Alcoholism

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Alcoholism a weakness, not a disease

Alcoholism is not a disease, alcohol is not an addictive drug and alcoholics should be taught to drink in moderation, a British writer says in a provocative new book.

Alcoholics Anonymous-style programs, which require total abstinence, are more about brainwashing than medical treatment and lead to binge drinking for the majority who cannot stay the course, writes Andrew Barr in the controversial Drink, a Social History of America.

"The disease concept of alcoholism is destroyed by its own internal contradiction," Mr. Barr writes.

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"Any alcoholic who seeks treatment is told that by drinking alcohol, he sets off an irrepressible desire for the substance and that he must therefore agree as a condition of his treatment to abstain from drinking."

If the alcoholic does what he is told and abstains during the course of treatment, the theory that alcoholism is a disease that causes an inability to abstain from drinking is disproved, he says.

The notion that alcoholism is a disease is prevalent in North America, Mr. Barr writes, but argues that it is not in Europe.

There, the treatment emphasis is on controlled-drinking therapy, which teaches alcoholics to drink in moderation. In Britain, 75 per cent of alcohol-treatment facilities take that approach.

"The disease theory might be helpful, but there is no evidence that treating alcoholics on this basis helps them to break the habit," Mr. Barr says.

"The few scientifically reliable studies that have been carried out show that attending Alcoholics Anonymous works no better than no treatment at all."

He says the majority of heavy drinkers don't join Alcoholics Anonymous, and most who do eventually leave. Drinkers stay in the Alcoholics Anonymous program only if they can remain reasonably abstinent and accept the Alcoholics Anonymous way of life, Mr. Barr says. It doesn't mean Alcoholics Anonymous keeps them sober.

"Those who join Alcoholics Anonymous are told that they can never drink again. This prohibition encourages many Alcoholics Anonymous members to switch their fixation from alcohol to cigarettes, coffee and high-calorie desserts, without dealing with the underlying problem that led to the abusive drinking in the first place."

The alcoholism-as-disease theory wasn't invented by William Wilson and Dr. Robert Smith, who founded Alcoholics Anonymous in 1935. They simply popularized the idea, which was widespread in the medical community in the 19th century, but not communicated to the public. It would have contradicted the message of temperance campaigners that habitual drunkenness was a moral failure.

Mr. Wilson and Dr. Smith established the National Council for Education on Alcohol to educate the public about the "momentous discovery" that alcoholism was a sickness. By the end of the late 1950s, the claim that alcoholism is a disease was routinely presented as fact in mass-circulation magazines. In polling done in the late 1940s, only 20 per cent of interviewees agreed that alcoholics were sick and that alcoholism was an illness; by the early 1960s, 66 per cent agreed.

Alcohol manufacturers liked the disease theory because it did not finger them. Doctors accepted the theory because it encouraged hospitals -- which used to refuse to admit habitual drunks, deeming them unco-operative -- to change their view that alcoholism was merely a bad habit.

The theory that alcohol is a disease makes it easier for people to admit they have a problem, Mr. Barr writes, adding that people are more likely to admit they have an illness than admit they have a failure of personality.

"Alcohol is certainly a drug, which is a substance that affects the body in some way, but it is a less addictive one that caffeine," he writes.

Most people who use alcohol do not suffer from feelings of compulsion or withdrawal symptoms, Mr. Barr says. And of the minority who abuse alcohol -- alcoholics -- many do not develop withdrawal symptoms, he says.

"Alcohol can hardly be a very addictive drug when even alcoholics do not experience feelings of compulsion when they try to do without the substance on which they supposedly depend," Mr. Barr says.

The disease theory, he says, is "unhelpful and it is wrong."

Telling alcoholics they can never drink again produces the same unhealthy consequences that Prohibition did, Mr. Barr says. It encourages behaviour that alternates between sobriety and lapses into binge drinking, rather than teaching people how to drink in a civilized manner.

