NIAAA Official Says Alcoholism 'Isn't Usually' a 'Chronic, Relapsing Disease'


The Los Angeles Times notices that people can overcome drinking problems without abstaining from alcohol for the rest of their lives. More important, the Times quotes Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, who admits that the one-size-fits-all, abstinence-only approach preached by Alcoholics Anonymous is inconsisent with the evidence on drinking patterns (emphasis added):

We're on the cusp of some major advances in how we conceptualize alcoholism. The focus now is on the large group of people who are not yet dependent. But they are at risk for developing dependence….[Alcoholism] can be a chronic, relapsing disease. But it isn't usually that.

Sticklers may question whether a pattern of behavior—in this case, excessive drinking—can ever be accurately described as a disease. But for the treatment establishment, long dominated by A.A.-style thinking, these concessions count as substantial progress. The Times attributes the shift to the findings of the National Epidemiologic Survey on Alcohol and Related Conditions, which has been checking in on a representative sample of 43,000 Americans since 2001. According to the survey, "About 30% of Americans had experienced a disorder…but about 70% of those quit drinking or cut back to safe consumption patterns without treatment after four years or less. Only 1% of those surveyed fit the stereotypical image of someone with severe, recurring alcohol addiction who has hit the skids."

The Times understates the significance of these numbers, saying "top addiction experts" now believe that "many drinkers can evaluate their habits and…change those habits if necessary" and that "even some people who have what are now termed alcohol-use disorders…can cut back on consumption before it disrupts education, ruins careers and damages health." What the research actually indicates is that the vast majority of problem drinkers "get better" without treatment. And among those once classified as "alcohol dependent," moderation is about three times as common as abstinence. The scenario that traditionally has been presented as typical—the alcohol abuser who can get his life back on track only by swearing off booze forever—is in fact unusual among problem drinkers.

The psychologist Stanton Peele, an addiction expert who has long questioned the abstinence-only approach to alcohol problems, highlighted the evidence supporting a moderation alternative in the November 2000 issue of Reason.

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  1. What you mean drugs don't take away your free will? You mean just because you drink that isn't an excuse to be a degenerate? That we are still free to act responsibly? Who'd a thunk it.

    We will never end the drug war until we end the rehab industry and the myth that drugs are poison that take away your free will.

    1. Well, never miss an opportunity to be a blowhard with all the answers!

      1. Never miss an opportunity to remind everyone you're a nanny-state douchebag.

      2. Open your mouth again. I dare ya.

    2. How would you end the drug war? Continue locking every user up until half the country is in prison? We could just chain everyone up, just to be safe. You're such a libertarian John!

      1. Tony, you retarded fetus, may I ask how the fuck you got that out of John's statement?

        1. I get the feeling Tony was responding to Ray "I'm Not a Blowhard but You Are" uh Butlers.

          Threaded comments strike again.

          1. *was trying to respond to Ray

            (just noticed that he actually addressed it to john, so now i'm totally confused as well)

            1. Tony probably thinks prison is the only alternative to being force into programs like AA. The option of government being completely uninvolved doesn't exist in his world. So, since John doesn't like the rehab industry, he's in favor of locking up drug users, according to Tony's thought process.

              1. John is an authoritarian Republican who doesn't like to pay taxes. He thinks drug addiction is a moral problem and is in favor of the drug war status quo.

                1. Tony stop talking out of your ass, John might have a tendency toward being a Republican apologist, but i've never seen him tow the drug war lion.

              2. And I am anti-AA as it is not evidence-based but religiously-based and doesn't have a track record of actually reducing alcoholism.

              3. I think we got caught between two facetious posts.

                *insert the simpsons bullies not being sure about their own sarcasm anymore*

  2. the one-size-fits-all, abstinence-only approach preached by Alcoholics Anonymous is inconsisent with the evidence

    But as a quasi-religious institution, AA does not concern itself
    with epistemological inconsistencies.

