Pissed-off Toff

Alcoholism is not a disease

in Big Issues

Pissed-off Toff argues that alcoholism is not a disease … but that drink is certainly a demon.

A few months ago my life in England collapsed. With all my possessions in storage, I took refuge in a house in Italy lent to me by a generous well-wisher. Here, I had ample leisure to reflect on the multiple errors and character faults that had led to my predicament. The past seemed a shameful catalogue of misguided choices, wasted opportunities and sheer idiocy; the future a bleak and lonely wilderness. By night I found oblivion in drink; in the mornings I woke up consumed by despair, prey to misery of an overwhelming intensity.

“If you carry on drinking, you’re done for,” said an old friend who was passing through and in whom I confided over a mid-morning espresso in the local bar. “You must stop now, completely,” he insisted. 

No more drink, ever? No more claret with the roast beef and Yorkshire pudding at Sunday lunch? No more champagne, no more gin and tonic by the fire in the evening? This was too much to contemplate; but later, I swore to myself that I would not touch a drop of alcohol for one month. No spirits, no wine, no beer … not one drop, under any circumstances, for thirty-one days.

* * * * *

According to the websites of various rehab centres, my decision to stop drinking without seeking hideously expensive professional help was rash indeed; dangerous, even. 

‘Generally speaking, withdrawal symptoms from alcohol may level off inside of a week. [But] if users are attempting to quit drinking alone, especially after heavy use, they may face serious health risks, and even death [my italics], during that week,’ warned the Addiction Center in the US, pulling no punches (addictioncenter.com). On the same website, the caption to a video talk given by a man of Asian extraction with long grey hair and the general demeanour of some yogic guru read thus: ‘Safety during the detoxification process and the importance of continued rehabilitation is detailed by Dr Ashish Bhatt, MD.’ 

Or how about this: ‘You should not attempt to detox on your own,’ cautioned American Addiction Centers (americanaddictioncenters.org). ‘A doctor or other medical professional can best determine the level of support you will need for appropriate management of withdrawal.’

Nevertheless, the process was surprisingly un-difficult, especially after the first few days. Temptation presented itself at regular intervals, but I resisted. After just a fortnight of no drink and long daily walks in the hills and valleys nearby, I felt a great deal better; nor did the future look quite so bleak or terrifying. To my surprise, I was even hit on by a woman at a local festa

By the end of the thirty-one days, my skin was glowing with health, my eyes were clear, and the face that I saw in the mirror was transformed. “You look ten years younger,” said a friend with whom I met up for a celebratory dinner of filetto al pepe verde washed down with a bottle of Chianti. “And well done doing it alone: you’ve saved yourself £20,000,” he continued, referring to the cost of one month in rehab.

* * * * *

About the self-administered detox, I will write at a later stage, drawing on the diary I kept at the time. But at the end of the process, a question presented itself. If, as we are constantly informed, alcoholism is an incurable life-threatening disease; if, according to current medical orthodoxy, I am to be accounted a confirmed alcoholic (along, it would seem, with a large proportion of the British public) … if this is the case, how was I able to give up alcohol for a month with barely a shrug of the shoulders? 

How, to put it more dramatically, was it possible for me to take time off from a killer disease? After all, if you have cancer or leukaemia or multiple sclerosis, you can’t decide to take a month off it. You can’t say: “I don’t think that this cancer is doing me any good at all; I think I’ll give it up for a while and see how I feel.” And yet having made up my mind to do so, I simply walked away from my own disease. Which rather suggests that it was not a disease in the first place.

Indeed, no disease can be cured or even temporarily halted by willpower alone. Therefore in logic, alcoholism cannot be a disease. It is as simple as that, nor do you have to be a doctor or scientist to work it out. What is surprising is that the notion of a physical disease to which you can say hello and goodbye at will should have been unquestioningly accepted by almost the entire medical establishment. Nor am I alone in pointing this out.