Environment, not genetics, called key factor in alcoholism

Putting brakes on the scientific rush to blame alcoholism on genes, a study using twins suggests genetic influence is not a significant factor in alcoholism among women or in men who become alcoholic as adults. The study, by researchers at the University of Minnesota, published in The Journal of Abnormal Psychology, suggests that environmental factors, particularly family environment, play a much stronger role in the development of alcoholism than many scientists believe. "Our findings suggest . . . researchers may be ignoring the significant influence that environment has in the origins of alcoholism," the study says.

Mind over body prolongs life: Study

A new study has added credence to the idea that a healthy mental outlook can prevent or diminish the effects of disease. On average, women with breast cancer who were in group psychotherapy lived nearly twice as long as women who did not receive psychological counselling, a Stanford University study found.

Carbon monoxide poisoning caution

To many people's surprise, an automobile engine that runs in a closed garage can produce dangerous levels of carbon monoxide in 10 minutes or less. Even when driving, it is a good idea to keep a window slightly open to make sure the gas is not present in high concentrations, experts advise. Be alert for the initial sign of carbon monoxide poisoning - grogginess.

New British moms make quick job returns

Forty-six per cent of the women in the United Kingdom who held jobs when they became pregnant returned to work full- or part-time within nine months of giving birth, according to the Policy Studies Institute in London, an independent research group. It questioned nearly 5,000 women who gave birth in 1989 as well as 500 employers in England, Scotland and Wales. Of those who worked full-time in 1989, 20 per cent returned to their jobs, up nearly threefold since 1979.

Drunk flies buzzing with clues to alcoholism

Fruit flies that are literally falling-down drunk may provide the first insight into why some people can hold their liquor better than others, San Francisco researchers reported yesterday.

The flies have a genetic defect, dubbed "cheap date" by the scientists, that causes them to display all the characteristics of human drunkenness: hyperactivity, loss of co-ordination, disorientation and, ultimately, unconsciousness.

Moreover, they become intoxicated on 30 per cent less alcohol than is required to produce the same effects in their healthier brethren, geneticist Ulrike Heberlein and her colleagues at the University of California, San Francisco, reported in the journal Cell.

The gene is the first that has been definitively linked to a propensity for alcoholism and, experts said, it is not unrealistic to think the discovery could lead to new ways to reverse the effects of overimbibing.

"It's a very interesting and provocative result," said Bob Karp, director of extramural genetic programs at the National Institute on Alcohol Abuse and Alcoholism. "This is the beginning of the elucidation of a pathway for sensitivity to alcohol."

Alcoholism is a pervasive public health problem, affecting an estimated 14 million Americans. Although it often strikes victims seemingly at random, researchers have long suspected a strong genetic link.

People who have a sibling who is an alcoholic are three to eight times as likely to develop alcoholism themselves as are those with no family history of the disease.

No one has yet linked a single gene to alcoholism in humans, but the new research gives them a good idea where to look for at least one of them.

MUTATED COPY

Studying cheap date's genes, Heberlein's team found it has a mutated copy of a previously known gene called "amnesiac," which produces memory problems.

The normal form of the gene stimulates production of a chemical called cyclic AMP or cAMP. The cheap date flies do not make as much cAMP in their brains and that, Heberlein says, makes them more sensitive to the effects of alcohol. But the team found that if they gave the flies drugs that increase production of cAMP in the brain, the flies became more tolerant to alcohol and could last as long as healthy flies in the inebriometer.

Presumably, similar drugs could help humans resist the effects of alcohol.

Scientists have been looking for alcoholism-related genes for more than a decade, since Karp's institute began a massive project called the Collaborative Study on the Genetics of Alcoholism.

The project has received about $6 million a year in funding and has accumulated more than 350 families and collected data on about 10,500 people.

Last month, the team said the search for such genes has been narrowed to small areas on chromosomes 1, 2, 4, 7 and 11 -- five of the 23 pairs of chromosomes that carry the human blueprint.

"Alcoholism. . .is not due to a mutation in a single gene," said Dr. Enoch Gordis, the alcoholism institute's director. "In all likelihood, it is a handful of genes" that cause it.

