N Heather1. 1. National Drug and Alcohol Research Centre, University of New South Wales, Kensington.
Abstract
OBJECTIVE: To expound the argument that alcoholism (or "problem drinking") is not best regarded as a disease. SUMMARY: Excessive drinking can cause physical disease and involve physical dependence without therefore being a disease itself. The "disease concept" of alcoholism is not needed to justify medical intervention or a caring approach to those who are dependent on alcohol. There is a specific and a general version of the disease concept of alcoholism. The specific disease concept, associated mainly with the Fellowship of Alcoholics Anonymous, is contradicted by empirical evidence and unhelpful for preventive and treatment responses to problem drinking, especially for the effort to detect and modify problem drinking at an early stage. The more general disease concept shares these disadvantages and is also ineffective in engendering sympathetic attitudes towards problem drinkers among the general public. It is more useful to view problem drinking as the result of the interaction between the individual's personality and the social context in which he or she has learned how to drink. CONCLUSION: For an effective and compassionate societal response to problem drinking, the disease model of alcoholism should be replaced by a social learning perspective.
OBJECTIVE: To expound the argument that alcoholism (or "problem drinking") is not best regarded as a disease. SUMMARY: Excessive drinking can cause physical disease and involve physical dependence without therefore being a disease itself. The "disease concept" of alcoholism is not needed to justify medical intervention or a caring approach to those who are dependent on alcohol. There is a specific and a general version of the disease concept of alcoholism. The specific disease concept, associated mainly with the Fellowship of Alcoholics Anonymous, is contradicted by empirical evidence and unhelpful for preventive and treatment responses to problem drinking, especially for the effort to detect and modify problem drinking at an early stage. The more general disease concept shares these disadvantages and is also ineffective in engendering sympathetic attitudes towards problem drinkers among the general public. It is more useful to view problem drinking as the result of the interaction between the individual's personality and the social context in which he or she has learned how to drink. CONCLUSION: For an effective and compassionate societal response to problem drinking, the disease model of alcoholism should be replaced by a social learning perspective.