The Alcoholic´s Mind

Recently, while researching the literature for a longer essay on whether AA works, I came across Understanding the Alcoholic's Mind by Arnold M. Ludwig, one of my most enjoyable reads ever on addiction: Here are some excerpts:

There is no general agreement about the nature, cause, or treatment of alcoholism. What is an alcoholic? Where does one draw the line between problem drinking and alcoholism, between alcohol dependence and addiction? Is alcoholism one disorder or a collection of different disorders? Is it a moral failing, a bad habit, or a disease? Do alcoholics have distinctive personality features? Is alcoholism hereditary or learned? Does excessive drinking represent a symptomatic expression of an underlying conflict or is it the primary problem itself? Which treatment approach, if any, is most effective? Who is best qualified to help? The questions can go on and on. There are no scientific answers. In the absence of facts, opinions and beliefs tend to prevail. Sometimes they seem paradoxical and inconsistent. Consider the following.

• "Hitting bottom" is presumed to be a necessary step for recovery. even though being in dire straits, for all other illnesses, usually indicates a poor rather than favourable diagnosis.


• Recovery from alcoholism - at least according to Alcoholics Anonymous - depends upon admission and acceptance of helplessness by the alcoholic. To gain control over the disease, the individual must relinquish his personal will to that of a Higher Power and to the community of fellow alcoholics. In effect, the acceptance of personal weakness becomes the basis of strength.


• Along with other addictions, alcoholism is unique in the extent to which the individual is blamed if the treatment fails. If the alcoholic does not remain abstinent, therapists and staff presume that he is unmotivated for or unreceptive to help.


• In many hospital treatment settings, alcoholics are immediately discharged from the program if they are presumed to be uncooperative, unmotivated, setting poor examples for others, or if they are found to be intoxicated or drinking on the premises. In other words, they are not regarded as suitable for treatment if they show evidence of their sickness; namely, an inability to control their drinking. The catch-22 is that they must remain sober in order to receive help.


• Alcoholism represents a disorder in which alcoholics presumably cannot refrain from drinking, yet most therapeutic programs expect them, once abstinent, never to consume that first drink.


• Alcoholics are regarded as "sick" - at least for purposes of hospitalization or treatment - but society tends to hold them responsible for their transgressions or crimes.


• Alcoholism as a disease is still presumed to exist even when an alcoholic has been sober for years. Once an alcoholic, always an alcoholic, as the saying goes. Even with cancer, the prognosis is not that grim.


• Because alcoholism is regarded as a "disease", certain therapeutic agencies do not hold alcoholics responsible for the harm caused by past drinking, but they do regard them as responsible for their present and future behaviors, an important and interesting distinction.


• Alcoholism is the only "disease" for which communion with a Higher Power is regarded by many as an essential element for recovery. Even physicians who are otherwise wary of the role of religion in medicine and rely primarily on drugs and procedures of proven, scientific merit for the treatment of serious illnesses, endorse participation in Alcoholics Anonymous, which has a strong spiritual emphasis, as an importnat component of therapy.


• Alcoholism is a "disease" in which characteristic symptoms, such as urges and cravings to drink, can appear mysteriously at certain times, for example, during evenings and weekends, and be absent at others, as at work or at church. With the exception of other addictions, what medical diseases are so dependent on the mental expectations of the sufferers and the physical settings in which they exist?


• When uncomplicated by medical problems, alcoholism is assumed by many to be better treated by those who have suffered from it than by trained professionals who never have. Alcoholism is the only "disease" about which the recovered patient is presumed to know more than the doctor.


• Alcoholism is the only disorder for which the label of "alcoholic" is regarded as a stigma or a moral condemnation by some and a badge of honor by others, the qualification of automatic membership into a fellowship of like-minded sufferers. Unlike individuals with cancer, hypertension, or other medical diseases, alcoholics tend to become defined by their disease, which presumably obliterates their individuality, putting them on the same footing as other alcoholics. They are alcoholics first and foremost, even when sober, rather than individuals with a drinking problem.

With all these paradoxical claims, it is not surprising that so many claim expertise in this area.