Talk:Alcoholism

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To and From the authors of this article and from again

Mythobeast sez: I'm going to try to break this down into arguments on individual points. Please try to keep the individual arguments on individual points, and please hold off on name calling and presenting personal opinions as conclusions.

Alcoholism is an illness

MoP: alcoholism isn't a sickness. It can be interpreted as one, yes, but fundamentally it is a chemical dependence much like tobacco addiction.

Mythobeast: I believe that this one is addressed in this article, and in several portions of the discussion page. I'm currently looking for someone who can present a list of scientifically supported reasons why it is an illness. Something more than anecdotal evidence, please.

Alcoholism is not an addiction

The first sentence in the article states, as if it were fact, that alcoholism is an addicttion. This is what needs to be neutralized. Theyshallsee God 19:22, 15 June 2006 (UTC)[reply]

MoP: Alcoholism is physiological, yes, and has similarities to drug addictions, but it also has strong differences, both physically and in other ways. Theyshallsee God 19:22, 15 June 2006 (UTC)[reply]

MoP: Alcoholism is an addiction, which is a fact. It does all the things other addictions do; make you dependent on it, make you happier when you're drinking, and give you withdrawal problems when you're trying to stop. It makes you think you need it to live. So, we have groups like AA which provide mental support to make quitting easier. Master of Puppets ^{Giant Enemy Crab!} 19:51, 15 June 2006 (UTC)[reply]

Mythobeast: Specifically, the neurochemical portion of alcoholism is an addiction essentially identical to opiate addiction. Opiates are naturally occuring chemicals which closely resemble endorphins. Endorphins are released by our system when we drink alcohol causing the same biological reaction as if we had artificially introduced opiates directly.
Mythobeast: This, however, only covers one of the three factors which encourage us to drink alcohol. Social/psychological/spiritual is a second one, also as addressed by the article, and physical dependence is a third, again mentioned in the article. Detox corrects the third, and AA is very effective at addressing the second, but neither treat the first.

Asking a chemical dependency counselor about alcoholism is about tantamount to asking an illiterate person to teach you how to read.

MoP: Counselling can help. If it can't, then millions of people have lied to us about how they stopped being alchoholics. TSSG: I'd like these millions of people to show exactly how it has helped. Counselors like the man said above, are in it for the money. They can 'help' by adding to a person't pile of bills. Theyshallsee God 19:22, 15 June 2006 (UTC) MoP: The world is corrupt and greedy, I know, I've heard it before. However, counselling can help much in the same way groups like AA do, only AA is more efficient; a counsellor can help you discover why you may be drinking so much, etc. Sometimes only other people can help with your internal problems. TSSG: It's interesting how you'll believe millions of people by reading some book or whatever that says millions of people say it has helped, but you won't listen to the millions of alcoholics in Alcoholics Anonymous that says AA works. Theyshallsee God 19:22, 15 June 2006 (UTC) MoP: Que? Your statement is a bit... puzzling. I meant that millions of people have fought off alcoholism, and most of them did so by counselling/support groups. So yes, I am listening to the millions that say AA works. Master of Puppets ^{Giant Enemy Crab!} 19:56, 15 June 2006 (UTC)[reply]

Mythobeast: This is an ad-hominem attack on dependency councilors, essentially can be boiled down to "my treatment is better than your treatment". Please give statistical evidence and site your sources.

If you want to know about alcoholism ask a recovered alcohlic not a counselor that has read some books.

Mythobeast: Follow up studies of alcoholics from all categories show an extremely high relapse rate. Most studies, in fact, tend to cite their success on "mean time until first drink" or "mean time until reversion to heavy drinking". Follow up studies are a common and highly reliable way of "asking a recovered alcoholic". As a side note, the "pill" I mentioned has a nearly non-existent relaspe rate for those who continue to take their $3 pill before drinking - something like 1% - and the patients typically drink about one or two drinks, once a week.

TSSG: I don't need to read some uninformed article here or anywhere else to know that the solution to alcoholism is in participation in AA, not in paying some hoke-ass counslor all kinds of money, to tell someone they're an alcoholic, after reading a few crapical books. Theyshallsee God 19:22, 15 June 2006 (UTC)[reply]

Mythobeast: This tells me that you have no interest in listening to what others have to say, that your mind is made up, and that trying to explain the opinions of others to you is pointless. Is this really how you feel?

AA does not claim to have a corner on the treatment of alcoholism. However, it has the greatest success rate of any

TSSG: AA has done more than research for 72 years. Theyshallsee God 19:22, 15 June 2006 (UTC)[reply]

Someone said something about a cure to alcoholism. There is none.

MoP: There isn't a cure in the way that you can just pop a pill and be done with it, but the "cure" (so to speak) is getting help from counsellors. See article, and above.

Mythobeast: Master of Puppets, I need to correct you on one point of your response. As a rule, there is no "take a pill and get better" solution for any disease. In most cases its "Take a pill and HOPE you get better". With alcohol, such a cure exists for the neurochemical addiction component of it, which is unaddressed by the majority of treatments in existence. As I've added to the article, the use of endorphin antagonists coupled with the continuation of normal drinking habits results in the person losing interest in their normal drinking habits, with a roughly 87% success rate. This technique also addresses the physical addiction. After these two are handled, the psychological/social factors of addiction can be handled much more effectively by existing methods. Mythobeast 17:57, 15 June 2006 (UTC)[reply]

MoP: Hmm, I didn't know there was a cure as in pill...

TSSG: This irresponsible statement, "the use of endorphin antagonists coupled with the continuation of normal drinking habits results in the person losing interest in their normal drinking habits, with a roughly 87% success rate." is exactly the sort of thing that actually helps kill alcoholics. Theyshallsee God 19:22, 15 June 2006 (UTC)[reply]

Alcoholsim is a physical disease with a spiritual solution.

TSSG: It isn't a disease, and the solution is mental, not spiritual. Actually it is a three-fold illness.

physical
mental
spiritual

And mental (pychiatric) approaches to alcoholism have been a phenomenal flop. Theyshallsee God 19:22, 15 June 2006 (UTC)[reply]

MoP: Welcome to Wikipedia. Firstly, WP:NPOV. Mainly, don't try to impose your views on the majority's. Research the topic a bit if you're unsure of the information's quality; if you aren't, talk about it on the talk page first. I mean, if you're strongly opposed to it you can act without asking others, but this is generally considered to be the wrong thing to do. Master of Puppets ^{Giant Enemy Crab!} 19:56, 15 June 2006 (UTC)[reply]

Mythobeast: Hello, TheyShallSee. As Master mentioned, it is the job of Wikipedia to present all information on a particular topic, and hopefully provide some insight into the controversies involved with it. What you are presenting is your personal opinion about it, which is to say, one side of the controversy. Alcoholism is particularly complicated in that there are many ways that people look at it, and we've attempted to present all of them with the information available from other sources as necessary to enlighten the reader. This includes all of the "inane nonsense" that has resulted from the past 50 or so years of research.

TSSG: I'm not imposing my views or opinion, I'm sharing my experience. I resesrched the topic for 42 years, from one end to the other. You said, "generally considered to be the wrong thing to do?" I'll talk about it here if you like, as I can see it's benefits, but back to reality, Wikipedia itself says be bold. Theyshallsee God 19:22, 15 June 2006 (UTC)[reply]

A "spiritual illness"? And of course the "cure" is Jesus or a god of some sort? Mr Christopher 20:23, 16 June 2006 (UTC)[reply]

Hey

No. It does involve getting to coming to believe in and then accepting and then relying on a God of your own understanding. There is no religion forced down your throats.

There is no known cure. There is a solution. It is in attendance at AA meetings, joining a group, getting a sponsor, and then your sponsor taking you through the steps. This has nothing to do with counselors, or treatment centers, or taking pills. A person who calls himself an AA counselor cannot be trusted. There is NO such thing. AA is made up of sober drunks helping newcomers. It is a totally spiritual solution, no dues to pay, no axes to grind..just altruism..one drunk helping another. It works. Theyshallsee God 09:19, 17 June 2006 (UTC)[reply]

Stop stating as if it were fact that alcoholism is an addiction. I removed most of the addiction stuff because they are palpable lies. The misinformation that is in this article is exactly what kills drunks. How do you feel knowing that these bald faced lies are helping to kill alcoholics? Start showing some references before you put that addiction crap back in the article. You are messing with the wrong person where this topic is concerned. If you care to know I can show you how alcohlism is not an addiction. Just ask. Theyshallsee God 09:16, 19 June 2006 (UTC)[reply]

The contributors to this article have presented many scientific studies that demonstrate that the information they have presented in this article has factual basis. Your lack of desire to actually click through the links and study a few of them does not make for a case for removal of these points. I believe they have adequately argued their case and presented evidence, while you have provided us with nothing except accusations, invectives, and threats. I believe that the burden of evidence lies on your side. Mythobeast 02:33, 20 June 2006 (UTC)[reply]

Here's the problem. Theyshallsee God has a point - indeed the disease alcoholism isn't the equivalent of addiction in the manner that the term is frequently used. The disease is about continued use of alcohol despite oneself and one's own best interests, and once alcohol use has ceased it is about refraining from such use and rebuilding one's life. That being said, the APA is on the verge of changing their terminology as they move from DSM-IV to DSM-V; one of the current considerations is to rename "alcohol dependence" (which is the psychiatrists' very poor way of referring to alcoholism) as "alcohol addiction." That would be a terrible mistake IMHO for a wide variety of reasons. In terms of terminology that makes sense to the public, I suspect we should define our terminology as part of the article. Addiction should likely refer to the physiologic entity in which a human will suffer from physiologically measurable withdrawal should alcohol suddenly be stopped. Alcoholism should likely refer to the disease entity described in our current first ¶ and within which patients sometimes suffer from alcohol addiction. But we should recognize that the medical community is moving away from this separation of terms.Drgitlow 03:15, 27 June 2006 (UTC)[reply]

Physical Dependence vs. Addiction

Both physical dependence and chemical dependency -- neither very good articles in their own right -- both list alcoholism as a "dependence". Does the chemistry of the body truly change such that it requires alcohol to survive? Or do people just feel they need it so badly that they'll die without it? I realize this is probably one of "those" debates, but I haven't seen where anyone has really produced an answer, which (it seems) should be easy to do given the fact that surely citable experiments have been performed that would demonstrate whether or not alcoholism is something one eventually feels compelled to WANT or if it's something the body eventually comes to truly NEED. I also think it's no good to have articles featuring alcoholism as something it's not purely as a part of being on a soapbox. Turly-burly 06:57, 20 June 2006 (UTC)[reply]

Hi, there. There are two physical parts to alcoholism, and this probably causes your confusion. The "dependence" part of alcoholism is the body's aclimation to having alcohol in the system. For heavy drinkers, the complete and sudden removal of alcohol can kill a person. The other part is the neurochemical addiction, which is essentially identical to a morphine addiction. This part couldn't be called a dependence because you can lock a person in a room and deprive them of the substance without killing them. They would just be very, very miserable.

Any citation for any of this? And how would it kill them? Would they break down and kill themselves, or would their body actually cease functioning? Turly-burly 23:56, 20 June 2006 (UTC)[reply]

I believe the specific mechanism for this is heart failure due to neurological maladjustment. See Delerium tremens for lots of details on the most significant alcohol withdrawl symptoms. If you want to go off-wiki for information, check out MedicinePlus's article on the topic, or the one on eMedicine. They have many cites there. - Mythobeast 16:19, 22 June 2006 (UTC)[reply]

Leave Arguing about Alcohol to Medical Professionals

It is reasonable to leave the editing of this article to medical professionals. That said, the discussion here is representative of the disagreement within the lay community and has validity as a result. I'd suggest that we keep a section of the article in which various opposing views can be represented. Drgitlow 02:26, 26 June 2006 (UTC)[reply]

Your comments are astonishing. Leave the editing of this article to medical professionals who say this is a disease yet they have failed to ever prove that claim, they want you/us to accept what they say on faith. These so called medical professionals cannot seem to grasp the difference between a definition and an actual disease. No thanks Doc, we should stick to supported, cited evidence and I suggest we beware of self-described "experts" and AA counselors if you ask me. Their livelyhoods are all dependent on the public's blind acceptance of this unproven, so called "disease" Not exactly an unbiased group of editors, no? Mr Christopher 16:20, 26 June 2006 (UTC)[reply]

Sorry, Dr. Gitlow, but I find your reasoning to be suspect. The medical community does not agree on what causes alcoholism, nor on how to treat it. Various groups of authority have official stands on it, but these stands are also in disagreement. You cannot claim to speak for the entire medical community because they do not speak with one voice.

I didn't say that the medical community agrees as to what causes alcoholism, nor did I say that they agree as to how to treat it. They simply agree that it is a disease, that there are a variety of factors leading to its existence, and that there are a variety of symptoms that typify the presence of the illness. They also agree that there are a variety of potential treatment modalities. You're right that I cannot claim to speak for the entire medical community but you're wrong that they do not speak with one voice. All state and specialty medical societies are part of a federation of medical organizations that speak through the American Medical Association via the AMA's House of Delegates. In fact, the AMA has policy, approved by its House, stating that alcoholism is a disease (among other things).Drgitlow 19:55, 28 June 2006 (UTC)[reply]

Even if it did speak with one voice, it would still not be acceptable to take their viewpoint as the only one acceptable. It is a doctor's hubris to believe that they know all there is to know on a subject. Medical science, psychiatry, psychology, and sociology combined have yet to provide a solid reason for alcoholics continuing to drink. If it did, it should be able to provide a way of undoing the effect. Until it does so, all avenues must be considered.

That isn't a doctor's hubris, but rather an educated opinion through years of education and years of experience. The next time you're traveling in a commercial airliner and the pilot encounters a weather phenomenon or faulty engine, would you rather the pilot make the decision as to what to do, or would you prefer that the guy in 11C go up there and deliver his opinion? Unless the guy in 11C is also an experienced commercial pilot, I'd prefer he share his opinion later...on the ground. You're right that there are many opinions, but the opinions that a knowledgable and educated public prefer to listen to are the ones that are based in sound education and experience. We don't even know why people get headaches, how aspirin works, or why we dream. We don't know the basis of cancer, diabetes, or multiple sclerosis. Yet for some reason, you don't see these arguments in those Wiki entries. I'm not sure why you're going off in this direction.Drgitlow 19:55, 28 June 2006 (UTC)[reply]

My experiences with the medical community in regards to alcohol is that various people have differing opinions about various treatments, and everyone involved is EXTREMELY attached to their opinions. Like you, it is typical for medical professionals to discount anything that doesn't come from another medical professional, even if what comes from them is a compilation of placebo controlled peer reviewed studies performed by qualified research doctors.

Furthermore, any actual cure for alcoholism would result in the destruction of many large, well funded institutions. In a world where corporate interest has a stranglehold on science, it is unreasonable to assume that word of any such thing would come through official channels. This, coupled with the trickle-down effect that this has on physicians like yourself makes the medical community suspect. Mythobeast 17:34, 27 June 2006 (UTC)[reply]

I totally agree with this last point.Drgitlow 19:55, 28 June 2006 (UTC)[reply]

And as an addiction medicine specialist myself (I'm a physician), my livelihood is in no way dependent upon the public's blind acceptance of whether alcoholism is a disease or not. I've treated hundreds of patients over the years with about 85% of those with alcoholism continuing to do well (abstinence) in treatment. My practice has grown only from referrals from friends/family/colleagues of treated patients. That's typical for addiction MD's; we don't need to advertise. The prevalence of the disease is enormous and the availability of skilled MD's who have board certification in addiction medicine or addiction psychiatry is minimal. You're probably right that I have a personal bias - like I said, I've seen hundreds of patients get better first-hand. But again, there is no controversy in the field that patients get better with treatment.Drgitlow 21:20, 26 June 2006 (UTC)[reply]

Alcoholism is clearly not a disease

The disease model of alcoholism is widely rejected by scientists. Anyone not completely blinded by ideology can recognize this fact. See, for example, the section titled "Conflict Between the Disease Theory and Social Science Research" in "The Cultural Context...," a scholarly article first published in The American Psychologist and reprinted in the book, Alcoholism [1] See also

Supreme Court [2]
World Health Organization (WHO) [3]
From the medical journal, Lancet: Disease theory is controversial [4]
Med Help International [5]
American Heritage dictionary [6]
Dictionary definition [7]
Webster's Collegiate dictionary, 10th ed. [8]
Depression Dictionary [9]
Havard Medical [10]
National GAINS Center [11]
Health Science Center [12]
Nature of Alcoholism [13]
Biology Online [14]
Presbyterian Health Plans [15]
Online Learning Center [16]
Black Women's Health [17]
Datasync [18]
What is Alcohol? [19]
Johns Hopkins University [20]
Genetics Topics Dictionary [21]
Family Health Guide [22]
Addiction Center [23]
Rosemary Hennessey [24]
e-Medicine [25]
Dr. Ann Reyes [26]
Dr. Jeffrey Schaler [27]
Dr. Mark Lender [28] (posted from above)Medical Man 02:41, 28 June 2006 (UTC)[reply]

Using the AMA/APA POV for this article

It's nonsense like this

Of importance is that frequency and quantity of alcohol use are not related to the presence of the disease (definition, as per 1992 JAMA article cited below); that is, individuals can drink a great deal without necessarily being alcoholic, and alcoholics may drink minimally and/or infrequently.

that makes this article so pathetic (in places) and makes the motives of the AA doctors and counselors here so transparent. What the good AA doctor is suggesting is that minimal and/or infrequesnt drinking is also a sign of this mysterious, unproven disease. This is complete nonsense when the medical community tells you that very little drinking is also a sign of alcoholism. So, if you drink alot you may be a alcoholic and need life time treatment, if you drink every little you may be an alcoholic and need life time treatment. They pretty much cover the bases so pretty much everyone on the planet is a candidate for life time treatment. Treatment of course is handing over your money, talking alot, and being subject to religious indoctrination and instruction.

How can I invest in this multi-billion dollar racket? The fact that the introduction that was the result of editor consensus continues to be changed to reflect the POV of the AA based treatment industry.

When it comes to alcohol related problems the AMA and APA are not exactly neutral parties when it comes to embracing the AA vision and ideology. Are you guys aware of how deep the AA influence is in the medical community and the AMA specifically? Any doc who has an alcohol problem is forced to attend AA meetings or have their license taken away. They can go to AA or NA and those are their only choices. Find a higher power or lose your medical license is the course of "treatment". It's called the State Physician Impairment programs. You can find the specifics for each state here http://www.ama-assn.org/ama/pub/category/6020.html. Yes Virginia, under the threat of having their license taken away, the American Medical Association forces its own members with alcohol problems to go to AA or NA. So it is no surprise that our local AA doc and "treatment" expert wants us to promote the AMA POV in this article. He's admitted he'd like the editorship limited to "treatment" folks. That would be the most effective way of limiting the article to the AMA/APA pro A.A. POV. Mr Christopher 20:08, 28 June 2006 (UTC)[reply]

It's not nonsense, but fact. Not controversial fact, just fact. Frequency of alcohol intake and quantity of intake are not related to the presence of disease. I know it might seem counterintuitive, but realize that you can have diabetes with a glucose of 100 (normal). You can have hypertension with no subjective symptoms at all. That's the way diseases work. Alcoholics are still alcoholics even when they're not drinking. And some folks (look at any college) drink a great deal without having any substance use disorder. That's just the way it is, and you may not like it (for whatever reason) but that doesn't change anything. I'm not suggesting that minimal and/or infrequent drinking is a sign of the disease, and if you re-read the topic you'll see that. I'm simply saying that alcohol intake quantity and frequency is not germane to making a diagnosis. By the way, the AMA doesn't force anything upon its members - the state physician impairment programs are run by the state boards at the behest of the state populations - the AMA has kindly posted the information at their site but they don't run, oversee, or in any way regulate these programs. I've also said next to nothing in any of my content about AA. This article is about alcoholism, not AA, so I'm unsure why you refer to me as an "AA Doc." As for promoting the AMA POV within the article, that would be reasonable. The AMA as the voice of American Medicine is a reasonable standard to use for incorporating medical information within any encyclopedia of content. Not doing that would leave the entry without any firm scientific basis. 68.9.164.90 20:31, 28 June 2006 (UTC)Drgitlow 20:33, 28 June 2006 (UTC)[reply]

Promoting the AMA POV here is innapropriate. The article should be NPOV and the AMA is one of many views. And your analogy about alcoholism and diabetes is absurd if not insulting. Mr Christopher 20:43, 28 June 2006 (UTC)[reply]

I'm sorry you don't understand. My analogy of alcoholism with diabetes is neither absurd nor insulting, and there is published literature that uses the exact analogy (Run a PubMed lit search on alcohol and diabetes and you'll find it). Drgitlow 21:19, 28 June 2006 (UTC)[reply]

Intro Redo III

We need to rework the introduction (again) and go back to a NPOV one. We should cite the AMA (and whomever else) but not make the introduction and definition the AMA POV. I'm tired right now so maybe someone else can throw some ideas together here and we can get some consensus again. What we had before was much less POV than what we have now. As difficult as it is for the AA treatment people here to understand, Wiki article is not supposed to reflect a POV. The AMA is a source, an extreemly biased source, but a source nonetheless, and not the final authority on this article. Mr Christopher 20:52, 28 June 2006 (UTC)[reply]

To be clear - I think our readers will be best served by a non-biased definition of alcoholism, one that does not come from the treatment industry or any other organization that profits (monetarily or by increased membership) from a certain viewpoint concerning alcoholism. Using the AMA or APA definition for alcoholism is a blatant act of POV pushing. I am not suggesting we ignore the AMA/APA viewpoint, those should be included in the article, but not use their viewpoint as the foundation for this article. We're not here to line the pockets of the treatment industry or push their controversial and disputed perspective. The fact that the AMA/APA assert alcoholism is a disease, they have never proven this claim, and they make billions off of this notion does not make them a neutral party. Mr Christopher 21:13, 28 June 2006 (UTC)[reply]

The latest edit by Medical Man is an improvement, much of the POV was removed so we're making some progress. Mr Christopher 16:43, 29 June 2006 (UTC)[reply]

Consensus

The discussion on this page has been interesting. It appears that we have at least two perspectives being shared. On the one hand are the perspectives like mine: alcoholism is a disease, much like any other lifelong chronic illness, with well-accepted definitions in the field as to symptom profile, course, and recommended forms of treatment. The other perspective is personified by Mr. Christopher's statements: alcoholism is not a disease, and much controversy exists among learned individuals regarding alcohol and associated issues. In some ways, I feel as if we could write two entirely separate articles which would barely overlap. The addiction medicine community would disagree with Mr. Christopher's perspective, but obviously there are those who would disagree with the addiction medicine community's perspective as well. So the real question is: What should we do about this? I don't know that Wiki is open to a point/counterpoint type of article, and I doubt we could have two parallel articles in the system. But it's madness for us to continue bickering when it's clear that neither side is about to convince the other as to the merits of their points. So what's the next step?Drgitlow 23:28, 28 June 2006 (UTC)[reply]

My point is the the disease of alcoholism currently exists as a definition and not a scientific fact. I am not alone in this recognition and there is debate within the medical communuty as well, not just here. Although the disease "concept" is abpout as dumb as it gets, my point is it is an unproven disease, not that it is not a disease. Science might one day discover an alcoholism disease, they might also discover Elvis walks the moon. I cannot rule out either.

