Alcoholism, Disease, and Insanity

Abstract

It is argued that alcoholism, and substance addiction generally, is a disease. It is not of its nature chronic or progressive, although it is in serious cases. It is better viewed as a psychological disease than a neurological one. It is argued that each time an alcoholic takes a drink, this is the result of choice; however, in cases of serious affliction, such choices are compulsive and may be called ‘involuntary’ in that they are made against the subject’s will, motivated by an overwhelmingly powerful desire that he wishes he did not have and not to act on. Alternative accounts in terms social learning theory and behavioral economics are critiqued. The conception of alcoholism as a tripartite disease composed of a ‘physical allergy,’ a mental obsession, and a ‘spiritual malady’ is defended from a contemporary scientific point of view.

Denial in Addiction

“…So an intervention—foregoing drugs now or in the short to medium term—may not produce the effect—the disappearance of negative consequences of use—which would support the acquisition of knowledge of a causal relationship between them. To take a well‐worn example (Segal, ): if a person's drinking is contributing to ruining their marriage, but they are drinking in part because they are unhappy in their marriage, then stopping drinking will neither immediately fix the marriage nor correspondingly offer clear evidence that drinking is a cause of the problem.…”

“…Even brought photos home they took with the endoscope to remind myself. I now had a super esophagus and was good to go, so to speak (quoted by Segal (, p. 306) who reports the conversation took place after this person's doctor told him that if he were to continue to drink, he would die).…”

“…Although addicts retain the capacity to refrain from use in many circumstances (see Section 1), there is no question that the desire for drugs characteristic of addiction is very strong and hard to resist (Robinson and Berridge, ; Holton and Berridge, ; Segal, ); and, moreover, for many addicts, drugs additionally serve valuable functions (Muller and Schumann, ; Pickard, and forthcoming) as well as offering pleasure (Foddy and Savulescu, , ). Despite the costs, addicts are nonetheless strongly motivated and highly incentivized to continue to use drugs.…”

How do you know you have a drug problem? The role of knowledge of negative consequences in explaining drug choice in humans and rats

“…They don't want to know because they want to continue to use drugs -whether that is because of the strength of their motivation or craving (cf. Robinson and Berridge 2008;Segal 2013); the pleasure of using (Foddy and Savulescu 2006;; the immediate functional value of drugs in their present circumstances (Pickard 2012); or some other reason. Perhaps, too, they don't want to know because of the shame such knowledge typically brings (Flanagan 2013).…”

Is addiction a myth? Donald Davidson’s solution to the problem of akrasia says not*

“…Yet it is astonishing how seldom such issues are ever addressed by addiction scientists, particularly by those interested in explaining addiction from the perspective of the medical, behavioral, or social sciences. (They are, of course, addressed by philosophers; see Mele, 1987;2002;Pears, ------IJADR 4(1) ------1984; Pickard, 2013;Segal, 2013;Wallace, 1999;Watson, 1999; among many others). It may be a fear of raising all the moral and legal complications that arise as soon as one appears to suggest that the addict's drinking might in some sense be within the realm of personal choice.…”