Alcohol Abuse

In ancient Greece the festival of Anthesteria was a four-day long celebration of feast and worship in honor of Dionysus, the god of wine. This time of merriment included the consumption of wine as well as the welcomed effects of intoxication. The festival would end on a more sobering note as the ancient Greeks made atonement and rejoiced in the resurrection and return of Dionysus.

In modern times, people have continued this tradition of consuming alcohol in celebration on holidays or at other joyous occasions, such as weddings. However, for many people alcohol is a source of misery and pain. For these individuals, alcohol is not a symbol of merriment, but rather a vice and an obsession that consumes them.

In the United States alone, approximately 14 million people combat some form of alcohol abuse. Alcohol abuse is broadly defined as a destructive pattern of alcohol use. Under this definition, excessive or “binge” drinking is a form of alcohol abuse, since it can cause the drinker to experience physical illness, blackouts, and even death. In addition, individuals may engage in violent or irresponsible behavior while intoxicated. Drunk driving is also a form of alcohol abuse, since it may harm both the drinker and others. The abuse of alcohol can have severe implications on one’s personal, occupational, and social life. Alcohol abuse is prevalent among men, women, and teenagers alike.

Alcohol abuse and alcoholism
Some alcohol abusers, but not all, are alcoholics: Of the approximately 14 million alcohol abusers in America, it is estimated that slightly less than 7 million are alcoholics. Alcoholism is the most severe form of alcohol abuse. Whereas alcohol abuse is defined as the destructive use of alcohol, alcoholism is the destructive addiction to alcohol. Alcoholism is characterized by the repeated, obsessive, and uncontrollable use of alcohol despite extremely negative consequences.

Alcoholism has long been accepted as a debilitating disease to which some people are more disposed to than others. Elvin M. Jellinek, of the Yale Center of Alcohol Studies, first popularized the disease concept of alcoholism in 1960. He maintained that alcoholism is a progressive, lifethreatening disease. He also stated that individuals who suffered from this disease could never drink in moderation, and that complete abstinence from alcohol was the only healthy choice for alcoholics.

Since then, physicians, researchers and policymakers have accepted that alcoholism is indeed a disease. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), “Alcoholism is a chronic, often progressive disease with symptoms that include a strong need to drink despite negative consequences, such as serious job or health problems. Like many other diseases, it has a generally predictable course, has recognized symptoms, and is influenced by both genetic and environmental factors that are being increasingly well defined.” Today, the majority of treatment options for alcoholism, and some forms of alcohol abuse, are based on this disease theory.

However, there is opposition to this widely accepted view that alcoholism is a disease. Herbert Fingarette argues in his book Heavy Drinking: The Myth of Alcoholism as a Disease that the disease theory is ambiguous and contradictory, and therefore has been abandoned by most scientists and researchers. Fingarette believes that by defining alcoholism as a disease, the medical community sends a message that alcoholism is purely physical and that the individual alcoholic is not responsible for his or her compulsive behavior. Fingarette also warns that the disease theory thwarts treatment because it establishes alcoholics as victims of a disease that they cannot control and yet tells them to learn to control it with abstinence.

Alcoholics Anonymous and its critics
One of the biggest supporters of the disease theory is Alcoholics Anonymous (AA). AA is a well-known recovery group for alcoholics and alcohol abusers. AA, which was founded in 1935, has helped thousands of alcoholics over the years and now boasts over 2 million members across the globe. AA describes itself as a “fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.”

AA is based on a series of 12 steps. These famous 12 steps, which have become the foundations for many other recovery programs, are often viewed as a series of confessions, the first of which is the alcoholic’s admission that he or she is powerless over alcohol. Other steps require alcoholics to submit to a “higher power,” leading some critics to charge that AA forces its own form of religion on its members. Supporters of AA insist that while the 12 steps lead alcoholics on a spiritual path to recovery, AA itself is not affiliated with any particular religion.

AA’s meetings are the foundation of the organization. AA functions with two kinds of meetings: open and closed meetings. Open meetings are open to everyone—alcoholics, their families, friends and anyone wanting to find out information on solving a drinking problem. Closed meetings are only for alcoholics who come together to share and discuss their experiences with alcoholism and the steps for achieving recovery. AA prides itself on being committed to recovery, anonymity, and openness.

Over the years, AA has become an icon of treatment, synonymous with recovery from alcohol abuse. The majority of professionals in medicine and therapy consider AA to be the most successful treatment program for alcoholism and alcohol abuse. In fact, almost all major substance abuse and public health organizations advise most alcohol abusers to seek help with AA.

Members of AA have also been influential in spreading the word about AA. Many of these members have gone on to write books on their experiences with AA. Meredith Gould, author of Staying Sober: Tips for Working a Twelve Step Program of Recovery, states in her book, “Of course . . . there are recovery programs around that are purportedly less sexist, more secular, less structured, and more permissive. [However,] at the same time, I know that Twelve Step programs are exactly what doctors, psychotherapists, social workers and clergy invariably recommend after everything else has failed.”

However, despite its worldwide acclaim and proposed success in helping alcohol abusers, scientific research studies have failed to support AA’s success rate. While there are numerous accounts of individual alcoholics who have achieved sobriety through the 12 steps, research studies designed to measure whether AA members have better recovery rates than nonmembers have been ambiguous at best.

This lack of evidence has led critics to question whether or not AA is truly a panacea for alcohol abuse and alcoholism. Stanton Peele, a lawyer, researcher, and activist well known for his controversial opinions, argues against the disease model of alcoholism, which is fundamental to AA. Peele also takes issue with the AA view that abstinence is the only way to recover from alcoholism. Instead, Peele believes that moderation is an alternative solution for many alcohol abusers.

In Alcoholics Anonymous: The Unseen Cult, F. Alexander and M. Rollins write, “AA teaches that the only way for an alcoholic to recover is total abstinence, a demonstrably false assertion accepted on faith.” Advocates of moderate drinking believe that AA’s abstinence-only proscription is a one-size-fits-all approach to a complex issue. An individual’s alcoholism or abuse of alcohol, they argue, may be due to a variety of physical, emotional, and psychological reasons. Abstinence may be the only recourse for some alcoholics, but some heavy or irresponsible drinkers may simply need to learn how to control the amount they drink.

Alcoholics Anonymous, as well as the much talked about disease theory of alcoholism, are just two of the debates surrounding alcohol abuse. The essays in At Issue: Alcohol Abuse explore these and other issues relating to the prevention and treatment of alcohol abuse.