Do you think alcoholism isn't really a disease? Careful – you'll be branded as a heretic
Disease or destructive habit?
If you’re a member or an ex-member of Alcoholics Anonymous, think very carefully before you question its belief that alcoholism is a disease. That’s what I’ve just done, and this week I found myself tied to the stake for heresy – by the Guardian, of all publications.
Here’s the background. In The Fix, my book about modern patterns of addiction, I say that AA probably saved my life by helping me give up drinking – but also that the “disease model” it endorses is based on dodgy science. Cue a furious attack from a Guardian writer accusing me of writing “a poison pen letter” to AA.
What I’d done was suggest that alcoholism and other compulsive problems are fundamentally self-destructive behaviour, not an incurable illness. But, in the eyes of true believers, that amounts to scribbling in green ink. On Thursday an article appeared in the Huffington Post suggesting – so predictably – that I was “in denial”. At least the author didn’t trot out the old AA joke “denial isn’t just a river in Egypt”, which gets a supportive laugh in meetings however often it’s repeated.
According to the HuffPo writer, addicts’ belief that they suffer from a disease is what gives them the strength to maintain their recovery. Perhaps that’s true. But the point of a scientific definition isn’t to serve as an emotional crutch: it’s to describe something as accurately as possible using the best available evidence.
This is where the addiction-as-disease lobby runs into real trouble.
There is no medical test for addiction: no brain scan or blood screening that enables a doctor to detect its presence.
And the disease model doesn’t just fail to meet scientific criteria: it doesn’t pass the common sense test, either.
Suppose an alcoholic kills a child while driving drunk. He can wave a certificate signed by every addiction specialist in the country testifying that his actions were involuntary because he has the disease of addiction. Quite rightly, it won’t make a blind bit of difference to the verdict.
But imagine that someone suffering from coronary disease has a heart attack at the wheel and kills a child. It would be outrageous to jail him. Or, to choose a less clear-cut example, what about an axe killer suffering from schizophrenia? We may feel uncomfortable that he’s sent to a secure hospital rather than to prison, but we understand why it’s appropriate: the killer’s volition was affected by a mental illness over which he had no control.
Ah, say the disease-model advocates, but addiction does change the brain by making it crave rewards. True, but all sorts of behaviour rewires our brains. I’m happy to accept that, when I was a young drunk, my unwillingness to say no to that third bottle of wine at lunch had a neurological component. But, in the end, it’s just another excuse for the fact that I felt like getting smashed. (Incidentally, I wish I’d been able to bluff about dopamine and neural circuits at the time: my supply of excuses was always running dry.)
There’s no doubt that addiction is a scourge – and spreading fast, as the makers of fast food, computer games and online porn learn how to manipulate our neurotransmitters. Technology makes us like things too much. But it doesn’t turn us into robots.
In the end, no one benefits from labelling compulsive over-consumption as a disease – apart, that is, from a “recovery industry” of clinics and courses that makes billions of pounds from persuading people that they’re helpless. Maybe I’ll write about that scandal one day. After I’ve stocked up on green ink, of course.The Fix: How Addiction is invading our lives and changing your lives is published by HarperCollins.
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