Chapter 11 How Can Alcoholism and Drug Addiction Be a Disease? T I was sober for 23 months until Friday night, when I decided to test if I still really have a problem. What an idiot! My husband is away for the weekend so I drank both Friday and Saturday, and was not surprised to learn that my alcoholism is going strong. I am very sad today, and kind of brain dead. Boy, I sure didn t miss hangovers. -Reba R. 123
I can finally say I m a recovering alcoholic. I drank for 30 years and can t even count how many times I was in the hospital for alcohol poisoning, horrible isn t it. Shakes, pukes, the shits, excuse the language. I would not stop. I was in intensive care close to three years ago. I was on life support, and was suppose to die. Every one says how you have to hit bottom, well I m here to tell you I would hit bottom only to bounce right back up. After I got to feeling better, back out I would go. After getting out of intensive care, I was just so grateful to be alive and swore to myself I would never touch the stuff again. Yea right. 110 days later I drank. In the last chapter, I introduced you to the idea that alcoholism and drug addiction are a bio-psycho-social-spiritual disease. I briefly discussed what I meant by the phrase, bio-psycho-social-spiritual. In this chapter I ll discuss how it is that alcoholism and drug addiction are referred to as a disease. A disease is a pathological condition. A pathological condition is a condition that deviates from a normal condition. A disease is a pathological condition that has a cause as well as signs and symptoms. We ve already discussed what the normal condition of alcohol and other drugs consumption is in chapter 2 (How Can I Tell If I Have a Substance Abuse Problem?). A normal condition is the non-problematic consumption of alcohol and other drugs. The non-problematic consumption of alcohol and other drugs is defined as the continued consumption of legal alcohol and other drugs without the occurrence of recurring 125
ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? adverse consequences. On the other hand, pathological consumption of alcohol and other drugs is the compulsive consumption of alcohol and other drugs despite the recurrence of adverse consequences. We discussed the cause of this pathological condition in the previous chapter. The cause of the pathological condition known as alcoholism and drug addiction is the complex interplay of bio-psycho-social-spiritual variables. And of course, we ve already discussed in chapter 2 and chapters 5 through 9 the signs and symptoms of alcoholism and drug addiction. As a reminder, the individual who has a Substance Dependence problem exhibits a pattern of compulsive consumption of alcohol and other drugs characterized by three or more of the following signs occurring at any time in the same twelve-month period. Pathfinder s Checklist Diagnostic criteria for a Substance Dependence problem* 1) Continued consumption of alcohol and other drugs despite the recurrence and/or exacerbation of adverse consequences to one s emotional, physical, interpersonal, occupational, social, and/or spiritual well-being as a result of the consumption of alcohol and other drugs. 2) Important social, occupational, and/or recreational activities are reduced or given up as a result of one s consumption of alcohol and other drugs. 3) Increasing preoccupation with one s consumption of alcohol and other drugs. 4) Loss of control over one s consumption of alcohol and other drugs. 126
How Can Alcoholism and Drug Addiction Be a Disease? 5) Experiencing a withdrawal syndrome upon cessation of consumption of alcohol and other drugs. 6) Development of tolerance for the substance(s) consumed by the individual. *Based on Diagnostic criteria that appears in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition So it can be said that alcoholism and drug addiction are a disease because they deviate from a normal condition, the nonproblematic consumption of legal alcohol and other drugs, caused by a complex interplay of bio-psycho-social-spiritual variables that have specific signs and symptoms. Next, I would like to be more descriptive about what the nature of the disease of alcoholism and drug addiction is. The disease of alcoholism and drug addiction is a: Primary disease Chronic disease Progressive disease Prone to relapse disease Oftentimes fatal disease When I say that alcoholism and drug addiction are a primary disease I mean that alcoholism and drug addiction is a condition in and of itself. Alcoholism and drug addiction do not occur secondarily to some other emotional, physical, psychological, and/or moral condition(s). Instead, alcoholism and drug addiction occur solely from the complex interplay of bio-psycho-social-spiritual variables. This means that alcoholism and drug addiction are not caused by any other: 127
ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? Disease process Physical condition Psychological condition Deficiency of character Lack of willpower Lack of self-control Type of personality Moral depravity The following excerpt from Brenda B. is an example of the acknowledgement by her psychiatrist that she has a condition, problem drinking, in and of itself, not as a result of some other underlying emotional disorder. I went to a new psychiatrist last week. He was very impressed with me told me that I knew more than most people. He also told me that I have no problems, psychologically that is. He says that my problem is my drinking. Charley C. s e-mail reveals his awareness of how his alcoholism exists separate and apart from any other conditions, problems, or circumstances that exist in his life. I have seen a lot of psychiatrists. I thought I had been working on my problems, and I had many, many problems. I wanted to figure it all out, make sure that I knew what this was all about before I was going to do anything about it. I lied to the psychiatrists and anyone who would have the nerve to bring up my drinking. I could sit in the psychiatrist s office for hours, and try to rationalize all the reasons why my life was a mess. I could work on all my problems right there in the office with the psychiatrist. The only problem 128
