14 April, 2018
Alcoholism is viewed in a few diverse ways. Some people view alcoholism as a disease, which can then be broken down into types of diseases such as a brain disease, a family disease, or that it can cause diseases such as liver failure, and types of cancer. Other people view alcoholism as a personal defect. In this paper I will be discussing why people view alcoholism in these ways.
For starters, in “Alcohol Consumption and Non-Communicable Diseases: Epidemiology and Policy Implications,” (Parry) it explains how alcoholism causes a few types of diseases such as cardiovascular diseases, cancer, and liver disease. Cardiovascular disease is a condition that involves narrowed or blocked blood vessels. Hypertensive disease, hemorrhagic stroke, and atrial fibrillation are usually caused by alcohol. Chronic heavy alcohol use has been associated with cardiovascular diseases. With light to moderate drinking there is a protective effect on ischemic diseases, which disappears when the drinking becomes irregular or drinking becomes heavy. “For example, Roerecke and Rehm found in meta- analyses of studies which says that consumption of 60 grams of pure alcohol on occasion among otherwise light to moderate drinkers is associated with no cardioprotective effect at.” (Parry,1719) Also, the effects of heavy drinking occasionally on ischemic diseases are consistent with the physiological mechanisms. This increases clotting and a reduced threshold for ventricular fibrillation, which happens with heavy drinking. The lower risk of coronary heart disease is associated with moderate alcohol consumption. The u-shaped curve seen with all-cause mortality owes much to its cardioprotective attributes. Some suggested mechanisms include changes in lipids and hemostatic factors, inhibition of platelet reactivity, lower levels of inflammation, and improved vascular function.
“In 2007, the International Agency for Research on Cancer said that there was sufficient evidence that there was a connection between alcohol and cancer of the oral cavity, pharynx, larynx, esophagus, liver, colon, rectum, and breasts in females.” (Parry,1720) All these cancers showed evidence of a dose-response relationship. The dose-response relationship is that the risk of cancer increased with greater volumes of drinking. The strength of alcohol consumption varies for different cancers. For example, “when it comes to female breast cancer each additional 10 grams of pure alcohol per day is associated with an increase of 7% in the related risk of breast cancer, whereas, regular consumption of about 50 grams of pure alcohol increases the risk of colorectal cancer by between 10%-20%, which indicates that it is more likely for females to get breast cancer.” (Parry,1720) The average consumption for pharynx, larynx, and esophagus cancer is higher than the alcohol consumption between breast cancer and colorectal cancer. Among normal mechanisms that have been indicated for causing some cancers is acetaldehyde. Acetaldehyde is a metabolite of alcohol. After the “Alcohol Use Disorders Identification Test,”the median weekly alcohol intake of the Alcohol Liver Disorder subjects was 84 units in the cirrhosis/ progressive fibrosis group. In 2006, alcoholism was found to have caused 3.2% of deaths and was linked to 60 diseases such as, cancers, cardiovascular diseases, liver cirrhosis, neuropsychiatric disorders, injuries, and fetal alcohol syndrome.
Alcohol is associated with various kinds of liver disease, such as fatty liver, alcoholic hepatitis, and cirrhosis being the most common. The amount of heavy drinking is a crucial factor into the likelihood of developing liver disease. “For men, drinking 30 grams of absolute alcohol per day is associated with a risk of 2.8 of dying from liver disease and 7.7 for females. For men, drinking 54 grams of alcohol per day has a risk of 2.3 for acquiring liver cirrhosis.” (Parry, 1720) Several types of mechanisms have been put forward for how alcohol is associated with liver disease. For example; acetaldehyde which individually damages liver cells. Fatty liver disease, and oxidative stress play a role is Alcohol Liver Disease. In the United Kingdom, liver disease is a major cause of alcohol- related deaths.
