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This paper discusses the concept of addiction and some major points related to it. In relation to this concept is its relation to alcoholism, how it is developed, and its disease. This paper also emphasizes on the disease model of addiction or alcoholism as reported by E.M. Jellinek and other related authors.
One of the problems that the society faces today is the problem with addiction. Addiction may come in many forms and is usually associated with negative ideas or concepts. This concept of addiction would automatically suggest one person’s excessive wanting for something, and because the world at present has become more open to a lot of vices and worldly things, the concept of addiction may not be considered as something new. With the advancement of technology, addiction to video games is not a new idea to us. With the improvement of ways in planting and harvesting, addiction to prohibited drugs such as marijuana is no more taboo With the increase in the production and the innovation of different alcoholic beverages, addiction with it is not anymore a new issue. However, although the addiction of several people may not be a big deal with a majority of the world’s population, the serious consequences that follow it may become inevitable. We may not admit it, but due to the negative notions we attach to this idea, addiction would still alarm us.
Addiction and Its Models
When we hear the word addiction, what comes first in our mind is its root word “addict”, which literally means a devotee, a fan or an enthusiast. More or less, we can admit that in one way or another, each of us have addictions, such as eating, sleeping, drinking, watching television, and the likes. As cited, we continue this addiction as we get immediate gratification from them and find them very hard to give up; a very good definition of addiction indeed ( 2005). Addiction is not just merely excessive use. It describes a chronic pattern of behavior that continues and is perceived to be hard or impossible to quit at any time. In addition, it is quite common for an addict to express the desire to stop the behavior, but find him or herself unable to cease (2006).
In relation to this is the emergence of several thoughts of scientists and scholars regarding their different beliefs in addiction, especially in considering it as a disease. The Disease Model of Addiction describes addictions as a biologically bases, lifelong disease that involve a loss of control over behavior and requires medical or spiritual treatment for recovery. In the disease model, a tendency to addiction is either inherited or acquired by a person early in life ( 2006). In support to this claim, we can site a study wherein genetics may play a major role in determining the cause of addiction.
Many a study have shown that genetic components have been found to play a part in dependence on many of the most commonly used licit and illicit substances, suggesting that some people are more vulnerable than others to developing drug and alcohol problems (2005). It was explained that each individual possesses two alleles at each gene, one inherited from each parent. When different alleles of a gene are circulating in a population, the gene is said to be polymorphic, and these different alleles are represented as differences in the base sequence of the DNA coding for the gene product, a protein. As a result, the first level of genetic variation that can give rise to individual behavioral differences is due to DNA sequence differences ( 2005).
Moreover, there are also those in the field that would go further to say that genetics is almost the sole cause of addictive behavior. In a study done on genetic and environmental contributions to alcohol abuse and dependence in a population-based sample of male twins, it was found out that genetic factors played a major role in the development of alcoholism. This study also concluded that environmental factors shared by family members appear to have had little influence on the development of alcoholism in males ( 2005). This study supports the claim of the disease model as it states that current or recent problems or relationships are not believed to be the cause of the disease, and this includes the present environment, family, and society of the person.
In addition, the disease model of addiction states that the habitual use of alcohol or drugs can be characterized as a disease. Studies show that irreversible changes occur in those who use substances repeatedly. When individuals become addicted to alcohol or drugs, those changes make being a normal drinker or social drug use impossible. The more severe the loss of control while using or drinking, the truer this is. Substance abuse becomes an obsession of the mind, in which the only thing that matters is drinking or using ( 2006).
However, despite the explanation and the support of many on this matter, some contradicts the idea of the disease model. Critics of the disease model, particularly those who ascribe to the Life-Process Model of Addiction argue that the disease model is not founded on scientific principles and has negative social effects. The criticism is based on the argument that the disease approach has not discovered any biological mechanisms to identify addictive behavior. They argue that labeling people as addicts keeps them from developing self-control and stigmatizes them ( 2006). In contrast to the disease model of addiction, the Life-Process Model of Addiction is the view that addiction is not a disease but rather a habitual response and a source of gratification and security that can be understood only in the context of social relationships and experiences. This model of addiction is in direct opposition to the disease model of addiction. The proponents of this model argue that the biological mechanisms that might account for addictive behavior have not bee identified and thus do not support using the term disease, preferring to emphasize the individual’s ability to overcome addiction by repairing relationships and personal strength of will (2006).
