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Saturday, August 20, 2011

Is there a generally accepted physical mechanism that explains alcohol addiction?

I created this blog in response to an issue that kept arising in LinkedIn discussions about addiction;

What is the cause of alcohol addiction, and what can be done to treat the cause successfully?

Most of the LinkedIn discussions dealt with the 12 Step approach to treatment.  With those favoring 12 Step programs proclaiming that only strict obedience to the principals articulated in the Big Book of Alcoholics Anonymous could help alcoholics stay sober, and those opposed generally attacking the 12 Step approach for being quasi-scientific or for requiring acceptance of a Higher Being Who could and would relieve the alcoholic's addiction if He were accorded the correct propitiation.

As both a recovering alcoholic with over 13 years of daily attendance at 12 Step Meetings and as a psycho-pharmacologist with over 20 years research experience at Harvard Medical School, I realized that both pro and con arguments assumed that the basic defect causing some people to crave alcohol had to do with a "spiritual loss of values," thus making the  disease of alcoholism by definition an affliction of those who were ignorant of or who had rejected the moral imperatives of Christianity.

In essence, nearly all the LinkedIn discussions about alcohol addiction hinged on a system of beliefs rather than evidence about a disease process that results in devastating physical deterioration.  If alcoholics only suffered from inappropriate behaviors alone, or behaviors that a Christian would find repugnant - without any other characteristic psychophysiology - then accepting spiritual salvation would be the "cure" for the alcoholic without which no improvement could be possible. Furthermore, the obverse would also be true - that those who could not stay sober would have to be suffering from profound moral decay manifested by a definite pattern of seriously reckless and illegal behavior.  The physical manifestations would not be the defining characteristics of the illness.   The thought of a chronically relapsing alcoholic would who was not also a criminal would be unthinkable.

This is not far from the status quo for American alcoholics and those who abuse other substances that follow a pattern of cravings and relapses.  In America, addiction is definitely a moral/criminal issue.  We imprison and stigmatize those who cannot stay sober AS IF they were simply bad people who could be driven into submission by determined civil authorities with the power to imprison rather than an obligation to do biomedical research. 

The cynic in me wants to say that, here, we lock up our treatment failures.  We marginalize those who lack the financial means to live a law abiding life.  We disenfranchise anyone who has done jail time - for which the most common crime is possession of substances that have been made illegal by the same people who profit from running prisons and chasing down users.      

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