I’m about three weeks from being done with my first semester of grad school. From there, only three more semesters until I have a Master’s in Clinical Psychology. I’ll be pretty happy for a break, but I genuinely missed being in school. The following was written for Abnormal Psychology in response to the question:
Do you feel that alcoholism is a disease or a failure of will power and self-control? Why?
Etiology of a disorder is important for a number of reasons, particularly when it comes to directing treatment options. Is the disorder primarily biological, necessitating a more medical approach; or is it environmental, such that treatment will be more cognitive and/or behavioral. For alcoholism it seems the jury is still out. There’s a prevailing school of thought siding with the disease model, going so far as to suggest a “gene for alcoholism.” Likewise, there’s a pushback from those who believe alcoholism results entirely from a failure of willpower. Taken individually, neither side provides a full picture of the disorder. For this reason, I feel alcoholism is neither a disease nor a failure, but a combination of a predisposition to certain personality traits, environmental effects, and a lack of adaptive coping strategies.
There’s a very small cluster of disorders that research has found a “gene for;” examples include Huntington’s disease, cystic fibrosis, and Tay-Sachs. The disease model of alcoholism tends to portray the disorder in this light; however, research has yet to find a psychiatric disorder that is inherited in this manner. It is true that alcoholism has been shown to run in families, but to say there’s a gene for alcoholism simplifies the issue far too greatly. When considering inheritance, one must look at the traits associated with alcoholism, such as aggression, anxiety, and impulsivity. This follows with research showing alcoholism is polygenic, and accounts for those who lack a family history of the disorder.
People who lack self-control, regardless of whether or not alcohol is involved, would more than likely exhibit aggression, anxiety, and/or impulsivity in some way or another. The inability to exert willpower over the choice to drink alcohol is a result of an inability to control these traits in the face of stressors, particularly after having had an example of alcohol use as stress control. A person develops this over time, potentially beginning in an alcoholic household; a person could also observe peers or celebrities drinking to excess, a family member need not always be the example. Alcohol begins to function as a maladaptive coping mechanism, or a way by which a person can regulate their emotions.
Treatment is, of course, primarily composed of the 12-step program. Though it does a lot of good, the program assumes the disorder is for life, and alcohol becomes something a person can never again come into contact with. It turns alcoholism into a self-fulfilling prophecy; if someone were to relapse there’s a built in excuse that alcohol can never be conquered and once it touches the lips a cycle begins that can’t be stopped. We would never conceptualize a depression relapse like this; if a person began to slip into depression again we would encourage them to use coping skills to head off a full-blown episode. Thinking about alcoholism as a need to learn to handle one’s emotions in a more effective manner instead of some immovable force may make it more treatable.
The etiology of alcoholism can often lead to heated arguments seeking to assign responsibility for the disorder. In the extremes, it either lies with a person’s genes or solely on the choices they make. Meeting in the middle, a person is dealt a genetic card of a predisposition to certain traits and is then exposed to an environment that either teaches or deprives them of the tools to effectively adapt to stressors. It is neither a disease nor a lack of willpower, but manifestation of the diathesis-stress model.