February 06, 2010
Recently, I’ve been involved in an academic debate regarding the concept of alcoholism and addiction as diseases. During that debate, I discovered what I consider to be a major contradiction between the diagnosis of alcoholism (upon which I will focus in this post) and its “treatment.” That discovery led me to a second and even more startling revelation.
Without doubt, the advent of alcoholism as a disease accomplished some positives. E.Morton Jellinek was the major force behind the development of the disease model. Without going into Jellinek’s ideas and the conclusions he reached from his research, some of which are unquestionably wrong, it need only be stated for now that without Jellinek, alcoholism might still be considered the result of “character defects.”
Redefining alcoholism as a disease seemingly de-stigmatized alcoholism. However, that de-stigmatization occurred only in the definition of alcoholism, not its treatment. That contradiction is the subject of this essay.
While nearly every therapist, psychologist, psychiatrist, and physician in the United States accepts the disease model of alcoholism and other addictions, they almost-uniformly refer every one of their patients to AA as the one and only road to recovery. Remember that these professionals have, as part of their acceptance of the disease model, obviously concluded that diseases are not caused by “character defects.”
But at the same time, in its primary document (the Twelve Steps), AA members “must” (of course they can ignore it, but no reason to attend AA exists in that case) accept the 6th Step, i.e, being “entirely ready to have God remove all these defects of character” [bolding and italics mine].
This raises two points, the first being the most important.
- (1) Because almost all therapists, psychologists, psychiatrists, and physicians accept the disease model of alcoholism, they also by default accept that a disease does not result from “character defects.” However, the only “treatment” they offer is referral to AA, which, while paying lip service to the disease model, clearly views alcoholism as the result of “character defects,” otherwise known as a “sinful nature.” Such “treatment” negates the very essence of the treatment community’s own diagnosis. That’s precisely parallel to a physician who knows the use of shark cartilage as a cancer treatment goes against everything he believes about the disease of cancer, but he still points every cancer patient to shark cartilage as the only treatment that “works.”
- (2) Because AA accepts the disease theory of alcoholism, at least on the surface, its own 6th Step repudiates the definition of alcoholism as a disease and AA as a coherent “philosophy.” AA inculcates the idea of alcoholism as the result of “character defects,” the very idea Jellinek, the founder of the disease model, disputed. Thus, AA is entirely based upon a “sin and redemption” approach. While it may work for some, it is, without question, a faith-based organization, as both the Twelve Steps and the fact that, at least in my experience, every AA meeting ends with the specifically-Christian Lord’s Prayer and the Serenity Prayer (“God grant me the wisdom…”) attest.
Point (1) is far more important than a blatant contradiction. That the sole recovery model to which patients are referred denies the very diagnosis and understanding of alcoholism that the entire treatment community accepts is an almost unbelievable fact. Of even more concern is that no one has ever noticed this unbridgeable gap between the treatment community’s diagnosis and understanding of alcoholism and the sole model of recovery it suggests.
The point is not to engage in argument with AA or its members; rather, the point is a psychological, medical, economic, and political one: Why is AA never questioned as the sole road to recovery by those who so depend upon it when “treating” patients? Why has no one else ever noticed the black hole between diagnosis and “treatment”? How can the treatment community not notice that AA’s primary document stands in direct opposition to its own accepted definition of alcoholism?
The American Medical Association’s own diagnosis states: “Disease means an involuntary disability. It represents the sum of the abnormal phenomena displayed by a group of individuals. These phenomena are associated with a specified common set of characteristics by which these individuals differ from the norm, and which places them at a disadvantage” [again, bolding and italics mine].
The American Psychiatric Association never mentions AA in its Substance-Related Disorders Position Statement. Its Diagnostic and Statistical Manual of Mental Disorders describes only criteria; it no longer addresses etiology in regards to any disorder or, in the sole case of alcoholism/addiction, “disease.”
Despite this avoidance of the issue at hand, the American Psychological Association, the American Psychiatric Association, The American Medical Association, and The World Health Organization all consider alcoholism a disease. And to prove how the medical community and AA are becoming still more integrated, some medical schools are now including AA “education” as part of their academic requirements.
What does all of this mean for the patient? Isn’t the treatment of a disease the role of the treatment community? Or is the treatment community’s addiction to AA psychological, so that it refers patients to the most available “resource” as a stress reliever? Is it economic, since AA is free, much like church? Is it political, with “disease” more likely to gain legislative support that in turn provides funding for research, grants, etc.? Is it simple ignorance? Going back to the patient, left to a cold war of the self, the answer hardly matters. However, were the treatment community to recognize or admit the discrepancy between its diagnosis and treatment of alcoholism, it would make all the difference in the world.
In conclusion, given the treatment community’s ubiquitous acceptance of alcoholism as a disease and acceptance of AA as the sole recovery model for alcoholic patients despite AA’s insistence that alcohol is the result of “character defects,” the entire psychological, psychiatric and medical communities are not only complicit in the inevitable relapse of patients but engaging in nationwide malpractice.