How Can Alcoholism and Drug Addiction Be a Disease? that I wasn t willing to get honest about and work on was my own alcoholism and since that was the only problem that this drunk had, my life remained unmanageable on a daily basis. When I say that alcoholism and drug addiction are a chronic disease, I mean that alcoholism and drug addiction are life-long in duration. Once an individual has the disease of alcoholism and/or drug addiction, an individual will always be chemically dependent it never goes away. Evan E. writes about his failed attempts to make his alcoholism and drug addiction go away. No matter the method, no matter the attempted cure, Evan s disease endures despite his every attempt to extinguish its existence. No matter what I tried to do to figure out there I was right back to the drinking and drug use and my inability to control it. Just like it says in chapter three in the Big Book, I would exercise more, read inspirational books, swear off drinking in the mornings, switch from hard liquor to beer, travel. I tried to stop for my wife, my children, my parents, my wife s parents, for the courts, and all the time I was sincere, but all to no avail. This thing just never goes away. Ken K. s letter suggests the same lessons that Evan E. has learned once you ve got this disease, you ve got this disease for life. As a test I would stop for three to four months, never really missing it, start again and WHAM! The cycle would start all over again each time worse. I would click off and become sloppy drunk almost instantly. 129
ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? When I say that alcoholism and drug addiction are a progressive disease, I mean that alcoholism and drug addiction get worse over time if they go untreated and unmanaged. What this means is that there are stages to the disease of alcoholism and drug addiction. These stages contain distinct signs and symptoms. I have listed for you the stages and the signs and symptoms of each stage in Appendix A on page 187. Frankie F. s letter expresses how the disease of drug addiction gets progressively worse over time whether or not there have been intermittent periods of abstinence. The first time I quit cold turkey. Almost a year went by and one day I felt bad. I said I can control it. I will only take one. WAS I WRONG. The second time was worse than ever. I was taking five to seven Percocet at a time. Gail G. knows only too well the progressive nature of the disease of alcoholism. I ve relapsed five times in 28 years. What I ve noticed is that my relapses have become progressive. It didn t matter the amount of sobriety between the relapses. I would begin to drink more and more often each time I went back to drinking. Kathy K. s consumption of marijuana escalated over the course of eight weeks even after being abstinent from marijuana for eighteen years. I quit smoking marijuana eighteen years ago. About two months ago I started smoking it again. It didn t take long for me to become very addicted to it. I know there is a lot of controversy about whether it s addictive or not, but I know it is for me. My first 130
How Can Alcoholism and Drug Addiction Be a Disease? quarter bag lasted a month. My second lasted two weeks. And now I m smoking a quarter in a week. I can t have it in my possession or I want to smoke it all day long. Period! Irving I. s wife reports that his drinking escalated after a brief period of abstinence followed by an even briefer attempt at controlled drinking. I am the wife of an alcoholic and I don t know what to do. We separated five years ago. Then he quit drinking and stayed sober for about 3 months. Then started back up, very controlled and moderate and I really didn t have a problem with it. Well not anymore. He s worse than ever. He s drinking anywhere from twelve to sixteen beers a night. When I say that alcoholism and drug addiction are a relapsing disease, I mean that this disease is characterized by a vulnerability to relapse. Because alcoholism and drug addiction are chronic in nature, no matter the period of time that the disease of alcoholism and drug addiction is treated and managed, the chemically dependent individual will always be vulnerable to relapse that is returning to the consumption of alcohol and other drugs in a compulsive out of control manner. John J. knows too well how easily relapse can sneak up on somebody. It s so hard to admit this but I have relapsed AGAIN. I ve been trying for six years to get and stay sober the longest I ve ever managed was a year and one week. I can t believe how automatically I drove to the store to get wine. Bottles and bottles of it, and drank all weekend up until about 9 P.M. last night. Of course, this morning I woke up sick, barfing and shaking 131
ASK DR. STEVE... How Can I Tell If I Have a Problem with Alcohol and Other Drugs? Lorna L. has watched her husband struggle with maintaining sobriety after having fallen prey to the process of relapse. We were both in recovery until last November when my husband relapsed after twenty-one months clean. He continues to relapse with alcohol and pot and speed daily When I say that alcoholism and drug addiction are a potentially fatal disease, I mean that alcoholism and drug addiction can be and is oftentimes deadly. Alcoholism and drug addiction can cause death by causing damage to one s vital organs such as heart, kidneys, and liver. Alcoholism and drug addiction can also be fatal when it s associated with overdose, suicide, and accidental deaths. Marvin M. knows first hand how alcoholism can be contributory to and the cause of someone s death. I knew that no good would come of her continued alcohol abuse. I was slowly and progressively losing the woman I had married, and she was only 41. By the age of 42, she had gone onto chronic drinking, and her health suffered. Finally, she was diagnosed with terminal liver disease. Her alcoholism pushed it past the point of regeneration. She died at the age of 42. Nancy N. also knows how alcoholism can lead to the death of a friend or loved one. My friendly neighbor passed away on Friday. She was a diabetic with heart problems, and a bad drinker. She drank all kinds of vodka and stuff. Before she died she would fall and pass out and we neighbors had to help her up. She would cuss at us and say she 132
How Can Alcoholism and Drug Addiction Be a Disease? hated us but she didn t mean it. What killed her was vodka on top of her heart failure and diabetes. To say that a chemically dependent individual has a disease is NOT making excuses for them. An individual who s chemically dependent is no more to blame or to be held responsible for having their disease than is an individual who has diabetes or asthma. Having said that no one should be blamed or held responsible for having developed the disease of alcoholism and drug addiction, let me be perfectly clear, every person who has the disease of alcoholism and drug addiction should be held accountable for the treatment and long-term management of their disease. In Chapter 12, Why Do I Need to Stay Abstinent From ALL Alcohol and Other Drugs?, I ll discuss the first step to take if you intend to manage your disease of alcoholism or drug addiction. 133