Treatment or mistreatment: CDC confirms alcoholism, partying not the same

A throat infection and throat cancer wouldn't get the same treatment just because they present similar symptoms. One gets a course of antibiotics, the other gets chemo and a lifestyle change. But there's a disconnect in that sort of logic when it comes to managing drinking problems versus counseling problem drinkers.

Part of the challenge is that society labels both the same, however a CDC study released Nov. 20 (see related chart and article) documents that nine of 10 adults who drink too much alcohol are excessive drinkers and are not alcoholic. Alcoholism is a chronic, progressive, primary and fatal disease, like cancer. The CDC says excessive drinking includes binge drinking, which is like the throat infection in the analogy above.

It’s a clinical difference and a behavioral one, borne out completely in study after study for sixty years. If you are a problem drinker, you aren’t automatically an alcoholic. The gap between is detrimental to addressing either. An alcoholic cannot consistently choose to drink or not to drink due to physical dependence, tolerance and altered cellular metabolism. A drinking problem is the loss of the ability to choose, a problem drinker can still choose but decides to drink anyway.

Alcohol Abuse may be a prequel to alcoholism—an alcoholic in training maybe—but it is not the same as alcoholism. This was called the Disease Concept. It’s not a concept anymore, though, any more than we have a world-is-flat concept. Misinterpreting the disease by applying the disease label to an excessive drinker gives that problem drinker an alibi for failing to make the right choice. Conversely, alcoholism isn't a social or psychological dependency, it is a physical dependency. Searching for a reason why alcoholics drink is superfluous. They drink because they have to.

We’ve come a long way since the disease was identified. Some credit Dr. Benjamin Rush for calling it a disease as early as the 1800s, but Dr. E. Morton Jellinek is acknowledged as the one to credit for our modern description. In fact, there is some effort to rename alcoholism Jellinek’s disease, much the way other diseases are named (Lou Gehrig’s, Hansen’s). That could settle any confusion about the behavioral problem versus the medical problem.

In our overly politically correct 21st century society we’ve become scared to death to call a spade a spade. A problem drinker is not sick. They are immature and self indulgent. JUST ASK ONE. Those are objective definitions, not sugar-coated ones, but not moral judgments either, like wicked or shameful.

One of the top researchers, Don Cahalan wrote “Problem Drinkers: A national survey” (Jossey-Bass) in 1970 based on four studies he authored or co-authored in the 1960s. He said, “Comparing estimates of alcoholics and problem drinkers is a rather futile exercise because the concepts of Alcoholism and problem drinking are not very similar, do not necessarily apply to the same people and have quite different implications for prevention measures and treatment.”

If alcoholism was a behavioral or emotional or psychological or moral or social or spiritual failing, lab rats would not be alcoholic. Rats do not even like alcohol to begin with—so they are incapable of excessive drinking—and haven’t the capacity of all of those psychological expressions commonly given as “causes” for alcoholism. Their genes are altered. They are biochemically different when alcoholism is present, not morally deficient.

Cahalan and others saw the difference between the Alcoholics and Alcohol Abusers in studies of drinking behavior in the armed services. There’s a lot of heavy drinking in the military. You’d expect it in a population consisting largely of young males away from their families and in a stressful environment. Many drank so much that they were at a high risk of developing alcoholism. Most however only had disciplinary problems, not telltale changes in body tissues. The medical risks and physiology of alcoholism weren’t there.

Extending the term alcoholic to excessive drinkers is like saying a Rottweiler and a water buffalo are the same since they are both mammals or that a rat and an opossum are the same because they both are ugly, eat garbage and scare girls. Or that a throat infection and throat cancer require the same treatment because they present the same symptoms. Treating one with the treatment designed for the other just may be mistreatment instead of treatment and may do more harm than good.

-- excerpted from Every Silver Lining Has a Cloud and What the Early Worm Gets

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Visit alcohologist.com for a replay of the Bringing Inspiration To Earth show feature with Scott Stevens. Lucy Pireel's "All That's Written" included a feature on Every Silver Lining Has a Cloud called "When alcohol doesn't work for you anymore."  Details on the third literary award for Every Silver Lining Has a Cloud also can be found on www.alcohologist.com, plus an interview with Scott Stevens on Health Media Now and one at Christoph Fisher Books.  Mr. Fisher is an acclaimed international author from the UK, among his works is the Alzheimer's book "Time to Let Go."