Scientists have not yet found the amnesiac gene in humans, but that may be just because they have not been looking. The human genetic blueprint contains an estimated 100,000 genes and researchers have so far identified fewer than half of them.

But human genes are similar to fruit fly genes "to an astonishing degree," Karp said, and it is likely that amnesiac has a human counterpart. He predicted that someone will find and test that human gene soon.

Get educated about alcoholism

Q-I'm a high school student worried about my mother. Lately, I've noticed she seems to be consuming a lot of red wine. At the beginning of the day she's perfectly fine, but later on, especially in the evenings after dinner and at night, she seems to be not herself. I'd describe her as "out of it." She's not "wildly drunk" and she never becomes incoherent, but her speech seems mildly slurred. My siblings have also noticed this. This drinking tendency of hers doesn't appear to affect her daily life, and she is the most wonderful, loving, caring and responsible mother anyone could want. I worry though that her dependence on alcohol could get worse, and am wondering how to approach the subject. How should I tell her I'm worried?

Concerned

A-Mom's lucky, and has likely worked hard in the past, to have raised a daughter as thoughtful, caring and concerned as you. Alcoholism is truly a family disease affecting everyone who has a relationship with the problem drinker. This is an important time for you to get more informed about the condition, but also to learn that it's not your responsibility to resolve. To help her, you have to help yourself first - to understand what's going on, and to grow in further compassion for your mother's experience with this addiction. Getting educated about alcoholism will also help you avoid becoming the person in the family who counts the drinks, or tries to control Mom's behaviour, or manages the family's reaction to her. I strongly urge you to contact Al-Anon/Alateen to better understand your connection to your mother as a problem drinker. Once you're better informed and talk to others in similar situations with their close family members, you may learn some strategies to encourage Mom to face up to her alcoholism and seek her own help. But even if that doesn't happen, Alateen will bring you together with other teenagers who, confidentially, share experiences, strength, and hope with each other and encourage each other through this process. See www.al- anon.alateen.org, or call 1- 888-4AL-Anon (1-888-425-2666).

Q-I've met someone who I think about often, we've gone out only as friends. I have feelings for her but I've never been in a relationship where I felt this strongly for anyone. I'm finding it hard to say anything about my feelings, since I'm sure her answer will be a rejection. It wouldn't be my first, but it'll be the hardest to endure. I don't know how to approach this "issue" of mine.

Holding Back

A-Recognize that it's hard to succeed, if you set yourself up for failure. This is clearly your pattern and it has to do with expecting rejection....and then going out and courting it. This woman is, so far, a friend only, one you're still just getting to know. So it's too early to start confessing feelings or questioning hers. I suspect that your pattern is to get excited about someone based on very early attraction. You'd do better to take time with this woman or any other, to build a bond of sharing good times and fun together. After awhile, as you talk and tell about yourselves, you start to develop trust and share some confidences. That's when it becomes apparent whether either or both of you have feelings for each other and want to date as a couple. For now, go slow, and stop visualizing a dead end.

Q-Last year, I attended the wedding of a childhood friend but forgot to bring the gift (cash) along with me. I invited my friend and her husband for dinner at a later date to give them the card and gift but they cancelled and never re-scheduled with me. The gift and card are still with me. Now I'm getting married and I've invited them. I feel so awkward because I haven't given them their gift and it's been more than a year. How can I address this with them and make things right?

Remorseful Bride

A-It's as easy as 1-2-3: 1) Put the money in the card; 2) put the card in an envelope; 3) hand-deliver with verbal apologies. Your awkwardness isn't what's important. It's your continuing to put this off that's rude and childish and leaves them believing you've simply shafted them. Act like the grownup you want to be, and get this gift over to the couple immediately, with no further excuses or delays.

Alcoholism may not reflect disorder: researchers

In his book, The Natural History of Alcoholism, psychiatrist George Vaillant of Harvard Medical School makes the point that very little is really understood about alcoholism and that not much progress has been made toward greater understanding in the last 25 years.

Vaillant's 40-year study of 600 men yields evidence to suggest something that runs contrary to prevailing opinion that alcoholism seems not to reflect some underlying personality disorder.

