Alcoholism Types of Disease

There are three basic types of alcoholism disease models that have been proposed at various times. They all tend to share the same basic characteristics but the aetiology (underlying mechanisms which cause the condition) are different.

Pre-Existing Physical Abnormality

The first and oldest model is that there is some (often unspecified) Pre-Existing Physical Abnormality. This model suggests that alcoholics/addicts are born with an inherent flaw in the way their body reacts with substances.

The manual for AA, called Alcoholics Anonymous, begins with a discussion by Dr Silkworth of what form the disease takes. In this section, called the Dr’s Opinion, he suggests that the alcoholic is allergic to alcohol and this is the reason alcoholics drink and behave in an abnormal fashion. This led to much speculation that alcoholics/addicts were genetically programmed to be addicted. For many years research found no evidence for this proposition and the model’s support waned, although AA continued to promulgate it. More recent research, using more advanced technology such as gene probes, has found that there may indeed be a genetic component, if not an alcoholic gene, to addiction. The exact mechanism is still unclear and a genetic predisposition would appear to be only one prerequisite for what is a complex behaviour.

Psychopathology or Mental Illness

The second model suggests that alcoholism/addiction is a Psychopathology or Mental Illness. To some extent this model has

echoes of the original theories of Trotter and Rush who suggested a disease of the mind or will. Many theories have been proposed to support this model. For example the work of Freud has been used to suggest that alcoholics/addicts were fixated at the oral stage (lack of self-control, self-destructive). The influence of Freud continues today in the language of addiction, for example a typical view of the alcoholic is that they are in denial (refuse to admit their problem) and practice projection (blame others). Another theory that continues to be given credence, at least with laymen, is the addictive personality. That is some people are prone to be addicted to numerous substances (alcohol, drugs, tobacco) and/or behaviours (eating, exercise, gambling, internet). No convincing evidence has been produced that unequivocally supports this model as it is difficult to separate what is cause and what is consequence. That is does having a particular type of personality predispose a person to addiction, or does addiction cause a person to exhibit certain personality traits.

Acquired Addiction

The third and final model suggests that addiction can be acquired through alcohol/drug use. Unlike the other two models this one suggests that the disease does not precede and cause the problematic use but is instead a consequence of it. Certainly this model tends to given more credence than the others both by professionals working in the addiction field and by laymen. Witness for example the current views of heroin or crack cocaine and how addictive it is. This model is the forerunner and influence of the Dependence Syndrome.

The Essential Characteristics of the Disease Models.

Although there are differences between the above models there are four essential elements that are common to all disease models. These elements are based on Jellinek’s gamma alcoholic, or as he suggested – the real alcoholic.

The first characteristic is that alcoholism/addiction is a discrete entity, that is people either are or are not alcoholics/addicts, as some say you can't be a bit of an
alcoholic in the same way you can't be a bit pregnant. Thus alcoholics/addicts are viewed as different (physically or psychologically) from non-alcoholics/addicts. In the first model above (and in some versions of the second model) the alcoholics/addicts can never be normal in respect of alcohol/drug use and normal alcohol/drug users can never be alcoholics/addicts. Even in some versions of the third model alcoholics/addicts are viewed as qualitatively different from non- alcoholics/addicts rather than quantitatively different. That is they are seen to be different by what they are (alcoholics/addicts) rather than what they do (drink or use drugs excessively).

The second characteristic is that the alcoholic/addict suffers from loss of control and abnormal craving. Indeed these symptoms are often regarded as the hallmark of addiction. It is suggested that alcoholics/addicts have great difficulty abstaining form alcohol or drugs because of an abnormal craving and once they do begin to consume, the lack of control means that they cannot stop. This is summed up in the old adage “One drink, one drunk”.

The third characteristic is that this abnormal craving and loss of control is irreversible. That is once a person is or becomes an alcoholic/addict, they are always an alcoholic/addict. The only recovery possible is that they abstain forever, since, even after a long period of abstinence the mechanisms of abnormal craving and loss of control are still present and any consumption will result in a return to the prior state of alcoholism/addiction.

The fourth and final characteristic is that if left untreated the disease is progressive. Jellinek described this progression in his phases of alcoholism and Glatt depicted it in his diagram that showed quite graphically that without treatment alcoholism/addiction would result in insanity or death.

Go to Alcoholism Disease Evidence

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