As dumb as I personally think the disease concept is, I am not suggesting we claim alcoholism is not a disease in the article, I am saying we should avoid taking sides in this debate and treat it on neutral grounds (aka "NPOV"). You, on the other hand want to push the AMA/AA treatment industry POV and act as if this disease is anything other than a definition or assertion. An unsubstantiated assertion made by a medical community that makes billions of dollars from these unproven claims. You keep pushing the AA and/or the AA treatment industry POV (subtle difference). You would do well to learn about Wikipedia and what goes in an article, what constitutes NPOV and POV.

You can pretend I am the only guy in the world who is hip to these facts all day long but you know better. How long have you been a member of AA? Mr Christopher

OK...that clarifies your point. Among the reasons why the medical profession agrees (per the 1992 consensus statement in JAMA, among other references) that alcoholism is a disease is that the symptoms, course, and dysfunction are predictable and replicable. I don't think you're the only person in the world who disagrees, but the fact that alcoholism is a disease is not one that is refuted within the medical community. Of course there are those out there who think major depression isn't a disease and that diabetes isn't a disease, but that doesn't mean they aren't treated as diseases by the medical community and to a large part the general public. Alcoholism is in the same group. I know you don't like that, but that's just the way it is. You keep asking for scientific fact, and I'm not sure what you're looking for. The literature has extensive scientific backing of alcoholism as a genetic entity. I don't know whether you've read those articles and disagree or if you haven't seen them. I therefore can't tell if you support your position as a result of being naive or if you have a well-educated reasoning that you'd like to share. I feel like I'm trying to convince someone that the world is round - he's saying there's no proof and I'm trying to argue a point based upon extensive astrophysics literature that he hasn't read or isn't familiar with. You might think it's dumb that alcoholism is thought of as a disease, but that doesn't change the fact that it is thought of as a disease - by medical professionals, by the vast majority of the public, all except a few folks who tend to be very vocal.

You also keep speaking of POV's, or perspectives. Let's say we were writing about reciprocating engines. You'd want the writer to have a background in engines, perhaps be an engineer or automobile designer. You'd want to leave out arguments about whether gasoline is the downfall of our society. You wouldn't want to sound like you're from GM or Ford, but rather would simply describe how the engine works. How it works would be fact, and while there would be some who disagree, that wouldn't stop the facts from being correct. Here, we're writing about alcoholism. That means we'd like the article written by someone who specializes in the treatment of the disease, or by someone who has the disease, or by someone who otherwise has a great deal of expertise in the field. My bias is that I don't have the illness, don't attend AA, and therefore can't write the article with that perspective. It would be nice to have input from someone who has the insights gained from such an experience. Can you share with the rest of us the basis upon which you're contributing to this article? Drgitlow 00:38, 29 June 2006 (UTC)[reply]

Good to see you still working away, Gitlow! Some points to address, though:

If I was writing an encylopedia article about reciprocating engines, I would be expected to know something about them. Most engineers and automobile designers lack the ability to actually *fix* their own cars, sadly enough... they aren't shadetree mechanics. Having a working knowledge of some area of the field is helpful, of course, for the sake of contribution, but it's far from actually completely knowing a field.
On wikipedia, credentials mean nothing, because credentials are so easily faked over the internet, and experts are often overly-biased in their pet theories about a field. (Hence, acrimonious debates over alcoholism genes, conditioned/learned behavior, etc.)
On wikipedia (and this is IMPORTANT to remember), facts are irrelevant. This may come as a surprise. Our golden standard here is VERIFIABILITY. I doesn't matter what any editor thinks is a fact, or not, what matters is if we can cite and *verify* that somebody else thinks that something is a fact.
As far as the gasoline debate, we *do* have articles on that topic (just not in the engine article), so we may want to migrate out the "disease/behavior" debate in such a way that we have an article on what alcoholism is commonly accepted to be, and put the debates elsewhere.
Your statement "specializes in the treatment of the disease" belies an underlying POV (one which we had discussed way back..). Hopefully, you can also "write for the enemy", to explain their POV in a neutral way.
My personal experience comes from working daily with several thousand drinkers of varying types of behaviors, some who label themselves as having a drinking problem if they "talk back" to their spouses after having a single glass of wine, to people who were drinking 30-40 standard drinks a day, homeless, jobless, and clinically depressed.
You are wrong that there is complete consensus that alcoholism, in toto, is considered a disease, in toto, by the whole of the medical community. Perhaps part of the problem is that *much* of the community considers *many* of the symptoms to be common, but after that, it somewhat falls apart. To convince me that alcoholism is a genetic disease is quite simple: Find me the one study, accepted and published, that shows *identical* twins are *identical* alcoholics. You can't, it's already been tried. Maybe something is affecting gene expression, which means that the disease is only present in *some* people with specific genetic factors.
Any finally, (quite sadly), most of the drinkers I deal with feel totally let down by treatments offered under the existing disease model, in that treating drinking as a disease did not improve their health (and in some cases, increased their drinking, worsening their health). "Do no harm" is being intentionally ignored, perhaps, because current medical practices are often thought by some to be "the best we have".

Good to see this article hasn't been abandoned yet, I know it's a tough topic with literally billions of dollars associated with it. Ronabop 06:12, 2 July 2006 (UTC)[reply]

Logical Moves

We had diagnostic entries in the alcoholism as a disease category, and disease info in the diagnostic category. I tried to move each entry to their logical place. Mr Christopher 20:35, 29 June 2006 (UTC)[reply]

Looks good. I'll work on obtaining some of the citations this evening. It looks as though some of the footnotes aren't present. Some citations were obviously made at some point in the past but the footnotes have since been deleted or never added. I'll see if I can find them as well. This may take a few days.Drgitlow 21:19, 29 June 2006 (UTC)[reply]

Can you also cite some of the quoted definitions and ideally provide a link or something where the reader can go directly to the source? I think most of the APA/AMA/et al definitions can be found online. I need to look at the manual of style again because I think there is a specific format we should be using when quoting a person or organization and I forget whether we are supposed to use italics or just "quotes" or

blockquotes

...Mr Christopher 21:29, 29 June 2006 (UTC)[reply]

Alcoholism as a disease

Alcoholism might be a disease but there is no consensus within the medical research community that is is, in fact, a disease. I don't know whether it is or or not; I'd put the odds at perhaps 50-50. But our personal beliefs about the question of disease/not-disease are completely and totally irrelevant.

Until such time as there is scientific consensus among researchers (not consensus among therapists, practioners and others with an ideological or financial self-interest), we are obligated to assume that alcoholism is not a disease.

That's how science operates, and that's how an encyclopedia article needs to present the matter. We can't assume that alcohol is a disease. The only honest way to handle the matter is to present the question as an open one about which there is no scientific consensus.

Within that context, balanced arguments from both sides of the issue can then be presented.

If we do that we have prepared an honest, objective encyclopedia article on a controversial subject about which we can all justifiably be proudMedical Man 21:57, 29 June 2006 (UTC)[reply]

Your conclusion, Medical Man, is an interesting one. There has been scientific consensus among researchers for decades on the topic of alcoholism as a disease. The US government knows it (look at NIDA and NIAAA), the medical community knows it (look at the AMA, ASAM, and the APA), and current research is dedicated to determining the origins of the illness. Other encyclopedias (look at Britannica, for example) note that alcoholism is a disease. Your argument is therefore wanting. Presenting both sides of an issue is sensible when the verdict isn't in. This verdict has been in since the late '50s. Your not knowing that doesn't mean that we should follow your lead.Drgitlow 23:49, 29 June 2006 (UTC)[reply]

Honesty and integrity needed

Drgitlow asserts that Encyclopedia Britannica defines alcoholism as a disease. I don’t understand how any intelligent and honest person could interpret the Britannica’s definition and article in that way. Appears to be another of Gitlow's many distorted and deceptive "facts."

Britannica's definition of alcoholism:

"excessive and repetitive drinking of alcoholic beverages to the extent that the drinker repeatedly is harmed or harms others. The harm may be physical or mental; it may also be social, legal, or economic. Because such use is usually considered to be compulsive and under markedly diminished voluntary control, alcoholism is considered by a majority of, but not all, clinicians as an addiction and a disease." [http://www.britannica.com/eb/article-9110089?query=alcoholism&ct= ]

Britannica's alcoholism article:

Alcoholism is a complex, many-sided phenomenon, and its many formal definitions vary according to the point of view of the definer. A simplistic definition calls alcoholism a disease caused by chronic, compulsive drinking. A purely pharmacological-physiological definition of alcoholism classifies it as a drug addiction that requires imbibing increasing doses to produce desired effects and that causes a withdrawal syndrome when drinking is stopped. This definition is inadequate, however, because alcoholics, unlike other drug addicts, do not always need ever-increasing doses of alcohol. Opium addicts, on the other hand, become so adapted to the drug that they can survive more than a hundred times the normal lethal dose, but the increased amounts to which alcoholics become adapted are rarely above the normal single lethal dose. Moreover, the withdrawal syndromes in alcoholism occur inconsistently, sometimes failing to appear in a person who has experienced them before and never occurring in some drinkers whose destructive behaviour is otherwise not distinguishable from that of someone who is pharmacologically dependent on alcohol.

(Membership required to obtain missing text)

A third definition, behavioral in nature, defines alcoholism as a disorder in which alcohol assumes marked salience in the individual's life and in which the individual experiences a loss of control over its desired use. In this definition, alcoholism may or may not involve physiological dependence, but invariably it is characterized by alcohol consumption that is sufficiently great to cause regret and repeated physical, mental, social, economic, or legal difficulties. Clinicians call such a behavioral disorder a disease [Editorial Note: presumably "most clinicians," given Britannica's definition above] because it persists for years, is strongly hereditary, and is a major cause of death and disability. In addition, alcohol permanently alters the brain's plasticity with regard to free choice over beginning or stopping drinking episodes. As with other medical diseases but unlike most bad habits, prospective studies demonstrate that willpower per se is of little predictive significance. An informed minority opinion, especially among sociologists, believes that the medicalization of alcoholism is an error. Unlike most disease symptoms, the loss of control over drinking does not hold true at all times or in all situations. The alcoholic is not always under internal pressure to drink and can sometimes resist the impulse to drink or can drink in a controlled way. The early symptoms of alcoholism vary from culture to culture, and recreational public drunkenness may sometimes be mislabeled alcoholism by the prejudiced observer. In the general population, variation in daily alcohol consumption is distributed along a smooth continuum. This characteristic is inconsistent with the medical model, which implies that alcoholism is either present or absent—as is the case, for example, with pregnancy or a brain tumour. For such reasons, the sociological definition regards alcoholism as merely one symptom of social deviance and believes its diagnosis often lies in the eyes and value system of the beholder. For example, periodic intoxication can cause sickness necessitating days of absence from work. In a modern industrial community, this makes alcoholism similar to a disease. In a rural Andean society, however, the periodic drunkenness that occurs at appointed communal fiestas and results in sickness and suspension of work for several days is normal behaviour. It should be noted that this drunkenness at fiestas is a choice and does not produce regret. If the sociological model were entirely correct, alcoholism should often be expected to disappear with maturation as is the case with many other symptoms of social deviance. This does not occur, however. Finally, epidemiologists need a definition of alcoholism that enables them to identify alcoholics within a population that may not be available for individual examination. To define alcoholism they may rely on quantity and frequency measurements of reported community drinking and alcohol-related hospitalizations, on a formula based on the frequency of deaths from cirrhosis within the population, or on arrests for alcohol-related misbehaviour.(Emphases added) [http://www.britannica.com/eb/article-251752?query=alcoholism&ct= ]Medical Man 19:42, 3 July 2006 (UTC)[reply]

Yes, Honesty and Integrity would be useful

Encyclopedia Britannica's definition, as posted online, reads (emphasis mine):

Excessive habitual consumption of alcoholic beverages despite physical, mental, social, or economic harm (e.g., cirrhosis, drunk driving and accidents, family strife, frequently missing work).

Persons who drink large amounts of alcohol over time become tolerant to its effects. Alcoholism is usually considered an addiction and a disease. The causes are unclear, but there may be a genetic predisposition. It is more common in men, but women are more likely to hide it. Treatment may be physiological (with drugs that cause vomiting and a feeling of panic when alcohol is consumed; not an effective long-term treatment), psychological (with therapy and rehabilitation), or social (with group therapies). Group therapies such as Alcoholics Anonymous are the most effective treatments. Suddenly stopping heavy drinking can lead to withdrawal symptoms, including delirium tremens.

This information is readily available at: http://concise.britannica.com/ebc/article-9354910/alcoholism

I stand by my original statement. Drgitlow 20:26, 3 July 2006 (UTC)[reply]

drgitlow edits

gitlow, the ^{[citation needed]} instances you just overwrote were appropriate and what you replaced them does not conform with Wiki standards. Saying something like "is referenced in the above section" or what not is not how sentences are cited. I know you are new here but can you start citing an entry at the entry and not allude to another one elsewhere in the article? Cheers! Mr Christopher 22:09, 29 June 2006 (UTC)[reply]

gitlow, feel free to knock off the vandalism as well and stop removing this referenced and appropriate entry:

Most argue that because the American Medical Association (AMA) has proclaimed alcoholism a disease, the idea is without reproach. But, the fact is that the AMA made this determination in the absence of empirical evidence. After reviewing the history of the decision, it would not be unreasonable to suggest that the AMA has been pursuing its own self-interest agenda in the face of evidence negating the validity of alcoholism....The promulgation of the disease concept, in conjunction with AMA approval, has created a multi-billion dollar treatment industry that contributes billions to the health care industry....The promulgation of the disease concept, in conjunction with AMA approval, has created a multi-billion dollar treatment industry that contributes billions to the health care industry.[29]

I am getting tired of fixing your vandalism to this article. Mr Christopher 22:20, 29 June 2006 (UTC)[reply]

The AMA claims alcoholism is a disease, this has been defined but never proven scientifically. I added a piece that is critical of the AMA claim about alcoholism as a disease. This is relevance, please stop removing this information from the article, gitlow.

You and your sock puppet have removed it at least 3 or 4 times, you also removed it after I had request here you not do so.  That is what we call bad faith.  Please knock it off, if you object to the entry then discuss it here. Mr Christopher 02:02, 30 June 2006 (UTC)[reply]

Feel free to stop anytime. I'm requesting mediation for this page. It's obvious that a group of people are mishandling the entry. It's also obvious that we both feel the other one is responsible for the problem. Drgitlow 00:33, 30 June 2006 (UTC)[reply]

What the heck is going on, we now have a disease model section and another disease section...holw cow Mr Christopher

Sigh...the AMA has made no such claim. The AMA is simply a policy-oriented association. The AMA does in fact have policy stating that the medical community as a whole is in agreement that alcoholism is a disease. This has been defined, demonstrated, and rigorously borne out in the literature. Your lack of knowledge about the field does not give you the right to single-handedly rewrite the scientific knowledge base. If in fact you do have knowledge about the field, please share with us where this knowledge comes from. Perhaps then we'll take your perspective more seriously.Drgitlow 02:09, 30 June 2006 (UTC)[reply]

That was not my perspective you have deleted now 4 or 5 times, it was the Baldwin research Institute's. Obviously you are going to treat this article as your own personal domain and have no intention of playing by the Wiki guidelines. Mr Christopher 02:15, 30 June 2006 (UTC)[reply]

Have you looked at the credentials for the Baldwin Research Institute? Again, many entries in an encyclopedia will have alternative views that could be contributed. Typically, one incorporates alternative views from valid sources. I don't see that any physicians (or doctorates) work at the Baldwin Research Institute. While the fact that they disagree with the scientific community is without argument, their banter is not material to the content of this article. Feel free to incorporate a reference to their website so that readers can obtain their alternative views. Their comments about the AMA, however, would be more appropriate on a Wiki entry about the AMA, not here at the Alcoholism entry. Drgitlow 02:27, 30 June 2006 (UTC)[reply]

Obviously I wasn't clear, I'll try again,

That was not my perspective you have deleted now 4 or 5 times, it was the Baldwin Research Institute's. Obviously you are going to treat this article as your own personal domain and have no intention of playing by the Wiki guidelines.

It is not your role to determine which viewpoints are to be considered, you are not the sole judge and jury of a reference's integrity. We are discussing competing ideas, not the size of their diplomas. And limiting the references only to viewpoints from the AMA, APA and other organizations that not only reap billions of dollars each year as a result of the disease of alcoholism, they are steeped deeply in a pro-AA ideology, is way out of line.

Your obvious attempts to silence any legitimate reference that is critical of these controlling bodies and their ideas is way out of line here. A controversy exists, we owe it to our readers to inform them of the varying viewpoints. You seem to think you have the right to regulate viewpoints here.

Some of us have been working on this crippled, contentious article for quite some time now. When exactly did you arrive again, and who exactly hired you to?

You are way out of line here. And a stunning example of what is wrong with the modern alcoholism treatment industry. Mr Christopher 03:01, 30 June 2006 (UTC)[reply]

I arrived in January. You arrived several months later and began crippling what had previously been a consensus-driven entry. Noone hired me. You and I both have the same right to be here. Drgitlow 03:50, 30 June 2006 (UTC)[reply]

gitlow, in view of the fact you are a psychiatrist, work in an academic setting (where doctors are taught about alcoholism), have published pamphlets and books on the subject, the things you continue to remove from this article are amazing if not shocking. You even removed the part where the Supreme court justice wrote "a substantial body of medical literature that even contests the proposition that alcoholism is a disease, much less that it is a disease for which the victim bears no responsibility".

Its as if you are hell bent on keeping ANYTHING that points out the lack of scientific evidence for the disease or the lack of consensus amongst scientists out of the article. You keep removing anything that is critical of the AMA or APA or the disease concept. Astonishing. Mr Christopher 17:32, 30 June 2006 (UTC)[reply]

You've been misinformed. I've never published a pamphlet. I have written a book, but only the one. And I don't work in an academic setting (though I indeed am on academic faculty). It's interesting though that you've attempted to find out more about me. Why don't you just ask? Feel free. I've certainly been curious as to your background, but you've not told us anything at all. Drgitlow 16:14, 1 July 2006 (UTC)[reply]

Alcoholism as a disease

There is no consensus within the scientific research community that alcoholism is a disease. The American Hospital Association, the AMA and other physician and other healt provider organizations are not scientific bodies but professional organization designed to promote the interests of their members. Practicing physicians and other treatment personnel are not scientists. Nor are the members of the National Council on Alcoholism and Drug Dependence, an organization founded by Marty Mann, the first woman member of AA. I await evidence of consensus within the scientific research community that alcoholism is a disease.Medical Man 02:40, 30 June 2006 (UTC)[reply]

You are correct that the AHA, AMA, and other physician organizations are not scientific bodies. You are incorrect, however, that practicing physicians are not scientists. They are doctorate level experts in the medical profession with training and background in biology, chemistry, and physics, and easily fitting in with the scientific ranks. The scientific community of treatment professionals (and there are many related organizations) are in agreement as to alcoholism being a disease. The fact that NCADD started with Marty Mann is irrelevant to its acceptance by the broad community. If you're awaiting consensus that arrived decades ago, perhaps you missed the mail. Drgitlow 02:45, 30 June 2006 (UTC) (NCAAA is a de facto AA group that has falsely claimed for years that the APA defines alcohollism as a disease when, in fact, it has explicitly rejected that view.) [30]Medical Man 20:23, 30 June 2006 (UTC)[reply]

Physicians are trained as scientists but those who practice medicine are engaging in the art of medicine that is backed by science but is not itself science. Practicing medical scientists are most often M.D.s, Ph.D.s, and D.Sc.s. Practicing physicians and M.D. scientists have largely different self-interests.

There is consensus within AA, twelve-step programs, most alcoholism treatment providers (including their profesional organizations) that alcoholism is a disease.

But there is no consensus within the scientific research community that alcoholism is a disease.