    1. I'll drink to that.

  3. 'Isn't Usually' a 'Chronic, Relapsing Disease'

  4. From my own experiences as a child of someone who has been deeply involved with AA for many years, I have to say that, from their perspective, it's the most useful solution to the problem they have. I have a hard time believing that anyone who's been in the program long enough truly supports court-ordered meetings as an effective disciplinary/reform tool. The idea is that "it works if you work it." Since one of the primary tenets of AA is that it's entirely non-profit, they don't worry about "losing market share" to other praxes or paradigms.

    1. Have you ever worked with not-for-profits? The turf wars are constant, as is the competition for grant funding.

  5. AA is an explicitly religious organization that preaches that you are not responsible for your addiction and that only your "higher power" (i.e. God) can help you fight the demon alcohol. It throws personal responsibility out the window.

    1. Missing that point comes as no surprise. Did you know that sometimes people don't have any personal responsibiltiy and that AA gives someone to shoulder the burden?

    2. Well, not really. AA tells its members that they have to change their lives. Throwing in a 'higher power' doesn't change the fact that the person, not God, is the one who has to decide that they life sucks so bad that they need to quit drinking. They do emphasize that the individual has to take responsibility for their actions.

      As the son of an agnostic alcoholic who went cold turkey without AA, I can attest that AA doesn't work for everyone, just those susceptible to quasi-religious beliefs.

  6. """The focus now is on the large group of people who are not yet dependent. ""

    How many drinks do you have in a week?

    I recenly had a friend tell me a story about how his doctor was appalled by him drinking a bottle of wine on the weekend. Doctors like that may want to report you as a potential problem.

    If the doctor uses an EMR, your alcohol consumption may be reported to the city or state.

    1. I seem to recall a Balko link from some time ago about a man in PA who had his license suspended because he told his doctor he drank a 6 pack every night.

    2. Doctors are nanny state loving bastards. They give you shti about drinking, owning guns and pretty much anything else that is none of their business.

      1. You're over-generalizing. Doctors can be libertarians, nanny-statists, Rs, Ds, the whole gamut.

        I'm married to one, and know hundreds of them.

        1. Oh, and the chief lobbyist for the Hawaii Rifle Association is a doctor and a friend of mine, so I'm so not buying that "all doctors want to take away your guns" bullshit.

        2. Fair enough. Not all of them. But a lot of them are.

          1. I worked on an epidemiology project when out of school, doing surveys of tens of thousands of people in the NYC area. The questions on alcohol consumption labeled anyone who had 12 or more drinks in a 7 day period or more than 4 drinks at one sitting an alcoholic.

            The PhD running the project mentioned she had done a similar project in Europe, and told me that almost 85% of the German population was considered alcoholic.

            1. We is all alcoholics now! *burp*

    3. If my doctor told me I had a drinking problem for drinking one bottle of wine a weekend, I'd be going to different doctor. If I'm really destroying myself and you can show me, fine tell me that if I continue drinking I'll do whatever damage to my body based on your expert opinion(that's part of the job). If you're appalled at my behavior keep it to yourself, or tell me you don't want to treat me. Don't judge me.

      1. But doctors are better people than you and me. They KNOW better. You should just listen to their sage advice.

        (did i manage to keep a straight face there?)

        1. The same stupid fuckers that die on average 10 years earlier than other people.

          Doctors are like everybody else. 80% of them are ok or bad at their jobs.

      2. Oh, and 4 in a sitting? I'm on the "12 beers in a 24 hour period" plan.

    4. The problem is made worse by forcing professionals to do police work. Like bank tellers reporting too much cash or not enough cash or depositing the same amount of cash every Friday.

  7. This isn't generating the density of glazed-over new guys that posts about cults usually bring out. Arise, StepWackos, and testify.

  8. Epi,

    I'm not so sure either is accurate. I had a freind in another Anonymous program (not alcohol) who was a staunch atheist. The first few meetings had a high Christian demographic, and he was turned off. On one of the christian's suggestions, he tried meetings down near the local university. There's a lot of atheists there and they tie into some non-divine higher power. And he said it worked for him.

    Second, one of the twelve steps is apologizing for you past actions, which requires one to take responsibility.

