Monday 20 May 2019

It's time to accept that alcoholism is not a disease

Every individual makes the initial choice to start drinking and, equally, it is up to the individual to make the choice to stop
Every individual makes the initial choice to start drinking and, equally, it is up to the individual to make the choice to stop
Ian O'Doherty

Ian O'Doherty

It's that time of the year again - the sun had finally decided to show its face while the sound of lawnmowers and the heady scent of neighbouring barbecues compete for our attention as the country gets ready to bask in the hottest week of the year.

That means we will be exposed to the usual warnings about the dangers of drinking in the sunshine, although they are no different from the usual public service announcements we hear during the winter, or whenever there is a large occasion for national celebration.

We have a strange and vaguely obsessive relationship with drink in this country. It's an obsession which seems to burn most brightly in politicians and those self-appointed guardians of public morality who seem determined to paint anybody who has more than three pints in one sitting as a chronic binge drinker who is a menace to themselves and those around them. Of course, whether it's the powers-that-be suggesting that we raise the minimum price of a bottle of wine to a tenner, or whether we persist with forcing off-licences to close at 10pm, or whether we want to ban booze companies sponsoring events, there is always one thread common to these suggestions - the belief that people can't be trusted to take control of their own life or responsibility for their own actions.

That, of course, comes from the great myth that alcoholism is a 'disease', and one which the patient is powerless to overcome on their own. This dangerous fallacy has been peddled by the world famous Mayo Clinic, which claims that: "Alcoholism is a chronic and often progressive disease that includes problems controlling your drinking." Similarly, AA remains a hugely divisive organisation, primarily for their repeated suggestion that the victim is suffering from a 'total disease' and, of course, their insistence that members believe in a higher power.

In a culture where personal responsibility is now seen as an optional extra rather than a central plank of civic responsibility, the idea that bad or destructive behaviour can be explained away by the 'disease' model is a dangerous one. In his new book, 'The Biology of Desire: Why Addiction Is Not A Disease', neuroscientist Marc Lewis skewers the commonly held myth that alcoholism and addiction should be seen as external, chronic illnesses. Lewis has written extensively on this topic before and as a former addict he has had the added benefit of personal experience of the topic.

But no matter how many books and theses he produces on the matter, it's hard to escape the impression that his views will never be accepted by the establishment for the simple reason that he speaks unpalatable truths.

Unpalatable truths will never prevail over comforting platitudes and that is why it's easier, for both the addict and the people around them, to pretend that this is about anything other than a lack of self-control. That may sound harsh. Even worse in our current climate, it may even sound judgemental - a new secular sin, if ever there was one. But what Lewis and others have argued is that there is simply no point in telling an addict that they are suffering from a disease because it removes their personal responsibility and, with it, the best opportunity to escape their destructive habit.

As he says: "Addicts aren't diseased and they don't need medical intervention in order to change their lives. What they need is sensitive, intelligent social scaffolding to hold the pieces of their imagined future in place."

Even the fact that alcoholism is now considered by many mental health professionals and employers to be a genuine disability is nothing but an insult to the disabled. Obviously, nobody chooses to become an addict. But there is still no comparison between someone who was born with a disability or has suffered a life-changing physical trauma and someone who has allowed their appetites to get the better of them.

Few readers will have been unscathed by alcohol or drugs. Indeed, I doubt there is a single family in this country which hasn't been rocked by a loved one's substance abuse issues.

But what we should be doing to combat excessive misuse is to remove all the excuses, all those comforting shibboleths which reassure the individual that they are not to blame for their predicament, and start to remind people that they are the ones in ultimate control of their own destiny, not some fake illness.

Of course, some people are more predisposed to excessive drinking than others. That may be environmental, or it may be an inherited trait. Equally, some people develop a habit which is initially pleasurable, but which ultimately becomes a joyless compulsion before morphing into a full-blown addiction - and when you continue with your habit, even when it has stopped being fun but is now a hindrance, is when you can safely say you've joined the ranks of the addicted. There are as many reasons for addiction as there are addicts. Everyone's story is unique in its own way, although there tends to be certain common themes underlying addictive and destructive behaviour.

But as long as we persist in naively hanging onto the 'disease/illness' model, we remove the individual humanity of the individual. After all, as comforting as being told that your condition isn't your fault may undeniably be, it deliberately ignores the crucial factor - bad personal choices.

After all, what other life-threatening disease can be cured by will power alone? That chronic addiction is a potential death sentence is undeniable and many of us have watched impotently as a loved one sinks inexorably into a substance-fuelled decline.

But those powerless witnesses will also admit to feeling resentment that the 'patient' could, with sufficient will power, determination and grit, heal themselves.

Every individual makes the initial choice to start drinking and, equally, it is up to the individual to make the choice to stop. No touchy-feely waffle about it being a 'disease' will change that fact.

Let's face it - nobody with cancer ever healed themselves by simply saying: "Not today" - but that's the only cure for addiction.

Irish Independent

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