It is argued that alcoholism, and substance addiction generally, is a disease. It is not of its nature chronic or progressive, although it is in serious cases. It is better viewed as a psychological disease than a neurological one. It is argued that each time an alcoholic takes a drink, this is the result of choice; however, in cases of serious affliction, such choices are compulsive and may be called 'involuntary' in that they are made against the subject's will, (...) motivated by an overwhelmingly powerful desire that he wishes he did not have and not to act on. Alternative accounts in terms social learning theory and behavioral economics are critiqued. The conception of alcoholism as a tripartite disease composed of a 'physical allergy,' a mental obsession, and a 'spiritual malady' is defended from a contemporary scientific point of view. (shrink)

Many believe that it is morally wrong to give lower priority for a liver transplant to alcoholics with end-stage liver disease than to patients whose disease is not alcohol-related. Presumably, alcoholism is a disease that results from factors beyond one's control and therefore one cannot be causally or morally responsible for alcoholism or the liver failure that results from it. Moreover, giving lower priority to alcoholics unfairly singles them out for the moral vice of heavy drinking. I argue (...) that the etiology of alcoholism may involve enough control for the alcoholic to be responsible for his condition and accordingly have a weaker claim to receive a new liver than someone who acquires the disease through no fault of his own. In addition, I show why it is more plausible to reframe the question of priority in terms of control and responsibility rather than virtue and vice. Given that medical resources like livers are scarce, some people may justifiably be given lower priority than others in receiving these resources. (shrink)

It is now commonplace to call persons sick when their wrongdoing becomes entrenched, extensive, and extreme. This mixing of moral and therapeutic categories seems incoherent if we uncritically embrace a morality-therapy dichotomy: Behavioral problems like alcoholism are either moral or therapeutic matters, but not both. This paper dissolves the dichotomy by arguing that chronically abusive drinking is simultaneously a sickness and wrongdoing. Alcoholism is at least partly a self-inflicted impairment of responsible agency that has unhealthy consequences and usually (...) requires therapeutic interventions. Morality and therapy are not inherently opposed. Morality enjoins compassionate helping and nonjudgemental therapy, and therapy is rooted in moral values of caring and respect. The polarized positions of Herbert Fingarette in Heavy Drinking and George E. Vaillant in The Natural History of Alcoholism are reconciled by paying close attention to their accounts of the condition, causes, consequences, and cure of alcoholism. (shrink)

The shift in the prevailing view of alcoholism from a moral paradigm towards a biomedical paradigm is often characterized as a form of biomedicalization. We will examine and critique three reasons offered for the claim that viewing alcoholism as a disease is morally problematic. The first is that the new conceptualization of alcoholism as a chronic brain disease will lead to individualization, e.g., a too narrow focus on the individual person, excluding cultural and social dimensions of (...) class='Hi'>alcoholism. The second claim is that biomedicalization will lead to stigmatization and discrimination for both alcoholics and people who are at risk of becoming alcoholics. The third claim is that as a result of the biomedical point of view, the autonomy and responsibility of alcoholics and possibly even persons at risk may be unjustly restricted. Our conclusion is that the claims against the biomedical conceptualization of alcoholism as a chronic brain disease are neither specific nor convincing. Not only do some of these concerns also apply to the traditional moral model; above that they are not strong enough to justify the rejection of the new biomedical model altogether. The focus in the scientific and public debate should not be on some massive “biomedicalization objection” but on the various concerns underlying what is framed in terms of the biomedicalization of alcoholism. (shrink)

The shift in the prevailing view of alcoholism from a moral paradigm towards a biomedical paradigm is often characterized as a form of biomedicalization. We will examine and critique three reasons offered for the claim that viewing alcoholism as a disease is morally problematic. The first is that the new conceptualization of alcoholism as a chronic brain disease will lead to individualization, e.g., a too narrow focus on the individual person, excluding cultural and social dimensions of (...) class='Hi'>alcoholism. The second claim is that biomedicalization will lead to stigmatization and discrimination for both alcoholics and people who are at risk of becoming alcoholics. The third claim is that as a result of the biomedical point of view, the autonomy and responsibility of alcoholics and possibly even persons at risk may be unjustly restricted. Our conclusion is that the claims against the biomedical conceptualization of alcoholism as a chronic brain disease are neither specific nor convincing. Not only do some of these concerns also apply to the traditional moral model; above that they are not strong enough to justify the rejection of the new biomedical model altogether. The focus in the scientific and public debate should not be on some massive “biomedicalization objection” but on the various concerns underlying what is framed in terms of the biomedicalization of alcoholism. (shrink)