    1. What exactly is a "non-divine higher power"?

      1. My wife, Michelle.

      2. The guv'ment?

      3. Todd, is there any power higher than yourself? Then that is a "higher power." for example, the love of your children who you might be pushing away by waking up in your own vomit at 3 AM.

      4. Chuck Norris.

        Oh wait, you said "non-divine". Never mind.

      5. The gravitational pull of the supermassive black hole at the center of our galaxy?

        How's that work?

      6. Myself.

    2. Apologizing for your past actions is not taking responsibility when you blame those actions on the alcohol.

      AA explicitly states that you are powerless to control your alcohol use and need the help of the "higher power".

      It may help some people, and that can be good, but it's still a fucked up way of dealing with a problem.

      1. It's less fucked up than continuing to get so fucked up every night that you can't function.

  9. Two thoughts:

    Alcoholism, like gambling, like smoking, is not a disease. It is a behavior.

    Major missed alt-text opportunity. C'mon, the bar has been raised!

  10. AA does have the philosophy, though, that you're only sober if your in the program.

    If you stop drinking on your own, without the help of "the program," you're just a dry drunk who really hasn't helped him/herself at all.

    I've never really understood that philosophy.

    Disclaimer: child of an alcoholic who used AA to overcome the drinking (successfully and w/o proselytizing me). Married to another CoaA whose sober parental unit proselytizes at every fucking turn.

  11. I quit drinking once.
    I went to an AA meeting, but it didn't help. All they did was talk about booze...

  12. Hmm. Yeah, I fit the pattern. I used to drink a lot. Like a 12 pack a night on weeknights, and more than that on the weekends. That period also includes one DWI, an ordered psychiatric evaluation, and one month where I spent every day some variety of hammered. Drinking wasn't doing me any favors.

    Now? Well, right now I'm taking Vicodin for a surgery, so I haven't had anything to drink for two weeks. But in general my alcohol consumption is down to one beer in the evenings. And all this without ever going to an AA meeting or anything else. I just have other things to do now than drink myself senseless.

    1. I used to drink a lot. Like a 12 pack a night on weeknights, and more than that on the weekends. That period also includes one DWI, an ordered psychiatric evaluation, and one month where I spent every day some variety of hammered.

      Sounds like everybody in my SAE pledge class.

  13. Man, what's with all the AA hate? It's a voluntary self-help organization that has no political agenda. If it works for them, why shoot venom?

    1. Because often it isn't voluntary. Many DUI/DWI offenders are forced to go to AA. Which to me, since you have to "submit to a higher power," goes against church/state separation.

      1. Exactly. There are a lot of judges who think nothing of ordering people to AA without any consideration of whether they might be atheists.

      2. It's my understanding that they can attend in lieu of other penalties. So if they want to pay a fine, lose their license, go to jail, then they can choose that instead.

        Alternatively, this is not a reason to dislike AA it is just a reason to dislike judges ordering people to go to AA.

        Also, I think even atheists can admit that there are things in the universe with greater power than themselves. Like the Sun. Or a hurricane.

        1. I have a higher intellect than the sun and all hurricanes combined.

          1. Then why do hurricanes always win?

        2. A hurricane can help control my drinking?
          Gotta be at least a Level 3, right?

          1. Uh, The Hurricane is a drink. How does giving yourself over to an alcoholic drink help with alcoholism?

            1. Well, it certainly helps the drinking continue. OH, sry, you meant help stopping.

              Who cares. Pass me one of those Hurricanes.

              1. Knowing a hurricane is coming is an excellent reason to drink.

                1. What else is there to do in the storm cellar? (gonna steal the obvious 1st answer: Screw)

            2. i've never blown more chunks than when i drank hurricanes all night on bourbon street when i was 22.

        3. Actually, in almost all DUI cases (esp. repeat offenders), "treatment" e.g. AA is required as part of the sentence in addition to other penalties like probation, fines, interlock, etc. Appellate courts have consistently ruled that forcing someone to go to AA is unconstitutional but often defendants don't fight it because they don't want to piss off the judge.

          1. Again, not AA's fault?

            1. I dunno. Does AA oppose their mandatory attendees or do they welcome the influx? Or do they just not address it?

              If they have actively opposed the practice, then more power to them. Otherwise, yeah, they can share some of the fault.

