Yes, alcoholism is a disease, and this debate is pointless

Its depressing predictability in no way reduced the sadness of the news, which emerged at the end of last week, that Charles Kennedy’s untimely death was clearly linked to his on-going struggle with alcoholism.

Sadly, alcohol will always overshadow this wonderful man’s legacy, as it brought about an abrupt end to a political career full of potential.

Kennedy was elected to Parliament aged just 23, having no knowledge whatsoever of London and staying with a friend. His rise was swift, and he led the Liberal Democrat party through the most successful period in its history.

Yet as the tributes have poured in, so too, has the debate about alcoholism re-emerged, and it is, quite frankly, a debate whose focus, I don’t understand as it seems very wide of the mark to me.

It is the question of what “model” one should adopt when trying to understand this problem, in particular whether it should be viewed as a disease. That is because it straddles the boundaries of the social and medical worlds, not fully explained either by medicine as a purely medical problem, or by those who seek an explanation through social sciences, be it the sociological argument that addiction arises from our appalling drink culture, or psychological explanations centring on the notion that it is an addiction, and addiction is a psychological problem.

Opponents of the disease theory, such as Dr Max Pemberton, who wrote a controversial critique in the Daily Mail last week, believe that labelling it a disease somehow gets the drinker off the hook.

It portrays them as a helpless victim in the grip of an illness they can do nothing about, in the same way they could do nothing about getting cancer or diabetes, for example. Drinking is a choice, and a choice that the addict makes every day.

Disease theory critics may be generous enough to concede that putting down the bottle is difficult for some-one who has developed an addiction, as they seek to condemn the addict for what is an evidently foolish choice, whilst showing some sympathy and compassion.

They shouldn’t bother. They should just accept it’s an illness and stop trying to argue against it in order to repudiate spurious logic about the implications of viewing alcoholism as a disease.

I, however, am going to come up with a disease-based explanation, based on common sense, which I’d like to see them contest.

Let me be clear: alcoholism is an addiction, addiction is a disease. Research has even shown genetics can be a contributing risk factor to the development of alcoholism, backed up by its tendency to run in families.
Anti-disease advocates, as I’ve said, want us to see that the alcoholic makes a choice to drink and therefore has to take responsibility. I do not understand, however, how something can’t be defined as a disease just because it is in part or in full a consequence of choices.

Think about diabetes: this is a disease. Is it any less a disease if I get it because I threw a load of fizzy drinks, cakes and chocolate at my poor pancreas for years? Of course not. Is lung cancer not a disease because it’s nearly always caused by the decision to smoke?

Yes, some-one may have started to drink heavily, gradually building up to a state of physical and psychological dependence, but there is no reason not to say they are ill just because they didn’t start off that way.

Secondly, anti-disease advocates point to the fact that by self-discipline and an act of the will, an alcoholic can get well. That, I’m afraid, is a dismally ignorant view. 

An addict doesn’t stop being an addict because, mustering every bit of courage they’ve got, they conquer their addictions. They are a recovered addict. Sobriety is, for the alcoholic, an accomplishment and a goal they have to achieve afresh every day.

If they repair relationships and return to good mental health, why can’t they resume a normal drinking pattern? I can’t be the only one who’s turned to drink in times of celebration and in times of trial and then gone back to a normal drinking pattern with ease?

Alcoholics virtually never develop the normal ability to moderate drinking. The reality is, alcoholics can’t stop, and as soon as they pick up the first drink they will completely relapse and once again lose rational judgement; the loss of relationships, jobs, their health and even the possibility of losing their life can’t make an alcoholic put the brakes on, like it would you and I.

They have developed a completely different response to alcohol to the rest of us, and it’s nearly always the case that this response endures forever. 

With any disease we can shape our own prognosis; taking your tablets and choosing to check your sugars regularly improves the outlook for a diabetic patient, attending treatment programmes and mutual support groups improves the outlook for an alcoholic. Spot the difference? I can’t.

Thirdly, I believe anti-disease advocates have a social agenda, and a noble one at that. They are trying to critique the drink culture we have at the moment.

Look at A&E on a Friday, the vomit-soaked streets on a Sunday morning, or watch one of the myriad of programmes celebrating the exploits of boozed up Brits abroad, and you’ll see why. They want to show that we as a society have a problem with alcohol of our own making.

Unfortunately, however, they downplay the distinctiveness of alcoholism. Our problem is that people go out with the intension of getting drunk and are applauded for it. Our health is suffering because of the rise in binge drinking and the availability of cheap, strong products that make it just so easy. Such drinkers have a problem, arising from the culture of heavy drinking that they feel the need to fit in to. It is a social problem, perhaps even a psychological one.

They are not, however, drinking from dawn to dusk, day after day, knowing they are dying, destroying their families, careers and health and yet feeling absolutely overwhelmed by the enormity of stopping.

A caller on a radio programme this morning said this about stopping: “If I hadn’t had my can of Special Brew this morning, I’d be defecating without volition, I’d be puking without volition. I’d be shaking so bad I couldn’t stand up.” These are a vastly smaller group of problem drinkers. If their social group drank less, they would be no less inclined to drink the same dangerous levels.

The truth is, if we really want something good to come from the tragic death of Charles Kennedy and others before him, we’ll stop having this pointless discussion as to whether it’s a disease or not. It’s just a word.

We won’t use the death to re-examine the societal impact of all manifestations of problem drinking.

Rather, we’ll look long and hard at what support services are like for alcoholic people battling their demons, and how they can be improved. To be honest, I don’t know the answer to that question, but I’d rather we were using this sad opportunity to have the discussion, instead of obsessing over labels.