You've obviously received junk mail.Medical Man 03:19, 30 June 2006 (UTC)[reply]

LOL. Your point about self-interests is very well taken. If I understand you correctly, you're arguing that the economic bias of physicians and the medical treatment community is subrogating their medical ethic to do the right thing by their patients. If you truly believe that, how do you treat your own or your family's medical symptoms when they arise? Are you not concerned that your physician is simply trying to line his pocket rather than to see that you get better as rapidly and in as risk-free a manner as possible? Yes, the economic interests of the two groups are different, but for the purposes of this article, the consensus is the same: I urge you to look at the findings of pure scientific groups: The Research Society on Alcoholism, The National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism. I'd also urge you to present here any findings of a widely accepted research body that indicate alcoholism to be some entity other than an illness. Drgitlow 03:28, 30 June 2006 (UTC)[reply]

Alcohol researchers know a great deal about alcoholism. Practicing physicians generally know very little. Examining a CME (continuing medical education) course on alcohol and alcoholism reveals that it is very rudimentary. Most practicing physicians will not have even that low level of knowledge about alcoholism. Their views are irrelevant.

NIDA and NIAAA are government bureaucracies that promote federal policies at any given time and are not scientific organizations. The Research Society on Alcoholism is a scientific organization. It does not define alcoholism as a disease but rather refers to it as a condition and a disorder.Medical Man 16:27, 30 June 2006 (UTC)[reply]

Speaking of the APA and NIDA...I just found an interesting article on the APA's web site. It's written by Dr Alan I Leshner, who is the Director of the prestigeous National Institute on Drug Abuse. Not the cook in the NIDA cafeteria, not the guy who works in the mail room, but the Director.

In this article[31] the good doctor tell us addiction (aka alcoholism) is actually a

brain disease
a brain disease expressed as compulsive behavior
the quintessential biobehavioral disorder
complex biobehavioral disorder
true brain disease

Of course he doesn't provide s a shred of evidence for any of these wild claims. Predictably, he tells us how treatment is going to fix it all and there's help even for law breakers:

Understanding the bio-behavioral nature of addiction also helps in thinking about strategies to deal with addicted criminal offenders. That they have this brain disease helps explain why untreated addicted offenders have such high post-incarceration rates of recidivism both to drug use and criminality.

Amazing he can diagnose law breakers without ever meeting them. Apparently breaking the law and drinking/drugging too much is a sign you have this disease, brain disease, quintessential biobehavioral disorder, complex biobehavioral disorder. Yes that explains it all. I think it is safe to say that NIDA Is not a scientific organization and they seem to promote ideas that promote more treatment for more people and they have this amazing ability to diagnose entire groups of people with brain disease.

You got to read this article to believe it and keep in mind guys like this are shaping our alcoholism and addiction public policy and awareness and obviously they have no problem just making stuff up on the fly. Mr Christopher 22:08, 30 June 2006 (UTC)[reply]

Reading the Director of NIDA's article again made me wonder what other "brain diseases" are "treated" with spiritualism? Mr Christopher 22:19, 30 June 2006 (UTC)[reply]

Do either of you two have any kind of educational background in the field. I feel like I'm arguing scientific semantic points with someone who has received no education in the area. Are you both physicians, scientists, or are you simply interested in the field? If you're just interested, please let those of us who work in the field 24/7 get this job done. If you're truly knowledgable, then why not work toward the eventual goal instead of wasting all of our time here?Drgitlow 22:29, 30 June 2006 (UTC)[reply]

Stuart, lighten up. Even a well respected AA counselor such as your self has to admit that article from the Director of NIDA was a knee slapper. I was getting dizzy from all those definitions of the same thing. Even you have to admit the treatment industry who wants to see the whole world signed up for life time "treatment" are a crack up sometimes. Come man, lighten up - it was f-u-n-n-y. Mr Christopher 15:01, 1 July 2006 (UTC)[reply]

Chris, I'm not an AA counselor and have never made any such claim. Alcoholics often need to remain in treatment just as those with other chronic diseases often do. Your failure to recognize this, while unfortunate, is not important unless you're in a profession where you are responsible for the lives of patients with this disease. And if you were, you'd quickly recognize how important it is for successful outcomes that patients remain in some form of treatment (whether self-help, at no cost, or through professional care). With the number of people who die of this disease on a daily basis, the fact that you find the whole thing funny is rather telling. Drgitlow 16:09, 1 July 2006 (UTC)[reply]

stuart, we're having another communication break down again. My fault I'm sure. I am not saying people with alcohol problems are funny, that's not funny at all. What some of the self serving people in the "treatment" indutstry say and write (with a straight face) about alcoholism and addiction and "treatment" is a laff riot. That was my point and this guy was a very good example. Sorry I wasn't clear. Mr Christopher 22:54, 1 July 2006 (UTC)[reply]

Chris, it seems that the major point on which we disagree is whether alcoholism is a disease, and that may be due to our differing definitions of "disease" rather than differing beliefs about "alcoholism." Can you describe for me what you feel alcoholism is? Perhaps that will help us to build a consensus on the topic -- we can work on issues OTHER THAN whether alcoholism is a disease. (We obviously have other disagreements, but we can always come back to those. Personally, I'm with you on the CAGE, but the CAGE has been field validated for reliability and validity in properly assessing the presence of alcoholism, so the science is against us both on that one.) I often find myself in disagreement with the folks at NIDA and NIAAA, but at least they are generally attempting to base their statements upon the latest research. By the way, there are a number of other illnesses that are treated with methods similar to those used for alcoholism -- eating disorders quickly come to mind. When control issues are present as part of a disease process, the symptoms lend themselves to this kind of treatment and therapy. Drgitlow 23:22, 1 July 2006 (UTC)[reply]

Mediation

I've made a formal request for mediation. Mr Christopher 13:57, 30 June 2006 (UTC)[reply]

Many thanks, Mr. Christopher.Medical Man 15:57, 30 June 2006 (UTC)[reply]

Feel free to help me out with the request template, it's a maze and they have already nuked one of mine. I am going to put you down as a mediation party. Mr Christopher 16:29, 30 June 2006 (UTC)[reply]

Any editor here who wants to participate (or not) in the mediation process can agree or disagree to that process here http://en.wikipedia.org/wiki/Wikipedia:Requests_for_mediation#Alcoholism Mr Christopher 16:38, 30 June 2006 (UTC)[reply]

Encouragement

The article needs to reflect as completely as possible all aspects of alcoholism. This means that each verifiable aspect of alcoholism should be written about in a neutral point of view using reliable sources. Every major and significant minor theory should be included. You all are doing a pretty good job of staying focused on the content and not dwelling on the editor. Mediation is a good idea if you cannot agree. Settling a content dispute is hard work and can be time consuming. Do not expect that everything will fall into place immediately. If you keep working toward agreement eventually it will. Keep up the good work. FloNight ^talk 19:09, 30 June 2006 (UTC)[reply]

Thanks for these reminders, FloNight ^talk, especially the neutral point of view link. Mr Christopher 20:51, 30 June 2006 (UTC)[reply]

Accuracy and integrity are essential

George Vaillant has written that:

“The American Medical Association, American Psychiatric Association, American Public Health Association, American Hospital Association, American Psychological Association, National Association of Social Workers, World Health Organization, and the American College of Physicians have now each and all officially pronounced alcoholism as a disease. The rest of us can do no less. (70)”

Reference: "70. Vaillant, Natural History, 3. Vaillant's source for this quote is S.E. Gitlow, "Alcoholism: A disease," in Alcoholism: Progress in Research and Treatment, eds. P.B. Bourne and R. Fox (Academic Press, 1973), 8. The statement is inaccurate, however, in at least one and perhaps more instances. G.R. Vandenbos, acting chief executive officer of the American Psychological Association (APA), wrote me (29 March 1989) that the APA has never taken the position that alcoholism is a disease and that, in fact, it had explicitly rejected adopting this position. Nonetheless, the National Council on Alcoholism has stated in public documents for a number of years that the APA supports the view that alcoholism is a disease." [32]

So much for honesty and integrity. They seem to be ignored when blindly defending the ideology of "alcoholism is a disease" is at stake. I think it's time for someone to recuse himself.Medical Man 19:33, 30 June 2006 (UTC)[reply]

Very interesting. So George Vaillant, a famous and well-respected researcher in the field of addictive disease, and you, with an unknown background, are in disagreement. And the American Psychological Association wouldn't necessarily take up any perspective on disease since it is not a medical organization. The APA that we speak of within the article is the American Psychiatric Association, which is a medical organization. (The former is a group of psychologists while the latter is a group of psychiatrists). NCA refers to the psychiatric group, not the psychologic group. You appear to have been confused by this issue, which is admittedly confusing.

I'm also not surprised that you disagree with SE Gitlow's article in the research journal you cited. That Gitlow has hundreds of citations and was one of the founding members of the American Society of Addiction Medicine, the medical organization that is now the representing group of the addiction field in the medical federation. It is not unusual for individuals to disagree with science or with scientific progress, but we must not mistake such disagreement as being representative of a nonexistent scientific controversy. Drgitlow 23:20, 30 June 2006 (UTC)[reply]

Fascinating. So it appears this S.E. Gitlow was writing things that were not true about the current state of the debate concerning alcoholism as a disease all the way back in the 1970s? His "we should all go along with the herd because the truth is always on the side of the herd" is bad enough, but misleading people for their own good as well?

Since Stanton Peele called his dishonesty out, I bet this S.E. Gitlow views guys like Stanton Peele as "pundits" and would rather the opposition to the alcoholism disease theory not be a part of this article. If he were only here to read it, I bet he would get steamed that we are posting all the viewpoints concerning alcoholism that directly conflict with books he has written and claims he has made.

Is it me or are certain members of the alcoholism "treatment" industry somewhat Orwellian in their practices? If you drink you much you're an alcoholic, if you don't drink very much you're an alcoholic. Denying the disease of alcoholism is a sign you are an alcoholic, denying you are an alcoholic is a sure sign you're an alcoholic. The most effective treatment for alcoholism is life long self-help meetings and medical treatment/therapy... Mr Christopher 20:28, 30 June 2006 (UTC)[reply]

I can't tell given your sarcastic tone, but you do understand that SE Gitlow is not me, right?Drgitlow 22:19, 30 June 2006 (UTC)[reply]

There is no consensus

In his Counselor journal article, "Addiction disease concept: Advocates and critics," ([33]William White describes the rise of the disease concept in the early 18th century, its later fall, "its resurrection in the mid-20th century, and the subsequent growing debate in the late 20th century regarding its scientific validity and personal and social usefulness."

There clearly is no consensus regarding whether or not alcoholism is a disease and the encyclopedia article must reflect that fact.Medical Man 20:15, 30 June 2006 (UTC)[reply]

As a regular columnist in Counselor magazine, I know the editor and understand that she likes to make sure all perspectives are given a voice. Note that the magazine is not a scientific journal, but simply a magazine. And despite your argument, there is indeed a consensus. Drgitlow 22:20, 30 June 2006 (UTC)[reply]

What a fantastic policy they have there at Counselor Magazine, perhaps we should try and abide by the Wiki policy of assuming a NPOV and making sure all perspectives are given a voice. Especially since Wikipedia is an online encyclopedia and not a scientific journal. What do you think, s gitlow? That way we can allow those who are not a part of your imaginary consensus to voice their ideas. You see, you keep deleting all the comments that do not support your consensus myth. There is a Wiki policy which forbids this, s gitlow. Mr Christopher 22:25, 30 June 2006 (UTC)[reply]

Obviously you've set yourself up as the chief bottle washer here. Luckily, the rest of us can ignore you and get the job done, even if it means we have to do it repetitively.Drgitlow 22:41, 30 June 2006 (UTC)[reply]

By the way, you can keep saying that there is no consensus even though there is. I suppose since YOU disagree with the scientific community, there is indeed no consensus. I agree that we should be more specific. The scientific communty has consensus. Drgitlow 23:54, 30 June 2006 (UTC)[reply]

Paging Doctor S Gitlow

gitlow, before you start removing ideas in this article that you personally do not like, please follow the liks left here by FloNight. She is an admin here and when its wise to listen when any admin speaks of Wiki standards. Please familiarize yourself with the the Wiki links she provided before you make any more changes or deletions to the article. This will show a good faith effort on your part to work with your peers here. I think if you learn more about Wiki standards and policies we'll be able to work much more effeciently in the immediate future. Thank you for your cooporation. Mr Christopher 22:30, 30 June 2006 (UTC)[reply]

Mr Christopher, please refrain from altering a scientific article further until you share with us the basis upon which you make the wild claims that you've made.Drgitlow 22:41, 30 June 2006 (UTC)[reply]

Please read our policies. Verifiability comes first, credentials mean nothing. Ronabop 06:24, 2 July 2006 (UTC)[reply]

The Benjamin Rush edit

I'm not tied to having anything about Benjamin Rush in here. There have been repeated attempts to add material about Benjamin Rush to this article rather than simply referring viewers to the Benjamin Rush article. While I've removed the material multiple times, it keeps being returned. If you have something of value to say about Dr. Rush, say it on the entry about him.Drgitlow 23:12, 30 June 2006 (UTC)[reply]

That's revealingvery . Apparently you believe the alcoholism page is yours and that you get to decide on your own what stays and what goes!Medical Man 01:20, 1 July 2006 (UTC)[reply]

No, not mine. But not yours either. Are you and Mr. Christopher one and the same? I note that you both are always here more or less simultaneously.Drgitlow 01:56, 1 July 2006 (UTC)[reply]

POV Arguments

There have been repeated arguments within this discussion that the alcoholism article is presenting an AMA or APA or AA point of view. If we had an article on Apollo 11 and its voyage to the moon, some would likely argue that the article presents a NASA or government point of view, when reality is that we never really went to the moon and the entire thing was simply designed to draw attention away from Vietnam. Does that belong in the Apollo 11 article. Yes, as a one sentence statement indicating that there are some individuals who disagree with reality. The same holds true here. The standard of care in the nation is based upon alcoholism's recognition as a disease by government, physicians, insurance companies, and scientists. There are a few people out there, who like the Apollo 11 nonbelievers, are trying to refute what is already an accepted scientific consensus. They deserve a few sentences at the close of an otherwise scientifically-based article about a medical illness.Drgitlow 23:50, 30 June 2006 (UTC)[reply]

For starters I would encourage you to read the links provided by an admin earlier today. This will help you understand what constitutes POV vs NPOV as well as broaden your understanding of what Wiki is and is not. Sorry this is been such a challenge for you, gitlow. I can tell your getting frustrated. We all are but the sooner you invest some time actually understanding what Wiki is the sooner we can work together improving this article. Mr Christopher 01:12, 1 July 2006 (UTC)[reply]

You speak as if you've been here at Wiki longer than the rest of us. That's actually not the case - perhaps you should take your own advice. You're right, however, that I'm frustrated. I've not run into this type of problem in my work on other entries. You should closely read what the admin wrote about using reliable sources. Again, if you don't understand this, you should review what I wrote about Apollo 11. A quotation from a pundit does not mean you've used a reliable source as a basis of an entry on a scientific subject. And NPOV doesn't mean one should bring up all the junk that exists on the topic or we'd have a worthless encyclopedia. Drgitlow 01:54, 1 July 2006 (UTC)[reply]

Let's start with this, I am not one of your students, I am not one of your patients, I am not one of your children, the sooner you drop these infantile analogies the sooner we can have an adult conversation and then get down to the business of improving this article. If you want to discuss Apollo 11 please do so on the Apollo 11 article, do you understand me? And every single cited reference that you continue to delete will be going right back in this article. But not on a Friday night, I have far better things to do at the moment. The night is young! :-) Mr Christopher 03:34, 1 July 2006 (UTC)[reply]

Now you're just trying to be petty and to argue. We'll pick this up when you've cooled down. Drgitlow 04:13, 1 July 2006 (UTC)[reply]

MedicalMan Edits

MedicalMan, your latest edits look good. I added the need for a citation to one of your statements in the Disease-Con section where you say the medical research community is not in agreement with respect to alcoholism as a disease. Could you cite an example within the article of a reliable and respected research organization that does not concur? Drgitlow 02:17, 1 July 2006 (UTC)[reply]

Also, I wonder since we have a Disease Hypothesis section (I'm changing the header to match your terminology elsewhere), it begs the question as to what the alternative is. That is, some say alcoholism is a disease, while others say it is a ______. We could have another header dedicated to the pros and cons of this additional hypothesis. Drgitlow 02:20, 1 July 2006 (UTC)[reply]

Hmmm...the RSA has their introduction as: The Research Society on Alcoholism (RSA) provides a forum for communication among researchers, who share common interests, in alcoholism. The Society's purpose is to promote research that can lead the way toward prevention and treatment of alcoholism.

What would you call something that a medical research society wants to prevent and/or treat? It's a roundabout argument, but isn't that a disease?

I'll leave the citation there, but I don't know if the RSA would agree with their being cited in that way. Should we check with them to see if they have an official policy or statement on the topic? Drgitlow 03:03, 1 July 2006 (UTC)[reply]

What's a pundit?

Pundit: An expert in a particular subject or field who is frequently called on to give opinions about it to the public (according to my computer's dictionary). My use of this term to refer to such individuals was removed. Did someone think it meant something else? Drgitlow 03:05, 1 July 2006 (UTC)[reply]

"The Disease model of addiction is probably the most controversial and debated topic in the entire field of substance abuse/addiction"

“The Disease model of addiction is probably the most controversial and debated topic in the entire field of substance abuse/addiction. One would have to be well informed on the subject to even attempt to understand the controversy intelligently. This site will not claim to know for sure one way or the other (disease/not disease) but will present a little of both sides of the on going debate with in the professional circles. First, we must accurately define Disease, since when the word disease is mentioned most think of something like cancer, aids, heart, etc., something which can be isolated in part and extracted from the body and visibly viewed and observed by the eye under a microscope or other apparatus. This is not the case with the "disease of alcoholism/addiction" or at least not at this time. According to Webster's Dictionary disease is defined as follows: "Disease: Any departure from health presenting marked symptoms; malady; illness; disorder." Then we must go on to define concept as well, which according to Webster's is: "Concept: A notion, thought, or idea." This popular model of addiction is credited to E.M. Jellinek who presented a comprehensive disease model of alcoholism in 1960(13). The World Health Organization acknowledged alcoholism as a serious medical problem in 1951, and the American Medical Association declared alcoholism as a treatable illness in 1956. Following Jellinek's work, the American Psychiatric Association began to use the term disease to describe alcoholism in 1965, and the American Medical Association followed in 1966 (14). As with many concepts and theoretical models in the addiction field, the disease concept was originally applied to alcoholism and has been generalized to addiction to other drugs as well. The "disease of addiction" is viewed as a primary disease. That is, it exists in and of itself and is not secondary to some other condition. This is in contrast to the psychological model of Dual Diagnosis (discussed in the next section), which addictive behavior is seen as secondary to some psychological condition.

Arguments Against the Validity of the Disease Concept

As earlier stated, the disease concept is controversial and not without critics. Two well-known critics are Stanton Peele (16) and Herbert Fingarette (15), both of whom have written books, as well as articles disputing the disease concept of addiction. Since the disease concept is attributed to Jellinek, a lot of criticism has been directed at his research, which was the basis for his conclusions about the disease concept. Jellinek's data were gathered from questionnaires that were distributed to AA members through its newsletter, "The Grapevine". Of 158 questionnaires returned, 60 were discarded because members had pooled and averaged their responses, and no questionnaires from women were used. Jellinek himself acknowledged that his data was limited. Therefore, one might wonder why Jellinek's concept of the disease of alcoholism received such widespread acceptance. One reason is that the disease concept is consistent with the philosophy of AA, which is by far the largest organized group dedicated to help for alcoholics. Secondly, as Peele noted: "The disease model has been so profitable and politically successful that it has spread to include problems of eating, child abuse, gambling, shopping, premenstrual tension, compulsive love affairs, and almost every other form of self-destructive behavior... From this perspective, nearly every American can be said to have a disease of addiction." (16) Herbert Fingarette goes on to state that the alcohol industry itself contributes to forming a public perception of alcoholism as a disease, as a marketing ploy: "By acknowledging that a small minority of the drinking population is susceptible to the disease of alcoholism, the industry can implicitly assure consumers that the vast majority of people who drink are not at risk. This compromise is far preferable to both the old temperance commitment to prohibition, which criminalized the entire liquor industry, and to newer approaches that look beyond the small group diagnosable as alcoholics to focus on the much larger group of heavy drinkers who develop serious physical, emotional, and social problems." (15) There are many other criticisms of the disease concept, however we will not go in to them at this time. Instead we will review some of the evidence to support the disease concept.

Arguments Endorsing the Disease Concept

Since the introduction of the disease concept research studies have examined a possible genetic link in alcoholism/addiction. One such study demonstrates that the offspring of alcoholics are approximately three to five times more likely to develop alcoholism than offspring of non-alcoholics (18). However, the genetic influence on other drug addiction has received less research attention. Also, in 1983, there was a popular theory of alcohol addiction expressed by D.L. Ohlms in his book "The Disease Concept of Alcoholism"(17) that proposed that alcoholics produced a highly addictive substance called THIQ during the metabolism of alcohol. THIQ is normally produced when the body metabolizes heroin and is supposedly not metabolized by non-alcoholics when they drink. According to Ohlms, animal studies have shown that a small amount of THIQ injected into the brains of rats will produce alcoholic rats and that THIQ remains in the brain long after an animal has been injected. Therefore, the theory is that alcoholics are genetically predisposed to produce THIQ in response to alcohol, that the THIQ creates a craving for alcohol, and that the THIQ remains in the brain of the alcoholic long after the use of alcohol is discontinued. This would provide a physiological explanation for the fact that recovering alcoholics who relapse quickly return to their previous use patterns. More recent research on genetic causes of alcoholism has focused on some abnormality in a dopamine receptor gene and deficiencies in the neurotransmitter serotonin or in serotonin receptors (19).

