Dear Readers,
In my 1999 columns about addiction being a brain disease, I reviewed the scientific evidence that abuse of certain psychoactive drugs (including the drug,alcohol) can result in significant structural changes in the brains of patients who have fallen victim an addictive disease. I offered my professional opinion that patients with such changes should choose abstinence, not the very risky "moderation management" approach as the treatment modality. The author of a letter to the editor of the Twin-Boro News stimulated this lengthy response which, I hope, proved to be enlightening. He rightly noted that I had failed to define of the term," alcoholism," has been lacking in my earlier columns. I answered that briefly but, it seems obvious, that I need to "flesh out" that definition.

Over 10 years ago the National Council on Alcoholism and Drug Dependence and The American Society of Addiction Medicine and the AMA approved the following definition now serves as the keystone of research in the field: "Alcoholism (read also, "other drug addiction") is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic: impaired control over drinking (using), preoccupation with alcohol or other drugs, use of alcohol or other drugs despite adverse consequences, and distortions in thinking, most notably denial.

--- "Primary refers to the nature of alcoholism/other drug addiction as a disease entity in addition to and separate from other pathophysiological states which may be associated with it. Primary suggests that alcoholism/drug addiction, as an addiction, is not a symptom of an underlying disease state.

--- "Disease means an involuntary disability. It represents the sum of the abnormal phenomena displayed by a group of individuals. These phenomena are associated with a specific common set of characteristics by which these individuals differ from the norm, and which places them at an disadvantage.

--- "Often progressive and fatal means that the disease persists over time and that the physical, emotional, and social changes are often cumulative and may progress as drinking/using continues. Alcoholism/drug addiction causes premature death through overdose, organic complications involving the brain, liver, heart and many other organs, and by contributing to suicide, homicide, motor vehicle crashes, and other traumatic events.

--- "Impaired control means the inability to limit alcohol/drug use or to consistently limit, on every drinking/using occasion, the duration of the episode, the quantity consumed, and/or the behavioral consequences of the drinking/using. (Dr. Bill note: To me, the modifier, "consistently" is the key evidence of true addiction.)

--- "Preoccupation in association with alcohol/drug use indicates excessive, focused attention given to the drug, its effects, and/or its use. The relative value thus assigned to alcohol/drugs by the individual often leads to diversion of energies away from important life concerns.

--- "Adverse consequences are alcohol/drug-related problems or impairments in such areas as: physical health (e.g. withdrawal syndromes, liver disease, gastritis, anemia, neurological disorders): psychological functioning (e.g. impairments in cognition, mood and behavior changes): interpersonal functioning (e.g.: marital problems, child abuse, impaired social relationships): occupational functioning (e.g.: scholastic or job problems: and legal, financial, or spiritual problems.

--- "Denial is used here not only in the psychoanalytic sense of a single psychological defense mechanism, disavowing the significance of events, but more broadly,to include a range of psychological maneuvers designed to reduce awareness of the fact that alcohol/drug use is the cause of an individual's problems rather than a solution to those problems. Denial becomes an integral part of the disease and a major obstacle to recovery."

I'll discuss denial next week... a key symptom of addiction which, I believe, attracts alcoholics to the so-called "moderation management" movement.