The Disease Concept of Alcoholism, Addiction, Obesity, and More

     Alcoholism was initially declared to be a "disease" in the United States in order to get insurance companies to pay for treatment. Treatment used to consist of detox followed by an automatic twenty eight days in a rehabilitation center. Insurance companies got tired of paying for anything automatic I think around the early eighties. If the paid addictions counselors said anything too glowing about a patient's progress in rehab, suddenly some insurance company somewhere would decide that the patient was ready to go. "Oh but __________ is so sick," the staff would exclaim, "and needs more treatment." Counselors learned how to record things in the patients' notes so that insurance companies would not be able to force discharge as often. 

     Addiction to other drugs was soon declared to be a "disease" also by those treating addicts. "I have a disease," addicts who have been through treatment would state. This in my opinion was a much harder sell to the American public. These days, some of us know that addiction is addiction and that alcohol is in fact a drug. Some alcoholics don't much care to be lumped in the same vat with the addicts. And the American public could find sympathy for functioning alcoholics and even for stumble bums-- but not for crazed and scary drug addicts.

     Now on television there are commercials advising us that obesity is also a disease. Treatment for being too fat has evolved away from fat farms and gatherings of foodies and more toward the provision of sleeves, lap bands, and by-passes for the morbidly obese. I have no quarrel with that. For some folks, those things can certainly save their lives and their health. Along with surgical intervention, the obese patient must reduce their caloric intake as well as take nutritional supplements as prescribed. [Those that don't can and do die. I've seen that]. Having said that, here is my problem: It's the whole "disease concept" that leaves me pondering certain dark and unpopular questions.

     All of this is my opinion only. If you are happy believing that you have a disease, my hat is off to you. If you are threatened by the idea that your alcoholism/addiction/obesity may not be a disease, you may be better off escaping from this ranting blog post now. Please don't torture yourself on my account. It's simply not worth it.

     In the eighties, alcoholism was compared to diabetes, tuberculosis, and AIDS. [The comparison to AIDS horrified me personally. I am way too close to the devastation that AIDS can cause to the folks who have it, their families and friends, and society at large.]. Diabetes is technically not a disease. Diabetes has more than one etiology [cause or origin]. Diabetes is in fact a condition which has a disease process. Like alcoholism and other drug addictions, diabetes can be progressive and fatal.

     I believe that alcoholism and other drug addictions are also conditions. Like diabetes, there is more than one etiology. Like diabetes, a disease process may be present which dictates progression and fatality unless interrupted. Until further notice, I believe that alcoholism and other drug addictions [and over-indulgence in food] are all behavioral disorders [or what used to be called psychological conditions].

     What medical evidence do we have that these things are "diseases"? None. We do not have a shred of medical evidence that points to alcoholism, other drug addictions, or over-indulgence of food as being diseases. Period. The development of tolerance or progression or fatality or the presence of "stages" is not evidence of a disease. The medical community will have to do more than that in order to convince me of this so-called "disease concept." [And no, I also do not believe that these things are "an allergy"].

     The disease concept proliferated with the development of treatment centers for addictions. Even in the early eighties, it was not common to hear the "I have a disease" refrain in gatherings of addicts who were attempting abstinence. [What I remember hearing is, "Oh I have a disease so I think I will go out and relapse ha ha ha" said in a mocking way]. Now this disease talk has become all too common.

     What is the benefit of believing that this thing "is a disease" or that we have a "genetic proclivity" to over-drink, over-eat, over-drug? Simple. There is an abhorrence to the idea that we may have done this to ourselves. Saying, "I have a disease" avoids any self-responsibility.

     For the Addictions Treatment Industry, the disease concept means that people who are "suffering" from a disease deserve "treatment"-- their idea of treatment. And what is involved in treatment after detoxing?

     Detox is a medical event. I detoxed at home, not knowing any better. People who detox at home can and do die. Some percentage of people who detox in a hospital also can and do die-- but the chance of dying during medical supervision of withdrawal is less than without. Because detox is defined as a medical event, certain criteria must be met for admission. This is why some addicts are denied admission. If they don't meet the criteria, they are judged as medically stable.

     Treatment after detox [or without detoxing first if not medically indicated] may involve any of the following: a thorough history is taken-- sometimes called a psycho-social, interviews of any family members as well as the identified patient, groups, individual counseling, referrals to residential treatment, referrals to aftercare, referrals to day treatment or evening treatment.

     Groups and individual counseling-- whether in-patient in a rehab or out-patient in the community in a day/evening treatment setting or other-- usually involve one or two counselors who work with the patients/consumers/customers/clients/participants on things like "the disease concept," spirituality, the importance of attending twelve step programs, how to avoid "relapse," identifying "triggers" which may lead the addict "back out," grief, family systems, taking the fun out of dysfunctional, "co-dependency," identifying feelings, motivational counseling, vocational counseling, therapeutic recreation, and pop psychology. 

     By pop psychology, I mean specifically certain New Age-y type ideas which have infiltrated the addictions industry. Pop psychology includes the use of affirmations, showing of certain films or discussion of certain books purporting to reveal ancient secrets that will cause folks to attain higher "vibrations" and succeed at life, the differences between men and women as delineated by certain popular authors and what that "means" for recovery, meditation or trance work, beating on pillows and bitching about woebegone childhoods, inner child work, dream therapy... All of these things are attractive to some folks because they lead away from any ideas involving hard work.

     Is addictions treatment really needed? That depends upon who you ask. Those involved in the addictions treatment industry will say yes. I maintain that we would do better to provide detox to those who are in medical need of such and then dump all treatment programs. What will all these people do without treatment? The able-bodied can work. Unfortunately, being engaged in treatment in the United States means that some professional tells the newly abstinent individual, "Oh you can't work now. You have to concentrate on your recovery." Le sigh. More folks on the public dole.

     The addiction treatment industry tells their patients that they must attend one or more twelve step programs in order to maintain their abstinence or recovery-- and they must do this for the rest of their lives. After all, these patients are powerless over their addictions and must rely on some sort of Higher Power in order to not return to active addiction.

     How can addictions treatment possibly be effective when each and every patient is funneled into attendance at twelve step programs? Some people will respond favorably to attendance at twelve step programs. I'll grant that. Others achieve abstinence through churches or other faith-based organizations and agencies. Some do better with secular programs such as S.O.S. Some may respond to Rational Recovery or other internet-based info. Some achieve success with harm-reduction sessions. Some folks remain abstinent without any attendance at any mutual aid groups at all. [I have two relatives who remained abstinent that way until their deaths from old age]. Self-determination is practically non-existent when "choices" are limited to one way of doing things. Attendance at twelve step groups is not a choice when it is the only option presented as being viable. Is this about people or is it about the cash cow that addictions treatment industry has become? 

 sapphoq needing coffee says: People can and do quit their destructive behaviors without "treatment." Treatment is costly and not effective. If treatment for addictions is to survive, then more research is needed on how to identify the best intervention with the best possible outcome for each individual patient. Until then, twelve step ideology combined with pop psychology and a lack of self-responsibility will continue to dominate the addictions treatment industry. This is truly a sorry state of affairs.