Disease Model of Alcoholism
One type of addiction is alcoholism. Alcoholism is also known as alcohol dependence and is considered a disease with symptoms such as craving or feeling a strong urge to drink; loss of control or not being able to stop once drinking has begun; physical dependence such as nausea, sweating, shakiness, and anxiety; and tolerance or drinking greater amounts of alcohol to “get high” ( 2006). Many people believe that drinking alcohol will and may ease their problems regarding their family, work and the society, but in fact, it would not. Acquiring alcoholism may lead to more serious complications and fatal illnesses that would cause the person’s life.
Several think that alcoholism is a disease, and in fact this statement is supported by the (2006), stating that is considered a disease. It states that the craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems. It was further explained that like many other diseases, alcoholism is chronic, meaning that it lasts a person’s lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing it is influenced both by a person’s genes and by his or her lifestyle (2006).
The disease model of alcoholism has a history dating back more than two hundred years, and is considered by many to be the dominant paradigm guiding scientific inquiry and treatment approaches for much of the 20th century (2002). An early proponent of the disease model was E. M. Jellinek who published research in the 1940s and 1950s. His work, in conjunction with the growth of Alcoholics Anonymous, the self help movement which embraces its own version of the model, led to formal acknowledgement of alcoholism as a disease by the World Health Organization in 1955 ( 2006). However, as early as the 1960s, the disease model came under attack due to the emergence of anomalous scientific and clinical findings (2002). This in turn, affected the alcoholism treatment community in the United States and other countries.
In line with this Jellinek felt that heavy drinking was initially a result of learning and that the disease of alcoholism developed at some point as drinking became increasingly excessive, and did not believe that an alcoholic lost control over his drinking every time he took alcohol. In relation to Jellinek’s belief that alcoholism is a result of learning is that it may depend on the person’s exposure to drinking. This is based on the assumption that the introduction of a substance into the body on a regular basis will inevitably lead to addiction ( 2005). Furthermore, explanations for this are that some substances, when introduced to the body, cause a change to the body’s natural endorphin, producing capabilities. Endorphins are naturally occurring painkilling substances that bring about pleasurable feelings, the body can become reliant on the substance to release these endorphins either to avoid the withdrawal sensation or because the body has cut down on natural production ( 2005).
With these, Jellinek identified five types of alcoholic ranging from mildly to severely alcoholic, and within this continuum, he distinguished between psychological and physical dependence, and continual and episodic drinking ( 2006). Jellinek came up with the idea of grouping different drinking patterns and naming them by giving each a Greek letter. One might think that the purpose of such a classification is to expand the range of alcoholism and include as many people as possible under the disease concept; but in contrary, it in fact tries to limit its scope, stating that most of the types described might be alcoholics, but they are not diseased because they do not suffer from loss of control ( 2006).
- Alpha Alcoholism. The earliest stage of the disease, manifesting the purely psychological continual dependence on the effects of alcohol to relieve bodily or emotional pain. This is the “problem drinker”, whose drinking creates social and personal problems. Whilst there are significant social and personal problems, these people can stop if they really want to; thus, argued Jellinek, they have not lost control, and as a consequence, do not have a disease.
- Beta Alcoholism. Also called polyneuropathy or cirrhosis of the liver, from alcohol without physical or psychological dependence. These are the heavy drinkers, and drink almost every day. They do not have physical addiction and do not suffer withdrawal symptoms. This group does not have a disease.
- Gamma Alcoholism. This involves acquired tissue intolerance, physical dependence, and loss of control. This is the A.A. or Alcoholic Anonymous alcoholic, who is very much out of control, and does have a disease.
- Delta Alcoholism. Similar with Gamma alcoholism but with inability to abstain, instead of loss of control.
- Epsilon Alcoholism. The most advanced stage of the disease, manifesting as dipsomania, or periodic alcoholism.