Instead, the reverse seems to be true that depression, inability to cope and other familiar problems are the direct results of alcoholism.

Then what causes alcoholism?

Nobody has an answer that everybody will accept. But it seems apparent to Vaillant that clinical treatment is not especially helpful in dealing with alcoholism.

"Alcoholics recover not because we treat them but because they heal themselves. Staying sober is not a process of simply becoming detoxified, but often becomes the work of several years or in a few cases even of a lifetime."

Carl Berger, who describes himself as "a psychoanalytic therapist specializing in the treatment of alcoholism," is attending psychiatrist at Pennsylvania Hospital in Philadelphia.

He also is psychiatric consultant at Help Inc., a Philadelphia-based outpatient drug and alcohol program.

His approach to treatment is analytical, he said, but not analytical in a classic Freudian sense, involving conflict between ego and conscience. Rather, it involves helping the alcoholic "toward repair of the damaged self, which underlies the addiction."

The "damaged self," in Berger's view, predates and is a primary cause of alcoholism.

"Over a period of time" somebody on the road to alcoholism "commonly suffers repeated blows to the intactness of self. There is regressive change, marked by a variety of symptoms, and there is erosion of self-esteem. Usually, by the time I see an alcoholic, he has reached the point at which he uses his addiction as a means to try to secure his shattered self-esteem."

Helping the alcoholic to understand why he drinks, to confront himself as he is without the crutch of alcohol and to repair his self-esteem are the cornerstones of treatment, Berger said.

This approach is not for everybody "you have to make an assay of the total of what the person is the problem, resources, liabilities, the context of social life, and how these factors influence the alcoholic."

The cure rate based on prolonged abstinence probably is no greater than in group support provided by Alcoholics Anonymous, he said.

"But they (the patients) have insight into what impels them to drink. In treatment they have a shot at building a mature, integrated whole self."

Scientists find gene linked to alcoholism

Researchers say they have pinpointed for the first time a gene that may make people prone to alcoholism, adding weight to the argument that alcoholism is a disease and not a moral weakness.

U.S. government scientists called the finding "provocative and promising," even if it requires more study. But a leading investigator in the field said it was impossible to say an "alcohol gene" had been identified.

The researchers reported their findings in the Journal of the American Medical Association.

They studied a chromosome previously linked to alcoholism. They found a particular gene on the chromosome to be far more common in alcoholics than in non-alcoholics.

If verified, the finding would represent the first specific identification of a genetic root for alcoholism.

Alcoholism tends to run in families. Previous studies of families and of adopted twins have suggested environmental and genetic factors contribute to the disorder.

Scientists have said three chromosomes might have a role, but no one had isolated any gene on those chromosomes as likely culprits, the researchers said.

Chromosomes are threadlike structures comprised of thousands of individual genes, the "fingerprints" of DNA that carry each cell's hereditary blueprint. A person's traits are determined by the nearly 100,000 genes in each cell.

The gene pinpointed in the new study has two forms. Each produces a type of nerve cell called the dopamine D2 receptor, believed to play a key role in experiencing pleasure.

The researchers looked at both forms of the gene - the A-1 allele and the A-2 allele - in brain matter from the cadavers of 70 subjects, 35 alcoholics and 35 non-alcoholics.

"We found a very high association of the A-1 allele with alcoholism and a very high association of the A-2 allele with non-alcoholism," said Dr. Ernest Noble, a co- leader of the study and director of the Alcohol Research Centre at the University of California, Los Angeles.

The A-1 allele was present in 69 per cent of the alcoholics, but only in 20 per cent of non-alcoholics, the researchers reported.

Such a high correlation was surprising, given that alcoholism comes in a number of types and is almost certain to have a number of causes, the researchers said.

"A large majority of alcoholics in the present study had experienced repeated treatment failures in their alcoholic rehabilitation, and the cause of death was primarily attributed to the chronic damaging effects of alcohol on their bodily systems."