Article From Proceedings Of The Fifth Annual Meeting Of The Catholic Theological Society Of America, June 26-28, 1950.

What are the ethical obligations of a researcher who wishes to study another culture's ceremonial practices, in particular those of the Native American Church (NAC)? What promise do peyote and the NAC peyote ceremony show for the treatment of alcoholism amongst NAC members? How does one approach the philosophical issues regarding “consciousness” within the context of such a study? In this interview, Dr. John Halpern, M.D., discusses how the fields of medicine and anthropology converged and informed one another over (...) the course of his study into the effects of the NAC peyote ceremony on alcohol addiction. He tells the story of how he, as an outsider to the Church, was eventually accepted as a member of the NAC community. He also reflects upon how one's philosophical stance on what consciousness “is” informs such a study. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Moral Responsibility:Disorders of Personhood as Harmful Dysfunctions, With Special Reference to AlcoholismJerome C. Wakefield (bio)Keywordsalcohol dependence, philosophy of psychiatry, mental disorder, harmful dysfunction, psychiatric diagnosis, person, moral responsibilityIn his paper, Ethical Decisions in the Classification of Mental Conditions as Mental Illness, Craig Edwards grapples with a profound problem: why is it that when we classify a mental condition as a mental disorder, that tends to take (...) the condition out of the sphere of moral responsibility or virtuousness of character? For example, it is not uncommon when someone commits suicide and the question is raised as to why he or she did it, that instead of a reason or character trait that would place the act within a moral calculus, one is offered the explanation "she was clinically depressed" or "he was bipolar," and this tends to terminate discussion and make reasons and moral evaluation superfluous. Why does such a comment have that effect?As Edwards notes, this can get complicated as the moral and the disordered interact. Certainly people are sometimes morally responsible for acting on their disordered impulses (as in pedophilia), and they are responsible for putting themselves in the way of disorder, as when someone imbibes in a way likely to lead to alcoholism. But at the normal/disorder divide, there seems to be a consistent lifting of some responsibility, reflecting the application of the sick role. For example, the rough equivalent of our current category of post-traumatic stress disorder (PTSD) was recognized as a disorder in earlier wars ("shell shock," "war neurosis"), but often considered an expression of cowardice; the cowardice was morally evaluable as a failure of virtue (even if, like many personality traits, being a coward is not within the person's direct voluntary control) and led to contempt for those with PTSD, but nonetheless—except in cases thought to be malingering—the PTSD that resulted constituted a disorder for which the individual was [End Page 91] not in the same direct sense blameworthy. This moral shift requires explanation.This topic also has important social ramifications. Relief from responsibility may sound like a good thing, and it is trumpeted by mental health advocates as a reason for supporting the classification of many conditions as disorders. But as Edwards is aware, it is a two-edged sword. Disordered status may allow escape from censure and offer the protections of the sick role, but it also changes the relationship of the agent to his or her own actions and imposes the responsibility of the sick role on the individual to attempt to change ("get better"). The sick role allows for no defense of an idiosyncrasy based on normal variation ("It takes all kinds…") or the individual's eccentric vision or steadfast integrity, for that vision or sense of integrity are now seen as pathological and not morally legitimate. The individual is subjected to endless entreaties to seek help and it is implied that not to do so is irresponsible, so that a decision to embrace one's nature and remain as one is becomes illegitimate. Moreover, the sick role allows for no explanation in terms of the individual's normal defensive response to unjust, deprived, or challenging social or environmental circumstances, thus weakening the motives for social change rather than individual intervention.In sum, there is an inevitable sense in which being placed in the sick role inherently stigmatizes the "sick" condition in virtue of the special moral attitudes extended to the disordered. Cultures can thus easily exploit the sick role and its much-touted relief from responsibility to extend the reach of social control processes. This is one reason why the distinction between disorder and non-disorder is so important, and why it is crucial to identify when non-disordered conditions are mislabeled as disorders—as when, for example, psychiatry gets it wrong about the distinction between normal and disordered sadness (Horwitz and Wakefield, 2007). Such overpathologization can redefine the boundaries of our moral universe on mistaken grounds.Edwards offers two provocative answers—not entirely at ease with each other—to the question of why mental disorders relieve the patient from moral responsibility: (1) mental disorders are... (shrink)