“For pancreatitis, drinking 48 grams per day has been found, with increased volume of alcohol consumed per day being associated with an increased risk.” (Parry,1720) The situation is more complex when it comes to diabetes. “A recent meta-analysis confirmed that there is a U-shaped relationship between the average amount of alcohol consumed per day and the risk of type 2 diabetes.” (Parry,1720)
According to the disease model, alcoholism is a chronic progressive, involuntary, irreversible and a potentially fatal biomedical illness. People with the disease have a chemical vulnerability that predisposes them to alcoholism. These people have become unable to have control over their consumption of alcohol, have become psychologically or physiologically dependent on alcohol, and often deny that their drinking behavior is an addiction. Alcohol is a global public health problem. Alcohol works as a stimulant and activates the brain stress responsive system. After chronic alcohol exposure, individuals develop a tolerance for alcohol. If advocates are correct about the acceptance of the brain disease model there will be more encouraging those who are addicts to seek treatment. Some critics are skeptical of the neuroscience research that supports that addiction is a brain disease. The critics identify some possible negative social consequences such as encourage fatalism, increase stigmatization of addicted persons, promote coercive addiction treatment and/or the over use of pharmacological treatments, and de-emphasize the role of social factors. In a qualitative investigation, they found that people in the Australian public have an understanding that addiction can be cause by overlapping factors; social environmental factors, emotional and experimental drivers, biology, rationality and education, the drug itself, and personal character. Many of these Australians were accepting of the brain mechanisms, but they did not accept that addiction was a brain disease. The brain disease uncovered multiple conceptualizations about the function of the brain. Although many say that alcoholism is a brain disease, it is most likely a psychological disease.
Alcohol consumption is often referred to as a method of coping with stressful life situations. Alcohol consumption is an important risk factor for mortality and morbidity. Consumption of alcohol is one of the main factors of non-communicable diseases. Alcohol consumption leads to increased alcohol metabolism, increased production of reactive oxygen species, resulting in oxidative stress, increased cellular toxicity, resulting in liver damage, and interactions with drugs such as, xenobiotics. Other than alcoholism being considered a disease, the alternative to this concept is that it is a social learning theory. According to this view, it says that other than behavior and biogenetic factors, someone’s interaction in the environment plays a role in alcoholism.
In early formulations of the Diagnosis and Statistical Manual Disorder (DSM), were grouped within the personality disorders. A different tradition saw these problems as a reflecting disease process, which was biologically determined and resulted in a person having some type of idiosyncratic reaction to alcohol. This conceptualization was subsequently embraced by self-helped movements such as alcohol anonymous. The concept of an underlying diseased reached its apotheosis in the 1940’s and 1950’s. A third tradition may be described as epidemiological, this visualization of alcohol related problems occurring fundamentally because of the overall level of use of psychoactive substance in society. The level of use was influenced by cultural traditions, the availability of the substance, the ease of distribution, and the price. Inherent in these perceptions was that individual pathology was considered a secondary importance. The social constructionist school viewed substance use problems as being disaggregated with no special relationship. During the 1960’s and 1970’s the concept of substance use being a disease was dismissed. The first edition of the DSM was published in 1952, it included a stranded nomenclature, definitions of terms and statistical classification. Alcoholism was defined as a ‘well established addiction to alcohol without recognized under disorder.’ Alcohol intoxication was referred to as a ‘non-diagnostic term.’ The second edition of DSM was published in 1968, there were no definitions or criteria and little descriptions of each condition was provided. The third edition of DSM, represented a big advance, diagnostic criteria was included, and expanded description of disorders, and a multi-axial approach to evaluation. A distinction was made between substance abuse and dependence. Substance abuse had three criteria’s; (1) a pattern of pathological use, (2) impairment in social or occupational functioning, (3) and a duration of one month or more. Dependence of a substance only has one, tolerance or withdrawal.