              1. AA isn't an organization with a leader. It's a bunch of individuals working off a common text. So there is no "AA" to oppose the practice. There's just a bunch of groups that welcome anyone who shows up for that meeting.

                1. Whoops. I had no idea. I would've assumed they had some over-arching national org to work on literature, media, and a single website, stuff like that.

                  I might just be lumping AA and MADD together. Again, My Bad.

                  1. There is a General Service Office (GSO)that dictates general policy matters, but each AA group is more or less self-autonomous, so long as they abide by the 12 steps and 12 traditions. A member can choose to become a member of one particular group as a "home group". Home groups meet regularly and decide things in the "collective conscience". i.e., smoking/non-smoking, functions, appointees, etc.

              2. Most groups fill out attendance cards without question, but are not required to.

                One particular group in my area did refuse. The chairman explained it more or less that AA was founded as an organization of attraction rather than promotion and that if you didn't want to be there voluntarily, you shouldn't be there at all.

                This was the only thing that asshole ever said that was respectable in the least.

            2. What is objectionable is that AA takes all comers, ordered there by courts, and applies a one-size-fits-all by telling everyone at the meeting that they have a disease. A friend of mine had a DUI and was ordered to attend. They had him convinced he was an alcoholic when in reality he was just too cheap to take a cab home.

  14. Were alcohol not the only legally obtainable drug, we would see a lot less problematic drinking. Sure, there will always be people who struggle with one substance or another, but it would be so much better if people were free to decide for themselves which substances work for them and which don't.

  15. R C:

    exactly. if alcoholism is a disease, then i'm a victim w/out responsibility for my condition. haven't met a person yet who beat diabetes w/ the 12 step program...

  16. Alcoholics Anonymous provides *one* path to recovery. Other methods can work, too - it's not either/or.

    A couple of commenters seem to suggest that *nobody* who holds traditional Christian views on sin can believe in free will. I think that's overgeneralizing. Bottom line: Yes, you can believe in the Christian concept of God and salvation through Christ while still endorsing the idea of free will and moral responsibility.

    Free will has perhaps prompted more debate, and more diverse views, among Christians than among other groups. Somewhere in there, you should find something resembling your own views on the subject.

  17. If it's a disease, and to prevent disease you get a small dose of the disease, it stands to reason (not yet...) that alcoholism should be vaccinated against every holiday season (OK, now drink) with semi-annual boosters (let's call them weddings or Cinco de Mayo or whatever).

  18. Did AA ever say that its approach is one-size-fits-all or that all alcoholics must quit cold turkey? I've never been in AA, so I can't speak from firsthand knowledge, but it would seem to me that the people who can quit on their own would never find themselves at AA to begin with, and people who don't find success with AA would leave and try something else. For those of you who have firsthand experience with them, pleas correct me if I'm wrong.

    The underlying problem I'm hearing here with AA is its quasi-religiousness. That's a perfectly fine reason for somebody to make the personal decision not to attend AA (and for courts to not force others to attend) but it fails to persuade me that it doesn't belong in the marketplace of ideas when it comes to treating alcoholism.

    1. A big problem is that many who do find themselves at AA in the first place are there due to compulsory attendance, not because they can't quit on their own.

      I can only speak about AA in my area, but from my experience with it, a good many of the "alcoholics" there aren't alcoholics, but people who've come to believe that they are.

      1. You ain't an alcoholic 'till you start goin' to the meetings.

        (an old SNL line if IIRC)

        1. Because Drunks don't have a problem with their drinking.


          Something along those lines. And i think it was a stand-up act, not SNL, but my mental reference engine isn't coming up with who.

    2. AA meetings vary tremendously--each group pretty much operates independently and has its own personality, based mainly on the most senior/influential members. Some groups are tolerant of other approaches, non confrontational, and open minded. Others are dictatorial, dogmatic, and domitated by control freaks who have replaced alcoholism with other addictions.