THIS ARTICLE IS AN ANALYSIS OF THE CURRENT LEGAL REASONING AND LAW AS TO THE CRIMINAL RESPONSIBILITY OF ALCOHOLICS, AND AN ANALYSIS OF THE MEDICAL AND FACTUAL BACKGROUND. THE LEGAL ARGUMENTS TO ABSOLVE THE ALCOHOLIC OF RESPONSIBILITY FOR CRIMINAL ACTS WHILE DRUNK ARE SHOWN TO REST ON UNSATISFACTORY ARGUMENT AND FUNDAMENTALLY FALSE FACTUAL ASSUMPTIONS.

Herbert Fingarette [1] argues that alcoholism is not a disease and that the alleged alcoholic under certain circumstances has the power to control his or her drinking disorders. I shall analyze Fingarette's argument and show that his position rests on some logical and conceptual confusions.In analyzing Fingarette's argument for the self-control theory of drinking disorders I conclude that it is problematic for the following reasons: (1) his argument assumes that the identification of a single cause of alcoholism is (...) a necessary condition of its being a disease; (2) unless it is already assumed (a priori) that persons with drinking disorders possess freedom and self-control to the extent that Fingarette assumes they do, then such persons are likely to suffer from apathy or defeatism regarding their condition; (3) even if Fingarette is correct in his criticism of certain health care programs for those with drinking disorders, it does not follow from this that certain theories about the possible causes of such disorders are false; (4) Fingarette's claim that those with drinking disorders are morally responsible for their actions that result from their disorders is problematic, that is, unless it can be shown that such persons act freely; and (5) Fingarette attempts to support the self-control theory of alcoholism by refuting a straw man conception of the disease model of alcoholism. (shrink)

During the 20th century, many researchers studying heredity sought to apply their findings in the arena of mental health and human (mis)behavior. Many of these have examined, from the perspective of heredity and genetics, the desire to drink and its consequences. In this paper, the author examines hereditary explanations of alcoholism in two historical snapshots: the early decades of the 20th century and in the 1990s. Two things come to light. First is the persistence of an“entrepreneurial spirit,”and second is (...) a remarkable failure to take into account the many-leveled heterogeneity in causes of alcoholism. The author describes some sources of this heterogeneity and showshow epistemological problems that arise from it suggest the failure of genetic accounts to consider the social dimensions of disease classification, observation, and diagnosis that form the very basis of the designation “alcoholic.”. (shrink)

An essential element in both lay and professional definitions of alcoholism is the a priori claim that afflicted individuals lack control over their drinking and/or over their behavior while drinking. The social, legal and scientific consequences of accepting this claim are examined. Based on specific evidence drawn from recent journal articles, we argue that alcohol researchers fail to adequately engage the issue of volition and that their research designs and findings are thereby flawed.