During adolescence, those between the ages of 10-19 years old are more likely to use alcohol, which in young people has been associated with this increased risk of tobacco and drug use, academic failure, pregnancy, and sexual transmitted diseases. Across the European Union more than 90% of 15-16-year old’s have drank alcohol in their life, on average they started drinking alcohol at the age of twelve and a half and getting drunk for the first time at the age of fourteen. About 13% of 15-16-year old’s have been drunk over twenty times. On a single occasion for 15-16- year old’s the average of alcohol consumed is 60 grams in Northern Europe, and 40 grams is Southern Europe. About 1% of 14-16-year old’s in the United Kingdom drink alcohol almost every day. Adolescents are very vulnerable to social influences and have lower alcohol tolerance levels compared to adults. Longitudinal studies have shown that when drinking before the age of fifteen it increases the risk for developing alcohol abuse or dependency. There is also a concern that it will affect the brain development during adolescence, which interferes with cognitive and emotional functioning. Comparative studies have helped determine how well countries measure up against one another and help understand determinants influencing drinking behavior.
In Germany, those who were alcoholics or abused substances were deemed anti-socials. Since addicts notoriously relapse into drug use, there is more of a possibility for those individuals to be considered habitual criminals. From the late nineteenth and mid-twentieth century, many criminologists believed that criminal behavior was a social disease, whereas others believed it was a hereditary defect, or even racial in nature. Those who were deemed anti-social were sent to spend time in concentration camps like other political and racial enemies of the Reich. The Nazis used the term anti-social to describe anyone who did not behave like a good citizen or someone who avoided his or her proper social responsibilities. Anti-socials were usually described as having weak characters, loose morals, and poor work habits.
According to data from a national representative sample, about seven million children live with a parent who has a current diagnosis of alcohol abuse or dependence. In some early clinical literature children with alcoholic parents were portrayed as homogeneous or troubled, but more recent studies show that comparing offspring from alcoholic and non-alcoholic parents, they have established diversity of those with alcoholic parents regarding substance abuse and psychological states. A few studies have tried to explain the different outcomes of alcoholic offspring by examining family and individual stresses and resources in childhood. Certain childhood stresses are reportedly most common in homes with alcohol abuse such as, parental mental abuse, sexual abuse, and parental violence. A literature review suggests that substance use outcomes may be more helpful if mediators are studied to explain heterogeneity and advocates formal tests of mediation.
It was thought that primarily men were alcoholics, but it cannot be coincidental that women are alcoholics as well. In the article, “Addiction as a Family Disease,” is states that “if we accept that alcoholism and addiction are family disorders, then developing group psychotherapists for women and family members is a logical next step.”
About 4% of the United States population meets the criteria to be considered an alcoholic. To be considered an alcoholic a person must show at least three of the seven criteria’s; tolerance, withdrawal, compulsive ethanol consumption, obsessive desire for alcohol, spending to much time pursuing alcohol, neglecting social, recreational, and occupational activities, and continuing the use of alcohol even after experiencing adverse consequences. In the United Kingdom, between 1991-2006 the amount of alcohol-related deaths more than doubled. The Soviet Union believes that alcoholism is a disease of capitalism. In 2004, 3.8% of deaths and 4.6% of disability adjusted life years was caused by alcohol. Alcohol was said to be the eighth highest risk factor in 2004.
Taiwan has some of the strictest laws on drinking and driving. In Taiwan, men had higher incidences of alcohol abuse, and dependence syndrome. Having a tougher alcohol blood content law had significant control over alcohol abuse and dependence syndrome due to the public controlling the overall consumption of alcoholic beverages. Blood level laws effectively reduce alcohol attributable morbidities with an exception of alcohol abuse and dependence. In 2007, the National Highway Traffic Safety Administration said that there were about 13,000 deaths that year due to drinking and driving. When having toughened laws on drinking and driving they have set standards both mentally and physically for individuals. With these laws people have been more conscious about the amount of alcohol they drink before they drive. The foundation of modern deterrence are the impaired driving laws which are applied to the drinking and driving preventions of collisions and fatalities.