Alcoholism no excuse the morning after

Two Hiram Walker employees hatched a plan to steal some whiskey from the distillery for their own, private stash.

One of the employees bought some plastic jugs and smuggled them into the far reaches of the Windsor, Ont. warehouse, where barrels of 25-year-old whiskey were stored. The conspirators had siphoned the equivalent of 38 bottles of retail product when their supervisor discovered them.

They were suspended, then discharged. One of the pair took an early retirement, but the other filed a grievance, claiming a five-month "problem with alcohol." The union argued he should be accommodated, not fired.

The question before the arbitrator was whether this was a case requiring an employer to accommodate an addiction, as mandated by the Ontario Human Rights Code?

Hiram Walker's director of industrial relations said he had never seen "anything of this size in terms of employee theft." Not only that, but the tax authorities took a very dim view of loss of product in that industry; the company was particularly concerned about whiskey being stolen and sold on the street. It therefore had a well-established history of punishing theft with discharge.

The employee had no record of an alcohol problem; he didn't have an attendance problem, and no one had ever smelled alcohol on his breath at work. He was sober when he committed the theft; in fact, he planned it in advance. His only rehabilitation attempts were counselling by his mother and wife, according to the grievor, who added that he was "now better."

The union argued alcoholism doesn't always show up as substandard work performance, poor attendance or on-the-job impairment; it can manifest itself in other egregious behaviour, like stealing. The union noted no product ended up on the street and, as mitigating factors, pointed to the employee's 15 years' seniority and unblemished disciplinary record. He also had personal problems involving a child needing considerable supervision.

Nevertheless, the arbitrator said unequivocally, "I side with the employer on this one." He characterized the grievor as a controlled drinker, who did not steal to feed an addiction but to provide a supply for himself and others. He noted the grievor was always able to attend work and perform adequately and that he controlled his drinking without professional help. He therefore did not show any need for accommodation.

The arbitrator noted the duty to accommodate might have arisen but only if the grievor's condition, and hence his behaviour on the job, had been much worse. In his view, "the large quantity involved, the fact that it was well-planned, the fact they took advantage of an unsupervised work area, are factors that override the mitigating ones."

So, what does a successful alcoholism defence look like? In another case, the behaviour was similar, but the outcome different.

A Canadian Pacific rail yard worker with 29 years' service and one minor rule violation was discharged for theft. Police were tipped that he was stealing from his employer. A search of his home revealed many items lifted from the workplace. He expressed remorse for his actions.

He stated that he had suffered from alcoholism for years and asked for help in dealing with that problem. In addition, he was struggling with a difficult divorce. The worker went for treatment at a detoxification centre and began attending Alcoholics Anonymous. At the time of the arbitration, he was no longer drinking.

The arbitrator concluded alcoholism was the driving force behind the worker's "aberrant behaviour" and that there were enough mitigating factors to allow a second chance as long as he agreed to random drug and alcohol testing and provided evidence of continued attendance at Alcoholics Anonymous.

What conclusions can be drawn from these two situations?

To use alcoholism as an argument to be re-instated, an employee has to show evidence of a serious problem and solid evidence of rehabilitation and counselling. Alcoholism cannot be seen as an "automatic defence." You can't concoct a disease and expect it to fly as a defense for bad behaviour.

On alcoholism as disease: PR campaign pushed the concept: sociologist

How did alcoholism first become considered a disease? Sociologist Ron Roizen spent more than 25 years in Berkley, Calif., studying the issue, writing numerous academic papers and refereeing others for the Journal of Studies on Alcohol and the American Journal of Public Health.

The following is a brief synthesis of the unconventional but copiously researched views of Roizen, who was born in Montreal. Unless otherwise noted, all quotations are Roizen's words.

With the repeal of Prohibition in the U.S. in 1933, after 14 years of battles between "dries" and "wets," people didn't want to hear about alcohol any more. "It was like talking about Vietnam in the '70s." Still, public policy had to be formulated regarding terms of sale of alcohol and how alcohol was officially defined in public schools.

