NIAAA Official Says Alcoholism ‘Isn’t Usually’ a ‘Chronic, Relapsing Disease’

Jacob Sullum enjoys a gotcha moment with Mark Willenbring.

After reading the original article, I don’t see this as the Perry Mason moment that Sullum does. The article suffers from the same problem that many articles on the subject do–it does a poor job of distinguishing when we’re talking about DSM dependence and when we’re talking about DSM abuse. The implications for each are vastly different. Most people with DSM abuse will find that their problems eventually resolve on their own or when other primary problems are resolved. For those with DSM dependence, the conventional wisdom has been that they all need professional treatment and that they all need professional treatment and they all need to abstain completely. We’re learning more about how this is not universal. Part of the problem has been categorization of problem drinkers. People with temporary, rather than chronic, alcohol problems may meet diagnostic criteria for dependence and then “mature out”. The example that most easily comes to mind are college students who engage in frequent heavy drinking and then moderate when they graduate, get married, or decide that it will interfere with their goals. That’s what this article examines.
What I find very interesting is the libertarian hostility toward the disease model of alcoholism. I read this a few days ago and was wondering if the objection was that the model challenges individual agency. A peek at the comments this morning suggests that the objections do coalesce around three issues:
  • An objection to the notion that free will (and, therefore, personal responsibility) is compromised.
  • The spirituality of AA.
  • That framing heavy drinking as something other than a personal choice opens the door to medical and state interference in a person’s life.
  • That treatment doesn’t look like treatment for the medical conditions that come to mind.

2 thoughts on “NIAAA Official Says Alcoholism ‘Isn’t Usually’ a ‘Chronic, Relapsing Disease’

  1. Indeed, the libertarian movement worries me. I've met very few who believe that we can combat climate change. Classic case of putting theory before fact.


  2. It's always nice when people shove a badly constructed argument in your face and want applause for it.I've been studying the neural basis of addiction for years and the notion that admitting interference with free will is somehow a weakness is, in my opinion, a simple sign of not understanding the body of knowledge. That, or simply trying to be sensational. Libertarians seem to be good at both.Chronic use of all drugs compromises brain systems that are important for decision making. Period. Read that sentence again and again until you understand it completely. That is at least one of the major processes through which addiction becomes, at least in some part, involuntary.It's not that free will is abolished, it's just that the tools used to act on one's free will are compromised. There's no way around that argument.


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