From the first public health school in the United States that was established in 1916 at Johns Hopkins University, sanitation was one of the main competencies taught. From this school, more schools would be developed and throughout the 1900s specific public health concepts were standardized. These concepts included: communicable diseases control, environmental sanitation, child health services, health education, industrial hygiene, nutrition, and medical care. One of the largest changes that occurred was teaching the public to be clean and treat foods properly in order to avoid disease. Simply speaking, having a clean environment and clean body eliminates the ability for diseases to for.
Looking at alcoholism (which is a special case) the disease model has completely failed in its ability to deal with this social issue. One of the major failings with alcoholism is the direct result of its definition as a disease and its treatment approach. Amazingly enough, Alcoholism is defined as a disease but the modern medical establishment has had little to do with writing that definition. Alcoholics Anonymous is the group responsible for defining the disease of alcoholism with most modern definitions based on an outdated understanding of allergies:
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. ~AA Big Book
Not only is the allergy definition outdated but is so nonsensical that the author, William D. Silkworth, M.D., cannot maintain the definition when writing. He calls alcoholism an allergy but then refers to it as a "habit" formed by drinking that somehow becomes a loss of "confidence" and "reliance upon things human" meaning something other than human is needed to cure this allergy?
Alcoholism when defined as a disease makes very little sense. Defining alcoholism in this way creates a highly subjective and malleable concept seen in in the Mayo Clinic's description.
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 (Mayo Clinic, 2012).
Since the time of this article’s original publishing in 2012, the Mayo Clinic updated its definition, now referring to Alcoholism as Alcohol use disorder: “a pattern of alcohol use that involves problems controlling your drinking” (Mayo Clinic, 2021). This change highlights the growing movement away from defining alcoholism as a disease.
The disease definition superficially sounds good but when examined critically the error in its definition becomes apparent. Watch what happens when alcoholism is substituted for another addiction:
Smoking is a chronic and often progressive disease that includes problems controlling your smoking, being preoccupied with smoking, continuing to use tobacco even when it causes problems, having to smoke more to get the same effect (physical dependence), or having withdrawal symptoms when you rapidly decrease or stop smoking. If you have tobacco dependence, you can’t consistently predict how much you’ll smoke, how long you’ll smoke, or what consequences will occur from your smoking.
When you define smoking in the same manner as drinking there is a logical problem. The claim that alcoholism is a chronic disease that makes your body dependent on alcohol; if this were true it would mean that a person who has never drank alcohol could contract the disease of alcoholism. Without ever drinking, one would begin suddenly craving to drink out of control. This is not possible since one cannot become an alcoholic without ingesting alcohol.
The point of this exercise is to show how the disease model fails and why it should be questioned constantly. From the point of social conflict, I find it amusing that the group (Alcoholics Anonymous) who wrote the definition of the disease is also the group that benefits the most from the medical community and government adopting this definition. What is even more revealing is the fact that Alcoholics Anonymous has a failure rate of 95% (Vaillant, 1995). Studies have shown that in many instances no treatment would have been preferable to the AA program. AA has shown through its own research that the program raises the death rate amongst group participants by 3% (Vaillant, 1995). I am critical of the disease model because of this situation.
References
Mayo Clinic (2012) Diseases and Conditions Alcoholism (Old URL mayoclinic.org/diseases-conditions/alcoholism/basics-definition/CON-20020866?p=1&DSECTION=all) New 2020 Definition
Vaillant, G.E. (1995). The natural history of alcoholism revisited. Cambridge, MA: Harvard University Press.
Anonymous. Alcoholics Anonymous: The Big Book (p. 13). Kindle Edition. who wrote aforementioned
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