Or let us approach it from another angle; not ‘scientific’, but nevertheless revealing. Imagine that the gods have decided that you will be afflicted with a lethal disease, but that they will allow you to choose between cancer, multiple sclerosis and alcoholism. Which of the three would you take? Would you choose the cancer or the MS, which will both certainly kill you? Or the alcoholism … the killer disease that you can walk away from if you want to. You would go for the alcoholism, would you not?

For these reasons alone, I conclude that there is no such disease as ‘alcoholism’. In many ways this is against my own interests. It would be convenient for me to disclaim all responsibility for my actions and to claim to be the victim of a cruel affliction that forces me to drink. But I won’t do so, because I know quite well that when I open a bottle of gin, splash the contents over crisp cubes of ice, add a slice of lemon and a little tonic water, and then raise the tinkling glass to my lips … I know that when I do this, it is not because I am a puppet in the hands of a disease beyond my control, but because this is what I choose to do, and because it gives me pleasure.

What follows is an attempt to demonstrate, both in theory and on the basis of my own experience, that the prevalent ‘disease’ concept of alcoholism is not just wrong, but positively harmful, as well as demeaning.

* * * * *

In 1946 an American scientist (of whom more later) called E.M. Jellinek wrote an influential study of what he dubbed the ‘disease concept of alcoholism’. This was not so long after the term ‘alcoholic’ had first been used, around 1890, to refer to a compulsive drinker. The terminology is significant, since whereas older words such as ‘drunkard’, ‘lush’ and ‘toper’ might suggest disapproval of – or even contempt for – the drinker as a degenerate with a moral failing, and whereas the now outmoded term ‘dipsomaniac’ suggests that the drinker might be unhinged or mentally unstable, the new more clinical terms of ‘alcoholism’ and ‘alcoholic’ were suggestive of a blame-free medical condition.

Now almost universally accepted by the medical establishment and the public alike, the disease concept of alcoholism can be summarised thus:

  • Alcoholism is an ‘incurable disease’ whereby the alcoholic is impelled to drink and is ‘powerless’ to stop once he has started;
  • The only hope for the alcoholic is complete and permanent abstinence;
  • However, even when he has stopped drinking, the alcoholic remains an alcoholic; and if ever he starts drinking again, even after a long period of abstinence, the downhill trajectory is inevitable.

All of which begs a few questions.

For example, are you born an alcoholic or do you become one? Because if the former is the case, we must in logic accept that even a boy who has never touched a drop might be an alcoholic. But if the latter is the case, and if an ordinary social drinking habit becomes a medically diagnosable disease, at what exact stage does this occur, and what are the diagnostic tests to prove it?

Furthermore, if the alcoholic is impelled to drink and is powerless to stop drinking once he has started, how is it that some alcoholics can and do stop drinking, and that they can and do return to normal drinking habits?

And now for the central contradiction in what can only be termed a dogma. If the alcoholic is ‘powerless’ in the face of alcohol, how is it possible to maintain that the only hope for him is to stop drinking … that is, to do the one thing which the dogma itself emphatically states that he cannot do? As though to make the impossible possible, the drinker is encouraged to take one day at a time. But the objection nevertheless stands: if the alcoholic simply cannot stop drinking, then even one day is too much to ask; and the contradiction remains. 

Alcoholics Anonymous (AA) gets round this problem by stating that the alcoholic must put himself in the hands of a higher power; in other words, that he should ask for a miracle to take place. At this point any semblance of medical credibility is lost, and we enter the realms of religious faith. Indeed, I have attended two AA meetings as an only half-willing observer, and was both times struck by the cultish feel of the proceedings, with attendees standing up to make public confessions or to tell the stories of their journeys and the miracle of their salvation.

* * * * *

There are also sound medical objections to the idea that alcoholism is a disease. A disease involves the presence of some physical abnormality that drives it. Thus in the case of cancer, we find malignant cancerous cells that spread throughout the body and eventually kill the victim; in the case of leukaemia, an imbalance in the blood cells; in the case of tuberculosis (formerly known as consumption), the growth of nodules in the lungs; and so on with every disease … except ‘alcoholism’; because leaving aside the damage he subsequently causes to his mind and body as a result of his drinking, the alcoholic has no underlying or pre-existing physical or biological abnormality

Huge sums of money have been spent by the alcoholism-as-disease lobby in an attempt to identify an elusive ‘alcoholic gene’, but none has been found; nor, with the alcoholic, can any other pre-existing biological imbalance or abnormality be found that constitutes a disease … no imbalance in the blood cells, for example; no abnormality of the chromosomes. Where, then, is the ‘disease’?

