Still Under the Influence, Part 2

Beyond the Influence : Understanding and Defeating Alcoholism
by Katherine Ketcham

(Page 2 of 2)

Yet the myths and misconceptions that distort our thinking about alcoholism, complicating both treatment and recovery, remain firmly in place. Two decades ago the myths and realities about alcoholism were presented in Under the Influence: A Guide to the Myths and Realities of Alcoholism, coauthored by James R. Milam and Katherine

Ketcham. Despite stunning scientific advances in alcoholism research in the last twenty years, these myths continue to influence the way we treat alcoholics.

Myth: Alcohol has the same chemical and psychological effects on everyone who drinks.

Reality: Alcohol, like every other substance we take into our bodies, affects different people in different ways.

Myth: Addiction to alcohol is often psychological.

Reality: Addiction to alcohol is physiological and involves profound chemical disruptions in the brain.

Myth: Alcohol is an addictive drug, and anyone who drinks regularly for a long enough period of time will become physically addicted to it.

Reality: Alcohol is a selectively addictive drug; only a minority of drinkers will experience the need or desire to consume alcohol in sufficient quantities and over a long enough period of time to become physically addicted to it.

Myth: People become alcoholics because they have psychological or emotional problems that they try to relieve by drinking.

Reality: Alcoholics have basically the same psychological problems as nonalcoholics before they start drinking, but these problems are aggravated (and new disturbances are created) by addiction to alcohol.

Myth: If people would drink responsibly, they would not become alcoholics.

Reality: Many responsible drinkers become alcoholics. Because of the nature of the disease — not the person — they begin to drink irresponsibly.

Myth: Some alcoholics can learn to drink normally as long as they limit the amount.

Reality: Alcoholics, who by definition suffer from a permanent brain addiction, can never safely return to drinking.

A little history may help here. Originally published in 1981, Under the Influence detailed the biochemical and neurophysiological factors — metabolic abnormalities, alterations in brain chemistry, heredity, ethnic susceptibility, and prenatal influences — that determine why some people become addicted to alcohol while others do not. The book helped fuel the "recovery boom" of the 1980s, a time of remarkable advances in alcoholism treatment and prevention efforts and a period marked by a growing commitment to the scientifically proven understanding that alcoholism is a primary, progressive, physiological disease requiring lifelong abstinence for recovery.

As the recovery boom gained momentum, growing numbers of behaviorists, social critics, and popular writers raised their voices to criticize the "disease concept," arguing that it failed to account for psychological and emotional factors. Many critics contended that focusing attention on the physical addiction released problem drinkers from moral responsibility for their behavior. What about willpower and simple human decency? If we call alcoholism a disease, the critics continued, we might as well call fingernail biting, obsessive TV viewing, and chronic boredom "diseases." One psychiatrist used a sunburn analogy: Redheads tend to burn more easily than brunettes or blondes, so shouldn't they protect themselves by staying out of the sun? And shouldn't those redheads who continually get sunburned take responsibility for and accept the consequences of their misbehavior?

Alcohol problems should be redefined as "maladaptive lifestyle habits," argued behavioral psychologist Alan Marlatt of the University of Washington. An outspoken critic of the "disease concept," Marlatt insisted that excessive drinking is a behavior that people do, not a symptom of what they are, and that alcoholics and problem drinkers can be taught how to modify their maladaptive habits through stress management, lifestyle changes, and basic learning principles. For those who want to reduce their drinking and avoid the health problems associated with excessive use of alcohol, Marlatt and other behavioral psychologists argued that moderation is the key.

In Heavy Drinking: The Myth of Alcoholism as a Disease Herbert Fingarette, a professor at the University of California and a consultant on alcoholism and addiction to the World Health Organization, dismissed fifty years of research on the neurological and biochemical nature of alcoholism with this statement: "No leading research authorities accept the classic disease concept." In The Diseasing of America: Addiction Treatment Out of Control psychologist Stanton Peele argued that disease definitions actually "undermine the individual's obligations to control behavior and to answer for misconduct."

Popular writers quickly latched on to the behaviorist trend. Audrey Kishline, a moderate drinker who believes she was mistakenly diagnosed as an alcoholic, observed in Moderate Drinking, "The act of lifting a drink to your lips too often is not a 'disease.' Drinking too much is a behavior, something that a problem drinker does, not something that he or she has."

As concepts such as "moderation," "responsible drinking," and "maladaptive habits" caught the public's imagination, society as a whole became less tolerant of alcoholics and their "misbehaviors." Changing attitudes toward alcoholics were reflected clearly in the increasingly popular use of the word abuse.* Beginning in the 1980s, government agencies charged with overseeing alcohol education and treatment programs abandoned the word alcoholism in favor of the term alcohol abuse and, more recently, substance abuse. In recent years the word alcoholism seems to have disappeared from official language while the term substance abuse has become as familiar as Budweiser's trio of frogs.

As alcoholism gradually became linked in the public mind with alcohol "abuse," efforts to teach "irresponsible" and "abusive" drinkers how to moderate their drinking grew in popularity. Critics of the disease concept argued vehemently that controlled-drinking therapy — tellingly translated as "behavioral self-control" — should be considered a valid alternative to lifelong abstinence. In the 1990s "harm reduction" programs such as DrinkWise, S.M.A.R.T., and Moderation Management expanded to the point where a 1997 U.S. News and World Report article predicted that controlled-drinking programs would someday "be as commonplace as Weight Watchers and Smokenders."

Copyright © 2000 by Katherine Ketcham and William F. Asbury with Mel Schulstad and Arthur P. Ciaramicoli, Ed.D, Ph.D.. Excerpted by permission of Bantam, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

About the Author

Katherine Ketcham is the author of nine nonfiction books, including five on alcoholism.