It’s not a disease.. poor me another
Disease: a disorder of structure or function in a human, animal or plant. Especially one that produces specific signs or symptoms. (My Mac’s dictionary/thesaurus widget)
Modern medicine, which has yet to yield to future medicine, is a machine of problems, innovations and life changing discoveries. From the ability to provide hearing to those who are deaf, to improving the status of frontal mammary accessories, humans are just trucking along with that ol’ scientific method punching out the answers.
How do you separate symptoms from disease? It’s almost a chicken and egg argument in some cases. Doctors depend on something called a differential diagnosis to help kill the chicken. I managed to find one ‘doc’ keeping track of some differentials on line, in case you want some examples.
But for at least one disease, I’m starting to think science took an initial observation as the chicken, and never stopped to consider all the possible eggs. Alcoholism is estimated to affect about 5% of the population with peaks in the 18-21 crowd. (Stats are for U.S. – I’d be curious to research the stats for other countries. The U.S. is 32 on the list of per capita drinking.. very low actually). One day, we even started finding the genetic code that drives some of us to the drink. That, surely, proves alcoholism is a disease. It’s a genetic disorder is what it is… right?
I was conversing with someone who has hands on experience with alcoholism and we came to agree that alcoholism was a misnomer. It’s an egg, as it were.
Through evaluative analysis of alcoholics we knew, while downing a robust Cabernet sauvignon, we came to a multi-part epiphany of our own differential diagnosis of alcoholism. We had noted distinct character traits that perhaps would be ‘relieved’ by drinking on a regular basis. Our observations led down a cognitive-like approach. I’d better hand out some examples before I totally lose you. This is a great time to grab another beer before we get into it.
Differential Diagnostic observation #1: Most alcoholics display some form of attentional problems. I mean the type that are most famous in ADD. It isn’t the wild variety where the person seems lost and unable to center, it’s more like an inability to clear away ’static’ life. Most recovering alcoholics I know are extremely busy and active and possibly even a form of overachiever. Take them away from booze, and they start to develop almost obsessive compulsive behaviors (some effective and some not).
Differential Diagnosis observation #2: Most alcoholics also display or struggle with depression. Hold with me on this one. Observe here that most people use a logic that a low self-esteem leads to depression rather than depression leads to a low self-esteem. In medicine, depression is first with a low self-esteem considered the symptom. That’s important. But wait, there is more.
Differential Diagnosis observation #3: Most alcoholics exhibit memory problems. Your first assumption is that they drank too much and so they’ve burned holes in their brain. That is a bit of a myth. What would your life be like if you couldn’t retain a certain type of memory? Let’s say social calendar events (I picked it for a reason). What would the stress of knowing you are forgetting to do something important make you feel like? Um, cool link to Duke University page on alcohol, memory and blackouts. Basically, alcohol can perform a temporary amnesia, not necessarily a long time memory problem.
Add on to this correlations with anti-social personalities, anxiety disorders and other things and it seems to be possible that alcoholism is the result, the coping mechanism, not the problem (per se… if you are feeling an itch, think serenity and call your sponsor).
I started thinking about this a long time ago when I realized how unsatisfying the answer was for cures to alcoholism during a Narcotics Anonymous New Years party. No, I wasn’t a guest, I was partial security/caterer at a Holiday-Inn I worked for in my high school years. We took all the mirrors out of the room to help out those who were off the coke and we brought in more ashtrays than any prior event I’d ever helped set-up there. We brewed enough coffee to support the Jamaican economy for the next year. For the alcoholics, we just stopped them from going to the bar.
That’s it. If you are an alcoholic, you are always recovering, never cured. That’s going to resolve some depression. I can’t quote a study per se just yet, but I have heard that some alcoholism is regularly treated as if it were depression, using anti-depressants to help cure the call to the ultimate depressant. That’s a step up from “Well, stay away and you’ll probably feel really tense for a good duration of your life, struggling to control your urges and never allowed to enjoy altered states of mind again.”
Basically, if you take all this in, I think alcoholism is yet another symptom for some unnamed dysfunction in the brain. I’d like to see some research that gets outside the box on this issue so that we can stop wasting our time inventing pills that make you throw up when you drink any alcohol what-so-ever (careful with the mouthwash… that is.. if you forced yourself to take your own restraint in the morning anyways).
It’s not that the solution can’t end up hard or tough to deal with, but the current line of thought just seems stuck and unworkable.
On the flip side, if anyone knows of any solid research that really firms up alcoholism as a core problem, not a symptom-like characteristic, I’d love to see it. My cursory viewing of what I could Google in a few days found that alcoholism is primarily determined by a panel of psychological observations (impressions, if you will) rather than a differential diagnosis.