As you can see from the above information there is still room for debate and I assure you that the controversy continues.” [34] Medical Man 03:37, 1 July 2006 (UTC)[reply]

You've put your finger on the problem. On the one hand, the source that you've cited here recognizes that several groups support the disease concept of alcoholism, groups such as the World Health Organization, the American Medical Association, and the American Psychiatric Association. And then the source cites two individuals, both of whom are well-known in the field for their controversial perspective that is in disagreement with the community standard. Two individuals, however, do not make for a debate and controversy. They are simply standing up to speak out against the status quo. That action is commendable. Without people like them, the world wouldn't change. But the broad scientific, medical, and research communities are not in agreement with these two individuals. Their perspective should be noted, but their perspective does not mean that the entire scientific basis of a disease state should be tossed out by Wikipedia any more than by the academic community. You might assure me that the controversy continues because you wish it would, but in my day-to-day work in this field, with ongoing contact with academic, research, and the scientific communities, I have seen no evidence of any such controversy. There are indeed many controversies in the field...do medications work to treat alcoholics...what genes lead to a predisposition to alcoholism...what percent of patients can be reliably treated with self-help groups; but the broad definition of alcoholism and epidemiology of its incidence and prevalence are all well-known and well-accepted. Drgitlow 04:11, 1 July 2006 (UTC)[reply]

Please don't read so selectively. The Research Society on Alcoholism and the American Psychological Association are not "two individuals. They can't be trivialized and ignored. It's obvious to anyone open to reality that "The Disease model of addiction is probably the most controversial and debated topic in the entire field of substance abuse/addiction". There is no consensus and you can't wish it into being.Medical Man 15:23, 1 July 2006 (UTC)[reply]

The Research Society on Alcoholism and the American Psychological Association are not the two individuals I spoke of. Nor are those organizations opposed to the disease model of alcoholism. The two individuals are the ones cited just above, Fingarette and Peele. What is apparently obvious to you isn't to the majority of the scientific and medical communities. It may be that you are much brighter than they are, and that they have some catching up to do, or it may be that you aren't up to date on the topic. Either is a rational explanation. If you really think the RSA and A. Psychological A. are opposed to the disease model of alcoholism, why don't you just ask both organizations to write you a note saying as much. The RSA is founded on the principle that alcoholism is a disease; it's the whole point of the RSA's being in existence. And the A. Psychological Association also appears to have policy on alcoholism and addiction as disease states; I refer you to their website for further information. So you've unfortunately been misled. Why don't you make a phone call and get a letter from either group's board saying that they don't believe in the addiction=disease concept? I suspect you'd get nowhere very quickly. Drgitlow 16:01, 1 July 2006 (UTC)[reply]

APA vs APA

I'm not sure how to handle the APA's in this article. I've made reference to the American Psychiatric Association in my entries. MedicalMan has made reference to the American Psychological Association in his. Both organizations use the abbreviation APA and some of our current paragraphs use the APA abbreviation as well. Readers won't know which APA we refer to. It's annoying, but I suggest we spell out each such reference to be certain readers (and we) know whom is being cited. Drgitlow 04:17, 1 July 2006 (UTC)[reply]

Likely that American Psychological Association is the more commonly recognized use of APA. Agree that writing out each one is necessary in this case. FloNight ^talk 15:39, 1 July 2006 (UTC)[reply]

Justice White Quotation

When quoting legal cases, the full case must be reviewed to determine the origin of material. Here is the section of interest from Traynor v Turnage with respect to the quotation recently edited:

Petitioners, however, perceive an inconsistency between 504 and the conclusive presumption that alcoholism not motivated by mental illness is necessarily "willful." They contend that 504 mandates an individualized determination of "willfulness" with respect to each veteran who claims to have been disabled by alcoholism. It would arguably be inconsistent with 504 for Congress to distinguish between categories of disabled veterans according to generalized determinations that lack any substantial basis. If primary alcoholism is not always "willful," as that term has been defined by Congress and the Veterans' Administration, some veterans denied benefits may well be excluded solely on the basis of their disability. We are unable to conclude that Congress failed to act in accordance with 504 in this instance, however, given what the District of Columbia Circuit accurately characterized as "a substantial body of medical literature that even contests the proposition that alcoholism is a disease, much less that it is a disease for which the victim bears no responsibility." 253 U.S. App. D.C., at 132-133, 792 F.2d, at 200-201. Indeed, even among many who consider alcoholism a "disease" to which its victims are genetically predisposed, the consumption of alcohol is not regarded as wholly involuntary.

The quotation, "a substantial body of medical literature...bears no responsibility," is not something Justice White said but rather is something that the District of Columbia Circuit Court stated in their decision. Justice White agreed with their decision. Note that the Supreme Court is not made up of scientists but of lawyers with political and fiduciary issues looming quite large in their minds. The basis of this case was in large part their knowledge that if indeed substance use disorders were to be considered on par with other diseases, the payment system in place would have been bankrupted. That is why so many mental health disorders are considered separately from other medical disorders by third party payors, Courts, and so forth. These decisions are unrelated to whether they are diseases or the degree to which they cause functional difficulty for the afflicted individual.

I have corrected the entry to accurately state what Justice White said in his decision. An alternative approach could include using the original quotation that appeared, but referencing the DC Circuit instead of the Supreme Court. Drgitlow 13:53, 1 July 2006 (UTC)[reply]

I think it's fixed now Mr Christopher 22:11, 1 July 2006 (UTC)[reply]

Yup. Looks great. Thanks. Drgitlow 22:43, 1 July 2006 (UTC)[reply]

“The debate on whether alcoholism is a disease or a personal conduct problem has continued for over 200 years.”

Thomas R. Hobbs, Ph.D, M.D. writes [35] that “The debate on whether alcoholism is a disease or a personal conduct problem has continued for over 200 years.”

He reports that

“Dr. Peele’s view that alcoholism is a personal conduct problem, rather than a disease, seems to be more prevalent among medical practitioners than among the public. A recent Gallop poll found that almost 90 percent of Americans believe that alcoholism is a disease. In contrast, physicians’ views of alcoholism were reviewed at an August 1997 conference held by the International Doctors of Alcoholics Anonymous (IDAA). A survey of physicians reported at that conference found that 80 percent of responding doctors perceived alcoholism as simply bad behavior.”

Dr. Hobbs indicates that

“Based on my experiences working in the addiction field for the past 10 years, I believe many, if not most, health professionals still view alcohol addiction as a willpower or conduct problem and are resistant to look at it as a disease. Part of the problem is that medical schools provide little time to study alcoholism or addiction and post-graduate training usually deals only with the end result of addiction or alcohol/drug-related diseases. Several studies conducted in the late 1980s give evidence that medical students and practitioners have inadequate knowledge about alcohol and alcohol problems. Also, recent studies published in the Journal of Studies on Alcoholism indicate that physicians perform poorly in the detection, prevention and treatment of alcohol abuse.”

I look forward with interest to see what technique(s) you use in an effort to try to debunk this additional evidence regarding the fact that there there is no consensus about the disease hypothesis of alcoholism.Medical Man 16:24, 1 July 2006 (UTC)[reply]

No debunking. Dr. Hobbs' statement in the paragraph immediately above is most insightful. It represents why tens of millions of dollars of public and private funds have been spent in the last year to fix the educational problems that Dr. Hobbs points out. Luckily, starting in the next year, hundreds of medical students each year will be trained in the disease model and abstinence-based treatment methodologies. By the end of the decade, all medical students will receive such training. That should solve the survey that was reported at the IDAA meeting and the problems identified by Dr. Hobbs. I wasn't able to find the reference of the 1997 survey in a Medline search, however, so I'm not certain as to the accuracy of the result that Dr. Hobbs reports. Again luckily, more recent attitudinal surveys indicate that physicians have come a long way in terms of recognizing that alcoholism is not a personal choice. You keep trying to say that it's a fact that there is no consensus about alcoholism being a disease, yet there is extensive policy and research in the scientific literature proving otherwise. So you can say it, but it doesn't make it so. Drgitlow 18:10, 1 July 2006 (UTC)[reply]

Nice effort, but a completely failed one. We're talking about whether or not a consensus exists now, not in the future.

The 80% of physicians who don't think alcoholism is a disease may be wrong -- but that's completely irrelevant. The essential fact is that there is no consensus among procticing physicians that alcoholism is a disease. And that fact must be adequately reflected in any legitimate encyclopedia article.

There may be a consensus in the future, especially if medical students are "trained" to believe the ideology. That sounds frightenly like Lysenko's "science" under the ruthless dictator Joseph Stalin. I would hope they would instead be educated as professionals to evaluate the conflicting evidence and judge for themselves.Medical Man 18:47, 1 July 2006 (UTC)[reply]

(Mr Christopher, please pardon me for inserting my comments here but I wanted them to follow immediately Gitlow's feeble effort.)

The so called consensus on the disease theory is found primarily amongst medical trade organizations, especially those who financially profit from the existance of such this unproven disease. The fact remains there is no biological test one can take to see if they have "alcoholism" and there is not one gene that anyone has proven causes or indicates problematic drinking.

All the "alcoholism" or alcohol dependency or alcohol abuse type diognostic tests are speculative, subjective and mostly unscientific. The CAGE exam is a laff riot, substitue masturbation or toenail clipping for drinking in the CAGE exam and you'll sooon see ho wstupid it is.

You have an obvious financial stake in this matter, that's why you keep trying to silence any opposition to the unproven assertions made by the various medical trade organizations you belong to. In short, you're an AA counselor with a lot of degrees and you have a vested interest in misleading people into having a blind faith in this unproven disease. Mr Christopher 18:20, 1 July 2006 (UTC)[reply]

And I suppose you'd argue that physicians have a vested interest in people remaining ill. If they all get better, the poor doctors wouldn't earn an income. Your repeated efforts to figure out what I do for a living aren't getting you very far, though. I have neither a financial stake in this matter nor am I an AA counselor. I eagerly await your sharing with us your basis for your position on this matter. Drgitlow 19:54, 1 July 2006 (UTC)[reply]

drgitlow, please respond. As I indicate above, your reaction to the fact that 80% of physicians reject the disease theory is completely irelevant; you ignore the present and jump to the future. Thus, my evidence stands and demonstrates clearly that there is currently no consensus regarding the disease model. Thus, the case is over.Medical Man 03:31, 3 July 2006 (UTC)[reply]

Nice try, Medical Man. You have the results of a single survey (which, by the way, you haven't provided a citation for...the citation has to be of the ORIGINAL survey report, not of someone inventing it out of thin air). A single survey doesn't mean that you have evidence, and it certainly doesn't demonstrate anything clearly. As I said, over 1000 physicians came together in the House of Delegates, representing American physicians in state and specialty societies, and voted that alcoholism is a disease. The World Health Organization considers alcoholism a disease. Of course there's consensus. Your "evidence" that one "survey" indicated otherwise doesn't change the facts. But if you can find the original citation, please share it so that we can figure it all out. Drgitlow 04:02, 3 July 2006 (UTC)[reply]

I have provided you the reference from a reputable published source, which doesn't have to be the survey itself.

You've invented out of thin air your belief that "Of course there's consensus." I've repeatedly shown you evidence to the contrary. You then either ignore it or try to explain it away like a child who desperately wants to continue believing that Santa exists. Santa doesn't exist and neither does a consensus.Medical Man 16:33, 3 July 2006 (UTC)[reply]

"The disease concept remains controversial”

Roger E. Meyers, M.D., writing in The Lancet, reports that “The disease concept remains controversial.” [36]Medical Man 19:04, 1 July 2006 (UTC)[reply]

The article you cite is actually by Roger E. Meyer (Lancet 1996;347:162-166). And let's be honest about what he writes:

The most robust evidence of persistent deficits in homoeostasis comes from clinical studies in alcoholics and heroin addicts. We need to identify persistent residual abnormalities in receptor function and gene expression that might be linked to clinical observations and the development of new pharmacotherapies. But there is a real excitement about the possibilities offered by molecular neurobiology to increase understanding of the pathophysiology of addiction. Molecular biologists studying rat strains that differ in drug or alcohol preference (or differential drug reinforcement) might also be able to account for (a) the differential initial reinforcing properties of drugs/alcohol, (b) the differential vulnerability to conditioning of the reinforcing stimulus properties of drugs/alcohol and sensitisation, and (c) the differential changes in gene expression of neurons in the mesolimbic dopamine system that might explain mechanisms of addiction and relapse. These animal models offer promise in understanding the molecular basis of "risk", and of characterising the pathophysiology of addictive disease(s) that have intrigued physicians for 200 years.

That's his conclusion. Look closely at his last sentence wherein he refers to the entire field as that of "addictive disease."

His statement that the disease concept remains controversial refers to an article in the British Medical Journal in 1976, when indeed the disease concept was still controversial. Thirty years have passed, the controversy is over, consensus statements have been issued by respected medical organizations, and your effort to indicate that the controversy is still going on refers only to splinter groups that are not generally recognized in the scientific and academic communities. I don't mean to undermine the importance of such varied beliefs, but rather am simply noting the fact that alcoholism and other substance use disorders are accepted within the compendium of disease as treated by physicians around the world. You may, of course, accept this or not based upon your own personal belief system. Drgitlow 20:03, 1 July 2006 (UTC)[reply]

We're making progress. You now acknowledge that the author was correct in his assertion (in 1976) that "The disease concept remains controversial." So this means that you agree that the disease idea was controversial in 1976.

Apparently your tactic is to argue that, for whatever reason, there is consensus now. To make this argument you are forced to make the ludicrous assertion that the Research Society on alcoholism and the American Psychological Association are "splinter groups that are not generally recognized in the scientific and academic communities."

I really don't think things can get more bizzare than this, but time will tell.Medical Man 21:45, 1 July 2006 (UTC)[reply]

I've always acknowledged that there was indeed a controversy regarding alcoholism and disease in the past. And yes, 1976 was at the tail end of that long-standing issue - it was still a controversy then. I'm NOT calling the RSA and the American Psychological Association splinter groups; they are very much recognized in the scientific and academic community. What I'm saying is that you've placed words in the mouths of those organizations in which you have them saying that alcoholism isn't a disease. I'm sure a quick letter to the Executive Director of both organizations would help you recognize that your thoughts are not reflected by theirs.Drgitlow 22:41, 1 July 2006 (UTC)[reply]

The Myth of Alcoholism as a Disease

Dr. Herbert Fingarette of the University of California, Santa Barbara, author of Heavy Drinking: The Myth of Alcoholism as a Disease says "the disease label is 'a vague slogan with no particular medical meaning.' Fingarette explains that " just about every major belief associated with the idea of alcoholism as a disease has been shown to be wrong. There is no one pattern of drinking that characterizes alcoholics. There is no unique cause of alcoholism. It is not true that an alcoholic who drinks any alcohol automatically loses control. And there is no medical treatment that has been shown to be effective.'"

"Fingarette, who studied a mass of published studies of treatment results, says that no one has ever been able to demonstrate that any treatment has a better success rate than simply letting alcoholics stop on their own. The most that can be said is that the treatment programs did not make matters worse, according to Fingarette." [37].

I again look forward to seeing what technique(s) will be used in an effort to try to debunk the importance of Dr. Meyers' and Dr. Finagrette's observations.Medical Man 19:04, 1 July 2006 (UTC)[reply]

Do you have the original source for Dr. Fingarette? The citation above leads to a Psychology Today article. I'd like to read his original work (not his book but his published research). Do you know where to find it? Drgitlow 19:50, 1 July 2006 (UTC)[reply]

This is the original source.Medical Man

Drgitlow, you might find this online article written by Fingarette of interest. Why We Should Reject The Disease Concept of Alcoholism, Herbert Fingarette, Ph. D. Mr Christopher 16:59, 2 July 2006 (UTC)[reply]

Thanks, Chris. Indeed, Dr. Fingarette makes an excellent argument. His argument is based in large part on the confusion which is omnipresent in the field in general: many people incorrectly assume that heavy drinkers are alcoholics. There are MANY heavy drinkers who are not alcoholic, who can stop drinking, reduce their drinking, stop and start again without any significant difficulties, and so forth. These individuals, as Dr. Fingarette points out, don't have any genetic predisposition and don't have a disease. Dr. Fingarette also indicates that many who diagnose alcoholism incorrectly believe or feel that alcoholics are not responsible for their drinking. That's less of a medical issue and more of a social policy issue but it might interest you to know that generally speaking addiction medicine specialists feel that alcoholics ARE responsible for their drinking. In my work as a forensic expert, I've testified on many occasions that alcoholics are criminally responsible for their conduct while drinking (there are several conditions that must be met for this to be true, but for the most part if an alcoholic does something while under the influence, they are responsible for their acts).

So in Dr. Fingarette's introduction, the addiction medicine community doesn't agree with his proposition #1 or #4. There is also disagreement with #3...by no means are medical specialists necessary for the treatment and relief of the symptoms. I've seen people who are alcoholic go directly to AA, never go near a physician or therapist office, and do quite well. The World Health Organization and others also disagree with his proposition #2 because it is generally recognized that there is no craving with alcoholism (unlike opioid dependence). So ultimately Dr. Fingarette is quite accurate in noting that the four propositions he notes are inaccurate. But those four propositions aren't why alcoholism is called a disease.

Dr. Fingarette goes on to write extensively in these chapters about heavy drinking. I believe he understands the following to be true: 1) Heavy drinking is not alcoholism. 2) Clinicians often confuse heavy drinking with alcoholism. 3) Clinicians have attempted to call alcoholism a disease, yet confuse the issue by actually referring to heavy drinkers as having the disease. Fingarette also points out some difficulties with many "treatment" programs: "On the contrary, both independent and government research shows expensive disease-oriented treatment programs to be largely a waste of money and human resources (Fingarette, 1989)." I agree entirely with him on that count. The disease is actually treated quite successfully in 1:1 sessions with an outpatient clinician combined with self-help groups. There have been multiple studies demonstrating just that, with 80%+ long term abstinence and successful re-entry into the workforce, in EAP's and among airline pilots (among others).

While the medical community disagrees with Dr. Fingarette regarding his conclusion (alcoholism is not a disease), Dr. Fingarette's important take-home messages are: 1) Don't confuse heavy drinking for alcoholism, and 2) Alcoholics should be responsible for their actions while drinking. I think you'd be hard pressed to find an addiction specialist who disagrees with either point. Drgitlow 18:22, 2 July 2006 (UTC)[reply]

And here is Stanton Peele on Fingarette Drgitlow, have you had a chance to read Heavy Drinking: The Myth of Alcoholicm as a Disease? With your back ground and insight I think you would find it a worthy read. Mr Christopher 17:25, 3 July 2006 (UTC)[reply]

Now you're starting to come over to an area that I think is very controversial - the area regarding treatment of alcoholism. There are several schools of thought. Much of the research identifies "standard" treatment - bachelors and masters level counselors providing some type of therapy to the patient who simultaneously attends some form of self-help group. This type of treatment shows highly variable efficacy, probably based in large part upon the skill level of the counselor. This type of treatment is standard in community mental health centers and governmentally funded facilities. There's another type of treatment: private care by a medical specialist, also combined typically with 12-step programs or similar. The two approaches have never been compared for efficacy but the outcome studies that used medical specialists have had very good results. Of interest, in other fields, the outcomes have been compared -- that is, if you take a diabetic and have him treated by an endocrinologist, their long term outcome is superior to the outcome if they were treated by a generalist. You may come to find that you and I don't differ very much on our feelings regarding how well (or how poorly) certain treatment approaches work.

There is reason, however, why you keep turning to Peele to support your contentions. He refers to himself on his website as the AntiChrist of the Recovery movement. There's noone out there quite like him. He is skilled with the language, resourceful, and capable of holding his ground during a debate. If indeed there were an extensive literature from other scientists demonstrating agreement with his positions, he would have to be taken more seriously. As it is, though, his view is primarily his view, one which does not reflect the perspective of the overall scientific community. As I've said before, such men are important - one person taking on the status quo leads to evolution and change. Sometimes, though, it's simply one person taking on the status quo. Peele has done this for decades - no change has occurred in response. He and I have had email discussions and have been quite cordial with one another; I even had him as a guest back when I ran the Alcohol and Recovery Forum on AOL. I'm always open to listening to all sides. My listening, however, doesn't change the scientific community's overall perspective on the matter. Drgitlow 18:05, 3 July 2006 (UTC)[reply]

Disease model not popular in countries where it's not profitable

As explained in "The disease model of alcoholism: a Khunian paragigm" [38], "The disease model of alcoholism has a history dating back more than two hundred years, and is considered by many to be the dominant paradigm guiding scientific inquiry and treatment approaches for much of the 20th century. However, as early as the 1960s, the disease model came under attack due to the emergence of anomalous scientific and clinical findings. Outside of the United States, the disease model is considered by many to have been discredited, and has long been abandoned in favor of alternative models, such as social-learning theory (Heather & Robertson, 1997). Yet, in the United States, the disease model and its primary treatment goal of abstinence continue to over-whelmingly dominate the treatment of alcoholism (Rosenberg & Davis, 1994; Rosenberg, Devine, & Rothrock, 1995; Weisner, 1996). Among other explanations, the financial and political motives of the U.S. alcoholism treatment community have been offered to explain why the U.S. continues to lag behind other countries in moving beyond the disease model (Fingarette, 1988; Peele, 1989; Sobell & Sobell, 1995). However, an alternative reason for the reluctance of the alcoholism treatment community to relinquish the disease model is revealed by utilizing Kuhn's (1996) model of scientific progress in an historical analysis of the disease model."

