AA, saw what you wanted to see, and arrived at a distorted assumption.

I am not attacking AA. Heck, I am not even attacking Marty Mann, but you probably believe that my words are a personal affront on her when they are not. All I was trying to do was point out that the traction of the current disease concept did not come from medical science, but misguided intentions and a doctor who was a fraud.

From my previous posts since you glossed over them and only saw what you wanted to see.

Originally Posted by Antiderivative
"I also have no problem using the "disease" concept as an analogy, as they did back in the old days of AA before the rehab speak of using a "disease" was infiltrated during the 70's and 80's. "

"Smithers was a great man and great philanthropist and Marty Mann had good intentions to get alcoholism labeled as a "disease" because she wanted to reduce the stigma associated with it...

...Good intentions do not make something true. "

The medical disease concept is an outside issue and historically AA never viewed at alcoholism as a disease in the medical sense. At best, "disease" was used as a metaphor in AA, until rehab speak started to infiltrated AA during the late 70's and 80's and then it started to change meanings.

"We have never called alcoholism a disease because, technically speaking, it is not a disease entity. 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 wish 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.”

--Bill Wilson addressing the annual meeting of the National Catholic Clergy Conference on Alcoholism in 1961
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Old 05-29-2011, 06:41 AM
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Originally Posted by Antiderivative View Post
No, but I see that we need to try this again.

One early member in AA pushed the disease theory as an outside issue. Her name was Marty Mann. I never said that the current disease concept was a fabrication started by AA as a whole. I also said Smithers was a philanthropist. Does that mean that every philanthropist pushed the modern day disease theory? Using your reasoning, you could have easily ask the same question, but you did not. Instead, you thought I was attacking AA, saw what you wanted to see, and arrived at a distorted assumption.
Well than maybe you can explain why you say that you want to take a look at the history of the disease concept and then only mention a single AA members involvement on it. That clearly implies that it began with AA.
Originally Posted by Antiderivative View Post
Take a look at the history of the disease concept. It was pushed by Marty Mann, the first woman in AA. She funded Dr. Jellinik who played an early and vital role in the disease concept. However, it turned out the Dr. Jellinik was a cheat who fabricated
Your post is clearly dishonest and follows in a very subtle manner the dishonesty of the standard anti AA nonsense.

If someone doesn't want this AA stuff legitimately that's fine. But lying to them, lying to people that are in a fight for their lives is a terrible thing to do.
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Old 05-29-2011, 10:01 AM
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Originally Posted by BadCompany View Post
Well than maybe you can explain why you say that you want to take a look at the history of the disease concept and then only mention a single AA members involvement on it. That clearly implies that it began with AA.
No, it doesn't. I also said that Smithers was a philanthropist. You could arrive the same faulty conclusion that the modern day disease concept originated with philanthropy. Instead, you want to twist my words, only see what you want to see, act in a dishonest manner, and pick a fight with me.

Your post is clearly dishonest and follows in a very subtle manner the dishonesty of the standard anti AA nonsense.
The one who is being dishonest and playing games is you. Marty Mann played a vital role in the disease concept. If you want to get all hot and bothered over this, then so be it. She also took it as an outside issue. Her intention was to get the medical community to view alcoholism as a disease, not necessarily to promote science, but remove the stigma associated with alcoholism.

If someone doesn't want this AA stuff legitimately that's fine. But lying to them, lying to people that are in a fight for their lives is a terrible thing to do.
Once again, AA doesn't subscribe to the medical disease concept. Disease is used as a metaphor. This is not a lie, this is the truth. However, you are the one lying and twisting and claiming that AA subscribes to the medical disease terminology as stated in the AMA guidelines. They don't.

If you want to believe that you have a medical disease, then go seek medical attention. AA's view on it is that it is an illness, a malady, or a spiritual disease. Why you are fighting me tooth and nail on this is beyond me.

I have had enough of your twisting, distorting, name calling, and logical fallacies. If you honestly believe that you have a medical condition, then go seek medical help. AA does not offer medical help.

Out of the thousand plus meetings I have attended, I have never lied to a newcomer and pushed them out of the rooms of AA. I don't even talk about the disease concept in meetings since it is an outside issue. I know that alcoholism is deadly. I know that it is real. However, I simply do not believe it to be a disease in the medical sense and a large part of this belief stems from a historical understanding.
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