  19. I quit drinking, usually when it's time to go to bed.

    1. I second this motion.

  20. 20 years ago I was married to a dirtbag whore so I started drinking to dull the senses (had never really drank before that). Got up to about a quart of hard liquor per day. So she start bitching about my drinking being the sole cause of all of her problems. So I said okay, bitch, and went cold turkey. No AA, no nothing. Not a drop for more than five years. Oddly, her problems never went away so I threw her ass out of my house. About 5 years after that, I began to drink responsibly. Been doing so for about 10 years.

    The problem for most heavy drinkers isn't alcohol, it's marrying dirtbag whores.

    1. Threadjack: how do you end up marrying someone like that? Are you such a poor judge of character that you can't see the dirtbag whore underneath the cleanbag whore exterior? Don't you figure this shit out before getting hitched?

      1. Some people are very good at hiding the rotten core. Look at how I fooled my poor wife.

        1. Yeah, but you're an android programmed to fool people. Most dirtbag whores aren't.


      2. If she was good-looking, that would explain a lot. Can takes a year or three before the cognitive dissonance builds up to the breaking point.

        1. add demon in the sack and you could easily be up to 6 years

    2. Can I have her phone number?

    3. She started out great, but then devolved over time. Fell in love with money. Pity, that. My divorce attorney said that in all her years of practicing family law, she was the strangest person she's ever had to work with.

  21. Were alcohol not the only legally obtainable drug, we would see a lot less problematic drinking.

    I have a friend who comes from a family with a lot of people who have drinking problems. He's told me that if he didn't smoke pot, he's pretty sure he'd have become an alcoholic.

    1. I had a friend like that. He chose video games as his addiction. Never drank a drop.

      Never got laid either. Ever.

    2. Willie Nelson says the same thing. He says that when he came up as a country musician in Texas and Nashville, everyone drank wiskey and smoked. Had he not discovered pot and stopped drinking, he says he would have been dead years ago.

      1. Yeah, I once heard an interview with Joe Nick Patoski where he said Willie was one mean drunk, but the weed kept 'em mellow. I'm just glad I'm not a mean drunk because I'm not about to give up beer any time soon.

        1. I'd hope not, after all the work us posters put in on your keg measurement system 😉

  22. The problem for most heavy drinkers isn't alcohol, it's marrying dirtbag whores.

    Or just having a shitty life in general.

    1. No No. Let's blame the substances, not the situations that caused people to abuse the substances in the 1st place.

  23. Also, there are non-Christian secularists who will tell you about how science disproves the whole idea of free will. I've heard some of them. Perhaps you've met some of them yourselves.

    1. There are non-Christians secularists who are envirowhackos and commies, too. Not a ringing endorsement.

  24. haven't met a person yet who beat diabetes w/ the 12 step program...

    Bad choice of diseases, unless you're talking about Type I diabetes. Type II could often be "beaten" if people weren't lazy asses unwilling to change their diets.

    1. That's how my great aunt beat it. Nearly made it to 90.

      1. My name is Sugar F. and I am an insulin addict.

        Sometimes it feels like I'd die if I didn't take two hits of it a day.

        1. So what happens to you if you try an Atkins-type diet with almost no carbohydrate? I remember some quote in Good Calories, Bad Calories to the effect that diabetics are insane to take insulin in order to eat cake.

          1. You just back off the amount of insulin you take. Even eating zero carbs doesn't mean I get to stop taking insulin. I'd still need it to metabolize sugar from fat storage.

            I restrict carbs, but I can't stop eating them at an Atkins level. I'm just not rational after a day or so.

            The slow v. fast absorption of food doesn't really matter that much to my type of diabetic. The only insulin I get is what I take. So there is no insulin build-up and crash I can train my body out of. In fact, for certain times of insulins, slow absorption food can mean that a fact-acting insulin is already out of your system by the time your blood actually needs it to release sugar.

            1. Sounds shitty. Are you a type 1 then?

              1. I and II. I don't produce insulin and I'm resistant to the insulin I take.

                1. Jesus. You probably know that for nearly the entire 19th century, and the early 20th, they used to prescribe codeine for diabetes. Perhaps you could ask your doctor...