Drgitlow, this seems inconsistent with your argument that 1976 was the tail end of the long disease controversy. What's your explanation?Medical Man 04:16, 2 July 2006 (UTC)[reply]

Paging drgitlow.... What's your explanation???Medical Man 01:31, 3 July 2006 (UTC)[reply]

There is currently no consensus about the disease theory

There is currently no consensus in support of the disease theory, nor has there been one recently as the following documents demonstrate:

Korhonen, M. Alcohol Problems and Approaches: Theories, Evidence and Northern Practice. Ottawa: National Aboriginal Health Organizations, 2004 [39]

Nackerud, L. The disease model of alcoholism: a Khunian paradigm. Journal of Sociology and Social Welfare, 2002 [40](Presented above but awaiting response from dritlow)

Kelly, D. Understanding the Nature of Alcoholism (2001). Discusses the disease controversy. [41]

Schaler, J. A. Thinking about drinking: the power of self-fulfilling prophecies. The International Journal of Drug Policy, 1996, 7(3), 187-191 [42]

Doweiko, H. E. Concepts of Chemical dependency. NY: Brooks-Cole, 1996.

Levy, M.S. The disease controversy and psychotherapy with alcoholics. Journal of Psychoactive Drugs, 1992, 24(3), 251-256. [43]

Maltzman, I. Is alcoholism a disease? A critical review of a controversy. Integrative Physiological and Behavioral Science: The Official Journal of the Pavlovian Society, 1991, 26(3), 200-210 {

[44].

Working through content disputes

The editors of this article need to resolve the their article content disputes using WP:Consensus and Dispute resolution. It is time consuming to do this but necessary according to Wikipedia policy. Since this article is controversial every non-minor edit probably needs to be discussed on the talk page. This includes putting information in the article and taking it out.

Since material is included in the article based on Wikipedia policies instead of the qualifications of the contributor, I'm going to insist that that you stop speculating about why an editor is contributing any specific material. This type of discussion never helps the situation. At best it draws your attention away from the proper criteria for inclusion, and at worst it increases the conflict and tension in the dispute.

It is my belief that all Wikipedia users have a responsibility to try and resolve their conflicts with other editors in the least disruptive way possible. This means that every editor needs to try and work with the other editors by assuming good faith. WP:AGF is a cornerstone Wikipedia policy.

If there is a particlular passage of text, external link, or some other content that is objected to by one or more editors it needs to talk out on the article talk page. If the editors can not come to an argreement then the steps for dispute resolution need to be followed. As a first step, getting the input of a larger number of editors is probably a good idea. This can be done by asking for other editors to give an opinion. I'll ask a few editors to stop by and give their opinion. Please list a few specific areas of conflict so that outside editors can understand the issues.

Last but not least remember our important new official policy decree Wikipedia:No climbing the Reichstag dressed as Spider-Man I'm an offical member of the Rouge admin cabal and will enforse this ~~policy ~~decree as needed to keep the editors of this article safe. FloNight ^talk 03:13, 2 July 2006 (UTC)~~~~ [reply]

~~Work on new wording for "a few non-medical alcoholism pundits"~~
~~Make suggestions for new wording that meets WP:NPOV, WP:V, and NOR. Comment if you agree or make other suggestions FloNight ^talk 03:46, 2 July 2006 (UTC)[reply]~~
~~[45] Gitlow refers to two nationally recognized authors in the field of alcoholism who are critical of the disease theory "a few non-medical alcoholism pundits"~~
Pundits are well-recognized individuals in a field that actively speak to the public at large or to members of the press on a regular basis. In this case, the individuals to whom I referred are non-medical (e.g. they are not MD's or DO's) and speak actively regarding alcoholism to the press and the public through books, lectures, and talk shows. That makes them pundits. There is no pejorative connotation, but Chris made it clear that he didn't like the term and removed it. I've not added it back. To be fair to the audience, however, it is important that these individuals (Peele et al) be identified properly. They are not physicians nor do they treat individuals with alcoholism. They certainly have a right to an opinion but for us to portray their words as if they have as much importance or applicability to the field as scientists, researchers, and clinicians in the field means that our entry will have little practical value. Drgitlow 04:32, 2 July 2006 (UTC)[reply]
Peele is a Phd. Psychologist (A Doctor, but not an MD or DO), as well as an attorney, and has treated people who were dignosed with the debated dignosis [46]. We could also add DeLuca [47] to the list of those with qualms about the disease model, and he's actually an M.D./FASAM, and maybe also add in with Kern, Rotgers, Heit, Geller, Salsitz ... perhaps we could simply specify the credentials as we go, without trying to bias the reader? There's certainly no shortage of examples. Ronabop 06:58, 2 July 2006 (UTC)[reply]
Ronabop very good idea. The question "who are these people who question the AMA?" is one that should be answered in the article. I'll wait for others to add their ideas and see what sort of consensus we have prior to making any changes. Mr Christopher 13:42, 2 July 2006 (UTC)[reply]
And I forgot, I vote no to calling anyone in this article a "pundit" or use terms like "non-md" as both terms in the context of this article would appear POV if not down right hostile Do others have an opinion one way or another? Mr Christopher 13:46, 2 July 2006 (UTC)[reply]
I'm fine with that. I didn't mean pundit to sound pejorative so I'm fine with our not using it. And I never said Peele wasn't a doctor. I said he wasn't medical, which is true. DeLuca would probably be a better choice, Ronabop. Thanks. There isn't any issue of questioning the AMA. The AMA simply forms policy based on input from other organizations.Drgitlow 15:22, 2 July 2006 (UTC)[reply]
Actually, I'm puzzled now. I just reviewed Dr. DeLuca's position on his website; I don't see where he is supportive of your position (alcoholism is not a disease). He has had difficulties in the past based upon his confusion of the harm reduction model for treatment of opioid dependence and the abstinence-based treatment model for the treatment of sedative/alcohol dependence. This in part led to his leaving Smithers, if I recall the events there properly. But I don't think he's ever said that sedative dependence isn't a disease. He certainly has extensive background in the field, both in providing treatment and in training; if he is on the non-disease side, he would be a great reference to use here. Drgitlow 15:32, 2 July 2006 (UTC)[reply]
~~Garden-variety content dispute~~
The editors of this article are having garden-variety content dispute. Instead of proving that the other editor is a biased knuckle head intent on ruining Wikipedia, let’s assume good faith and focus on consensus editing the article. FloNight ^talk 14:08, 2 July 2006 (UTC)[reply]
~~Anyone have any links that provides a road map or guidelines for getting consensus amongst editors? Mr Christopher 16:39, 2 July 2006 (UTC)[reply]~~
~~Forum~~
Hello, and please bear with me. Conversations regarding the editing of the Alcoholism entry have entered the remediation process. I am requesting that those currently heavily active in discussing changes to the Alcoholism page join me in discussing these issues in a forum based setting. I've created a space for this kind of conversation on the Intellectual Icebergs forums.
I expect this drastic edit to the talk pages to be reverted shortly after I create it, but please leave it in place for about 24 hours so that all can see the notice. Robert Rapplean 18:30, 2 July 2006 (UTC)[reply]
~~The Talk page, here, is the proper place to discuss Wikipedia articles. —Centrx→talk • 20:47, 2 July 2006 (UTC)[reply]~~
We tried that. The conversation became unmanagable because of the many different directions that it was going, including many that were largely off topic. On a wiki page it is impossible to keep track of individual conversations without watching everything that anybody says because the topic drift results in an interweaving of conversations between different sections of the web page. Because of the high volume of conversations on this page, the attempt to use a talk page to discuss the changes became entirely unmanagable. Robert Rapplean 00:38, 3 July 2006 (UTC)[reply]
~~Returned discussions to talk page~~
The talk page of an article is the main place that discussion should occur. FloNight ^talk 00:55, 3 July 2006 (UTC)[reply]
Alrightey, away we go with the hammer model then. Robert Rapplean 21:35, 3 July 2006 (UTC)[reply]
~~Please be more careful~~
drgitlow, please be more careful in honoring Chris with edits I made. Because you chose to highlight Dr. Benjamin Rush's view that alcoholism is a disease, I think it essential to point out his view that Negroidism is also a disease because this helps the reader understand his conception of disease.Medical Man 01:46, 3 July 2006 (UTC)[reply]
I didn't highlight Dr. Benjamin Rush's view. I never wrote a sentence about Dr. Rush. I thought that was there before I ever got here, but I can check back in the history. Drgitlow 03:54, 3 July 2006 (UTC)[reply]
~~Yup...it was added on April 9 by someone without a user signature. After I started working on this, but not me. Drgitlow 04:09, 3 July 2006 (UTC)[reply]~~
~~Miscellaneous Trivia~~
Miscellaneous trivia regarding Dr. Benjamin Rush can be placed at Benjamin Rush and doesn't belong in this entry since this isn't an entry about Dr. Rush.
The controversy regarding EM Jellinek's degree can be found at E. Morton Jellinek and also doesn't belong in this entry since this isn't an entry about Jellinek. Drgitlow 16:24, 3 July 2006 (UTC)[reply]
I can understand why you want to censor this information about two of the major developers of the disease theory of alcoholism. However, it is essential information to help readers assess their credibility. By vandalizing it, you show a lack of good faith.Medical Man 18:33, 3 July 2006 (UTC)[reply]
No, I show a willingness to discuss it here before something controversial gets put into the article. If you want to help readers assess the credibility of Jellinek and Rush, you'd have to do one of the following: a) refer readers to the full reference of Jellinek and Rush, or b) put extensive information into this article demonstrating the full range of Rush's and Jellinek's biographies. You can't simply say that you're going to put inflammatory statements about them here into this entry and that it's essential information for readers. That's not the way this works. Drgitlow 18:38, 3 July 2006 (UTC)[reply]
Medical man, you have now added inflammatory material to the article on three successive occasions. Rather than simply revert the article yet again in response to your action, I think I'll just wait for the mediation to take place on this topic. Drgitlow 19:32, 3 July 2006 (UTC)[reply]
~~Evidence that there is no consensus that alcoholism is a disease~~
~~I have presented, among others,~~
~~Evidence that the disease theory is not popular in countries in which it is not profitable;~~
~~Evidence from scholarly publications that consensus doesn't exist; and~~
~~Evidence from a respected professional publication that 80% of physicians reject the disease theory.~~
What evidence will it take to convince a true believer ideologue that consensus doesn't exist??Medical Man 20:22, 3 July 2006 (UTC)[reply]
Medical Man, let's go through what constitutes "evidence." There are several potential sources of information in the scientific community.
Current medical peer-reviewed literature

Scientific studies

Expert consensus

Professional experience

Personal opinion
When a study is quoted, you need to cite the original literature, not a website that states something without an accurate reference. There is no evidence of any respected professional publication indicating that 80% of physicians reject the disease theory. I don't know where you got that from, but a medline search reveals no such finding. There is no evidence from peer-reviewed literature indicating that consensus doesn't exist. Indeed, as you've pointed out, there are at the least a very vocal minority who disagree with the consensus, but the consensus is present nevertheless -- voted on years ago by International and National organizations. Your evidence that the disease theory is not popular in countries in which it is not profitable isn't evidence - it's a correlation that requires investigation and explanation; no causality is implied. Drgitlow 20:34, 3 July 2006 (UTC)[reply]
The fact that the disease theory isn't popular in countries where the doctrine isn't popular demonstrates that there is no world consensus. The question of causality is totally and completely irrelevant.
Disregard the possible causal relationship. The fact remains that in many countries the ideology is not widely held among professionals. That proves there is no consensus. The fact is clear. You are completely wrong, period.
~~BTW, I've published much more than you have on the subject of alcohol and don't need your condescending lecture. Your list of evidence is incomplete.Medical Man 00:56, 4 July 2006 (UTC)[reply]~~
Please, then, share with us your list of publications on the subject of alcohol. I'd be very interested in reading your articles and textbook chapters. I'm sure I have much to learn from them. Drgitlow 01:06, 4 July 2006 (UTC)[reply]
You would clearly profit from doing more reading. Because you're only an assistant professor, I feel compelled to suggest that you direct your efforts to publishing scholarly books rather than either textbooks or handbooks (which, as you admit, your "textbook" really is). A textbook is usually equated with an article in a refereed journal for purposes of salary increases, promotion, etc. A handbook would probably equate to ½ of an article in a refereed journal.
Very important is advancing knowledge. Defending dogma counts for nothing in academia. Therefore, you might empirically test some of the implications of the disease theory. That might prove useful. Or alternatively, you might test the efficacy of different treatment modalities under different conditions.
~~You'll find it both personally and professionally rewarding to make original contributions to a field of knowledge.Medical Man 03:46, 4 July 2006 (UTC)[reply]~~
~~Starting our work~~
The article starts with:
Alcoholism is a condition within the Substance Use Disorders category that describes a multifactorial condition widely believed to be based upon both genetic (Lowinson JH, Ruiz P, Millman RB, Langrod JG. Substance Abuse, A Comprehensive Textbook, 4th Ed. 2005) and environmental factors.
This sentence has been edited so much as to no longer make grammatical sense. From a medical perspective, alcoholism is but one of the substance use disorders. While it is only one, it is also the most prevalent and most costly to our society when compared with the others. Alcoholism is 20x or so more prevalent than opioid addiction, for example. Perhaps that information should be in the leading paragraph? The citation here is one of the two major textbooks in the field of addictive disease and the content of this sentence is more or less the first line of nearly all the major texts in the area. But interestingly, we haven't said what the condition is, and that could be a much better introduction.
It's easier to say what alcoholism is NOT. It's not heavy drinking. It's not illegal use of alcohol (e.g. a 15 year old drinking). What I'd like to do is start off this way, and I've tried to temper wording in a manner I hope will be acceptable to all:
Alcoholism is a primary and progressive condition in which alcohol is used in an ongoing or intermittent manner despite one's best interest as measured via psychosocial function. In a 1992 JAMA article, the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published this definition for alcoholism: "Alcoholism is a primary chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, mostly denial. Each of these symptoms may be continuous or periodic."
I assume that some of you have another definition of alcoholism that you'd like to see in the lead-off paragraph, so perhaps the lead-off should also have an alternative definition for readers to consider? Drgitlow 20:42, 3 July 2006 (UTC)[reply]
I don't know if alcoholism is officially classified as a disease under medical definitions, but the current introduction is horrible, in defining it specifically in terms of a medical condition under categories and then filling up with a bunch of references from medical societies. This is a general-purpose encyclopedia, not the DSM. Even a medical encyclopedia would never start off an entry this way. For comparison, here is the first paragraph of the Britannica introduction, s.v. "Alcoholism":
excessive and repetitive drinking of alcoholic beverages to the extent that the drinker repeatedly is harmed or harms others. The harm may be physical or mental; it may also be social, legal, or economic. Because such use is usually considered to be compulsive and under markedly diminished voluntary control, alcoholism is considered by a majority of, but not all, clinicians as an addiction and a disease.

Here is the first sentence of the article at Medline Plus[48]:
Alcoholism is an illness marked by drinking alcoholic beverages at a level that interferes with physical health, mental health, and social, family, or occupational responsibilities.

—Centrx→talk • 20:55, 3 July 2006 (UTC)[reply]
Drgitlow, I agree the intro needs some work and is fuzzy at best. Due to the lack of editorial consensus and the current demonstrated mistrust amongst most of us alcoholism editors here, I would suggest we put this one on one ice for the time being and instead let's get our feet wet on something slightly less caustic before we tackle the definition of alcoholism. I think we need some baby steps so to speak.
I am currently writing something to add to the Pro/Con section that I think will give us a good opportunity to learn how to establish editorial consensus and it's on a topic that is slightly less volatile. Realistically I think we are weeks (or longer) away from having an article that everyone feels does a good job of articulating the subject of alcoholism, so I think we can address some of the more explosive subjects best if we wait until we've got a little editorial consensus under our belts. That's my take on it. If you agree then by all means go ahead and write what you think would be appropriate but I would suggest you not present for comments on the talk page until we ("we" meaning all the editors who are either active or wish to be active when things cool down) have established an ability to work constructively together. Mr Christopher 21:03, 3 July 2006 (UTC)[reply]
~~Centrx, you make excellent points. You didn't suggest alternative wording, but taking your thoughts into account, perhaps an approach like this would be better:~~
Alcoholism is an illness in which individuals intermittently or continuously use alcohol despite such use causing them objectively determinable harm in areas of personal, social, educational, and occupational function or in terms of increasing medical complications. Alcoholism is diagnosed not by the quantity or frequency of alcohol used but rather by the degree to which alcohol's use has caused harm to the individual.
The textbook definition of alcoholism (the JAMA reference) can be incorporated into some of the following text. Since we have had ongoing discussion regarding different opinions on the subject, it might be useful to have sidebars of boxed text to the entry that include the DSM-IV definition, the JAMA article definition, as well as any other pertinent definitions.
All that being said, I agree with Chris's point above as well and don't mind just coming back to this once we're done working elsewhere in the article. I don't even know if Chris and others feel the same way about the word "illness" as they do about "disease." The two words have different meanings to me: a broken bone is a disease, but not an illness; but I don't know if there's a standard there or not. Drgitlow 21:12, 3 July 2006 (UTC)[reply]
I think you both make very good points, I simply think this specific subject is ripe for a nuclear reaction, at least at the present. For me, this one merits waiting for a cool down as well as some consensus building experience. Mr Christopher 21:19, 3 July 2006 (UTC)[reply]
~~Hmmm...should we take the 4th off and agree not to even visit the page? :) Drgitlow 21:29, 3 July 2006 (UTC)[reply]~~
Personally, for now, I don't plan on changing anything in the article (other than a typo or broken link) without some sort of editorial consensus, no matter how nutty the article might get. And your suggestion for taking off the 4th sounds like a plan. I'll not add the ideas I previously spoke about to the talk page until after the 4th. Mr Christopher 21:49, 3 July 2006 (UTC)[reply]