Those who have a parent who is an alcoholic is predisposed to becoming an alcoholic. If the mother drank while she was pregnant the child could alter details of the brain development which could influence adult behaviors later in life. The rates of alcohol use in women seem to be rising. The rates of binge drinking have decreased but the rates of the amount of alcohol being consumed during binge drinking has increased. Alcohol abuse is present in 10-15 million Americans. Alcohol abuse increases the risk of domestic violence, suicide, accidents, cirrhosis, and some cancers.
Disease theorists emphasize that alcoholics tend to have a challenging time controlling over drinking, but most theorists say that an alcoholics control of their drinking is impaired in other ways. Problem drinkers often try to control their drinking, but they usually fail because they do not know enough about their individual limits. Fundamental problem drinkers have severe problems trying to control their drinking which usually leads to them drinking more and drinking themselves to death. An active alcoholic is more sensitive to the stimuli involved with drinking. A serious alcoholic is a person whose drinking is not regimented, and they will most likely be sensitive to a variety of triggers. Physical dependence is an occasional result of excessive drinking.
The Centers for Disease Control and Prevention has reported that alcohol use has annually contributed to 88,000 deaths in the United States. Approximately 50% of the risk for becoming an alcoholic is due to genetics. The National Institute on Alcohol Abuse and Alcoholism shows that in 2007 there were 29,925 deaths due to Cirrhosis.
The “New Alcoholism Findings Has Been Reported by Investigators at Saint Luc University Hospital (intestinal dysbiosis and permeability: the yin and yang in alcohol dependence and alcoholic liver disease),” says that, “alcohol dependence and alcoholic liver disease represents a major public health problem with substantial morbidity and mortality. By yet incompletely understood mechanisms, chronic alcohol abuse is associated with increased intestinal permeability and alteration of the gut microbiota composition allowing bacterial components, bacteria, and metabolites to reach the portal and the systemic circulation.”
As you may have noticed alcoholism is mainly considered a type of disease rather than a personal defect because of all these factors. People usually think of people who are alcoholics as bad people or people who have anger problems and people who are anti-socials but this I think, is a stereotype. I lived with a person who was an alcoholic for sixteen years of my life and occasionally, there would be a little anger but always about the insignificant things but, she was also social and was the nicest person you would ever meet. There is a possibility that there are most alcoholics that do have these problems but not all of them do.
Agardh, E. E., Danielsson, A., Ramstedt, M., Holm, A. L., Diderichsen, F., Juel, K., ; … Allebeck, P. (2016). Alcohol?attributed disease burden in four Nordic countries: A comparison using the global burden of disease, injuries and risk factors 2013 study. Addiction, 111(10), 1806-1813. doi:10.1111/add.13430
Bhala, N., Cézard, G., Ward, H. T., Bansal, N., ; Bhopal, R. (2016). Ethnic variations in liver- and alcohol-related disease hospitalisations and mortality: The Scottish health and ethnicity linkage study. Alcohol And Alcoholism, 51(5), 593-601. doi:10.1093/alcalc/agw018
Griffin, M. L., Amodeo, M., Fassler, I., Ellis, M. A., ; Clay, C. (2005). Mediating factors for the long-term effects of parental alcoholism in women: the contribution of other childhood stresses and resources. American Journal On Addictions, 14(1), 18-34.
Hatton, J., Burton, A., Nash, H., Munn, E., Burgoyne, L., ; Sheron, N. (2009). Drinking patterns, dependency and life-time drinking history in alcohol-related liver disease. Addiction, 104(4), 587-592.
Ian, O. (1981). Alcoholism: An Inherited Disease?. British Medical Journal (Clinical Research Edition), (6262), 481.
Meurk, C., Partridge, B., Carter, A., Hall, W., Morphett, K., ; Lucke, J. (2014). Public attitudes in Australia towards the claim that addiction is a (brain) disease. Drug ; Alcohol Review, 33(3), 272-279.