As earlier stated, the disease concept is controversial and not without critics (2006). Two well-known critics are both of whom have written books, as well as articles disputing the disease concept of addiction. Since the disease concept is attributed to Jellinek, a lot of criticism has been directed at his research, which was the basis for his conclusions about the disease concept. Jellinek’s data were gathered from questionnaires that were distributed to AA members through its newsletter, “The Grapevine” ( 2006). The result was, out of 158 questionnaires returned, 60 were discarded because members had pooled and averaged their responses, and no questionnaires from women were used. Jellinek himself acknowledged that his data was limited. Therefore, one might wonder why Jellinek’s concept of the disease of alcoholism received such widespread acceptance (2006).
One reason for the widespread acceptance of this concept is, as Peele noted, “The disease model has been so profitable and politically successful that it has spread to include problems of eating, child abuse, gambling, shopping, premenstrual tension, compulsive love affairs, and almost every other form of self-destructive behavior. From this perspective, nearly every American can be said to have a disease of addiction” (2006). Furthermore, it has opened new arguments to researchers. Since the introduction of the disease concept, research studies have examined a possible genetic link in alcoholism or addiction. One such study demonstrates that the offspring of alcoholics are approximately three to five times more likely to develop alcoholism that offspring of non-alcoholics. However, the genetic influence on other drug addiction has received less research attention ( 2006). In addition, in 1983, there was a popular theory of alcohol addiction expressed by in his book “The Disease Concept of Alcoholism”, that proposed that alcoholics produced a highly addictive substance called THIQ during the metabolism of alcohol. This substance is normally produced when the body metabolizes heroin and is supposedly not metabolized by non-alcoholics when they drink. The theory is that alcoholics are genetically predisposed to produce THIQ in response to alcohol, that the THIQ creates a craving for alcohol, and that the THIQ remains in the brain of the alcoholic long after the use of alcohol is discontinued. This would provide a physiological explanation for the fact that recovering alcoholics who relapse quickly return to their previous use patterns. More recent research on genetic causes of alcoholism has focused on some abnormality in a dopamine receptor gene and deficiencies in the neurotransmitter serotonin or in serotonin receptors (2006).
Jellinek’s Model and AA
Jellinek’s phase model of alcoholism has been the standard textbook description of the alcoholism process (1986). It has essentially gone unchallenged until recently. It has highly influenced most conceptualizations of alcoholism and its treatment within the past several decades. The phase model reflects Jellinek’s assessment and interpretation of data collected by the Grapevine, the official organ of A.A.
The phase model characterizes the “alcoholic” as generally passing through four phases and these include the prealcoholic symptomatic phase, the prodromal phase, the crucial phase, and the chronic phase. The prealcoholic symptomatic phase is characterized by a progression from occasional to almost daily relief drinking; that is, drinking to relieve tension. The second phase, the prodromal phase, is marked by “blackouts.” These losses of memory occur after a moderate amount of alcohol has been consumed; although persons affected may be able to carry on complex activities, they fail to recall them the following day. The prodromal phase is followed by the crucial phase. This phase is initiated by loss of control over drinking, that is, “any drinking of alcohol starts a chain reaction which is felt by the drinker as a physical demand for alcohol” (1986). Other characteristics of this phase include aggressive behavior, drinking rationalizations, remorse, periods of abstinence, and morning drinking. The last phase, the chronic, begins when drinkers can no longer hang on during the daytime and subsequently begin to engage in benders or periods of prolonged intoxication. Other features of this phase include impairment of thinking, indefinable fears, tremors, psychomotor inhibition, and loss of tolerance. During this phase, individuals control these symptoms by drinking (1986).
Addiction now becomes purely negative and problematic. The bright side is that addiction is a treatable disease. Many people who are addicted feel hopeless about their situation. They feel that they cannot stop using and cannot face life without the help of drugs or alcohol. The disease model offers a hopeful alternative. Treatment and sobriety can allow people to lead fulfilling lives ( 2006).
Alcoholism should not be judged as a problem of willpower, misconduct, or any other unscientific diagnosis. The problem must be accepted for what it is, a biopsychosocial disease with a strong genetic influence, obvious signs and symptoms, a natural progression and a fatal outcome if not treated (1998). We must know our roles in helping to combat this problem and with the advice and help of our loved ones; we can start by educating and convincing others to have a healthy lifestyle. This task might be overwhelming, but through strong intervention, this disease will be lessened and better results will be achieved.
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