Talk:Alcoholism

From Wikipedia, the free encyclopedia

This is the talk page for discussing improvements to the Alcoholism article.
Please sign and date your posts by typing four tildes (~~~~). Put new text under old text. Click here to start a new topic. New to Wikipedia? Welcome! Ask questions, get answers. This is not a forum for general discussion about the article's subject.	Be polite Assume good faith No personal attacks Be welcoming	Article policies No original research Neutral point of view Verifiability
Archives: 1, 2, 3, 4

Alcoholism has had a peer review by Wikipedia editors which is now archived. It may contain ideas you can use to improve this article.

	This article is within the scope of WikiProject Medicine. Please visit the project page for details or ask questions at the doctor's mess.
B	This page has been rated as B-Class on the quality assessment scale
High	This article has been rated as High-importance on the importance assessment scale

Discussions here have repeatedly involved the same arguments and views. Please review the recent comments below, or in the archives. New views and ideas on the subject are welcome; however, if your beliefs reflect already existing contributions, please consider withholding them.

Archives
Archive 1 Archive 2 Archive 3 Archive 4

Contents 1 Guidelines for new contributors 2 Forms of Alcoholism 3 peer review/copy editing, October 2006 4 genetic testing 5 screening 6 Rationing section 7 Naltrexone 8 genetic predisposition against alcoholism 9 alcohol abuse costs 10 Cultural and social causes of alcohol addiction 11 Costs of Abuse 12 Criticism by FutharkRed 13 Suggested Terminology Changes 14 Forms of Alcoholism Revisited 15 Forms of Alcoholism Debate 16 Now that we've come to an agreement, How do we alter the article? 17 A new beginning 18 Commentary on The Alcoholism Revolution by Dr. James R. Milam 19 Addiction Medicine specialists 20 I love what you've done with this place! 21 Funny Pair of Phrases 22 Wish to contribute 23 "Most people" cannot drink alcohol without risk of becoming an alcoholic 24 Today's modification 25 Summarized new contributor guidelines 26 New intro... 27 Adjusting the new intro for readability 28 Medical Perspective 29 Terminology 30 Incidence 31 Glutamine amino acid supplementation as treatment 32 Citation request examination 32.1 In addition, although the biological mechanisms underpinning alcoholism are uncertain, some risk factors, including social environment, emotional health and genetic predisposition, have been identified 32.2 Naltrexone is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and opiates. It also appears to act on glutamate neurotransmission. 32.3 The COMBINE study was unable to determine the presence of efficacy for Acamprosate 33 Dashkat: consistency of alcohol consumption? 34 The Binge Trend 35 JAMA Access 36 Prevention 37 Latest edits by Badgettr 38 What about Kudzu to treat alcoholism? 39 First paragraph changes 40 Moderation Management go bye bye 41 Augusten Burroughs interview 42 Restructuring Discussion 43 Restructuring, cont. 44 Star Sailor? 45 Self Test Suggestion 46 Removed Statistics 47 History entry in Genetic Predisposition testing 48 Template:Infobox Disease 49 Treatments / Medicines 50 Group therapy and psychotherapy 51 Medications 52 Pharmacological extinction 53 Disulfiram 54 Nutrition 55 Prevalence 56 Moderation 57 Deleted External Link 58 Citation for term "Big Book" 59 Alcoholism, not alcohol dependence 60 Remission 61 Screening 62 Polluted water substitute 63 Article references gone 64 AA definition of recovery in Terminology 65 Medications 66 Effectiveness 67 Epidimeology 68 Tests 69 Picture 70 Directory Of Alcohol Escape

[edit] Guidelines for new contributors

Welcome to alcoholism! To avoid common issues that have arisen in the past, please familiarize yourself with the following commonsense guidelines:

This article is for:

• facts about alcoholism
• facts about all conditions commonly called "alcoholism"
• all sides of alcoholism (biological, social, psychological, legal, etc.)
• standard terminology related to alcoholism
• historical perspectives on alcoholism
• modern perspectives on alcoholism
• a summary of the disease theory of alcoholism

This article is not for:

• unrelated facts about alcohol
• debating the "correct" definition of alcoholism
• opinions on alcohol or alcoholics
• creating new terminology
• advertising alcohol/alcoholism related websites
• debate over the disease theory of alcoholism

Things to keep in mind:

• Please base statements on reputable sources such as published studies and books.
• Whenever possible, cite original sources rather than secondary books/articles/websites.
• "Alcoholism" means different things to different people, if you say "alcoholism" or "alcoholic" make sure the definition you are referring to is apparent.

