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ATinNM:
Every disease, e.g., alcoholism, has "economic, social, psychological, personal and cultural factors."  Once a person is infected with cholera, say, giving them a job isn't going do a bit of good; neither is a heavy duty dose of "talky-talk" psychological therapy.

There are differences, and I'm not even sure that alcoholism should be described as a disease.  For instance there are v. effective medical treatments for Cholera and the disease probably wouldn't exist now but for "economic, social, psychological, personal and cultural factors".

The major difference is that there has (up until now in any case) been almost no effective purely medical treatment for alcoholism - the medical model hasn't done a whole lot better than faith healing in that respect.

I don't doubt that there are genetic and other neurological/physical factors which influence the likelihood of addiction, and hopefully effective gene or other therapies will be discovered which will eliminate those.  Many children of alcoholics I know won't drink any alcohol for fear of addiction and having experienced the damage done at first hand.

I don't think we disagree all that much, I just think Sven's total denial of willpower/motivation as a factor is a bit strong and his faith in medical "cures" is not borne out by the evidence to date.  As things stand, the medical profession's attempt to characterise alcoholism as a disease and control its treatment (thus excluding many alternative treatments and professions) is a power play which has been relatively unsuccessful in terms of actual achievement.

The narrative framing of alcoholism as a disease requiring a medically managed cure diminishes both the patient and their prospects of recovery.

If the medical profession DO come up with an effective treatment I am more than happy that they should take control of the therapeutic process, but even successful medical interventions often require a great deal patient advocacy and motivation and my biggest problem with "the conventional medical model" is that it dis-empowers patients and often actually hinders their recovery.

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Fri Dec 31st, 2010 at 03:10:56 PM EST
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I agree we don't substantially disagree.  

Something may be incurable and still be a disease.  Otherwise you'd have to say bubonic plague only became a disease when antibiotics were discovered.  My point was: alcoholism has a physical component that must be addressed, solved, for the intervention to be better than the "cure" rate of a placebo.

This is not to say the "Mind" side is irrelevant.  It seems to (un-professional me :-) the evidence strongly suggests alcoholism is a Mind/Brain disease and needs to be attacked with psychological as well as physical intervention. At a minimum, as you rightly pointed-out, the patient has to have the Willpower to take the damn pill.  Something, BTW, not limited to alcoholics; in the US people are being forceably hospitalized for tuberculous since it has been proven enough patients don't take the full course of medication, they relapse, and TB is starting to develop resistance to antibiotics because of this.  


She believed in nothing; only her skepticism kept her from being an atheist. -- Jean-Paul Sartre

by ATinNM on Fri Dec 31st, 2010 at 04:29:00 PM EST
[ Parent ]
my reasons for resisting the "alcoholism as disease" framing are not limited to the lack of efficacy of the medical paradigm, although that would be a major reason.

The "learned behaviour disorder" framing emphasises the fact that like all behaviours, learned behaviours can be unlearned and thus behaviour modification techniques, personal motivation, social interactions, institutional supports and alternative exemplars, mentoring and leadership take centre stage. Behaviour is not reducible to biochemistry even though the latter can of course be a major component of it.

Index of Frank's Diaries

by Frank Schnittger (mail Frankschnittger at hot male dotty communists) on Fri Dec 31st, 2010 at 09:34:36 PM EST
[ Parent ]
Frank Schnittger:
there are v. effective medical treatments for Cholera and the disease probably wouldn't exist now but for "economic, social, psychological, personal and cultural factors".
Smallpox has been eradicated. Does that mean smallpox is not a disease?

Of all the ways of organizing banking, the worst is the one we have today — Mervyn King, 25 October 2010
by Migeru (migeru at eurotrib dot com) on Mon Jan 3rd, 2011 at 05:13:34 AM EST
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