Meyer, R. E. (1996). The disease called addiction: emerging evidence in a 200-year debate. The Lancet, (8995), 162.
Neuman, M. G., Malnick, S., Maor, Y., Nanau, R. M., Melzer, E., Ferenci, P., ; … French, S. W. (2015). Review: Alcoholic liver disease: Clinical and translational research. Experimental And Molecular Pathology, 99596-610. doi:10.1016/j.yexmp.2015.09.001
Osborn, C. (1997). Does disease matter? Incorporating solution-focused brief therapy in alcoholism treatment. Journal Of Alcohol ; Drug Education, 43(1), 18-30.
Parry, C. D., Patra, J., ; Rehm, J. (2011). Alcohol consumption and non-communicable diseases: epidemiology and policy implications. Addiction, 106(10), 1718-1724.
Robinson, B. G., ; Atkinson, N. S. (2013). Is alcoholism learned? Insights from the fruit fly. Current Opinion In Neurobiology, 23(23/4 Addiction), 529-534. doi:10.1016/j.conb.2013.01.016
Roth, J. D. (2010). Addiction as a family disease. Journal Of Groups In Addiction ; Recovery, 5(1), 1-3. doi:10.1080/15560350903547189
Saraceno, L., Munaf, M., Heron, J., Craddock, N., ; van den Bree, M. M. (2009). Genetic and non-genetic influences on the development of co-occurring alcohol problem use and internalizing symptomatology in adolescence: a review. Addiction, 104(7), 1100-1121.
Saunders, J. B. (2006). Substance dependence and non-dependence in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD): can an identical conceptualization be achieved?. Addiction, 10148-58.
SEGAL, G. A. (2013). ALCOHOLISM, DISEASE, AND INSANITY. Philosophy, Psychiatry ; Psychology, 20(4), 297.
Tawa, E. A., Hall, S. D., ; Lohoff, F. W. (2016). Overview of the Genetics of Alcohol Use Disorder. Alcohol ; Alcoholism. Supplement, 51(5), 507-514. doi:10.1093/alcalc/agw046
Whitman, I. R., Agarwal, V., Nah, G., Dukes, J. W., Vittinghoff, E., Dewland, T. A., ; Marcus, G. M. (2017). Alcohol Abuse and Cardiac Disease. Journal Of The American College Of Cardiology (JACC), 69(1), 13-24. doi:10.1016/j.jacc.2016.10.048
Ying, Y., Weng, Y., ; Chang, K. (2017). The impact of alcohol policies on alcohol-attributable diseases in Taiwan—A population-based study. Drug And Alcohol Dependence, 180103-112. doi:10.1016/j.drugalcdep.2017.06.044
Zhou, Y., ; Kreek, M. J. (2014). Alcohol: A stimulant activating brain stress responsive systems with persistent neuroadaptation. Neuropharmacology, 8751-58. doi:10.1016/j.neuropharm.2014.05.044
No Author Provided
A biological threat or a social disease? Alcoholism and drug addiction in Nazi Germany. (n.d). JOURNAL OF EUROPEAN STUDIES, 39(3), 371-385.
An integrated genome research network for studying the genetics of alcohol addiction. (2010). Addiction Biology, (4), 369.
ESBRA 2015 EUROPEAN SOCIETY FOR BIOMEDICAL RESEARCH ON ALCOHOLISM 12-15 SEPTEMBER 2015 VALENCIA, SPAIN…ESBRA 2015 European Society for Biomedical Research on Alcoholism 12¿15 September 2015 Valencia, Spain. (2015). Alcohol ; Alcoholism. Supplement, 50i1-i67.
(2018). New Alcoholism Findings Has Been Reported by Investigators at Saint Luc university hospital (Intestinal dysbiosis and permeability: the yin and yang in alcohol dependence and alcoholic liver disease).(Report). Mental Health Weekly Digest.