That means the doctor doesn’t necessarily hear any other problems you say once you have alcoholism as a primary concern. You see, if you use an impression to diagnose, then you have no options to eliminate, your job is done. Differentials are powerful because they force you to consider alternatives and eliminate or enforce them as tests are performed.
Want to get a feel of what an impression test is like? Take the MAST test.
Have an odd sensation this isn’t the only ‘disease’ that should consider a different view? I’d love to hear about it!
I have seen some people following the line of thought that specific violent actions, lets take rape and murder, are possible in some cases because of a mutant genome.
Whats your take on that may i ask? Genetic disorder, disease or fathomless?
Comment by Panther — August 16, 2005 @ 17:24
Read: “On Being Insane In Sane Places”
All psycological disorders are thought to be incurable, not by modern medicin but rather, by social stigma.
Glad to see you’re back.
Comment by Jim — August 16, 2005 @ 19:32
I don’t know that I’d call these mental things incurable. I’ve overwritten parts of my personality, I’ve redesigned the way I think about things, I’ve overwritten memory…nothing I’d call a disease, but the mind is not some fixed thing which never changes. To rule out all mental disorders as incurable seems to me to be jumping to conclusions. What, because it can’t be permanently fixed by a drug, it’s incurable? Nonesense.
I think a similar thing might work on alcoholism. It seems to me that the problem is that when alcoholics drink, they don’t stop after, say, the first beer, or the second beer, they keep going until they pass out drunk or whatnot. So what if they jsut alter their mind so that they never take that third or second beer? What if they rewrite their personality to include that kind of restraint?
Comment by Adkenar — August 16, 2005 @ 21:22
A book recommendation.. excellent. The social stigma is actually what I am so critical of. I think alcoholism was labeled a disease almost on prima facia. Consider these two different syntaxes for the problem.
“He has a drinking problem” and “he has a problem and it is relieved by drinking.” I think current research and lines of thought seem glued to the first sentence, which also has with it a social stigma. The second sentence is one that I’m curious about, that I think may have a potentially enlightening path, as it were. (not cure, just.. another path)
Panther, as far as genetic disorders go, I’m convinced so far they are very real. And it’s not hard for me to understand them as I consider that similar to poorly written code for a program. It needs to be ‘debugged’ as it were, and a flaw in the program will lead to funky outputs. Do I think that makes these murderers and rapists with a genetic disorder free from penalty? – that’s where I look to Adkenar’s comment.
Adkenar, I’ve known quite a few ‘recovering’ alcoholics who seem to do something just like that. It’s never perfect, mind you. The self-designed repair includes coping mechanisms that are either intentional or side-effects unbeknownst to them. It also has a low success rate and a high tendency for relapse. It is ideal to repair yourself (something I’m positive the mind has the capability to do).
I’ve always wondered where personality variation stops and disorders begin. Sure, you can point me to a DSM-IV diagnosis book and it will dilineate those disorders out nicely, but I can draw lines in the sand, too. To be fair, some diseases have very obvious neural differences in brain structure and function that are clearly not normal, but these seratonin level based problems seem like a bell-curve of expected deviations from the norm (like a bag of peanut M&M’s, there’s always a few missing the nut and the occasional double-nutter as well).
Comment by JT — August 17, 2005 @ 06:06
I’m not convinced that genetics is the cause or excuse for someone being and alcoholic. I might be willing to concede genetics has and effect on the coping mechanism if there is one. In my personal experience and observations of my relatives on both sides, there seems to be a correlation between “issues” in the individuals life and their adult beverage consumtion.
It seems to me that in all cases when and individual turns to injesting something, they do it to avoid or escape something. Most members of my family that I have observed over indulging, did so in a particularly challenging stressful stage in their life and afterward in their later years no longer do so, yet they can have a drink now, for example, and not get on the slide of one after another. Perhaps genetics plays a role in the choice of substances but I am not convinced it plays a role in a weakness or disease.
I guess what I am offering up for discussion is, people resorting to control substances is a symptom of a greater ill. I suggest a discussion of the pressures and social ills and influences. Topic title suggestion… “Coping with life today without turning to shit” or “Resignation, The World is Going to Hell, so I’ll just drink through it.”
Comment by Boaterbob — September 18, 2005 @ 08:21
If you use alcohol to cope with issues, that is usually more under the heading of ‘alcohol abuse’. Abusing alcohol and having the ‘disease’ alcoholism are two separate things. This confusion is very common.
Alcoholics drink whether they have an issue or not. Typically, their drinking ‘leads’ to issues, as opposed to drinking to deal (or not deal as the case may be) with the issue.
Otherwise, I agree about the symptom to a greater ill, but I believe that ill may be a totally different disease. Perhaps a larger classification of some type; the same way that fever, coughing and sputum could be symptoms of bronchitus.
Comment by JT — September 18, 2005 @ 19:43