This essay argues that making a diagnosis in medicine is essentially a hermeneutic enterprise, one in which interpretation skills play a major part in understanding a disease. The clinical encounter is an event comprised of two voices; one is the voice of science which is grounded in empiricism, the other is that of human experience, which is grounded in story-telling and the interpretation of those stories.Using two voices, one from the Diagnostic and Statistical Manual of Mental Disorders-III-Revised, which describes alcohol (...) abuse and alcohol dependence, and the other, that of Claire, a character in Edward Albee's play, A Delicate Balance, who is conversing with her brother-in-law, Tobias, I apply principles from Hans-Georg Gadamer's hermeneutics to the clinical diagnostic process. The essay will demonstrate that we overlook an enormous amount of information about alcoholism by an overreliance on objective data and that our hope for understanding alcoholics is in listening to their voices, and sharing the interpretation of their experiences with them. (shrink)

This essay is framed by the work of Edward Sampson (1993), and is a sociohistorical analysis of the institutional vicissitudes in American history that have formed the ground of our current version of the “truth” about drugs, alcohol, the drug addict and the alcoholic. The drug and alcohol discourse has been used throughout American history to institute and maintain normative ideals. These ideals are contoured by Western individualistic understandings of human being. They revolve around a theme of freedom seen as (...) access to unlimited possibilities, which arises as a right for those individuals who are self-reliant. Alcoholics and addicts have been used as political identities, silently portraying the opposite and living out the underside of these normative ideals. As political identities they are used discursively to maintain mainstream illusions of self-reliance and to hide the falsehood of the capitalist promise of unfettered access to unlimited possibilities. Capitalist interests flourish through the maintenance of these illusions, and are able to disown responsibility via the silencing, through embodiment, of those who have been marginalized. This self-celebratory discourse is, hence, a monologue that undermines the possibility of hierarchical revolutions. Encapsulated in the embodiment of the alcoholic and addict are the covering over of political conflicts, the leveling down of difference, and the marginalizing of those who represent dialogical possibility. Twelve-step mutual help organizations participate in self-celebratory monologues that maintain the version of truth supportive of the agendas of the wealthy; however, they also offer an other-centered strategy by which dialogue again becomes possible. (shrink)

Excessive alcohol use has adverse effects on the central nervous system (CNS) and can lead to alcohol use disorders (AUDs). Recent studies have suggested that myelin reductions may directly contribute to CNS dysfunctions associated with AUDs. Myelin consists of compact lipid membranes wrapped around axons to provide electrical insulation and trophic support. Regulation of myelin is considered as a new form of neural plasticity due to its profound impacts on the computation of neural networks. In this review, the authors first (...) discuss experimental evidence showing how alcohol exposure causes demyelination in different brain regions, often accompanied by deficits in cognition and emotion. Next, they discuss postulated molecular and cellular mechanisms underlying alcohol's impact on myelin. It is clear that more extensive investigations are needed in this important but underexplored research field in order to gain a better understanding of the myelin‐behavior relationship and to develop new treatment strategies for AUDs. (shrink)

The author comments on the article “The Neurobiology of Addiction: Implications for Voluntary Control of Behavior,‘ by S. E. Hyman. Hyman’s article suggests that addicted individuals have impairments in cognitive control of behavior. The author agrees with Hyman’s view that addiction weakens the addict’s ability to align his actions with his judgments. The author states that neuroethics may focus on brains and highlight key aspects of behavior but we still risk missing explanatory elements. Accession Number: 24077912; Authors: Levy, Neil 1,2; (...) Email Address: [email protected]; Affiliations: 1: University of Melbourne, Parkville 3010, Australia; 2: University of Oxford; Subject: ADDICTIONS; Subject: ALCOHOLISM; Subject: COGNITION; Subject: BEHAVIOR; Subject: JUDGMENT; Subject: HYMAN, S. E.; Subject: NEUROBIOLOGY; Number of Pages: 2p. (shrink)

Alcoholism is endemic in Nigeria’s traditional religion and society. This abuse is especially common at New Yam festivals, Ekpe, Ekpo and Nmanwu masquerades festivals, burial rituals, birth, marriage and naming ceremonies. Some claim that this is driven by specific beliefs and activities in African culture, such as beliefs in ancestors, libation, hospitality and entertaining guests and strangers and the desire to maintain the cultural traditions of the ancestors. Alcohol abuse has generated major health and social issues for abusers, their (...) families and society, plunging families, towns and tribes into crises and conflicts that bring economic and political retrogression. This research studied how the African traditional religion encourages alcohol misuse and how to decrease it for national development. This study was on Nigeria’s South-South region. The study uses qualitative and ethnographic research methodologies, including key informants, in-depth and focus group interviews and the reward deficiency syndrome as a theoretical framework. Although African Traditional Religion (ATR) supports alcohol usage, greed, a lack of self-control, peer pressure, indiscipline and lack of moral upbringing led to alcohol misuse, which harms the person, family, community and country as a whole. Education and enlightenment are a remedy to free alcoholics and utilise them for national integration and development.Contribution: Some say Africans drink a lot because their religious heritage promotes drinking, leading to abuse. However, peer pressure, selfishness, a lack of self-control, bad parenting and not religion push persons with reward deficiency syndrome into alcoholism, according to this research. (shrink)