"It was a tough issue. Thoughtful citizens feared raising a new generation on the parchment-dry lessons temperance advocates had previously installed. Remember, this was the era where Nick and Nora Charles were flouncing around in The Thin Man movies solving crimes with martini pitchers in their hands."

Commissions sprang up to address the dilemma. In Virginia, a report by two esteemed physiology professors, who said moderate drinking wasn't all that bad, raised such a furor that legislators voted to burn the report in the State Capitol's furnaces before most of them had read it. "In an era when Nazis were burning books, the event offered a stark symbol of persisting cultural conflict over alcohol in the U.S."

Distillers' Money

The issue eventually became the province of mainstream science, eager to weigh in because its ivory-tower public image had been badly tarnished by the Depression, which many blamed on science's labour-saving technological innovations. Funding for scientific studies was negligible - except from the distillers, who believed that whatever disinterested science came up with would be better than traditional temperance-based findings.

However, the scientists feared the potential conflicts of interest that support by the booze industry could entrain. Thus, studies of alcohol per se (its effects on health, crime, poverty, insanity, traffic accidents, etc.) were dropped in favour of research on alcoholism, in an effort to detect whether it is diagnosable or curable. "This approach was little more than an end- run around the pressing need for the distillers' money."

When that funding turned out to be less generous than expected, Dwight Anderson - PR director of the Medical Society of New York State and a recovering alcoholic - proposed in 1942 that alcoholism's disease character was the image science needed to sell its new mindset, thereby, it was hoped, galvanizing public opinion in order to secure enduring sources of financial support for the research.

"Disease-alcoholism just dripped with scientific credibility, even though it hadn't really been `discovered' yet," but a turning point came in 1944, when E.M. Jellinek of the Yale Centre of Alcohol Studies - considered the scientific "father" of the modern American study of alcoholism - joined forces with public-relations consultant Marty Mann, described as the first woman to gain sobriety through Alcoholics Anonymous. (Alcoholics Anonymous had been founded in 1935 in New York City.) Mann's PR campaign revolved around four points - that alcoholism is an illness, that it can be treated, that the alcoholic deserves treatment and that alcoholism is a public-health problem - all borrowed directly from Anderson's 1942 plan aimed at the general public to promote a new scientific approach.

Rescued From Stigma

"But Mann added a crucial new spin. In her hands, the involuntary, disease-driven character of alcoholism became a way of offering alcoholics a kind of symbolic rescue from alcoholism's social stigma. Mann, in her own words, wanted `to make the alcoholic respectable.' "

By defining the alcoholic as the victim of society's ignorance, she finessed a lack of knowledge of the root causes of the disease process of alcoholism.

"Mann occupied a crucial mediating place between Alcoholics Anonymous and science. To demonstrate that alcoholism was treatable, she could refer to the therapeutic success of Alcoholics Anonymous, even if its approach was spiritual rather than medical. On the other hand, she could invoke the dignifying gloss of Yale science, even though the science with respect to alcohol was still pretty empty. The scientists needed something to demonstrate that something could be done, and they didn't have anything. The confluence between Alcoholics Anonymous and science is terribly important, because they created something new and powerful."

`A Lot More Wag'

Scientists can't sell themselves on their own. Organized groups of citizens affected by diseases - cancer, tuberculosis, Alzheimer's, attention-deficit disorder, AIDS - are needed to advocate research on each disease. "Some scientists didn't think Alcoholics Anonymous was going to last that long, that its religious sensibility wouldn't survive the sweeping secular approach of science.

"Ironically, Mann's message struck a resonant chord in American society. Her organization (Alcoholics Anonymous) acquired a free-standing, enduring status of its own. The advertising tail of the modern alcoholism- movement dog gets a lot more wag, and eventually the tail wags the dog.

"The disease concept has this marvelous double meaning. On the one hand, it seems to be an assertion about our knowledge of alcoholism, giving us something firm to grasp and use in addressing alcoholics. On the other hand, it seems a mere placeholder for knowledge about alcoholism, a kind of tacit promise scientists made to themselves to fill in real knowledge as soon as it became available.