Alcoholism

1. Alcoholism Group 4 Harrison, Erin, Emily, Viviana, Kadeem

2. Physiology of Alcohol • A necessary condition of deviant drinking is the drinking itself. • This condition sets alcohol and opiate abuse apart. • The fact that one must put a chemical substance, especially a psychoactive substance, into their body immediately established medicine as having control. • E.g. massive intoxication of alcohol requires medical intervention. • This is refereed to as the physiological, pharmacological, or medical consequences of drinking

3. Uncontested Medical Model • The jurisdiction over causes, consequences, and control over drinking, deviant or not, can be called the Uncontested Medical Model of Alcohol • Thomas Kuhn • The fact that lay persons as well as scientists consider the conditions we have discussed to be “obvious” medical problems means only that such a view has become part of the taken-for-granted wisdom of alcohol. • This wisdom is largely due to the pharmacological paradigm used to “make sense” of what alcohol is.

4. Alcohol and Behavior • Contested Medical Model? • The uncontested status of the medical model is compromised when the scope of the problems with alcohol is shifted from pharmacological processes to social conduct. • Negotiation continues about whether and to what extent deviant drinking should be defined and treated as medical. • If drinking is done in large enough quantities and under certain circumstances, people can “lose control” to varying degrees.

5. Alcohol and behavior • Lay persons and scientists, backed by tradition, holds that because of physiology and pharmacology of alcohol in the body, certain highly predictable consequences follow • Disinhibitor Hypothesis • As a result of chemical actions, alcohol removes inhibitions and lessens the degree of control over our behavior • Leads to typically deviant, unwanted, and potentially disruptive behavior • Predated the rise of science, this is “what everybody knows”

6. Alcohol and behavior • Although the pharmacological-physiological model of alcohol tells us the effects of alcohol inside the body, it produces faulty conclusions when applied uncritically to drinking behavior. • The problem lies at the intersection of alcohol and the individual drinker. • For almost 200 years, patterns of chronic and highly disruptive intoxication have been identified by medical labels.

7. Deviant Drinking as DiseaseHistorical Foundations • Colonial Period (17th-18th Century) • If there’s anything bad with drinking, it’s not the drink itself • Drinking in excess was the responsibility of the drinker. • Abuse was seen as the work of the devil, punishment was consistent with the dominant form of social control, religion. • Distinction between drinking and habitually being a drunk.

8. Historical Foundations • Free-Will • People behave the way they do because of the enjoyment and profit derived. • E.g. people break laws with intent, not by accident. • Jonathan Edwards • Freedom of the Will • Free-Will doctrine is at odd with the medical model, perhaps the clearest example of an explicitly moral paradigm on deviant drinking.

9. Deviant Drinking as Disease • Benjamin Rush • An Inquiry into the Effects of Ardent Spirits Upon the Body and Mind. • Mapped bodily and behavioral effects of alcohol • Provided a systematic clinical picture of intoxication. • Moral Thermometer • All people who have lost control of their drinking suffers from disease. • “A disease of the will” • This idea was further backed by Thomas Trotter • The key point behind both Rush and Trotter was their connection between drinker and drink as an addiction to liquors. • Further medicalization of alcohol affected moral language used to describe effects of alcohol. • E.g. the “love” of the drink was replaced by “craving” and “insatiable desire”

10. Disease Concept and American Temperance • Identification of chronic intoxication as a disease was attractive to those who urged control and reason in drinking behavior. • Clinical description of physiological effects toward end of 18th century. • Benezet • Observed behaviors with spirits among peers • The Might Destroyer Displayed • Distributed pamphlets that illuminated the medical problems with alcohol.

11. American Temperance • “Temperance Physicians” proved that repeated intemperate drinking is a disease. • “Drinking is a disease” became the rallying cry of the temperance movement • Widely shared thought between middle class as the perils of drinking • Disease as a label • Universally negative connotation • Unwanted • While intellectually and scientifically there was no “disease” of alcohol, this idea was a strong moral statement of the time.

12. American Temperance: Prohibition • Inebriate Asylums • Special hospitals for drunkards • Pg. 83 for specific treatment of patients. • National Temperance Society • Made of almost exclusively of physicians and members of the medical community. • The Journal of Inebrity • Ruled alcoholism as too technical and esoteric to warrant serious attention • 18th amendment passes for 13 dark years.

13. Post-Prohibition Rediscovery: Three Main Developments and The Yale Center • No organized support for alcoholism as a disease until the end of the 19th century after Prohibition • Scientific influence increased, church influenced decreased • Legalization of the chemical contributed to its changing image as a deviant behavior • Three Main Developments lead to a changing conceptualization of alcoholism as an illness • Yale Research Studies • Purpose was to study alcoholism from a social and personal perspective • However, they only ended up receiving funding in way of a more biological approach • The studies impacted the community as the notion of “alcoholism is a disease” grew in popularity • Yale Clinics assisted people struggling with alcohol by reaching out to treatment and rehabilitation centers • This shift offered relief to the jails and court systems (note the shift in authority) • Terms like, moral crusaders and humanitarian guardians were bused • Various organizations grew in their support, academically and financially, of the Medical Model,

14. Post-Prohibition Rediscovery: Alcoholics Anonymous and the Jellinek Formulation • Alcoholics Anonymous  • 2nd post prohibition development  • Oxford group, religious movement  • Oxford Group: 1930s, small discussion groups, shared confessions, honesty; talking out emotional problems, praying period • Bill W. -founder of AA; experienced a spiritual awakening at Oxford Group. Influenced by Dr. W.D. Silkworth • Basis of AA- Influence the thought of physical allergy in the body. - Many Americans see alcoholism through these AA ideas and principles. - Aims to ultimately relabel chronic drinkers; rid them of negative labels. • Recovery Theory • JellinekFormulation • E.M. Jellinek : codified the various meanings of the disease (alcoholism) concept as it had developed over the previous century and a half. • Challenge and Defense: Mark Keller and the Post-Jellinek era. 

