Ask Dr. Bill
ADDICTION IS A CHRONIC DISEASE

Dear Doctor Bill,
My brother is attempting to overcome his alcoholism. In spite of the support he gets at his AA meetings, he still relapses. As a result, he has become quite discouraged, suffering all of the pain and shame caused by comments of relatives and even some so-called "friends" who think he should have the " self control" to stay away from booze. I know that he needs long term professional help as well as AA program but his insurance company won't come near to covering the cost of treatment. I have talked to several insurance companies trying to help him get some coverage at a fair rate. Each request has been turned down using the reasoning that, unlike diabetes which they do cover, they must refuse because treatment success is poor, it's too costly and they are not convinced that alcoholism is a disease in the first place.

Discouraged in Teaneck

Dear Discouraged,

My medical dictionary, disease is as "any deviation from or interruption of the normal structure or function of any part of an organ or system (or combination thereof) of the body that is manifested by a characteristic set of symptoms and signs, and whose etiology, pathology and prognosis may be known or unknown." This vague definition is indicative of the broad range of conditions that are rightly called "diseases." It also illustrates that whether a particular condition is or is not designated a "disease" could be as much a matter of cultural prejudices as of scientific, medical truth. Yet rigid notions about the definition of disease persist, imposing criteria far more explicit than any in a medical dictionary. This stricter construction of the definition of disease that has often been applied selectively to psychiatric and addictive disorders, adding various "required" criteria such as an expectation that diseases will have a clear biological origin, be discrete pathological entities and have predictable signs, symptoms, progression, and outcomes.

But addiction does not follow this rigid formula which ignores the role of environmental influences and behavior factors. Environmental influences, especially poverty, result in life style and risk factors that, unlike diabetes for example, do contribute substantially to the number of alcoholics found in any given population. On the other hand, behavioral factors are critical in the etiology, progression and treatment of virtually every known chronic disease. For chronic disease, the management of behavior is a central feature for improvement of function. It is now well accepted that lifestyle factors such as tobacco use, diet, alcohol abuse, and sedentary lifestyle are the leading causes of disability and chronic disease in post-industrial societies.

Ultimately, behavior modification is in the hands of the individual with the disease, no matter if managed primarily by that individual, with the help of formal medical treatment (such as that which we offer at the Van Ost Institute), or through a self-help program, or both. The fact that recovery may or may not occur through formal treatment has little bearing on whether addiction is defined as a disease.

Discouraged? You have every reason to be. So am I, but that will not stop me from attacking the short- sighted stand of an insurance industry which is more interested in profits for their shareholders than in the nation's health. They ignore study after scientific study which confirmed the results of a major study published in the Journal of Addictive Diseases in 1993 reporting that use of medical care by treated patients decreased by 61% in the first year after treatment and 57% in the second year. Treatment too costly? Ineffective? Addiction not a disease? Baloney!!!