By our resident psychologist

Not everyone agrees that alcoholism is an illness, but the idea has been useful to many thousands of people in revising their relationship with alcohol. Even if alcoholism as such is not an illness, perhaps "addiction" is! Let's look at the ways in which addiction and alcoholism as a form of addiction are like illnesses and not like illnesses.

What does alcohol do to a person?

Alcohol, drunk in large enough quantities or over a long enough time, causes damage to the body with specific symptoms such as trembling of the hands, a tendency to bleed, liver abnormalities, pain, ulcers, loss of memory and learning ability, loss of subtle motor control and balance, and many others.

These conditions are treated symptomatically by medical practitioners who also sometimes give vitamin injections to try and help the failing liver and brain tissue to cope with the toxification. This is not controversial. It's an incurable physical disease, caused by self poisoning. It is said that up to 85% or more of deaths in Western societies are alcohol related in some way. We are literally drinking ourselves to death. And no one is making us do it either.

What is addiction?

So what about addiction? Addiction happens when a person keeps going back to the same substance or behaviour despite its negative and damaging consequences in his or her life.

It starts quietly and insidiously, makes itself felt in various ways, and has a recovery pattern which is remarkably similar once the addicted person decides to follow that path.

Recovery does not normally begin until the pain and suffering of being addicted exceeds the pain and suffering of being sober or withdrawal from the drug of choice. In this way, it is similar to many other illnesses, including mental illness. People will not opt to take antidepressant treatment, for instance, unless the suffering of their depression is worse than the side effects of the medication and the social stigma of asking for help.

Illness is not the only possible explanation of addiction, of course. In the history of human mental health (and bodily health as well), two models or systems of explanation have long competed for dominance.

The earlier model was not a "disease" model but a morality model, centuries older than the disease idea. When people in the Bible said to Jesus Christ, "Who has sinned that this man was born blind - was it his parents?" - they were expressing a perfectly normal and commonly held view of illness or disability, that it was caused directly by sin and going against the laws of God. This theory explained illness as being a punishment, but it ran into problems with such matters as birth defects, which didn't fit the theory without offending people's sense of natural justice. Yet even today, people often ask "why" a particular thing has happened to them or their family. They complain of injustice and wonder if they did anything to deserve it.

Mental health in particular took a long time to escape from this sin/punishment model, and even today some people still believe very strongly that mental illnesses such as depression and schizophrenia are caused by evil spirits. In churches, evil spirits are still frequently blamed for a person's addiction or alcoholism, and attempts to "cure" the addiction will involve attempts to drive away the spirit that is supposedly causing the problem. The beliefs of centuries don't fade away that easily!

Disease models became more widely accepted with the development of scientific medicine and especially the discovery of bacteria and viruses as the invisible cause of much human sickness and misery. The logic is that each illness or disease has a cause (e.g. infection, toxins, genetic), follows a particular pattern of signs and symptoms, and has a reasonably predictable outcome.

Each disease has its own treatment depending on the cause. Mental health has now embraced this model very strongly (some would say too strongly). It is much better than the moral model in some ways, not least because it opens more possibilities for helping the afflicted and doesn't blame them for their troubles. In the case of mental or behavioural disorders, the disease model has its limitations. Possibly, it is best viewed as an analogy rather than a literal description of a disease process.

Mental disorders are almost always complex and have biological, psychological, social, emotional and sometimes spiritual aspects that defy medical terminology or classification. Furthermore, the "treatment and cure" approach is often inappropriate. Alcoholism and other addictions illustrate these limitations of the disease or medical model rather well.

How does this apply to alcoholism?

If you look at a 12 step programme such as Alcoholics Anonymous (AA), you'll notice both models having an influence. Addiction is seen as a chronic, progressive illness for which there is no cure. The alcoholic did not set out to become addicted or lose control.

Yet part of "recovery" involves having to confess out loud to being an alcoholic and admitting that you are powerless to control the problem on your own.

It could come straight out of the New Testament - you take life one day at a time, you consult your "higher power", and you get a "daily reprieve". Go and sin no more! Obviously, there is a strong religious influence in the 12 step program of AA (and other "anonymous" organisations that sprung from it) which some people find objectionable.

Yet treatment according to the "medical model", for example through individual counselling or visits to a psychiatrist, has a very poor track record of actually making a difference to addiction, whereas AA has been highly successful. The reason for this is that the 12 step program of AA actually addresses the "disease of addiction" in a way that individual therapy or medication cannot. AA may not have the "only truth" about alcoholism and recovery, but if you're serious about recovery you'll find a programme that does at least as much as AA and does it as well as they do!