15. Is Alcoholism a Disease? • Considering the historical-constructionist perspective on the medicalization of deviance can help to conclude that alcoholism is a disease. • Alcoholism has been defined as a disease since 1940. • Before 1940, the disease definition was either ignored or not contested by the American medical field. • Medical professionals looked down upon habitual drunk individuals due to their own high standing and positive reputation in the community. • In the eyes of the medical field, drunks did not possess any self-control, were negligent, and were completely unmotivated.

16. Multiple studies were done to decide the views of the American medical field on “alcoholics.” • A very collective view taken from these studies was the thought that the intoxicated individual was “hopeless” and “weak.” • Harold Mulford conducted a study in 1961 that showed that 65% of the people surveyed considered the habitual drinker to be a “sick person,” but only 24% embraced the idea of a illness without assigning a moral judgment. • In 1977, Janet Ries found that alcoholics were considered to be in control of their actions and addiction. • When compared to other individuals living with a disease of their own, alcoholics received the greatest amount of intolerance from bystanders. • Harold Bischoff found that 60% of medical professionals entertained the idea that the person affected by alcoholism was responsible for their condition of addiction, unlike other diseased persons.

17. Medical Response to the Disease Concept • In the medical profession, alcoholism is seen as a disease. This is one of the main defenses to the idea that habitual drinkers suffer from an illness. • The idea of alcoholism is included in the medical fields manuals of diagnosis, and is known as a “mental disorder.” • These manuals are used by the entire medical community to identify and treat diseases. • In most of the manuals, alcoholism is referred to as “alcohol addiction.” • Hospitals have been known to refuse admittance to alcoholics and not consider them as true patients. • Many statements made to include alcoholism are vague when considering the ailment and its management.

18. Supreme Court and the Disease Concept • The Supreme Court argues that drug addiction is a disease. • The court states that it is illegal to penalize an individual for the straight symptoms of a disease, according to the Eighth Amendment. • In two 1966 cases, the court ruled in favor of both defendants. This was decided based of the medical field’s recognition of alcoholism and opiate addiction as a disease and the consideration that it was unlawful to punish the two “ill” individuals. • Although the Supreme Court favored the defendants, it was made very clear that the individuals were not excused for their behavior and deviant acts committed while intoxicated. • After the rulings of these cases, the medical and judicial departments were faced with the decision of finding an adequate treatment center for the individuals affected by alcoholism.

19. The court and medical field found that they had two options to choose from, confine the ill to mental facilities to be observed or to set them free without adequate treatment. • In 1968, there was a case of alcoholism were the defendant was ruled guilty in a five-to-four vote. The court stated that there was an absence of medical treatment facilities and that they would not allow the alcoholics to end up “roving the streets.” • After this ruling, the court expressed its disapproval of the medical community’s lack of education on alcoholism as a disease. • Hospitals and treatment facilities attempted to better treat alcoholics and to encourage their consistent admittance into said facilities. • Arguments were made that the help the alcoholic needed might have to come from a supportive family, close friends, counselors, etc. • Selden Bacon stated, “That to put it mildly, is strange medical practice.”

20. The Future Of The Disease Concept Of Alcoholism • Critics of the medical model in terming alcohol as a disease are slowly emerging • They argue that although the disease concept has been a practical strategy, it has outlived its usefulness. • The disease concept has become “an obstacle to progress in alcohol studies and problem solution”.

21. The Future Of The Disease Concept Of Alcoholism • In the past we have turned the problem over to churches, schools, or jails; now it is the medicine we turn to. • Relying on the medical model reduces interest and need in other research methods, training, and facilities.

22. Thomas Kuhn • He has identified various findings that threaten the disease paradigm by putting their claims to the test. • First, there was no clear medical definition of “alcoholism” for the longest time. • The proposition that alcoholics have predisposing characteristics that consistently differentiate them from nonalcoholics has not been supported by research.

23. Scientific claims • The medical model says that alcoholic drinking is a progressive process resulting in severe and “chronic” alcoholism. • Yet the evidence shows that there is no predictability when it comes to the continuation of problematic drinking. • The medical model also says that if a sober alcoholic resumes drinking, they will loose control of their actions. • The research shows otherwise, with experiments showing it depends on the circumstances at the time of renewed drinking. There is not a pattern of continued drinking.

24. Scientific claims • “Once an alcoholic, always an alcoholic” because of pushing psychological forces. • However, when an alcoholic becomes controlled, or normal “social drinkers” then those psychological forces are nonexistent.

25. The Future Of The Disease Concept Of Alcoholism • We no longer need to define someone as “sick” in order to help them cope with their behavior. But completely changing the way we view alcoholics would be a difficult task. • The emerging “problem drinkers” approach might be an easier change versus a new paradigm. • No underlying disease is associated with the drinking, only the behavior itself.

26. Credits / Emails • ekirby1@g.emporia.edu • eblack1@g.emporia.edu • ksatchel@g.emporia.edu • vgutier1@g.emporia.edu • hmulvihi@g.emporia.edu