I think, though, that we can agree that it's a "health condition", which is to say a condition that effects a person's health. Does anyone have a problem with that? Robert Rapplean 21:34, 3 July 2006 (UTC)[reply]
I have used "diseased condition", meaning that the body is not functioning normally or properly. I made it so that excessive drinking causes the diseased condition, which is absolutely true, not that excessive drinking is a disease caused by biological factors, which seems to be what is the contention. —Centrx→talk • 22:07, 3 July 2006 (UTC)[reply]
Alcohol intake itself can cause disease. It can cause hepatic difficulties, dementia, and so forth if taken in sufficient quantity. What it can't do is CAUSE alcoholism, although the condition can't be identified and diagnosed in the absence of alcohol use. Push comes to shove, there will probably come a day when we can identify individuals who are predisposed to develop the condition prior to their ever using alcohol. But that day isn't here yet. And then you get into the whole "What's a disease?" issue. Let me give an example: Imagine I have a patient with Huntington's. He has the gene but no signs or symptoms of the disease yet. We know that between age 35 and 50, he will begin showing the onset. Would you say he has the disease at age 20? Or must it wait for symptoms?
Similarly with alcoholism, if I take an alcoholic and move him to an alcohol-free environment, is he still alcoholic? What if he hasn't started drinking yet, but my crystal ball shows the future and sees that he will? Is he alcoholic now? That difficulty is part of why docs don't typically relate the disease to alcohol use itself.
So I agree that excessive drinking is not a disease. But excessive drinking does not cause the condition of alcoholism either, though SOME drinking is necessary for the condition to be present. If you want my opinion, what I tell patients is that alcohol use is simply a marker for the presence of the disease, which typically is more an issue of a failure for them to have learned how to relate on an emotional and intimate basis with other people combined with some genetic issue that causes them to have an unusual response to alcohol that on a short-lived basis helps them to feel better. That's in my textbook and is educated opinion, but I acknowledge that it's my opinion and not a belief that is necessarily shared by all addiction treatment professionals. Does it have a place in this article? Up to you all...it's in the book so I suppose it could be cited. :) Drgitlow 00:49, 4 July 2006 (UTC)[reply]
Let me cite a real life example. There's evidence that alcoholism is caused by an excessive production of endorphins when a person drinks. If a person never drinks, then the excessive level of endorphins never results in alcoholism. The excessive production of endorphins is actually a natural variation in human genetics. It allows the people to become more quickly aclimated towards exercise and risky behaviors like hunting and sporting competition. It just happens that the group of people with that particular adaptive trait are also succeptable to becoming addicted to alcohol.
~~Genetic variation is not a disease. It isn't a mutation, it's a naturally occuring variation that's fairly common in the gene pool. It even provides beneficial effects for many of its recipients.~~
Do we call addiction a disease? Since endorphin is a naturally produced chemical that acts like morphine (it's name is derived from "endogenous morphine") what we're dealing with, then, is identical to morphine addiction, except that the triggering mechanism is the consumption of alcohol. If not, then we have a real life example where alcholism might not be categorizable as a disease.
~~Again I have to reiterate that until we know what the cause is, we cannot state authoritatively one way or the other.Robert Rapplean 01:08, 4 July 2006 (UTC)[reply]~~
~~Let me take issue with a few of the things you've said:~~
1) Genetic variation indeed is not a disease UNLESS it causes disease. Sickle-cell anemia is a disease, is it not? And it is simply caused by a single gene variation. If a person is heterozygous for that variation, they do not have disease but they have a lower likelihood of getting malaria. We can see why the gene developed, but if you're homozygous, you end up with disease instead of the benefit. Huntington's is also a disease and also genetically based. So I wouldn't say that genetic variation can't cause disease.
2) If a genetic variation causes a different response to alcohol than would otherwise be present, that in and of itself does not mean that a disease is present. For instance, you could have the gene but never drink alcohol. No disease. Or you could have the gene but the different response is in no way dangerous or harmful. No disease. But if you have the gene, and you have alcohol, AND the different response is dangerous or harmful, then you have a disease. Again, though, it depends on how you define disease. What about those folks who are terribly allergic to peanuts: do they have a disease? If they live somewhere where there are no peanuts, they don't. What if they live in the US somewhere and are always being exposed to peanuts, peanut oil, or products that at one time or another came into contact with a peanut?
3) The endorphin issue ... let's say that's true ... that alcoholics are people who have such a response to alcohol due to genetic variation that no one with that response would have the will power to put the alcohol down no matter how bad things got in the rest of their lives. If that were true, wouldn't you say they have a disease if they lived in a community that had lots of alcohol around almost all the time?
4) We don't know what the cause is of migraine headaches. We don't know what causes cancer. We don't know why, of two identical twins, one gets juvenile diabetes and the other doesn't. Lacking the knowledge of a definitive cause, we still call each of those conditions "diseases," don't we? Drgitlow 01:18, 4 July 2006 (UTC)[reply]
Point (2), dunno, are allergic reactions considered a disease? It's essentially an autoimmune malfunction, and other autoimmune malfunctions like diabetes and arthritis are considered diseases. Whether we apply the word or not really doesn't help a person who dies from eating peanunts so I'd just take the AMA's word on it.
~~Point (3),in order to answer that, I need a clear answer to my question: is heroin or morphine addiction a disease?~~
Point (4) Migraine headaches are caused by fluctuation of blood flow in the brain. This has been demonstrated via MRI's. We don't really know WHY it fluctuates, agreed, but we can at least put our finger on a cause of the migrane. Cancer is caused by errors in cell division. The real question isn't why it happens, but why the normal responses don't clean it up like it does with other cell division errors. Daibetes is caused by a person's autoimmune system attacking the pancreas. You're right that we don't know what triggers it, but the mechanism is pretty well understood. We have no solid explanation for a desire to consume a neurotransmission inhibitor well beyond the point where you can no longer function.
So you feel that a mechanism must be identified and demonstrated as the basis of a disease before the symptoms and signs of the condition can be identified as a disease? You don't mind if the basis of the mechanism is unknown, so for instance in Alzheimer's, you're comfortable calling it a disease based on the histological changes in the brain even though we don't know the reasons as to why some people get the changes and some don't. Am I understanding your position correctly?
Those who agree that alcoholism is a disease generally also feel that opioid addiction is a disease. A different disease to be sure, but a disease.
If you're looking for mechanisms, then it may be some time before any of the psychiatric illnesses (some people include addictive disease in that category, some don't) meet your definition. These diseases are, for the most part, identified and diagnosed in a syndromic manner by identifying symptom clusters. But I'm going to guess that you don't think major depression, panic disorder, or schizophrenia are diseases either based upon your definition above. Am I right? There is a good deal of scientific research demonstrating a variety of environmental and neurotransmitter-based origins of these illnesses, but you want something definitive like the pancreas being attacked or cells running amok. The brain isn't that obvious (and when it is, it usually falls into the neurology category instead of the psychiatry category...but that's another discussion).
I'm just puzzled as to why you'd draw the line at identifying disease only once you know the mechanism. Would you have said the same thing in 1800, when we didn't know squat about any of these things? Drgitlow 01:51, 4 July 2006 (UTC)[reply]
The difference between alcoholism and things like cancer is that a person is, certainly, not causing a tumor. If indeed there is a biological reason why an alcoholic responds to liquor differently than other persons, it is similar to an allergy. The allergy itself, the susceptibility, is not a disease. Exposure to the stimulus, yes, produces a diseased condition but, like alcohol, if the allergic one does not eat peanuts there is no disease. If he wilfully and knowingly eats peanuts, he may be foolish or he may do as a result of dementia, and he will get sick, but the peanut-eating itself is not the disease. —Centrx→talk • 03:52, 4 July 2006 (UTC)[reply]
In short, Centrx I like the introduction and think it's the closest thing we've had to NPOV yet. I have two intitiall thoughts. One is the ethanol article does not describe ethanol as a drug, there they define it as
Ethanol, also known as ethyl alcohol or grain alcohol, is a flammable, tasteless, colorless, mildly toxic chemical compound with a distinctive odor, one of the alcohols that is most often found in alcoholic beverages. In common usage, it is often referred to simply as alcohol. Its molecular formula is C₂H₆O, variously represented as EtOH, C₂H₅OH or as its empirical formula C₂H₆O.
We'd be wise to not call ethanol a drug. Otherwise I this is a good place to reach a consensus. I think it does a pretty good job of tipping it hat to the medical community's take on the issue without assuming their POV. I'm sure some of the finer points could be expanded upon or even debated but we're better off with something brief and agreed upon. It is because the opening entry is no longer claiming alcoholism is a disease (what I have been calling the "AMA POV") that I think referencing the debate introduced by Medical Man in the opening section might be misplaced. To me those viewpoints should be heard but in a more logical section. You and I share some similar concerns so if you think I'm bonkers let me know. But the opening section does not glamorize the disease concept so I'm thinking this is a good compromise. I think the overall article will read better if we correctly categorize where conflicts in opinion are strategically best placed keeping in mind we don't want to silence any voices (verifiable, reliable, etc) on the subject. Anyhow, we gotta start somewhere, might as well be at the top of the article in the opening definition. Mr Christopher 05:40, 4 July 2006 (UTC)[reply]
The reason I included the ethanol mention is so that the introduction explicitly states the mechanism by which alcoholic beverages could ever cause any harm or why they would be used despite detrimental effects. It seems obvious to us, but a child would not know and perhaps others, and it should anyway be written for the ages. Most introductions to common subjects seem rather obvious to the average intelligent reader, but it is to introduce the unfamiliar reader and to exactly define the subject. Ethanol (an unusual name too) may not be the best to link to, because that article is primarily about its chemical properties. An alternative is Effects of alcohol on the body.

Alcohol is a drug. Specifically, it has a direct, substantial effect on the physiologic function of the body. There may have been some popular mutation of the term in the last 30 years, but the fact remains that aspirin and cocaine are both drugs, and that ethanol is a psychoactive drug. Both Effects of alcohol on the body and Alcoholic beverages agree. This is not to imply any Drug War hysteria or any sinister will-circumventing influence. —Centrx→talk • 06:31, 4 July 2006 (UTC)[reply]
~~Can we move the Disease argument to its own entry?~~
The vast majority of arguing on this topic is in regard to "is Alcoholism a disease". I'm firmly of the belief that this is a semantic argument, and is of little or no benefit to those suffering from or attempting to understand the problem. I'd like to suggest that we create an entry "Disease theory of Alcholism" and move all of those arguments to there.
My personal perspective is that if the AMA says it's a disease, then I'll call it a disease. However, since the AMA fails to actually provide an explanation for why people can't just put the bottle down, it remains an opinion on their part and not an authoritative statement. Until someone CAN actually give a physics/chemistry/whatever based explanation for why people can't just put the bottle down, all statements on the matter are opinions and will remain opinions. We can pile opinions up until we're all neck deep in quotes, but they will all remain opinions.
Which is to day there IS no definitive answer, and the debate can go on indefinitely without coming to a resolution. If someone can give a physics/chemistry based explanation for why people can't just put the bottle down, please correct me and we can start arguing about whether that explanation qualifies as a disease, but in the mean time I want to request that we set it aside as being distractive from information which people might actually find useful. Robert Rapplean 21:34, 3 July 2006 (UTC)[reply]
Thanks, Robert. I can actually give you an explanation, but it's a theoretical model and not definitive. So the bottom line is that the AMA position is a consensus, and it's a consensus of medical experts and the scientific community. But you're correct: consensus doesn't mean fact. It's sort of a semantic thing anyway, isn't it, as you point out. It depends as much on the definition of "disease" as it does on how we perceive alcoholism. Yell if you want the explanation...I think it might be too detailed for the entry but I'm happy to share it here. Drgitlow 00:59, 4 July 2006 (UTC)[reply]
~~Hi Robert- I think you’re right that this is largely a semantic problem. However the matter has very important implications for helping alcoholics.~~
It has long been argued that calling alcoholism a disease reduces the stigma attached to it and encoourages alcoholics to seek treatment, clearly a positive outcome. However, some alcoholics report being offended by the idea that they have a disease and are less likely to seek treatment. Their logic escapes me, but that's how they perceive it. I've never seen any analysis of whether the net result is positive or negative.
Of course the issue is of vital importance to those who are able to obtain third party payment for their services only if alcoholism is a disease. For the AMA, it was an economic rather than a scientific issue. That’s why we can’t rely on groups that have an economic self-interest for an answer.
I sugest that what we believe about the issue is totally irrelevant and that we waste our time to the extent we discuss it. The only issue is whether or not there is consensus that alcoholism is a disease. If there is not, I think the article must reflect this fact, present both pro and con arguments, and not take sides.Medical Man 02:21, 4 July 2006 (UTC)[reply]
The original AMA discussion never included any discussion of economic impact. You're right that some in the room might have been thinking about the potential economic issues. I'm saying simply that it isn't in the Proceedings. I'm puzzled though about why you can't rely on groups that have an economic self-interest for an answer. Do you go to doctors when you're sick? They have an economic self-interest. Do you listen to their recommendations? In a capitalist society, nearly all recommendations come from those with some economic interest, either positive or negative.
All that being said, I'm open to our saying that a medical consensus exists based upon the research, academic, and medical stakeholders' votes supporting AMA policy that alcoholism is a disease, BUT that a general population consensus does not exist based upon the materials that you've cited to date. Drgitlow 02:42, 4 July 2006 (UTC)[reply]
~~Of course the AMA delegates didn't publicly discuss their economic self-interest for the record. They weren't stupid, just looking out for their income!~~
~~Based on the evidence I've provided, I'm open to reporting that there is not yet a consensus, but might be in the future.~~
~~You're eager to accept the views of those who have an economic self-interest in declaring alcoholism to be a disease, but ignore the views of those who don't have an economic interest in the subject!~~
~~It's apparent that no proof in the world will convince you.Medical Man 03:19, 4 July 2006 (UTC)[reply]~~
I don't know whether or not you have an economic self-interest in this. Your screenname is Medical Man, so I assume you have some economic interest in this, no? Drgitlow 13:58, 4 July 2006 (UTC)[reply]
~~I'm objective, even when it's not in my economic interest.Medical Man 21:30, 4 July 2006 (UTC)[reply]~~
~~Medical Man Citations~~
Medical Man has made several citations in the last sentence of the opening paragraph, but the citations are simply a list of names rather than references. We need the actual references for (U.S. Supreme court, Fingarette, Peele, Schaler, Hobbs, Meyer, Kolata, Korhonen, Nackerud, Kelly, Doweiko, Levy, Maltzman). Drgitlow 01:28, 4 July 2006 (UTC)[reply]
Apparently, they are listed at the bottom under section References. Still, the introduction should not be cluttered with this many sources. If there is a controversy, it belongs in its own referenced section, with a statement about it in the introduction that is in reference to that section but without so many sources, many of which are rather tangential to the matter. —Centrx→talk • 03:34, 4 July 2006 (UTC)[reply]
~~Perhaps we should copy the ADHD approach~~
The folks writing the ADHD article have been where we are at now. Take a look at how it was handled there. They've done two things: a) they've set up a separate entry for Controversies about ADHD, and b) they incorporated an overview of the controversies into a segment of the ADHD entry itself. That seems to be a reasonable and rational approach. Do others agree that this would be a reasonable course of action to take, perhaps not yet, but at some point in the future if we continue to have significant disagreement regarding content? Drgitlow 02:17, 4 July 2006 (UTC)[reply]
~~I'll take a look at that article. Mr Christopher 15:22, 4 July 2006 (UTC)[reply]~~
~~The Debate~~
I have a suggestion. We might establish a venue where those who wish to debate the disease theory can openly do so. Seriously and I'm not being cute. Much like how the Intelligent Design editors will often guide people to the Evolution Talk pages (sorry I don't have a link handy) where they can engage in lively debate about the evidence for and against evolution and intelligent design. That way those who want to debate the subject can enjoy the back and forth and meanwhile on the talk page here we could focus our attention on how to improve this article.
I don't want to silence the debate here at all, but it is difficult to sort through it when you're in the mood to work on the article. Can someone establish something where such a debate/discussion could occur? I don't feel up to participating myself but I would imagine others might. Anyhow, the talk page is growing exponentially so I think it might be a way to make things more effective and manageable. Mr Christopher 05:03, 4 July 2006 (UTC)[reply]
~~Improved Effects section (Reposted comment from archive)~~
Despite the difficulties that we've had of late, the entry is coming together nicely. I'm looking over the EFFECTS section, which has a good deal of information on alcohol itself, and the impact of alcohol USE. It is difficult to tease out the effects of alcoholism versus the effects of alcohol. The effects of alcoholism when an alcoholic is in recovery, for example, would be different from the effects of alcoholism while an individual is drinking on a daily basis. (This is similar, of course, to the situation with other diseases - the effects of diabetes when an individual has well-controlled blood glucoses are different from the effects of untreated diabetes). Nevertheless, I wonder whether the entire section would be more appropriately found in the alcohol article rather than here in the alcoholism article. Can we build a consensus regarding this area? Drgitlow 05:29, 1 July 2006 (UTC) —Reposted 07:15, 4 July 2006 (UTC)[reply]
~~Curing by moderation (Reposted comment from archive)~~
There is reason that healthcare professionals have a tough time accepting any treatment that involves continued drinking. The Pendery article in Science in 1982 (Science. 1982 Jul 9;217(4555):169-75.) essentially blew the moderation movement out of the water by demonstrating that over the long-term, patients who truly had alcoholism and who tried to drink in moderation either a) died of alcohol-related disease, b) ended up with significant morbidity due to alcohol-related disease, or c) had successfully entered abstinence. One method of diagnosing the disease is to simply see whether a patient tries to control their alcohol intake; if they do, they probably have alcoholism (noone tries to control their orange juice intake -- if they did, one would think there's something wrong). Drgitlow 16:53, 3 July 2006 (UTC)[reply]
You're mistaking pharmacological extinction with moderation. Moderation is an attempt to use personal habits and willpower to attempt to decrease one's drinking habits to a more healthy level. Pharmacological extinction is an attempt to reverse conditioning placed upon a person's neurochemistry by providing stimulus, but by blocking the reward mechanism. I agree and accept that moderation doesn't work, but there is a great deal of evidence indicating that PE does. Robert Rapplean 21:45, 3 July 2006 (UTC)[reply]
—Reposted 07:15, 4 July 2006 (UTC)
I think part of the trouble we're having is based on terminology issues. When one of us uses a term like moderation, addiction, disease, etc., I suspect we're all thinking of different things. You're describing behavioral modification, I think. Can you post (repost?) the citation as to the efficacy of that approach for treating alcoholics?
The reason so many alcoholism treatment professionals reject the idea that alcoholics can drink in moderation is that it is completely inconsistent with the disease model. For many decades, all evidence that some alcoholics could learn to drink in moderation was dismissed as a fluke, as erroneous, or as impossible. It was rejected because it was a threat to their firm belief that alcoholics can never drink in moderation. When faced with increasingly strong evidence that some alcoholics can drink in moderation, they fell back on the lame argument that those successful people couldn't have been alcoholics or they couldn't have drunk in moderation! After all, they argued , and still do that , "an alcoholic is someone who must abstain because he or she can't ever learn to drink in moderation."
Reminds one of Freud's assertion that men could not suffer hysteria because it was defined as a disese of women. Or Jellinek's assertion that "a disease is anything the AMA says is a disease"! Or some of the arguments we've been getting trying to rebut evidence that there is no consensus about the disease concept of alcoholism in the alcoholism field.
~~However the NIAAA reports that about 18% of US alcoholics are now recovered (its term) and drinking in moderation (its term). [49]Medical Man 00:31, 5 July 2006 (UTC)[reply]~~

~~Problem with "intermittent or continual"~~
Textually, this means that any drinking at all, whether it be often or only intermittently every now and then, is alcoholism. The "excessive" is important, and something like "habitual" or "repetitive" is also. —Centrx→talk • 07:14, 4 July 2006 (UTC)[reply]
Hmmm, no, that's not the intent. I'll try to reword it. The problem is that an individual can have alcoholism but drink only rarely. A heavy drinker, on the other hand, might not have alcoholism. The disease is independent of the quantity of alcohol intake. Imagine, if you will, a binge drinker who doesn't drink for long periods of time, but then drinks to the point of oblivion, losing his job in the process and ending up in the hospital with DT's. His total alcohol intake might not be very much compared to your average college student, but he's alcoholic and the college student probably isn't. Drgitlow 13:56, 4 July 2006 (UTC)[reply]
I think the article would be incomplete without the APA's stance that lighter drinking can also be a sign of alcoholism as well as their definition of alcoholism. By introducing this in the opening paragraphs we're inviting more contention. I think there is a more logical place to put the APA's stance. To me the entry needs to be as contention proof as we can make it. Mr Christopher 15:16, 4 July 2006 (UTC)[reply]
I don't think that's the APA's position necessarily. The DSM diagnostic criteria don't address intake levels at all. I just looked through the DSM section and didn't see anything on light drinking versus heavy drinking. It's not that lighter drinking is a sign of alcoholism -- I'd never try to argue that light drinkers are, in general, alcoholics. I think in general (vast majority of the time) they are not. (We all agree on that, right?) The criteria are saying only that one need not be a heavy drinker to suffer from alcoholism. In my last edit, I tried to remove any indication of light versus heavy from the opening paragraph so that the condition is noted to be present solely based upon the effects of alcohol. I think that's consistent with the DSM definition, with the JAMA definition, and with your perspective as well, is it not? Happy 4th, by the way! Drgitlow 15:53, 4 July 2006 (UTC)[reply]
Well rain ended the fireworks display too soon but other than that things are swell this holiday weekend. Yes your latest edits to the entry are good and advance the cause of consensus building as well. Nice. I think we have made some significant recent strides. Mr Christopher 17:03, 4 July 2006 (UTC)[reply]

~~More evidence: No consensus in alcohol treatment field~~
A recent study of physicians and non-physician alcoholism treatment practioners in Canada reported that 82% of nonspychiatriatrist and 84% of psychiatrist physicians believe that alcoholism is a "mental disorder," that physicians "largely espouse a disease notion of alcoholism," and that "Physicians are more likely to endorse a disease concept of alcoholism than are nonphysician practioners." Social workers tended to be neutral and counselors tended to accept it on average very mildly. There’s clearly no consensus in the alcoholism treatment field.
Meza, E. et al. Alcoholism: beliefs and attitudes among Canadian alcoholism treatment practioners. Canadian Journal of Psychiatry, 2001, 46, 167-172. [50]Medical Man 21:19, 4 July 2006 (UTC)[reply]
Please do not clutter the introduction with 18 external links. A short sentence describing why it is thought that the "disease theory" may be wrong is what is appropriate, and the rest should be put in its own section. Something like, "However, others consider heavy alcohol use to be a wilful decision that is not caused by biological influences outside of the drinker's control." or "However, there is little confirmed evidence that heavy alcohol use is caused by forces outside of a person's control." —Centrx→talk • 21:45, 4 July 2006 (UTC)[reply]
Before you cite an article that allegedly supports your contentions, I suggest you read the article. This study, now over five years old, found that 82% of nonpsychiatric physicians and 84% of psychiatrists felt that alcoholism is a disease. The authors' conclusion from the last paragraph of the article: "...physicians favour the disease view of alcoholism and its classification as a psychiatric disorder." Thanks for that new bit of evidence demonstrating what I've said all along - there is a clear consensus in the medical community about alcoholism being a disease. Drgitlow 21:48, 4 July 2006 (UTC)[reply]
By the way, "espouse" means adopt or support. Physicians espousing the disease concept means they agree with it. And yes, physicians probably would endorse a disease concept of any disease moreso than would non-medical clinicians. The medical ethic incorporates a disease-oriented approach. The results here could probably be duplicated with any disease. Social workers and counselors are less concerned with disease and more concerned with functional and psychological issues. One is not better than the other -- they are simply different approaches to deal with different things. When I'm treating an alcoholic, I often ask that they see a social worker simultaneously - the social worker and I use different approaches, and the patient takes the approach that works for them (differing depending on the individual patient). Drgitlow 22:10, 4 July 2006 (UTC)[reply]
Reality check: If only 82% of nonpsychiatrist physicians endorse the disease concept, that's not conseensus. A substantial proportion of physicians, and an even larger of other treatment professionals, reject the hypothesis.Medical Man 00:05, 5 July 2006 (UTC)[reply]

~~There is currently no consensus about the disease theory~~
~~There is currently no consensus in support of the disease theory, nor has there been one recently as the following documents, among others, demonstrate:~~
~~Korhonen, M. Alcohol Problems and Approaches: Theories, Evidence and Northern Practice. Ottawa: National Aboriginal Health Organizations, 2004 [51]~~
~~Nackerud, L. The disease model of alcoholism: a Khunian paradigm. Journal of Sociology and Social Welfare, 2002 [52](Presented above but awaiting response from dritlow)~~
~~Kelly, D. Understanding the Nature of Alcoholism (2001). Discusses the disease controversy. [53]~~
~~Is Alcoholism a Disease? In: Tarr, J. D. (ed.) Current Contro0versies: Alcoholism. San Diego: Greenhaven, 1999.~~
~~Schaler, J. A. Thinking about drinking: the power of self-fulfilling prophecies. The International Journal of Drug Policy, 1996, 7(3), 187-191 [54]~~
~~Doweiko, H. E. Concepts of Chemical dependency. NY: Brooks-Cole, 1996.~~
~~Erickson, C. K. Invited review: A pharmacologist’s opinion -- alcoholism: the disease debate needs to end. Alcohol and Alcoholism, 1992, ‘’27(4), 325-328. [55]~~
~~Levy, M.S. The disease controversy and psychotherapy with alcoholics. Journal of Psychoactive Drugs, 1992, 24(3), 251-256. [56]~~
~~Maltzman, I. Is alcoholism a disease? A critical review of a controversy. Integrative Physiological and Behavioral Science: The Official Journal of the Pavlovian Society, 1991, 26(3), 200-210 {~~
~~[57].~~
~~Meza, E. et al. Alcoholism: beliefs and attitudes among Canadian alcoholism treatment practioners. Canadian Journal of Psychiatry, 2001, 46, 167-172. [58]~~
~~Fingarette, H. Heavy Drinking: the Myth of Alcoholism as a Disease. Los Angeles: UCLA Press, 1988.~~

~~The lack of consensus has also been demonstrated in other ways:~~
United States Supreme Court decisions

The fact that the disease hypothesis is not popular in many countries around the world (Therefore, there is no consensus)

Evidence from a respected professional publication that 80% of physicians reject the disease theory. (Secondary sources are completely acceptable. Gitlow probably used them in this handbook).