[edit] Forms of Alcoholism

There are at least two forms of alcoholism with no professional differentiation between them. Those who study one of them tend to insist that their form is the one and only true alcoholism, and this has resulted in a great deal of professional disagreement. The following few paragraphs are a description of these two forms based on research performed while writing this article. This should not be considered authoritative, and cannot go into the main article due to "original research" limitations, but I am presenting it here as a guide for those who wish to contribute to the article, to help them understand the considerations that have gone into it.

The first is the psychological/social addiction which comes about during a period of a person's life when alcohol consumption is of significant benefit to a person. This period may be a one time thing (like during college or after a divorce), or it may be a recurring thing (like that semi-annual girls night out or company party). This perception of benefit is often carried over for a considerable time after the benefit ceases to exist. This form of alcoholism can run rampant across the person's life until others help them realize that alcohol isn't providing benefit to match the problems it's causing.

The second form of alcoholism is a physiological condition in which the person's endorphin system convinces them that drinking alcohol is beneficial to them. It is essentially identical to a morphine or heroin addiction (endorphin being "endogenous morphine"), but is triggered by the consumption of alcohol (which releases endorphins into our system), and therefore alcohol consumption is the behavior that it reinforces. This form of alcoholism completely defies logic and sensibility, and often requires severely traumatic consequences to occur before the alcoholic is willing to admit that they have a problem. Even then they are often unable to quit drinking without assistance.

This results in several misperceptions of alcoholism. The most damaging one is due to differences in endorphin production and reception. Only about one sixth of the population is susceptible to the second form of alcoholism. This means that the majority of people who have suffered from the first type don't understand why the second type can't just quit.

In any case, the word Alcoholism does apply to both forms without differentiation, and therefore you will notice a few compromises in this article which are designed to reflect that unofficial duality.

Robert Rapplean 21:53, 28 September 2006 (UTC)

Maybe the form of addiction is related to the substance used? I have heard of no one who has died an alcoholic from drinking beer. All the alcoholics I have known or know of favor spirits. Can anyone contest this? —Preceding unsigned comment added by 24.201.169.149 (talk) 21:26, 3 September 2007 (UTC)

Please remember to avoid stories about "all the alcoholics I have known" as this is original research and tends to lead to disputes that are difficult to resolve. --Elplatt 22:20, 3 September 2007 (UTC)

[edit] peer review/copy editing, October 2006

Originally finding edge into this article via it's Peer Review request, i've finally finished and even done a good deal of copyediting along the way. Some overall comments:

• This article needs forked articles; identification/diagnosis, effects and treatment are all too long & multifacited to not do so. I meant, this article is big, like 30k, and it gets a little tough to stick with the article when it's this daunting. It took me like a week to get through it myself for Peer Review/Copyedit.

• More cites. It isn't usually an NPOV thing, but alcoholism is a very studied condition, and there just isn't any excuse not to have a shit-ton of sources to this baby. Someone might also look around userpages for a substance abuse counselor or something to help with these.

• A lot of the sections seem sort of disconnected; i even caught a few repeats of something that had been said in a previous part of the article. Like a good essay, each needs to lead into each other to make a better flow.

• Stop using that damn word 'result'. ;) Getting 'results' is one thing, but having everything 'the result of this' and 'resulting in that' makes this article seem like a robot.

• As previously mentioned, more diagrams and images would better this article. Also, i know there is a ton of statistics out there, and it'd be great to have this article peppered in them.