Furthermore, the cancer, leukaemia and tuberculosis mentioned above are characterised by physical symptoms. The one and only symptom of alcoholism, however, is not physical. It is behavioural. Alcoholism, we are asked to believe, is a disease that impels you to drink. In more graphic terms, alcoholism, we are asked to believe, is a disease that forces the victim to go down to the nearest off-licence, buy a bottle of gin, return home, open it and drink it empty. This bears repeating: the one and only symptom of alcoholism is that you simply cannot prevent yourself from going to Waitrose, buying a bottle of gin, and downing it.

Absurd it might be, but that is the accepted view today; and now that rehab is a multi-billion pound industry, the medical establishment has every interest in keeping things the way they are. Indeed, Jellinek’s 1946 study promoting the disease concept of alcoholism was funded by a certain R. Brinkley Smithers, the founder, in the US, of the National Institute for Alcoholism & Alcohol Abuse. Smithers ran a 28-day rehab programme for alcoholics, and only if alcoholism were pronounced a medical condition could the cost of treatment be claimed back on health insurance. So he was happy when, after heated debate, the American Medical Association declared alcoholism an ‘illness’ in 1956; and happier still when, further influenced by Jellinek’s 1960 book entitled The Disease Concept of Alcoholism, they upgraded it to a ‘disease’ in 1966.

In any case, the fact that the medical establishment currently maintains that alcoholism is a disease does not make the proposition true. Most telling of all, perhaps, is the fact that Jellinek, the very man who did so much to popularise the disease concept of alcoholism in the first place, later disowned his theory, admitting that he had doctored the evidence in order to arrive at conclusions which he subsequently repudiated. In other words, he admitted that his research was fraudulent … and, by extension, that the disease concept of alcoholism was nonsense; or at any rate, highly dubious. But the quacks and snake-oil merchants at the rehab centres don’t want to know: they’ve got too much skin in the game now.

* * * * *

If alcoholism is not a physical disease, is it perhaps a mental one? Does the alcoholic have a differently wired brain, so to speak, which impels him to drink? This again seems unlikely. If it were the case, the very first time a boy ‘hard-wired’ as an alcoholic had his first taste of alcohol, a circuit would be activated in his brain and he would feel impelled to drink his father’s cellar dry then and there.

And there is a deeper objection to all this. If some notional ‘hard-wiring’ of the brain causes alcoholism, why not argue that it causes everything else too? That good men are good and bad men bad because of the way their brains are wired? That the thief steals because he has to (poor lamb!); that the murderer just can’t help killing people (how awful for him!); that we are all just machines obeying instructions written into us as into a computer program … and ultimately, that there is no such thing as free will; or even humanity. The idea is repugnant. We reject it instinctively.

Indeed, when the Baldwin Research Institute (BRI) in the US interviewed 545 substance abusers, most of whom had been to at least one disease-based treatment facility, only three of them said they truly believed that they had a disease. However, of the approximately 450 interviewees who had been in conventional treatment, more than 400 of them had falsely stated, during treatment, that they thought they had a disease. To quote the BRI’s own research: ‘The pressure to conform to the treatment rhetoric and the built-in excuse to relapse were the primary reasons given by treatment clients for saying they had a disease, even when they believed wholeheartedly that it was not true.’

Which brings me to a point to which I alluded earlier: that the disease theory of alcoholism is not just wrong, but that it is also harmful and demeaning. Harmful, because if you tell an alcoholic he has a disease that is beyond his control, you give him the perfect excuse to return to the bottle. “I can’t help it, can I?” he will say. And demeaning, because in propagating the message that the drinker is ‘powerless’ to help himself, you infantilise the individual and demean the human spirit.