Alcoholics Anonymous acknowledgement that the disease debate is an active one (Alcoholics anonymous. “Is Alcoholism a Disease?” [59]Medical Man 02:07, 5 July 2006 (UTC)[reply]
Yes, we know how you feel. This is the sixth time in just a few days that you've posted an identical topic here. You can simply continue your discussion in the original thread without adding another heading every time you want to tell us again that there's no consensus. Rain, by the way, falls up from the ground and blows around in the wind. We only think it falls from the sky. Drgitlow 02:51, 5 July 2006 (UTC)[reply]
~~Actually, feelings have nothing to do with the subject. What you know or should know is that I have presented strong evidence that there is no consensus about the disease hypothesis.~~
For example, (a) the United States Supreme Court (“the law of the land“) has rendered its decision, (2) AA reports that the disease debate is an active one, (c ), conservatively, about one physician in five and almost half of counselors fail to accept the theory, and (d) the concept is not widely accepted an many countries around the world.
There is no consensus and you haven’t been able to prove there is one. Sounds like you’re the one who keeps insisting, in spite of evidence to the contrary, that Santa Claus exists. Like it or not, there is no consensus and there is no Santa.
Those who cling to the AA ideology often do so with a religious-like fervor that defies reality. That’s not surprising because the ideology is based on blind acceptance and religion. As the group tells those who dare question the doctrine, "Take the cotton out of your ears and stuff it into your mouth."Medical Man 17:25, 5 July 2006 (UTC)[reply]

~~Regarding Pharmacological Extinction~~
I think that the countersite on pharmacological extinction needs to be more closely examined. PA isn't an attempt at moderation, and the cited study is dated 1982, before PA was developed, which was around 1992. PA is based on observations that overdrinking prone rats have overactive endorphin systems. Endorphin is our body's chemical mechanism for making us want to perform behaviors like sex, exercise, and fighting, which aren't terribly productive or efficient in their own right but which provide notable benefits in the long run. It has been demonstrated that the consumption of alcohol releases endorphins in our system, so the theory is that alcoholism is caused by the inappropriate rewarding of our neurological system when we drink.
Pavlov demonstrated that providing a stimulus coupled by a reward causes conditioning, but he also proved that providing the stimulus without the reward causes the extinction of that conditioning. Bell without food results in cessation of salivation over time. For alcoholism the bell is all of the sensations involved with drinking alcohol, and the reward is an endorphin reward to our neurons. Naltrexone is an opioid antagonist. In short, it blocks our bodies from being rewarded when we drink. Thus, if we drink alcohol while on naltrexone, our neurons unlearn their drinking impulses.
So, again, it has nothing to do with attempting to moderate drinking, it has to do with providing stimulus without reward so that the urge to drink is extinguished. Thus, any study which involves moderation without naltrexone use has nothing to do with this. Similarly, any study which involves naltrexone (or nalphamene, or noloxone) coupled with abstinence or abstinence encouraging therapies (like AA) similarly demonstrates nothing about PA. If you would like a complete list of the studies which have been performed involving opioid antagonists, let me know. I have a list that was updated around Nov 2004. Robert Rapplean 02:13, 5 July 2006 (UTC)[reply]
Robert, the PA approach is a behavioral modification approach combined with neurochemical findings. And I see your point about it leading to abstinence through a process which involves some continued use of alcohol for the behavioral modification to occur. It's a fascinating idea. My understanding of it is that it works theoretically as follows:
Alcohol causes the production of endorphins. In some individuals, alcohol causes endorphins to a greater extent than usual. This causes those individuals to have a reduced ability to refuse alcohol (because, simply put, the alcohol is too enjoyable for them to refuse even if it causes them hardship). Naltrexone, among other drugs, stops the endorphins from getting their message through by antagonizing the neurotransmitter system involved. Therefore, if you give the naltrexone and these individuals drink, they will no longer feel the enjoyment they once did. Behavioral modification will result due to the lack of positive feedback and the drinker will ultimately be able to stop drinking on his or her own.
While liver toxicity is an issue with naltrexone, the doses necessary here would be low enough as to present a low risk of hepatic damage (in general), even when combined with alcohol. I reviewed the Sinclair paper from Alcohol & Alcoholism 36(1)2-10. 2001 that discusses this in greater detail. What Sinclair reports is something that hasn't been replicated well in US trials since the US trials haven't followed his instruction that naltrexone be given simultaneously with alcohol. This provides a potential explanation as to why the US trials for naltrexone have been less than successful. All very interesting and deserving of additional study. Drgitlow 02:43, 5 July 2006 (UTC)[reply]
~~This is almost correct. Right idea, but the theory states that it's a neurochemical effect, not a behavioral one. In order to clarify, I want to Quote Dr. Sinclair directly:~~
"On the other question, you are correct that mixing naltrexone and disulfiram together will not work. Many people would expect it to, but this expectation is based on the incorrect common sense understanding of behavior (CUB). CUB says that a person sits and contemplates what behaviors will bring pleasure and what will bring pain, and then choose to make the behavior expected to produce the most net pleasure. Inherent in this view is the idea that pleasure and pain add together algebraically. Like pleasure has positive numbers and pain has negative. So if you have behavior that produces something good (+2) but then you shock the person for doing it (-3), the end result is the algebraic sum -1, so the person will avoid doing that. If you only give a little shock (-1), the sum is +1 and the person will continue doing it. If you really wollop them (-5), then the sum is -3 and the person will avoid the behavior completely. This seems so logical. It is the basis for our legal system, the basis for economic, the basis for how most people raise their kid, and the basis for how most people treat others. It is, however, definitely incorrect.
~~"It has been the basis for how we treat alcoholism. And we have been punishing alcoholics with -5s and even -10s, but it almost never has worked.~~
"There is the classic statement that the effect of punishment depends upon which end of dog you inflict it upon. The reaction to pain is to find a response that gets rid of the pain. So punishing an alcoholic is most likely to drive them out of treatment. It does not get rid of the craving.
"According to CUB there is no mechanism of extinction. Naltrexone works, CUB says, because the patient is told that he will get no pleasure from drinking, so they do not bother. That was the logic that caused them to put in the instructions for naltrexone that the heroin addict is told first that they will get no pleasure and second that they may die if they drink while on naltrexone. You remember that this was completely ineffective.
"Making a response and not getting the normal positive reinforcement extinguishes the behavior. Adding punishment only makes the patient want to get out of the treatment. If you were to look in the brain, you would find, I believe, that after taking naltrexone and then drinking, that there is a process going on that weakens the pathways producing drinking. If you look in after drinking (without naltrexone) and then getting beat up in a fight, you will find the pathway causing drinking is being strengthened - the endorphins are still there producing the reinforcement. At the same time pathways the cause getting out of that bar and avoiding fights are also being strengthened. End result, the guy continues drinking but someplace else."
-Dr. John David Sinclair, Jan 21, 2006
The reason I want to make this distinction is because people's lives give them -10s when they drink. They lose their jobs, their spouses, their property, and can wind up in a gutter. This doesn't make them stop drinking alcohol, even though sensibly and obviously the net effect is quite negative. It just tells them that they need to get help, and sometimes even that isn't enough, which is why they have interventions. There's more to it than an intellectual assessment of the benefits.
Robert Rapplean 04:43, 5 July 2006 (UTC)[reply]
~~Definition of Alcoholism~~
Robert Rapplean, I hope you won't be angry that I copied this quote of yours from outside WP. I have been following the discussions and I think that you have a very valuable insight with this definition; I'd like to share it here for the sake of us who don't have doctorates but do have an interest in improving Wikipedia:
Alcoholism is a health condition characterized by impaired control over drinking habits, preoccupation with the drug alcohol and events surrounding the drinking of alcohol, and use of alcohol despite adverse consequences. It does not refer to heavy drinking, although that is one of the primary symptoms of it.
I think that this is an excellent definition, or at least represents the beginning of one, because it is readily understandable to a layman who is looking for basic information on the topic. I think it's very important that the introductory paragraph of an encyclopedic article should:
be as clear and concise as possible.

be intellectually accessible to the majority of readers.

be free from controversial issues which can reasonably be dealt with later in the article.
The fact that your definition avoids "alcoholism-as-disease" would seem to be a net benefit. That 'discussion' should probably have its own section with pros and cons presented there, rather than in the introduction. Obviously I lack the academic background to contribute to this article, but I hope that what I've brought up here will help give more of a "reader's-eye view". BTW - I appreciate the fact that everyone working on this article has done so well maintaining civilty and good faith; it's a nice contrast to certain politacal and religous articles that I wouldn't touch with a 3 meter keyboard :) --Doc Tropics ^{Message in a bottle} 17:45, 5 July 2006 (UTC)[reply]
Doc Tropics ^{Message in a bottle} Welcome to alcoholism! I appreciate your contribution and hope you plan to dig in and help us improve this article. I do have a concern, though. My concern is if we are not careful we will be redefining alcoholism every other week. Before we consider yet another definition I'd like to hear who objects to the existing definition and why. I could be wrong but I think we are close to getting editorial consensus on the existing definition, though there seems to be a lingering disagreement as to whether indroducing the debate over the disease called alcoholism belongs in the opening definition or not.
But again, we can write a new definition but is there a reason to do so? I'd like to first hear the comments of any editors (including yourself, Doc Tropics) who object to the existing definition and why before we consider replacing it with something else? Does that seem fair? Mr Christopher 17:58, 5 July 2006 (UTC)[reply]
Oh gosh, I certainly wasn't suggesting a rush to undo the hard work you've put into building consensus there! It's just that from a layman's standpoint the intro seems both dense and unwieldy; from an editor's standpoint it seems that some of that info could be used to best effect elsewhere. I didn't mean to muddy the waters here, but when I found that Robert Rapplean had produced such a clear and simple definition I found it very appealing. I certainly understand your concern about "...redefining alcoholism every other week". Stability is important to an article like this, and lack of stability on an important topic is potentially damaging to WP's credibility. I have no intention of 'interfering' with the good work you've all done on this article, I was just offering up something that I had hoped would be useful. --Doc Tropics ^{Message in a bottle} 18:20, 5 July 2006 (UTC)[reply]
Doc, your suggestion was an excellent one and I explained (and you heard and understood) my reasons for not taking your suggestion, at least not yet. And please do not back peddle too far, I have read some of your Wiki contributions and we can use experienced editors like you here. And I might be smoking crack, the other editors have yet to clearly chime in on the existing definition so it's possible I am the only one who finds it acceptable. Mr Christopher 18:32, 5 July 2006 (UTC)[reply]
Don't mind your using my words at all. The reason for making this kind of change (although not specifically this change) is a matter of linguistics. Precision, conciseness, and information density are all important when creating a written work. Let me give you a few examples. Here's the current entry:
Alcoholism is the use of alcoholic beverages—which contain the drug ethanol—to the extent that such use causes physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life.[1][2] Such chronic use causes a diseased condition marked by psychological and physiological disorders. Most medical clinicians consider alcoholism an addiction and a disease influenced by genetic, psychological, and social factors and characterized by compulsive drinking with impaired control, and preoccupation with and use of alcohol despite adverse consequences. However, the disease theory is still controversial and there is disagreement on the issue after 200 years of debate. U.S. Supreme Court decisions, books and scientific journal articles demonstrate this lack of consensus.
"the use of alcoholic beverages" is imprecise on one side and too precise on the other. Use could mean rubbing it on one's skin, for instance, thus I would replace it with the word "consumption". Also, alcoholic beverages is too precise. You don't need to specify beverages when you're consuming them, and alcoholics will drink straight grain alcohol. Everclear COULD be considered a beverage, but mostly it's an ingredient to be added to beverages, kind of like sour mix but with a kick. Thus "consumption of alcohol" would be better, and save us a couple of words. When a reader has to read too many words their attention drifts and their eyes cross.
DrGitlow: I agree that "use" is vague because it doesn't necessarily mean "imbibe." I'd be all for changing "use" to "drink," "imbibe," "consume," or some equivalent. It was a quick fix a few days ago.

Also, alcoholism ISN'T the consumption of alcohol. It's the DESIRE to consume alcohol. That's the whole "dry drunk" issue. If you're an alcoholic you can't even have one drink because it leads to binge drinking. An alcoholic who doesn't drink is still an alcoholic because any amount of drinking can result in drinking until he/she's unemployed and hospitalized. The cessation of drinking does not cure a person of alcoholism.
Also, we keep stating that the use of the word disease is controversial, and yet it appears three times in the introduction. If something is controversial, you don't use the opening paragraph to drill it into people's head. The heavy debate over whether or not alcoholism is a disease is taking over this page, and it's totally useless to those who are suffering from it instead of legislating about it. Can we please get a vote about whether or not we can move it to its own page?
Also, you're trying to pack too much information into the first paragraph, meandering over various points which are in heavy contention. The purpose of the first paragraph of a wiki article is to give the reader an operational explanation of what the topic is, not gloss over what everybody thinks about it. All of the arguments about alcoholism involve categorization, and we can get into the debates about alcohol later in the article. For the first paragraph we should provide a description of its functional impact on an alcoholic.

Thus, I would edit the first paragraph to read:
Alcoholism is a craving for alcohol that encourages the drinker to consume it beyond the point where it causes physical harm or interferes with the drinker's family, social, or work life. It is characterized by heavy drinking, but persists indefinitely even after an alcoholic maintains abstinence.
You'll notice that I completely skipped over trying to categorize it as a disease, addiction, or even a health condition because that's not nearly as important as describing it functionally. Also, I didn't specify what kind of alcohol because craving rather strictly implies consumption, and there's only one kind of alcohol we consume. In fact, ethyl alcohol is though of as the "default" alcohol, all other forms of alcohol requiring specification. We can link it to the ethyl alcohol page if people need further specification.
In the pre-Gitlow article the next section explained the terms used to describe alcoholism so that the rest of the article made more sense. The addiction article is useful, but it's necessary to break out the various forms of addiction within this specific article because alcoholism is the result of a collection of them, all of which must be treated individually. A casual reader is very likely to just gloss over a link to addiction and assume that they understand what it means.
Following that, I had it arranged (yes, that was my work) so that it progressed through the details of alcoholism in the order that they tend to impact an alcoholic and/or his family. I believe that the order was health problems, social problems, treatment options, societal impact, and political issues. Various ways to identify if you're an alcoholic would have been the first section of treatment options, but theoretically the descriptions under health and social problems would provide the reader with enough background to decide if it's worth it going off site to take a test.
When continuing the editing of this article, please keep in mind that we should be creating an article with content that is of value to the reader, not what you personally want the reader to know. Robert Rapplean 19:14, 5 July 2006 (UTC)[reply]
~~Here is my take on the existing paragraph sans the debate piece (which I think is not in the correct location):~~
Alcoholism is the use of alcoholic beverages—which contain the drug ethanol—to the extent that such use causes physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life.
Mr Christopher: This is acceptable to me, and I suppose we could change the "use" to consumption, but I really think anyone reading it will know we're talking about drinking alcohol and not rubbing it on our arms. This seems NPOV to me and there is nothing subjective about it.
Robert: Can anyone point me to a text that states that a drinker needs to be actively drinking in order to be an alcoholic? To my knowledge, there is no dividing line for abstinance at which a person suddenly stops being an alcoholic. The "which contain the drug ethanol" is entirely superfluous and breaks the flow of the statement.
Such chronic use causes a diseased condition marked by psychological and physiological disorders.
Mr Christopher: This is acceptable to me. Alcohol can cause all sorts of verifiable medical conditions. This seems NPOV to me and there is nothing subjective about it.
Robert: I disagree with this because it states that chronic consumption of alcohol automatically results in "a diseased condition". This is equivalent to stating that alcholism is a disease, which violates NPOV. We could replace this with "Such chronic use can result in many physical and mental health conditions." Be sure when you write this statement that you maintain cause and effect "alcoholism" causes "overuse" causes "health conditions". Short term alcoholism among the young and otherwise healthy mostly just causes gastritis and sleeping problems.
Most medical clinicians consider alcoholism an addiction and a disease influenced by genetic, psychological, and social factors and characterized by compulsive drinking with impaired control, and preoccupation with and use of alcohol despite adverse consequences.
Mr Christopher: Again, I think this is a reasonable sentence. This seems NPOV to me and there is nothing subjective about it.
~~Robert: I'm ok with the content, but feel that the very fact that you have to include "most" as the first word suggests that it should be de-emphisized to a later paragraph.~~
Mr Christopher: Some points you made which I do not wish to debate with you or anyone else but I feel they are highly subjective and invite debate/contention:
Alcoholism is a craving for alcohol that encourages the drinker to consume it beyond the point where it causes physical harm or interferes with the drinker's family, social, or work life.
Mr Christopher: "Craving" is a subjective term in this context and we'll be debating a definition for it as well. In this context one does not have to even drink alcohol to be an alcoholics, they just need to "crave". This seems highly subjective to me.
DrGitlow: The use of the term "craving" doesn't work though because alcoholics don't generally have craving the way opioid addicts do. In fact, one of the reasons the World Health Organization didn't recognize alcoholism as a disease back in the 50s was because craving was one of the defining points of addictive disease (and alcoholics don't have that). Ask an alcoholic who has relapsed why he relapsed and he will generally say it was an impulsive action based on availability or proximity. That differs from opioid dependent folks who acknowledge craving. (Since the '50s, the WHO changed the requirement for craving for addictive diseaes and added alcoholism to the category).

Robert: Ok, let's roll with the idea that "craving" is subjective. I've also used "desire", and you've used "preoccupation". Any of these would work for me.

What's the difference between window cleaner and alcohol? An alcoholic can forget that window cleaner exists. Personally, I have about fifty bottles of alcohol in my basement, but I forget they exist unless something reminds me of them. Alcoholics can't do this. It's part of any recovery program to dig out all of the bottles that an alcoholic has hidden away and get them out of his reach.

Answer me this: If there's no craving, why can't he ignore a bottle of alcohol the way he can ignore a bottle of window cleaner? The level of effort an alcoholic has to go to to get his hands on alcohol is certainly a factor in relapse, but if an alcoholic doesn't crave alcohol, why does he ever drink it again?
Go to an AA meeting and ask 100 people to tell you about their last relapse. The story you'll hear repetitively will be one like these...I was in my apartment and I found an old bottle of bourbon that I'd hidden in the back of the closet; I was walking down the street and suddenly found that I was in front of a bar where I used to hang out; I went out with some new colleagues from work and they all ordered wine with dinner. Those are different stories than the ones you'll hear if you went through the same exercise at NA where the people who relapsed did so because they actively sought out the drug even after a period of abstinence. I'm not saying this is true 100% of the time, but I think it's reasonably accurate. The alcoholic drinks again for many reasons: he/she wants to be "normal," and everyone "normal" seems to drink alcohol from time to time; he/she is uncomfortable, unhappy, stressed out, irritable, and realizes that alcohol will help all those feelings go away if only for a little while; it's a recognition that alcohol will help you feel better as opposed to the type of craving one might have for food if you haven't eaten in 1-2 days. Drgitlow 01:40, 7 July 2006 (UTC)[reply]
It is characterized by heavy drinking, but persists indefinitely even after an alcoholic maintains abstinence.
Mr Christopher: No offense, Robert, but this sounds very AAish to me ("persists indefinetly"). Again, I find it highly subjective and think it invites debate/contention.
Robert: I only know people for whom the desire to drink has persisted for about five years. I'll have to see if I can dig up a few abstinant alcoholics who can give me a better long-term view of the experience. I do know, however, that the inability to drink even small amounts without danger of overdrinking persists indefinitely.
Mr Christopher: And we'll also have to define "heavy drinking" and who's definition shall we use for that? Fingarette's? And fellow editor Drgitlow has suggested "heavy drinking" is not a sign of alcoholism (at least I think so, correct me if I am wrong Stuart).
DrGitlow: And thanks, Chris, yes, heavy drinking isn't required for the diagnosis, nor does heavy drinking mean that one has the diagnosis. And the definition of "heavy" of course varies depending on gender, weight, age, and overall medical status, so it's not a useful term either diagnostically or educationally.

