Alcoholism: Disease v. Behavior

Across the world, there are large philosophical differences in the treatment of alcohol dependence. Some look at alcohol dependence as a disease and others see it as an ingrained behavior.

In the United States, the most popular treatment program is Alcoholics Anonymous. Their twelve step program begins with the belief that alcoholism is a disease that prevents one from controlling their consumption of alcohol. The remedy is a series of steps based around complete abstinence.

There a variety of smaller treatment programs that focus on moderation rather than abstinence. Two of the significant ones are Moderation Management and HAMS (Alcohol Harm Reduction Network). These start with the assumption that drinking excessively is a behavior that can be controlled through self-control and behavior management techniques.

I saw a very interesting 20/20 special on alcohol-dependence a few years ago. Through a series of interviews, they demonstrated how vicious the politics between the two methods could be. They interviewed people who lost their jobs for suggesting that medical programs embrace behavioral treatment in addition to strict abstinence ones.

My first inclination is that there are degrees of dependence. Whereas some people may be so drawn to drinking that they literally can't stop once they start, others may be able to control it with behavioral cues.

For example, in the 20/20 special they observed people who had a counting system. They carried around chips in their pockets, each one representing a drink. If they started the program having 30 drinks a week, they would start with 30 chips. Every time they had a drink, they would remove a chip and put it in their back pocket. When the chips were gone, they couldn't drink. Each week, they would lower the number of chips until it was a reasonable amount. However, the could always choose when they used those chips.

Today, I decided to see what the research shows. Is AA more effective than Behavioral Treatment or vice versa? The National Institute of Alcohol Abuse & Alcoholism did a study between 2000 and 2005 and determined that moderation was effective over the short haul but abstinence had longer term success rates. They also suggested that the severity of the initial problem was a strong indicator of whether or not they would relapse.

I'm not proposing anyone use one program or another, but think it's important to know about all of the available options. If someone has tried both type of programs and has experiences to report, please share.

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David
Co-Founder of DailyHealth.net

I think alcoholism is one of those one size DOES NOT fit all things.
I have gone through times in my life where I have drank (drunk? drinked?) way too much, sometimes for more than a year. Then one day I get bored of it or whatever and stop. Historically I've been stopped more often than not. I'm sure there are people who, if they meet me during one of the periods in which I'm drinking would be convinced I was an alcoholic and needed abstinance. I'll admit to needing a little talk therapy some times if times are tough, but I'm not an addict.
Now, my hubby, son, dad, brother, they're alcoholics. They can not (or could not, in the case of deceased dad and brother) drink responsibly.
I firmly believe it's hereditary, too. Especially in males. That's my experience.

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~~~~Becky

~ ~ ~ "And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom."
~ ~ ~ Anais Ain

Becky, I'm glad you mentioned the hereditary part. A lot of evidence about smoking suggests that there is a huge genetic component in addiction. Some people can smoke 5-10 cigarettes a day for a few years and then quit cold turkey without cravings. Others continually increase the amount they smoke. Research has shown that there is a strong correlation between how much nicotine it takes to give you a buzz and whether you can quit. Those that are really sensitive to nicotine quit easily because they never smoke enough to get strongly physically addicted. There may be a similar thing going on in people with other substance abuse problems.

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David
Co-Founder of DailyHealth.net

My husband comes from an alcoholic family. I can't think of one male that didn't or doesn't drink excessively and this is a large family. I think it runs in families however I also think people have a choice. We took my fatherinlaw in 10 times and dried him out and 10 times he returned to drinking. He made the choice. My husband drank heavy for a period of time, I think it was 15 years. He started having black outs and I told him he could make a choice, either continue to be married to me and not drink or continue to drink and not be married to me. He stoppped drinking but not without a few slip ups but they were very short lived.

He liked the taste of beer and he has admitted he didn't know when to stop. There was a period of time when he would say, maybe someday I can have a beer with my supper, sure would taste good. It would only get the drinking started again and I have had to say, if you do it is all over between us. I don't like having to say that but I have never been more serious. He is one person that just cannot have a beer with supper and stop at that, wouldn't be long he would be right back at it.

Dusty, that's what my husband has said in the past. He would quit for 6 months or something, then, oh, one little drink will be fine. So tonight it's one, tomorrow it's two, in a week we're killing fifths of gin. ARGH!!!!!!!!!!!!!!!!!!!!!!!
He has changed his tone, so I'm a tad more hopeful this time. He has admitted that he can't stop at one. That's a HUGE step.

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~~~~Becky

~ ~ ~ "And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom."
~ ~ ~ Anais Ain

Becky....for your sake I hope he stays dry. I know how difficult it is to live with a person that drinks. I went through the DT's with my husbands dad numerous times with him offering to pay me $10 for one drink. I watched and I suffered. My husband never was violent when he was drinking it was just a constant "thing" that he did, not while working but when he wasn't it was continual. It also had to due with the friends that he was around also. Don't get me wrong, never blamed anyone else as I don't believe in, they had to twist his arm. What I mean is it is like peer pressure that kids go through, the friends that drink. Hope all goes well.
Ginny

Thanks Ginny, me too. Your story sure sounds familier. My son's dad's dad (lol) was a very anti-social nasty drunk, from what I've heard. He was always in his room whenever I was there. His death was awful, he just rotted from the inside or something. I honestly don't know. But he started vomiting blood, convulsed, fell down, and died. In front of one of his kids and grandkids. Yuck.
But like I said, this time he seems to get it a little better. And I knew exactly what I was getting in to when we got together. His disease, unfortunately, has progressed past what I can handle. I think it has to do with his PTSD.

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~~~~Becky

~ ~ ~ "And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom."
~ ~ ~ Anais Ain

I think alcoholism is a disease of the mind, body, and spirit. There are those who are hard drinkers(like becky) they can stop when there is a reason or desire. Normal drinker or a social drinker can have one or two drinks a month and not even think about it again. Then there are true alcoholics(like me) who continue to drink even though the consequences mean loosing everyone you love, possestions, sanity( seriously) health and even death. I have lost alot due to this disease of mine and my health and nearly my life a couple of times. I cannot have one drink, it sets off this great compulsion to literally drink myself to death, I become preoccupied with drinking. To me this is not a behavoiral problem. Psychologist and psychiatrist have said this is a disease that affects your mind, religions have long declared this a disease of the spirit and just within the past 40 years the medical profeesion has acknowledge this a disease of the body. So all these professions have said this is a disease, not a behavoiral problem.
I have been around A.A. since '93' but I have relapsed twice because I thought just one would'nt hurt but that again set off that great compulsion to drink more and more. I finally got it staright this time and have been sober for over 9 and a half years through practicing total abstince and a spiritual program that believing my Lord can releive me of that great obsession to drink.
Lately through internet studies I have learned modern medicine may have found another way out. There is medication someone could take that lessens that compulsion to drink to the point of being able to take it or leave it alone and finally leaving it alone. I personally have not met anyone who chose to do this and the medicine is not readily availible to just everyone. I don't know if it's still under study or what but not it's not in every market just yet.
this is just my 2 cents worth and how it has worked for me.

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Your friend,
TheJackRabbit
A.K.A. Christopher

CONGRATULATIONS on your sobriety.

Aw, Christopher. Big hugs and loves your way.
You rock.

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~~~~Becky

~ ~ ~ "And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom."
~ ~ ~ Anais Ain