And finally, one last argument – instinctive, but no less convincing for that – against the proposition that alcoholism is a disease. Nobody feels contempt for someone suffering from cancer or leukaemia, do they? The reason is that these are real diseases, and that the people suffering from them really are powerless to do anything about it. So the natural reaction is pity, not contempt. Whereas a large number of people feel contempt for the drunkard, and always have done, ever since alcoholism became a widespread problem at the start of the Industrial Revolution. The reason, surely, is that despite the fact that they unthinkingly tell pollsters that they believe alcoholism is a disease (this being the default answer, nowadays), most people would reject the idea that anyone really has to drink.

Similarly, why is it that unlike the cancer victim, the drinker feels guilt, remorse and shame? The reason can only be that deep down, he knows that he picks up the bottle because he chooses to pick it up; not because he is forced to.

* * * * *

If alcoholism is not a disease for which the one and only awful remedy is total abstinence, what then is it? 

Is it a bad habit which has taken hold? Or a compulsion? Or an addiction? Is it all three of these (they are, after all, very similar). Or perhaps it’s a vice to which the weak-willed and degenerate fall prey? This view was held throughout most of the 18th and 19th centuries, and still finds favour. And as the handmaiden of gluttony, drunkenness is clearly one of the seven cardinal sins.

Nor is the Bible silent on the matter. Here, for example, is St Paul in his letter to the Galatians. ‘Now the works of the flesh are manifest, which are these: Adultery, fornication, uncleanness, lasciviousness, idolatry, witchcraft, hatred, variance, emulations, wrath, strife, seditions, heresies, envyings, murders, drunkenness, revellings, and such like; of the which I tell you before [i.e. I warn you], as I have also told you in time past, that they which do such things shall not inherit the kingdom of God.’ (Galatians 5:19-21, King James Version)

Elsewhere in the Bible, the Book of Proverbs has this to say: ‘Do not mix with winebibbers, or with gluttonous eaters of meat; for the drunkard and the glutton will come to poverty, and drowsiness will clothe a man with rags.’ (Proverbs 23:20-21, King James Version) And with terrible acuity: ‘Who has woe? Who has sorrow? Who has contentions? Who has complaints? Who has wounds without cause? Who has redness of eyes? Those who linger long at the wine, those who go in search of mixed wine.’ (Proverbs 23:29-30, King James Version) 

And what of drink, as opposed to drunkenness?

Clinically speaking, alcohol is of course a drug; an anaesthetic, to be precise; and as such, a fast and easy route to a pleasurable sensation of wellbeing. All you have to do is open the phial and pour out a little magic potion, and your cares vanish. But like all drugs, it is addictive, and comes at a price. Here, again, is the Bible on the topic of wine that ‘sparkles in the cup’ and ‘swirls around smoothly’ (Proverbs 23:30, in words which foresee the advent of the G&T with uncanny accuracy): ‘At the last it bites like a serpent, and stings like a viper.’ (Proverbs 23:31)

But in non-clinical terms, the most persuasive voice concerning the nature of alcohol perhaps belongs to Evagrius, the late-fourth-century Desert Father who speaks to us from his cave in the Egyptian wilderness. He saw it as a temptation, and being a man of his time, he refers to it as a demon or a spirit … a manifestation of the Devil, therefore.

How right he was. I recently treated myself to a bottle of 12-year-old Scotch whisky to see me through a solitary Christmas in the south of Tuscany. I had forgotten quite how good it is. One dram led to a second, and to a third. And then there he was, in the corner of the room … there was the Devil with horns on his head, a red cape on his back and a fork in his left hand, urging me on to further self-indulgence. I saw him quite clearly. “Go on!” he whispered. “You know you like it! You know you do! Why not pour yourself another? Just one more!! You deserve it …”

Would Evagrius have fallen for the strange new notion that drunkenness is a ‘disease’? One doubts it. Ignorant of medicine, but with powers of intuition and perception that so many modern scientists entirely lack, this humble Desert Father understood that drink is a demon.


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