Although historians of addiction have long debated whether an oral culture of “sharing” or “Big Book”-based reading practices are foundational to 12-step recovery culture, the role other types of media have played in the development of contemporary recovery discourse has remained largely unexplored. This essay compares the production, reception and formal elements of the films The Lost Weekend and Smash Up in relation to the popularization of the disease concept of alcoholism. Through an analysis of archival sources, addiction narratives, (...) and nascent alcoholism research, this paper argues that, by emphasizing the importance of popular representations of alcoholics above scientific inquiry, early recovering “experts” successfully promulgated the disease concept of alcoholism, but the testimonials of later recovering alcoholics became relegated to the sphere of popular culture. (shrink)

Expecting Saving Mr. Banks to be a jolly jaunt about the creative development of the movie Mary Poppins (1964), I found myself waiting endlessly for the “jolliness” to begin—it never did. In fact, rather than joy, there was an ever-present sensation of tension as I watched the film. Having moved house myself in recent days (during a Queensland heat wave), the scenes of the Goff family leaving their home and trekking across hot, dusty Queensland were very emotional. However, seeing the (...) family patriarch Travers Goff (played by Colin Farrell) swig from an alcohol flask in a desperate manner told me that his was no “routine” family move. And, certainly, arriving at their destination—a dilapidated ranch home—shed even more light on the Goff family’s predicament: alcoholism and the cycle of employment and unemployment. Further, it is the downstream consequences of the family predicament that fuel the identity and behaviour of Mary Poppins—a fictional character created by Travers’ daughter, a. (shrink)

This essay investigates the tensions produced by the categorization of different forms of excessive desire under the singular model of addiction, and it challenges the increasing acceptance of addiction as an all-purpose explanation for unruly desires through a comparison of the different forms of disordered desire in sex addiction and alcoholism. Moreover, it argues for a broad understanding of addictive processes to undermine the normative and moralizing assumptions of addiction discourses. Refiguring addiction as a kind of intimacy is one (...) way of making sense of the intense relationships people can develop with substances and with activities. (shrink)

Providing up-to-date and comprehensive information, this practical guide uses clinical case examples and professional codes of ethics to help addiction counselors learn and apply ethical standards. Real-life examples of ethical dilemmas in clinical practice illustrate potential pitfalls and the actions needed when faced with a dilemma.Since most ethical decisions are not clear cut, the author explores the grey area of each dilemma and provides guidelines on how to determine the best course of action when the best course is unclear. This (...) book emphasizes ethics as a set of guidelines aimed at protecting the client, the clinician, and the profession as a whole. (shrink)

Morality and mental health are now inseparably linked in our view of character. Alcoholics are sick, yet they are punished for drunk driving. Drug addicts are criminals, but their punishment can be court ordered therapy. The line between character flaws and personality disorders has become fuzzy, with even the seven deadly sins seen as mental disorders. In addition to pathologizing wrong-doing, we also psychologize virtue; self-respect becomes self-esteem, integrity becomes psychological integration, and responsibility becomes maturity. Moral advice is now sought (...) primarily from psychologists and therapists rather than philosophers or theologians. This book asks: are we replacing morality with therapy, in potentially confused and dangerous ways, or are we creatively integrating morality and mental health? According to the book, it's a little bit of both. It surveys the ways in which morality and mental health are related, touching on practical concerns like love and work, self-respect and self-fulfillment, guilt and depression, crime and violence, and addictions. Terming this integrative development “the therapeutic trend in ethics,” the book uses examples from popular culture, various moral controversies, and draws on line of thought that includes Plato, the Stoics, Freud, Nietzsche, and contemporary psychotherapeutic theories. The book develops some interesting conclusions, among them that sound morality is indeed healthy, and that moral values are inevitably embedded in our conceptions of mental health. In the end, the book shows how both morality and mental health are inextricably intertwined in our pursuit of a meaningful life. (shrink)