                  1. SF, I know you had diabetes, and I figured from other things you had said that it was metabolic, and not due to control issues, so I was careful to add "often" to my original post.

                    I should probably add that I "12 stepped" type II diabetes myself. A couple years ago, I was over 200 pounds (I'm 5'8"), and at a doctor's visit, I was asked if I was ever diagnosed as diabetic - due to a blood test.

                    For the next four months, I ate mainly broccoli, cauliflower, celery, strawberries, and watermelon - all of which have less than 200 calories a pound. I also started exercising again. I lost about 30 pounds over that time.

  25. DSM still (I believe) defines alcoholism in terms of physical dependence, and I have known people who were absolutely unable to control the urge to drink. I get the impression that people like this are pretty emotionally unbalanced to begin with, and would probably be so one way or the other. That said, I think this is rather rare, and I get annoyed by MDs, bureaucrats, and self-help types who try to characterize all drinking as varying degrees of physical dependence. Sometimes I go through periods in which I drink every day (job stress, life stress, etc.), but it doesn't bother me to stop for weeks at a time either (which I did when training for a race this summer).

    As far as AA, whatever. If it helps someone who's desperate to find help, they can believe what they want to.

    1. Physical dependence, and additionally interfering with your day to day life. If you get irritable without your morning shot of tequila, you're not an alcoholic. If you beat your wife after your morning shot of tequila, you are!

  26. I've got a great life. I drink because I like it. What the fuck is wrong with me?

    1. That you rationalize too much? 😀

      1. I dunno, actually sounds like hypochondria.

        Move along Citizen, nothing to worry about here.

    2. A bad case of Libertopus. You start with simplistic generalizations about complex subjects, progress to obnoxious self-righteousness, and in serious cases develop a tendency to join in cult worship of a dead caped lady in the name of hyper-individualism.

      1. Attila!!!

  27. I'd rather have a bottle in front of me than a frontal lobotomy.

    1. fixed link dammit:


  28. What the fuck is wrong with me?

    I would venture a guess that, like the majority of posters here, your drinking habits are the least of your mental issues.

      1. And just 51 minutes 'till bar time. Yum.

  29. I think the idea was that it was a disease in the sense that it had a certain predictable progression.

    How should "disease" be defined?

  30. Definition from Websters:
    a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms

    I can see alcoholism fitting in there. It's certainly a condition that impairs normal functioning that is typically manifested by distinguishing signs and symptoms.

    1. Except i don't think disease should be defined by the dictionary.

      It should be defined my medial practice.

      Kinda like how particles shouldn't be defined by a poster of the standard model, but by experimental practice.

      1. *by medical (gettin worked up about the subject, time for another beer)

        1. Er, if it it is defined by medical practice then it certainly is a disease, as most medical practices will recognize alcoholism as a disease.

          1. I'm not sure how to clarify my idea. Meant practice as the act of medical diagnoses and treatment. Not the name for a doctor's business.

            "People wont stop drinking, so it must be a disease" isn't the same as "Well, there's this g-protein coupled receptor, and in the presence of alcohol it....and voila that's WHY they cant stop."

            The former being the conclusion one reaches using a dictionary, the later conclusion one reaches by using science.

            Until, there's something to diagnose the "disease" from aside from behavior, well, I'm just not gonna buy it. Same for ADD/ADHD and Autism (more crappy dictionary diagnoses if you ask me)

          2. And yeah, DSM definitions are based on studies, but i think we know how those studies work out when something sinful is involved.

            1. I think there are many non-behavior symptoms of alcoholism doctors refer to when diagnosing it.

              1. Not true. Unless it's changed since DSM-IV, "alcohol abuse" is, basically, persistent use in spite of adverse consequences. "Alcoholism" is defined as physical dependence on alcohol, however the physician might define that. There's no sort of blood test or imaging study that defines a case.

              2. Not symptoms of the alcohol use (ie impaired liver, kidney, etc) but the CAUSE of the alcoholism.

                Diabetes isn't a disease because of the possibility of lost limbs or life. Its a disease because it impairs the fuctioning of the body's sugar regulation system (which can LEAD to loss of life and limb).

