This book (which continues as a best seller on the Amazon.com substance abuse and addiction lists) is the classic statement of the antidisease point of view. In this chapter, Stanton tackles the key elements of the disease model of addiction: that alcoholism and addiction are progressive, inbred, unconscious, insensitive to environmental variation, and amenable to AA and disease treatments. In showing that these are erroneous and harmful misconceptions, Stanton deconstructs two famous works in the disease canon, Jim Milam's Under the Influence and George Vaillant's The Natural History of Alcoholism.

Order the book

In: Peele, S. (1989, 1995), Diseasing of America: How we allowed recovery zealots and the treatment industry to convince us we are out of control. Lexington, MA/San Francisco: Lexington Books/Jossey-Bass.

Diseasing of America

3. Who Says What the Truths about Alcoholism Are?

Stanton Peele

AA, treatment centers and alcohol counseling are the only known successful methods of arresting the compulsion to drink or take drugs. Alcoholism was totally untreatable and fatal until 1935, when A.A. was founded.
—Ruth Harris, WomenSpace Shelter Project, Cleveland

What we "know" about alcoholism, like the points in Ruth Harris's quote above, has been determined by an active group of proselytizers for AA and the alcoholism movement, most of whom are alcoholics. These advocates have had very specific experiences with drinking. At the same time, many of their experiences and views were distinctive even before they became alcoholics and were in fact quite different from those of people less likely to become alcoholics. Nonetheless, public opinion surveys show that Americans at large have accepted all or most of the contentions of the modern alcoholism movement. Still, not everyone agrees.

The core beliefs that the alcoholism movement has successfully promulgated are:

1. Alcoholics don't drink too much because they intend to, but only because they can't control their drinking.
2. Alcoholics inherit their alcoholism and thus are born as alcoholics.
3. Alcoholism always grow worse without treatment, so that alcoholics can never cut back or quit on their own.
4. Alcoholism as a disease can strike any individual—it is an "equal-opportunity destroyer"—and respects no social, religious, ethnic or sexual bounds.
5. Treatment based on AA principles is the only effective treatment for alcoholism—in the words of one proponent, a modern medical "miracle"—without which no one can hope to arrest a drinking problem.
6. Those who reject the AA approach for their drinking problems, or observers who contradict any of the contentions about alcoholism listed here, are practicing a special denial that means death for alcoholics.

These keynotes to the AA and National Council on Alcoholism perspective existed before any research had been conducted to verify them—they represent folk wisdom. This folk wisdom has come to be accepted by most Americans. For example, according to a 1987 Gallup poll, 87 percent of Americans endorse the idea that alcoholism is a disease (although only 68 percent express strong agreement with this idea). This figure has increased steadily, jumping from 79 percent who agreed in 1982, as Americans are told they must accept the "truths" of alcoholism, which are said to represent modern scientific breakthroughs in our understanding of drinking problems. For example, Gallup presented Americans growing acceptance of the disease viewpoint under the heading "Misconceptions About Alcoholism Succumb to Educational Efforts."¹

The actual scientific evidence, however, strongly contradicts the contentions of the alcoholism movement. or example, the standard wisdom is that AA is unmatched in effectiveness for dealing with alcoholism and that alcoholism would be licked is only everyone joined AA. Certainly, many people who belong to AA tell us that AA stopped them from drinking. However, this no more demonstrates the general effectiveness of AA than testimony that some people decide not to kill themselves after they discover Christ is evidence that Christianity is the cure for suicide. In fact, research has not found AA to be an effective treatment for general populations of alcoholics. Consider the following summary by researchers at the Downstate (New York) Medical Center Department of Psychiatry:

The general applicability of AA as a treatment method is much more limited than has been supposed in the past. Available data do not support AA's claims of much higher success rates than clinic treatment. Indeed, when population differences are taken into account, the reverse seems to be true.²

Not one study has even found AA or its derivatives to be superior to any other approach, or even to be better than not receiving any help at all for eliminating alcoholism when alcoholics are assigned to different kinds of treatment. At the same time, other methods that have regularly been found to be superior to AA and other standard therapies for alcoholism have been completely rejected by American treatment programs. To preview the startling proposition that therapies that are universally advocated have already been shown to be ineffective and that more effective approaches are available, consider the prevailing approach to drunk-driving convictions in America—remanding drinking drivers for treatment. Advocates of a humane, informed approach to the problem continually plead for more referrals and bemoan primitive programs that simply arrest, imprison, or place on probation those caught driving while intoxicated (DWI). Meanwhile, comparative studies of standard treatment programs versus legal proceedings for drunk drivers regularly find that those who received ordinary judicial sanctions had fewer subsequent accidents and were rearrested less.³

While standard disease treatments and education programs for drunk drivers have conclusively been shown to fail at their mission, nondisease rehabilitation programs—such as those teaching DWIs social skills (like those needed to reject additional drinks), enhanced personal responsibility in decision making, and methods for drinking moderately—have shown beneficial results.⁴ Yet almost no such nondisease programs for drunk drivers remain in the United States, and those few are under strong attack. In 1985, the attorney general of New York and the State Division of Alcoholism and Alcohol Abuse attempted to close such a program in Rochester, although the program had operated successfully for years under the auspices of the county DA's office. (Eventually, the New York State Supreme Court ruled in favor of the program, Creative Interventions, mainly on technical grounds.⁵)

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