This trailblazing book provides a comprehensive view of the ethical issues that cut across the addiction field, from Employee Assistance Programs to treatment and aftercare. By addressing probing questions that illuminate today's complex ethical landscape, LeClair Bissell and James Royce explore how standard guidelines for professional conduct benefit counselors and clients alike.

The notion of recovery has become prominent in mental healthcare discourse in the UK, but it is often considered as if it were a relatively novel notion, and as if it represented an alternative to conventional treatment and intervention. In this paper, we explore some of the origins of the notion of recovery in the early 20th century in movements such as Alcoholics Anonymous and Recovery Inc. Whilst these phenomena are not entirely continuous with recovery in the present day, some (...) important antecedents of the contemporary notion can be detected. These include the focus on the sufferers’ interior space as a key theatre of operations and the reinforcement and consolidation of medical ways of seeing the condition without any immediate medical supervision of the actors being necessary. This has resonance with many contemporary examples of recovery in practice where the art of living with a mental health condition is emphasised without the nature of the psychopathological condition itself being challenged. (shrink)

ABSTRACT A number of philosophers have argued that alcoholics should receive lower priority for liver transplantations because they are morally responsible for their medical conditions. In this paper, I argue that this conclusion is false. Moral responsibility should not be used as a criterion for the allocation of medical resources. The reason I advance goes further than the technical problem of assessing moral responsibility. The deeper problem is that using moral responsibility as an allocation criterion undermines the functioning of medicine.

Epigenetics is currently one of the fastest-growing fields in the sciences. Epigenetic information not only controls DNA expression but links genetic factors with the environmental experiences that influence the traits and characteristics of an individual. What we eat, where we work, and how we live affects not only the activity of our genes but that of our offspring as well. This discovery has imposed a revolutionary theoretical shift on modern biology, especially on evolutionary theory. It has helped to uncover the (...) developmental processes leading to cancer, obesity, schizophrenia, alcoholism, and aging, and to facilitate associated medial applications such as stem cell therapy and cloning. Above the Gene, Beyond Biology explores how biologists in this booming field investigate and explain living systems. Jan Baedke offers the first comprehensive philosophical discussion of epigenetic concepts, explanations, and methodologies so that we can better understand this "epigenetic turn" in the life sciences from a philosophical perspective. (shrink)

The fable of the Emperor's New Clothes is a classic example of a conspiracy of silence, a situation where everyone refuses to acknowledge an obvious truth. But the denial of social realities--whether incest, alcoholism, corruption, or even genocide--is no fairy tale. In The Elephant in the Room, Eviatar Zerubavel sheds new light on the social and political underpinnings of silence and denial--the keeping of "open secrets." The author shows that conspiracies of silence exist at every level of society, ranging (...) from small groups to large corporations, from personal friendships to politics. Drawing on examples from newspapers and comedy shows to novels, children's stories, and film, the book travels back and forth across different levels of social life, and from everyday moments to large-scale historical events. At its core, The Elephant in the Room helps us understand why we ignore truths that are known to all of us. Zerubavel shows how such conspiracies evolve, illuminating the social pressures that cause people to deny what is right before their eyes. We see how each conspirator's denial is symbiotically complemented by the others', and we learn that silence is usually more intense when there are more people conspiring--and especially when there are significant power differences among them. He concludes by showing that the longer we ignore "elephants," the larger they loom in our minds, as each avoidance triggers an even greater spiral of denial. Social life in families, organizations, communities and even entire nations is full of situations where the emperor has no clothes. The Elephant in the Room illuminates the dynamics behind these situations, revealing why we ignore obvious and alarming realities. (shrink)