    2. I think most people who object to calling alcoholism a disease get hung up on the voluntary/involuntary aspect. I can't wake up tomorrow and decide to stop being a diabetic. I can't meet with a bunch of other diabetics and slowly give it up my sheer willpower.

      While I don't think it is not a disease, I see a distinction between between the voluntary and involuntary disease.

      And instructive model is the Type I diabetic and the Type II diabetic. I is an autoimmune disorder that usually strikes in childhood. II is usually the result of being, well, fat. Since I was I and then II, I've seen both sides. Some, maybe many, doctors, are pretty shitty to you if you are a II.

      "You brought this on yourself." It's hard to shake that, because it is partly true.

      1. Is high blood pressure not a condition? Some people with it can, simply changing their habits, drop down to safe levels.

  31. I'm not sure if any of it even matters. If it's a disease or a habitual pattern of conduct, both can be tough to beat and proper objects of sympaty and neither should totally absolve one of responsibility. A Wild Irish Rose by any other name...

  32. As for the whole "why's everyone hating on AA":

    I think that reaction happened because AA teaches a drinking/abstinence dichotomy. The material Sullum was talking about refutes such a dichotomy.

    It doesn't mean AA is crap. It just makes their stance one point on a spectrum of drinking.

  33. I think we should view addiction as a health problem. Boilerplate nonsense about "personal responsibility" misses the point that an addiction by definition takes away at least some free will.

    All drug dependency should be treated as a medical condition rather than a moral issue or a crime. There is pretty convincing evidence that this attitude goes a lot further to minimizing the social problems associated with drug and alcohol use.

    1. Agreed. The goal of harm reduction should be paramount to the search for the ultimate truth on free-will and consciousness alteration.

      1. (once the harm is suitably reduced, we can all hang out and get blasted considering the 2nd part)

    2. Go fuck yourself Tony.

      1. This is just unfair... what did I say? I favor legalizing all drugs and treating addiction as a medical condition rather than an excuse to lock people up by the millions. Isn't this supposed to be a libertarian magazine?

        1. Yes, but this place is very impolite at times, much to its discredit. Die of AIDS, Tony.

          1. In shadowy gay underground, AIDS dies of Tony.

    3. I think it should only be treated as a medical problem if the dependent person wants it to be. Otherwise it should not be anyone's business.

      1. Well, it is a medical condition. If people don't want to get treated for their conditions that's their right of course.

    4. If only you could kick your posting on H&R addiction.

      1. People, people, Tony has said nothing out of line yet. You know he will eventually, can't you just be patient before insulting him?

        1. I blame Lonewacko's absence. Everyone was just dying to tell him to STFU and Tony bore the brunt instead.

  34. If people don't want to get treated for their conditions that's their right of course.

    And if they do want to get treated, they need to pay for the treatment, not the rest of us. Right, Tony?

    1. I'm in favor of single-payer coverage of all healthcare costs in this country.

      1. I favor a single-payer open bar.

        1. at last: change I can believe in...!

        2. You're not being creative. Under Tony's system we could have unlimited methadone.

      2. See? Told you he'd get there.

        1. Tony loves all government, all the time, in every hole.

          1. And you definitely seem to have a thing with anal penetration.

  35. It's starting to look like the H&R trolls have no slot in their "liberal boilerplate tripe" decoder ring for a post about alcoholism.

  36. I was arrested for DWI at a checkpoint about five months ago. FWIW, I don't recommend going through that sort of thing. One recommendation I got was to seek out my own counselor before I ever saw the judge. One reason is to look good to the judge and show that I am taking responsibility on my own. The second reason is, in the case I am sentenced, the judge *may* let me stick with my own counselor rather than force me to attend AA meetings. So I chose a counselor who advocates moderation rather than abstinence because I think I can control my drinking and I don't want to be forced to go to AA.

    The moderation guidelines I have are: no more than four drinks in a day, no more than fifteen drinks in a week, and no drinking on consecutive days. That's quite a cutback for me, but it's definitely better than abstinence as far as I'm concerned.