Robert: Ok, I'll retract the "heavy drinking". That was a spur of the moment characterization based on various studies, which generally define it something like "five or more drinks on one sitting, or drinking on five or more occassions in one week", but again that's subjective. We could use "chronic consumption of unhealthy amounts of alcohol", and possibly point to the section somewhere below which lists the side-effects of overconsumption of alcohol.
Mr Christopher:So, to me, the existing definition (without the debate piece) is less subjective and less prone for debate and having to define additional terms. You have made some very good contributions to this article and although I have not responded to all your comments, I have read them all. I am only one editor here but I think the existing definition is far less subjective and therefore will best serve our readership.
~~Robert: I've broken it down into individual points of contention, with point and counter point. I'm looking for additional input.~~
~~FOLLOW UP: I can see where some might object to this piece in the existing definition:~~
Most medical clinicians consider alcoholism an addiction and a disease influenced by genetic, psychological, and social factors and characterized by compulsive drinking with impaired control, and preoccupation with and use of alcohol despite adverse consequences.
Unless we cite a poll that indicates most clinicians think alcoholism is a disease we're not presenting a NPOV. To me this is the only sentence that has some subjectivity to it and I would therefore suggest we work on that single sentence. Again, this my take on it. Mr Christopher 20:46, 5 July 2006 (UTC)[reply]
We do have that 2001 article that Medical Man brought up in which 82% of docs said alcoholism is a disease, so we could use that as a citation to meet Chris' point above if we decide that's the direction we all want to go.
It's nice to see some new names here. I think we've made some wonderful progress lately but the more input the better. I think we can end up with an article that really addresses the key features of alcoholism while creating some sections within which all perspectives can be explained.
~~Drgitlow 23:02, 5 July 2006 (UTC)[reply]~~
~~Request For Editorial Consensus~~

~~For now, can we agree or disagree on the following two initial sentences of of the existing definition:~~

Alcoholism is the use of alcoholic beverages—which contain the drug ethanol—to the extent that such use causes physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life.[1][2] Such chronic use causes a diseased condition marked by psychological and physiological disorders.
~~Please show your approval or disaproval with your signature thusly:~~
Approve <signature>

Disaprove <signatue>
~~Indicate your position below this line~~

~~approve Mr Christopher 23:15, 5 July 2006 (UTC)[reply]~~
I am not changing my "vote" but ethanol seems to be the hot topic so I thought it's worth mentioning I have already expressed my concern about ethanol and I'd be in favor of seeing it go. It could prove to be relevant elsewhere else but not in the definition. Mr Christopher 04:29, 6 July 2006 (UTC)[reply]
~~Approve - relatively clear and concise, but hits the most important points. Well done :) --Doc Tropics ^{Message in a bottle} 23:55, 5 July 2006 (UTC)[reply]~~
Comment: after reading later contributions I agree that the hyphenated ethanol statement could be deleted or moved to help maintain continuity. --Doc Tropics ^{Message in a bottle} 03:58, 6 July 2006 (UTC)[reply]
Approve Medical Man 01:44, 6 July 2006 (UTC)[reply]

Approve (am OK with either "use" or "consumption")(am also OK either keeping or removing the hyphenated statement about ethanol) Drgitlow 03:52, 6 July 2006 (UTC)[reply]

Disapprove Robert Rapplean 07:05, 6 July 2006 (UTC) I believe that the current first sentence fails to differentiate between a person who hasn't figured out that alcohol is harming them and a person who knows that it's harming them but can't quit on their own.[reply]
Oops, Robert. I earlier missed your comment about the "--which contains the drug ethanol--" being unnecessary and breaking the continuity of thought, to which I totally agree. Therefore, I don't think the current first two sentences are completely acceptable. I apologize.Medical Man 03:12, 6 July 2006 (UTC)[reply]
Medical Man, are you changing your previous "agree" to "disagree"? It's not clear to me in your comments, I'm cool either way, no need to apologize, I just want to make sure we're on the same page. And if that is the case I'd be hip to you changing your approval above and adding a comment like "previously agreed" or something for clarity.
Chris- Thanks for your understanding. I don't want to slow up the good progress that's recently been made and I think drgitlow's suggestion below neatly solves the problem.Medical Man 15:49, 6 July 2006 (UTC)[reply]
Robert, I read your latest comments and agree with you on much of it. I do not believe this will be the final word on the definition but to me it will give us a "beta" version, one that isn't exactly the way I would personally write it but it does not offend the senses. I view it as a editorial compromise that does not compromise the integrity of the article. I think the average reader would find it sensible. I agree it is imperfect and if we fail (in this round) to get consensus on the first two sentences we'll simply try again. Mr Christopher 04:08, 6 July 2006 (UTC)[reply]

I want to be clear, I was mainly taking about the first two sentences in my comments to you above, Robert Rapplean. Since that is what I am currently proposing we agree or disagree on. I too have some issues with some of the rest of it that I'll view and seek comments on after we decide about the first two sentences. Sorry if I seem anal, just wanting to be clear. Mr Christopher 04:12, 6 July 2006 (UTC)[reply]
I agree the "which contains the drug ethanol" breaks up the sentence badly, but something in reference to "drug" or "ethanol" or "Effects of alcohol on human body", or whatever that article is called, should remain. —Centrx→talk • 07:23, 6 July 2006 (UTC)[reply]
Centrx, I agree in that that ethanol belongs at least somewhere in the article. Since this seems to be an editorial sticking point, at least as it is currently written and in the opening sentence/definition, would you feel comfortable if we either put it elsewhere in the article or put it on ice for the time being where we can revisit the merits of it being in the opening definition later? And by the way, you're being an exception sport about us all sitting here nitpicking your handy work. I appreciate it. Mr Christopher 15:05, 6 July 2006 (UTC)[reply]
FYI there is some good stuff on ethanol in the Alcoholic Beverage article! Mr Christopher 15:17, 6 July 2006 (UTC)[reply]
It's unfortunate that alcohol is a generic term that refers to a variety of chemical substances that include ethanol, when really the only one we're concerned with here is ethanol. I suppose a more precise term would be Ethanolism. I don't suppose we could be single-handedly responsible for changing the terminology (though we could certainly try). Given that alcoholism is really talking only about ethanol use (consumption), it seems that we could change the first line to read "Alcoholism is the consumption of ethanol-containing beverages to the extent that such use...." Drgitlow 15:22, 6 July 2006 (UTC)[reply]
~~I agree with drgitlow's suggestion, which is both accurate and solves the problem.Medical Man 15:49, 6 July 2006 (UTC)[reply]~~
I don't want to be a stick in the mud but it still seems odd to me. In view of what FloNight added below, and as a compromise, how would you folks feel about us not putting the ethanol portion in the definition section, but instead make it the subject of the section following the definition where we could elaborate on the subject? So in effect we'd have
Alcoholism - here is our handy definition of alcoholism - yadda yadda

Alcohol - this is what constitutes alcohol, the key term here would be ethanol (yadda yadda).
~~Does that seem reasonable? Mr Christopher 16:55, 6 July 2006 (UTC)[reply]~~
To address my most recent comments, there is good stuff about ethanol on the alcoholic beverages article, but sadly it is not well cited. Stuart, on the ethanol topic I'd lean towards us handling it in a similar fashion on the alcoholic beverages article. Obviously I want to cite it better than what we see there but I think giving ethanol it's own section (within the article, not a spin off) makes sense to me. Mr Christopher 15:28, 6 July 2006 (UTC)[reply]
As for specialized terminology, we can still use the word "alcohol" rather than "ethanol", and either link it to Ethanol or to Effects of alcohol on the body. To clarify though, don't let this argument hold up the process of streamlining the introduction by removing this clause, at least temporarily. —Centrx→talk • 21:32, 6 July 2006 (UTC)[reply]
~~Regarding the nature of alcoholism~~
Question for Robert: You're right, it doesn't address that issue at all. I know that the distinction is important, but do you think it's absolutely necessary to address it in the very first sentence? I'm a fanatic about preserving useful information and I don't think anyone is suggesting that this point be excised, just shuffled around a bit. Could we, for the sake of our Hypothetical Reader, simply clarify that point later in the article? I'm hoping that if we can achieve even a general consensus on the intro it will give us a fresh start on collaborative editing and help the article move forward :) --Doc Tropics ^{Message in a bottle} 16:12, 6 July 2006 (UTC)[reply]
I'm afraid this is a bit of a sticking point with me. This definition states that drinking=alcoholism. If that were the case, there would be no studies which measure time until relapse. Once you stop drinking, you'd be cured. Because of this, I think that the first sentence dangerously mischaracterizes the problem.
The essential problem with alcoholism isn't that the alcoholic drinks. The problem is that they can't stop drinking. It's the urge to drink regardless of obvious consequences that identifies an alcoholic, not the actual consumption. This is an essential fact about alcoholism that must be understood for a person to understand alcoholism. I'll go even further to say that this is one of the biggest misunderstandings in the public regarding alcoholism, and results in the greatest amount of mistakes in its treatment outside of the medical field. I'm afraid I can't accept any description that doesn't address this. Robert Rapplean 17:11, 6 July 2006 (UTC)[reply]
Thanks for taking the time to make such a thorough reply; I understand and respect your postion on this. Flonight has given us an excellent guideline in a new section just below this. Let's try to find an intro that will satisfy everyone, but still be accessable to an "average" reader. To help get started can you give us an example of what you think would be a better wording for the intro? Since it seems that the rest of it is (mostly) acceptable to everyone, can we still use that as a framework and just add the necessary distinction? --Doc Tropics ^{Message in a bottle} 17:38, 6 July 2006 (UTC)[reply]
I think this can be achieved with a very minor change, thus:
Alcoholism is the urge to consume alcoholic beverages to an extent that results in physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life. The resulting chronic use can result in many psychological and physiological disorders.
Opinions? Robert Rapplean 18:27, 6 July 2006 (UTC)[reply]
Approve - This version seems to incorporate the suggestions made in discussions of the previous version and it seems very readable to me. I tried to bluelink "chronic", "psychological" and "physiological", but the results were non-useful and I didn't save that copy. --Doc Tropics ^{Message in a bottle} 18:58, 6 July 2006 (UTC) Addendum - I tried to bluelink from this page but didn't get the tags right. The bluelinks from the article page are good. --Doc Tropics ^{Message in a bottle} 19:07, 6 July 2006 (UTC)[reply]
Comment - I have temporarily stricken my Approval pending resolution of Mr Christopher's concerns (see below).
The opening sentence has two cites for reliable sources, those sources are other online encyclopedias. It's worth noting neither of them use the term "craving" or "urge" in their definition of alcoholism. Those references are well worth reading and are pretty NPOV in my opinion (at least the definition, they get a bit goofier as they go deeper in the subject). Robert, what reliable sources do you have to support this sentence you are suggesting? And as far as my own opinion goes, I am not in favor of using terms like "urge" or "craving" in the opening definition and feel things like urges and cravings (and things like the idea of time abstinence) belong elsewhere in the article. If you have not already, I really suggest folks read the two existing references and see exactly how other online encyclopedias handle this subject. My $.02. Mr Christopher 18:50, 6 July 2006 (UTC)[reply]
Ok, let's do some citing. NIAAA attempts to explain craving mechanisms, American Academy of Family Physicians describes craving as a symptom, Alcohol Craving in Problem and Occasional Alcohol Drinkers from the Oxford Journal of Medicine, What Is Craving? Models and Implications for Treatment from Alcohol Research & Health, Fall, 1999. I have to admit that this entire argument has caught me rather flatfooted. It's almost like trying to explain to people that pain is a symptom of a broken leg. Where would you go to cite articles about that? If alcoholics don't crave alcohol, why is it so hard for them to stop drinking? Robert Rapplean 20:09, 6 July 2006 (UTC)[reply]
Now we come to the heart of the matter...Robert made a wonderful comment above: alcoholism is NOT about the fact that the alcoholic drinks. Here's the best part, though: it's not about the alcohol at all. What I'm about to say isn't what I'm looking for the article to say; it's mostly opinion. Alcoholism is a condition in which the disease is all about the individual's discomfort when they're NOT drinking, discomfort that is so omnipresent and harsh that when the individual discovers that alcohol helps them feel better, albeit briefly, they continue to drink despite the hardship that such use brings. That's what leads to what I always tell alcoholics at their intake visit: once you stop drinking, then we'll start treating your alcoholism. That's when we'll be able to work on getting you to feel better.
Done with opinion now. I'm really sincere about our need to stay away from the term "craving." Although you WILL be able to find plenty of citations in which educated scientists speak of craving and alcohol in the alcoholic, for the most part such studies come from people who were originally trained in opioid dependence, or who don't distinguish among the various addictive conditions. Those of us who focus in the sedative/alcohol dependence world recognize that the sedative/alcohol dependent patients don't have "craving," at least not in the way that most people would define the term. Alcoholics use impulsively or chronically but not out of a craving. Drgitlow 23:30, 6 July 2006 (UTC)[reply]
~~Common ground~~
~~I think we're very close to something useable and it's just a matter of a couple of words. Let's try to find the common ground between these two:~~
Alcoholism is the consumption of alcoholic beverages—which contain the drug ethanol—to the extent that such use causes physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life.^[1]^[2] Such chronic use causes a diseased condition marked by psychological and physiological disorders.

Alcoholism is the urge to consume alcoholic beverages to an extent that results in physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life. The resulting chronic use can result in many psychological and physiological disorders.
~~What about this:~~
3. Alcoholism is the consumption of, or preoccupation with, alcoholic beverages to an extent that such use causes physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life.^[3]^[4] The resulting chronic use can result in many psychological and physiological disorders.
~~Opinions? --Doc Tropics ^{Message in a bottle} 20:23, 6 July 2006 (UTC)[reply]~~
Note that "addictive medical condition" is one of two major meanings, the other being "chronic excessive drinking". A person who no longer drinks could be considered an "alcoholic" under the first meaning, while a frequent, heavy, deleterious drinker who does not appear to satisfy the medical diagnosis can still be considered an "alcoholic" under the second meaning.

Clearly, it seems that the medical diagnosis is currently prevalent in the field, but the fact remains that all general sources do include that other meaning and it is not necessarily clearcut to distinguish between the two.

The primacy of the medical diagnosis may also be a recent phenomenon: The OED, 1989, whose definition appears to be primarily based on the 19th-century meaning, has alcoholism: "The action of alcohol upon the human system; diseased condition produced by alcohol." All of the quotations, spanning 1852 to 1882, indicate the "excessive drinking" meaning, not the "addictive medical condition" meaning. If the article is to be specifically about the modern medical definition, then that needs to be explicitly stated, and the other definition still warrants mention as it is the origin of this meaning. —Centrx→talk • 21:53, 6 July 2006 (UTC)[reply]
It sounds like we need to add a section for "Historical treatments of Alcoholism", or maybe "Historical views of Alcoholism". It seems reasonable that the main article would deal with contemporary views, but there is a lot of historical info that would be interesting and useful. --Doc Tropics ^{Message in a bottle} 22:18, 6 July 2006 (UTC)[reply]
There's no question that alcoholism has been redefined over the years. One of the reasons for the 1992 JAMA article was as an attempt to bring consensus to an area that had previously been fraught with multiple perspectives. If anyone had said that there's poor consensus in defining alcoholism, I'd be the first to agree. Still, I think it is reasonable for us to use more recent definition sources, at least for the first paragraph, then potentially explore earlier ones later in the article. The '92 definition does not talk of excessive use or of craving or of urges. The first paragraph above labelled "1." works. So does the third one, because preoccupation is spoken of in the DSM-IV definition. The second one doesn't quite fit. When you get right down to it, alcoholism is the repeated use of ethanol despite one's best interests. But we can't really say that, can we? Drgitlow 23:38, 6 July 2006 (UTC)[reply]
Heh, heh...if we could write the whole article at that level we'd be done in an hour. It seemed that there were hang-ups with both versions 1 and 2 so I tried to distil the commonalities into #3. --Doc Tropics ^{Message in a bottle} 00:40, 7 July 2006 (UTC)[reply]
~~I think you did an excellen job, Doc. Does everyone else find definition #3 to be acceptable?Medical Man 01:15, 7 July 2006 (UTC)[reply]~~
Agreed! Yes. Drgitlow 01:30, 7 July 2006 (UTC)[reply]

Agreed! (#3 is excellent and has my full support) Mr Christopher 14:34, 7 July 2006 (UTC)[reply]
Needless to say, I'm thrilled that we seem to be achieving something like consensus on this. I'm just waiting to hear from R. Rapplean before making any changes to the article itself. I'd also like to hear from Centrx, but he's a busy guy and his contributions may be infrequent. My thanks to all of you for being willing to work together and compromise for the sake of the article. --Doc Tropics ^{Message in a bottle} 15:38, 7 July 2006 (UTC)[reply]
In a brief exchange on his Talkpage, Centrx→talk expressed "no serious objections" to the proposed intro and suggested that we might as well proceed. I'm going to make the change in the article now, but if anyone, especially Robert Rapplean (who didn't have a chance to comment yet) does have a serious objection, then we can revisit it. Otherwise, I think we're ready to tackle the next sentence :) --Doc Tropics ^{Message in a bottle} 18:06, 7 July 2006 (UTC)[reply]
As mentioned I am in favor of door number three, but based on the history of this article, I'd really like to get Robert's opinion/buy off on this prior to making any changes. Again, based on the history until Robert buys off I do not feel we have consesus and for us to make changes without his opinion, if nothing else, looks bad. Mr Christopher 18:21, 7 July 2006 (UTC)[reply]
~~Manual of style: lead section~~
Manual of style, a guide not a policy suggests:
In general, specialized terminology should be avoided in an introduction. Where uncommon terms are essential to describing the subject, they should be placed in context, briefly defined, and linked.
Thought this might help. You all are making real progress. Keep up the good work. --FloNight ^talk 15:40, 6 July 2006 (UTC)[reply]
~~Intro, second half~~
I'll copy in the remainder of the intro below this (I took the liberty of bluelinking "disease"). I wanted to offer an observation about cites: Cites are a good thing in any article and a necessity in a complex article, but the presence of 7 cites at the end of a single sentence suggests that a rewrite might be in order for the sake of clarification. Regarding the actual content of these sentences, I have no problems with what's being expressed there, but this is where your collective expertise is so important: is there a general consensus that this is a good representation of the issue?
Most medical clinicians consider alcoholism an addiction and a disease influenced by genetic, psychological, and social factors and characterized by compulsive drinking with impaired control, and preoccupation with and use of alcohol despite adverse consequences. However, the disease theory is still controversial and there is disagreement on the issue after 200 years of debate. U.S. Supreme Court decisions, books and scientific journal articles demonstrate this lack of consensus.
Yes, why don't you pare down the references to what you think appropriate. Thanks,Medical Man 18:58, 7 July 2006 (UTC)[reply]
I'm going to be in a meeting for the rest of the afternoon, but I'll check in this evening. If no one else has started by then I'll have a go at it. If all 7 cites are necessary (I haven't read through all yet) then I would look at simply re-arranging things so that it's a bit tidier. My initial thought is that having more than 2 cites per statement ends up confusing rather than clarifying the issue. --Doc Tropics ^{Message in a bottle} 19:14, 7 July 2006 (UTC)[reply]
Gentlemen, I do not feel we have consensus yet on the first section/sentence yet that sentence has now been changed in the article which puts Robert in an awkward position should he object to it. I can't speak for Robert and I think "preoccupation" is an excellent compromise but he has yet to chime in and has expressed specific concerns regarding the opening sentence/para. Respectfully, can we wait for consensus on the first section before pressing on to the next? Mr Christopher 19:24, 7 July 2006 (UTC)[reply]
~~No problem. And I don't think Robert should feel diffident about voicing any objection(s) he might have.Medical Man 20:09, 7 July 2006 (UTC)[reply]~~
~~My apologies if I jumped the gun. I reverted myself until we have full consensus. --Doc Tropics ^{Message in a bottle} 20:53, 7 July 2006 (UTC)[reply]~~

^ Medline Plus Medical Encyclopedia (May 2006), s.v. "Alcoholism". Retrieved July 3, 2006 from http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm.

^ Encyclopædia Britannica Online (2006), s.v. "Alcoholism". Retrieved July 3, 2006.

^ Medline Plus Medical Encyclopedia (May 2006), s.v. "Alcoholism". Retrieved July 3, 2006 from http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm.

^ Encyclopædia Britannica Online (2006), s.v. "Alcoholism". Retrieved July 3, 2006.

[1] Medline Plus Medical Encyclopedia (May 2006), s.v. "Alcoholism". Retrieved July 3, 2006 from http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm.

[2] Encyclopædia Britannica Online (2006), s.v. "Alcoholism". Retrieved July 3, 2006.

[3] Medline Plus Medical Encyclopedia (May 2006), s.v. "Alcoholism". Retrieved July 3, 2006 from http://www.nlm.nih.gov/medlineplus/ency/article/000944.htm.

[4] Encyclopædia Britannica Online (2006), s.v. "Alcoholism". Retrieved July 3, 2006.

[1]

[2]

[3]

[4]

To and From the authors of this article and from again

Alcoholism is an illness

Alcoholism is not an addiction

Asking a chemical dependency counselor about alcoholism is about tantamount to asking an illiterate person to teach you how to read.

If you want to know about alcoholism ask a recovered alcohlic not a counselor that has read some books.

AA does not claim to have a corner on the treatment of alcoholism. However, it has the greatest success rate of any

Someone said something about a cure to alcoholism. There is none.

Alcoholsim is a physical disease with a spiritual solution.

Hey

Physical Dependence vs. Addiction

Leave Arguing about Alcohol to Medical Professionals

Tags

Alcoholism is clearly not a disease

Using the AMA/APA POV for this article

Intro Redo III

Consensus

Logical Moves

Alcoholism as a disease

drgitlow edits

Alcoholism as a disease

Mediation

Encouragement

Accuracy and integrity are essential

There is no consensus

Paging Doctor S Gitlow

The Benjamin Rush edit

POV Arguments

MedicalMan Edits

What's a pundit?

"The Disease model of addiction is probably the most controversial and debated topic in the entire field of substance abuse/addiction"

APA vs APA

Justice White Quotation

“The debate on whether alcoholism is a disease or a personal conduct problem has continued for over 200 years.”

"The disease concept remains controversial”

The Myth of Alcoholism as a Disease

Disease model not popular in countries where it's not profitable

There is currently no consensus about the disease theory

Working through content disputes

Work on new wording for "a few non-medical alcoholism pundits"

Garden-variety content dispute

Forum

Returned discussions to talk page

Please be more careful

Miscellaneous Trivia

Evidence that there is no consensus that alcoholism is a disease

Starting our work

Can we move the Disease argument to its own entry?

Medical Man Citations

Perhaps we should copy the ADHD approach

The Debate

Improved Effects section (Reposted comment from archive)

Curing by moderation (Reposted comment from archive)

Problem with "intermittent or continual"

More evidence: No consensus in alcohol treatment field

There is currently no consensus about the disease theory

Regarding Pharmacological Extinction

Definition of Alcoholism

Request For Editorial Consensus

Regarding the nature of alcoholism

Common ground

Manual of style: lead section

Intro, second half