It is big business today in America to label any compulsive behaviors related to food, drink, sex, relationships, or activities such as gambling, smoking, working, or shopping as a disease. The expensive residential treatment programs that stand to benefit most from the disease model have been successful in getting almost all addictions or compulsive behaviors labeled as diseases, even though there is very little research evidence to support this disease model. But, there is almost no solid research evidence to support the claims that participating in these treatment programs leads to recovery.
The National Council on Alcoholism, for example, says that you cannot recover from the disease of alcohol addiction and that you will always have to identify yourself as an alcoholic or an addict. Alcoholics Anonymous (AA) also supports this widespread notion, which was originally developed to counteract the moralistic judgments against alcoholics or problem drinkers who were cured by staying away from alcohol.
While there is some research linking alcohol and genetics, it is mixed and contradictory. What is clear is that some people cannot metabolize the sugar in alcohol and should stay completely away from it. These people have an allergy to sugar, not to alcohol itself. George Vaillant, a physician and a strong supporter of AA, argues that alcoholism is not, strictly speaking a disease [but] calling alcoholism a disease . . . is a useful device both to persuade the alcoholic to admit his alcoholism and to provide a ticket for admission into the health-care system.” However, he concluded, in the long run, it [the disease concept] is not effective. Vaillant also conducted the largest comparative study of the effects of AA support versus no AA support on long-term abstinence by former alcohol abusers. He found that 81 percent of those who quit on their own were still abstinent after ten years, while only 32 percent of those who attended AA meetings regularly remained abstinent after ten years. The popularity of the disease concept of alcoholism has been spread by AA and the National Council on Alcoholism.
In 1956 the American Medical Association determined that alcoholism was a disease, even though there was almost no research evidence to support the claim. As noted earlier, the founders of AA used the word disease metaphorically, meaning that they believed that alcohol addiction resembled a disease. Certainly, this concept was useful at that time, because of the widespread moral condemnation of alcohol abusers. The American Medical Association, however, began to see how useful and profitable it might be to drop the metaphoric use of the term, and stretched its diagnostic categories to include alcoholism.
So definitive and authoritative was this pronouncement that, by 1987 (according to a Gallup survey), almost 90 percent of Americans believed alcoholism was a disease.
In addition to helping more and more medical specialists become wealthy, the disease model has dramatically changed the insurance industry.
Once co-dependency and counter-dependency were diagnosed as mental diseases, practitioners were able to collect third-party payments from insurance companies for treating co-dependency and counter-dependency. Between 1978 and 1984, the number of for-profit residential treatment centers increased by 350 percent, and their caseloads rose by 400 percent.
Typical twenty-eight day in-patient programs (twenty-eight days is the usual maximum length for in-patient care that most insurances will pay for) cost the patient’s insurance company from twenty thousand to forty thousand dollars. Many of these ads played on people’s fears that their undetected disease would eventually kill them or a family member if they didn’t seek immediate treatment. This excess was a major influence on the managed care model of mental health that limited treatment of mental illnesses and severely reduced the liability of the insurance industry for mental health coverage. As noted, cost containment procedures in most insurance companies now limit the number of days of inpatient care; they also limit the number of sessions of outpatient care, or the dollar amounts for both.
Unfortunately,the short-term approach now in use, because of the cost-containment policies of insurance companies, has replaced the client-therapist relationship with prescription drugs, which do not, and will not ever, address the developmental issues inherent in addictions. Once alcoholism became widely accepted as a disease, so was the concept of co-alcoholism (now called co-dependency). Co-alcoholism was defined as a disease that a person caught by growing up in an alcoholic family.
This diseasing of alcoholism and co-alcoholism led to labeling other compulsive behaviors as disease, including sex, gambling, eating, worrying, smoking, shopping, rage, religious beliefs, and being in an abusive relationship. The only compulsive behavior so far to escape the disease label is compulsive working (workaholism).
Using the current medical approach, almost any set of behaviors engaged in excessively or compulsively that might have intermittently harmful effects on a person or others whom this person relates to is defined as an addiction, which (and now for the biggest leap) is then automatically defined as a disease.