Doctors’ Rejection of the Disease Theory of Alcoholism

David J. Hanson, Ph.D.

Many physicians reject the disease theory of alcoholism. As Dr. Lynne Appleton observes, "Despite all public pronouncements about alcoholism as a disease, medical practice rejects treating it as such. Not only does alcoholism not follow the model of a 'disease,' it is not amenable to standard medical treatment."1

Dr. Appleton explains that "medical research on alcoholism does not support the disease model; highly respected and influential medical authorities do not promote the theory and treatment of alcoholism as a disease."2

When a nation-wide sample of physicians in the U.S. was asked if they personally believe that alcoholism is mainly a disease or mainly a personal or moral weakness, 15% believed that it was the latter. When the sample was asked what proportion of alcoholism itself is a disease and what proportion is a personal weakness, the average proportion that was judged to be personal weakness was 31%. Only 12% of physicians believed that alcoholism is 100% a disease.3

A survey of over 88,000 physicians in the U.S. found that "Only 49% of the physicians characterized alcoholism as a disease." Over 75% believed that the major causes of alcoholism are "personality and emotional problems."4

A survey of psychiatrists and psychologists employed by the Veterans Administration was conducted by Dr. Wilma Knox. "Their attitudes were remarkably similar. Both groups rejected the disease concept in preference to characterizing alcoholism as a behavior problem, symptom complex, or escape mechanism. Both groups were inconsistent in advocating neuropsychiatric hospitalization while considering treatment benefits very limited. Members of both groups were reluctant to participate personally to any degree in rendering this treatment."5

One survey of physicians found that only about 20% believed substance addiction to be a disease.6 Another survey found that only 27% of physicians believed that alcoholism is a disease. The majority viewed alcoholism as a social or psychological problem rather than disease.7

It is significant that a survey of doctors attending an annual conference of the International Doctors in Alcoholics Anonymous (IDAA) found that 80% of its members believed that alcoholism is simply bad behavior - - not a disease.8

It is reported that "Many doctors have been loath to prescribe drugs to treat alcoholism, sometimes because of the belief that alcoholism is a moral disorder rather than a disease."9 Indeed, in a survey of physicians' beliefs about alcoholism, 55% said that there is "no effective treatment" for it.

Doctors, researchers, clinicians, therapists and other professions as well as insurance companies, courts, and other institutions have relied on the definitions and diagnostic criteria of the American Psychiatric Association (APA) since 1952. Between then and 1980, the APA defined alcoholism as a disease. However, based on scientific and medical evidence, it rejected the disease theory of alcoholism in 1981 and no longer defines it as such. Even earlier (1979), and for the same reason, the World Health Organization (WHO) had rejected the disease theory of alcoholism and continues to do so.

In 1956 the American Medical Association passed a resolution declaring alcoholism to be a disease. This enabled doctors to bill third party payers (insurance companies) for treating alcoholics. Had it not defined alcoholism as a disease, physicians wouldn’t be able to receive insurance payments. As one defender of the action asserted, “a disease is anything doctors choose to call a disease.”10 The American Hospital Association similarly passed a resolution defining alcoholism as a disease, which enables hospitals to receive payment for patients being treated for alcoholism in their facilities.

Yet in spite of those self-serving organizational actions, a large proportion of doctors rejects the disease theory of alcoholism. That’s a testament to their open minded acceptance of scientific evidence.

 

Resources

  • 1. Appleton, Lynn M. Rethinking Medicalization: Alcoholism and Anomalies. In: Best, Joel (Ed.) Images of issues: Typifying Contemporary Social Problems. New York: Aldine de Gruyter, second edition, 1995, p. 65. To locate the library closest to you that has this book, go to http://www.worldcat.org/search?q=ti%3A+Images+of+issues%3A+Typifying+Contemporary+Social+Problems&qt=advanced&dblist=638 and click on the title of the book.
  • 2. Appleton, Lynn M. Rethinking Medicalization: Alcoholism and Anomalies. In: Best, Joel (Ed.) Images of issues: Typifying Contemporary Social Problems. New York: Aldine de Gruyter, second edition, 1995, p. 69. To locate the library closest to you that has this book, go to http://www.worldcat.org/search?q=ti%3A+Images+of+issues%3A+Typifying+Contemporary+Social+Problems&qt=advanced&dblist=638 and click on the title of the book.
  • 3. Peter D. Hart Research Associates, Inc. The Road to Recover: A Landmark Study on Public Perceptions of Alcoholism & Barriers to Treatment. Conducted for the Rush Recovery Institute. Washington, D.C: January, 1998, pp. 5-7. This document is also known as The Rush Study. Available at http://www2.potsdam.edu/hansondj/Controversies/The-Road-to-Recovery.html
  • 4. Jones, R.W., and Helrich, A.R. Treatment of alcoholism by physicians in private practice: a national survey. Quarterly Journal of Studies on Alcohol, 1972, 33(1), 117. To locate the library closest to you that has this journal, go to http://www.worldcat.org/search?q=ti%3ATreatment+of+alcoholism+by+physicians+in+private+practice%3A+a+national+survey&qt=advanced&dblist=638 and click on the title.
  • 5. Knox, W.J. Attitudes of psychiatrists and psychologists toward alcoholism. American Journal of Psychiatry, 1971, 127(12), 1675-1679. Abstract available at http://psycnet.apa.org/psycinfo/1972-05134-001. To locate the library closest to you that has this journal, go to http://www.worldcat.org/search?q=ti%3AAttitudes+of+psychiatrists+and+psychologists+toward+alcoholism&qt=advanced&dblist=638 and click on the title.
  • 6. McLellan, T. Re-Considering Addiction Treatment: How Can Treatment be More Accountable and Effective? A continuing medical education (CME) course. Cranston, RI: Association for Medical Education and Research on Substance Abuse (AMERSA), 2006.
  • 7. Mignon, S. I. Physicians' perceptions of alcoholics—the disease concept reconsidered. Alcoholism Treatment Quarterly, 1996, 14(4), 33–45. http://www.tandfonline.com/doi/abs/10.1300/J020V14N04_02#preview
  • 8. Hobbs, Thomas R. Managing alcoholism as a disease. Physician's News Digest, 1998 (February), p. 1. http://www.physiciansnews.com/commentary/298wp.html
  • 9. Hathaway, William. Headache pill eases alcohol cravings. Hartford Courant, October 10, 2007. http://articles.courant.com/2007-10-10/news/0710100012_1_heavy-drinking-days-topiramate-five-drinks
  • 10. Jellinek, E.M. The Disease Concept of Alcoholism. New Haven, CT: Hillhouse, 1960, p. 23. To locate the library closest to you that has this book, go to http://www.worldcat.org/search?q=ti%3AThe+disease+concept+of+alcoholism&qt=advanced&dblist=638 and click on the title.

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