    My counselor has diagnosed me as a problem drinker, not an alcoholic. I guess the difference is a problem drinker occasionally lets their drinking get out of hand, while an alcoholic simply cannot function without alcohol. I've already changed my drinking habits significantly after my wake-up call.

    Is alcoholism a disease? I don't know. According to my counselor, there is a hereditary link when it comes to problem drinking or alcoholism, so it does have disease-like similarities. Whether it's a disease or an addiction, I don't think our much-too severe DWI laws help the underlying problem of addiction. And don't even get me started on checkpoints.

    I really don't have a problem with AA....just that I don't think it's right for me. As someone noted, if an alcoholic who needs help gets it through AA, more power to him. I think judges impose AA meetings because AA doesn't cost a defendant or the state anything and it looks good to MADD. I think a defendant should be allowed to substitute their own counseling for AA, but I'm sure the MADD people in the courtroom would go ballistic.

    So after all that, I am glad to see a study out there that shows that what I'm trying to do with my life can be done and has been done by plenty of people.

    1. Good on ya, Some Guy, good on ya.

    2. Good luck with that. Sorry about your trouble. Just out of curiosity, isn't it a condition of any DUI probation that you abstain completely? Not that it makes sense, just another manifestation of the new prohibition.

      1. Thank you. Yes, abstaining completely is usually a condition of release and of probation. Another condition is that you can't go into bars or handle alcohol. My case was dismissed for a time while the state got their act together. During that time, I was free from those restrictions. Once the state refiled their case, those conditions were imposed on me again.

  37. Something that majorly confuses thinking about this is the conflation of 2 definitions of "alcoholism", both consistent with types of -isms. One definition is the physiologic effects (acute & chronic) of alcohol. The other definition is the behavior pattern or tendency.

    1. But neither the acute nor chronic problems present in people without the pattern or tendency.

      Once again, basically saying "People who drink too much don't live as long." No diagnoses for why they keep drinking so much, despite the consequences.

      Personally, I'm hoping I get a heart attack before my liver gives out. Would rather die quick once my time is up. What does that make me? I know my drinking is destroying my insides, and i do it anyway, fully expecting to not live past 50.

      Do i Abuse Alcohol, am I an Alcoholic, or am I just a Nihilist? Maybe Just Happy? or just Dumb?

      And it all comes back to behavior defining a disease. I'll accept concomitant behaviors with a diagnoses, but i demand a physiological cause.

  38. I asked a lady with terminal cancer if she's ever heard about the disease theory of alcoholism. She said no and asked if I could explain it to her. I began to explain that there are people that believe alcoholism to be a chronic and progressive disease. These same people also believe that the only way to treat it is through a spiritual experience with the help of Alcoholics Anonymous. After I explained all this to her, she immediately and hysterically laughed! I asked, "Ma'am, why are you laughing?" She responded, "That is the funniest thing I have ever heard of in my life!"

    After the laughter there was a brief pause and I really started to think about this more than I ever had. I started to think about this woman's situation and how she truly had no control whatsoever over the outcome. I began to think about how she can't just change her actions and make her cancer go away, much like an alcoholic can make his problems go away if he just stopped drinking. I started to think about how companies in this country promote certain feelings as 'diseases' just to make a profit. I started to think about how Alcoholics Anonymous did the same thing with their program, just to increase their membership.

    After reflecting for a moment about alcoholism and the disease theory, I started to laugh! I laughed harder than I ever had in my life. It was just me and this woman, who is dying from a 'real' disease, laughing our asses off at one of the funniest things we've ever heard of! I'm glad I was able to put a smile on her face.


  39. Nice to see some people in America starting to question the disease model of alcoholism. In other parts of the world there is a considerable amount more research being conducted and addressing alcoholism and drug addiction as a behavioral issue and not a disease.

    1. Well said Wade. How can alcoholism be compaired to a disease like cancer? It is self-inflicted. Yes the pull is strong to drink but no on is forcing it down a addict.

  40. I'm glad I was able to put a smile on her face.

  41. Anonymous did the same thing with their program

  42. I'm glad I was able to put a smile on her face.

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