Anyways, i've really enjoyed working on this baby, and i'll be around to help it out. JoeSmack ^Talk(p-review!) 17:55, 4 October 2006 (UTC)

Thanks, Joe. Your input has been a great help. This article tends to get smacked around a lot by POV hacks, and it's good to get unbiased input on the content.

Glad to help. :)

BTW, there's a perfectly good excuse for not having a shit-ton of statistics. The majority of these statistics are performed by someone who's trying to prove their personal theory correct, and they often conflicting with other people's statistics. Reconciling those statistics is something that's of very little interest since there's no hard evidence one way or another and no money to be made by it. Because of this, any comparison of statistics has to be done on the fly, and gets labeled "original research". Not neccessarily a good reason, but a pretty damn good excuse. I'll keep working on it.

Robert Rapplean 21:26, 4 October 2006 (UTC)

You might put a little bit in about statistics being varied, and perhaps include a range of them a demonstration of such. Again, don't worry about 'original research' interpretations so much. I think you do a great job, be bold and see where it goes. :) JoeSmack ^Talk(p-review!) 17:05, 5 October 2006 (UTC)

[edit] genetic testing

At least one genetic test[3] exists for a predisposition to alcoholism and opiate addiction. Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymporphism. Those who possess the A1 allele variation of this polymorphism have a small but significant predisposition towards addiction to opiates and endorphin releasing drugs like alcohol[4]. Although this allele is more common in alcoholics and opiate addicts, it is by itself inadequate to explain the full effect of, or be a reliable predictor of alcoholism.

Which would it be, the small yet significant predisposition, or inadequate to explain/be a predictor to alcoholism? If it isn't significant, the word significant could be removed and it'd be fine. If it is, I'd say how that plays into its role as an indentifier but not a predictor. The wording is just a little ambigious here (one of those wtf moments). JoeSmack ^Talk(p-review!) 15:51, 29 September 2006 (UTC)

I think it's a usage issue. Maybe "small but statistically significant" is the proper phrase. It doesn't explain, predict, or identify an alcoholic. A person with this allele may be able to drink alcohol with no addictive results. However, this allele is slightly more common in those who have shown addiction to alcohol than in those who have shown the lack of this behavior. This suggests that, if all other things are equal the existence of the allele encourages people towards alcoholism, but that there are other factors and/or alleles that have a much stronger effect. Would you care to suggest an alternate phrasing that states this better? Robert Rapplean 19:07, 1 October 2006 (UTC)

i find this a little less cloudy:

At least one genetic test[3] exists for an allele that is correlated to alcoholism and opiate addiction. Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymporphism. Those who possess the A1 allele variation of this polymorphism have a small but significant tendancy towards addiction to opiates and endorphin releasing drugs like alcohol[4]. Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism.

I added the words 'correlated' and 'tendancy' so that the word 'predisposition' isn't used, as later it is stated it isn't an adequate 'predictor'. hope that clears things up. JoeSmack ^Talk(p-review!) 23:41, 1 October 2006 (UTC)

[edit] screening

i think that the screening section either should be the CAGE questionnaire and one more example, or they all need to be flushed out in more detail. right now it looks like a bunch of edits people crammed together. JoeSmack ^Talk(p-review!) 16:08, 29 September 2006 (UTC)

P.S. The DSM-IV diagnosis of alcohol dependence represents another approach to the definition of alcoholism, one more closely based on specifics than the 1992 committee definition. - wtf is the 1992 committee definition? not mentioned anywhere else. JoeSmack ^Talk(p-review!) 16:11, 29 September 2006 (UTC)

You've done a very good job of fleshing this out. I think at this point we might want to resort to listing them (like in the terminology section) and making sure we provide them with equal coverage.

The 1992 committee definition refers to something that was pulled out or moved away. Such statements that compare themselves favorably to other statements in the article were fairly common when we had many people contending for dominance on this article, and I haven't fully removed them all yet. This statement should be made to be more self-contained. Robert Rapplean 19:07, 1 October 2006 (UTC)

Done, done. JoeSmack ^Talk(p-review!) 23:29, 1 October 2006 (UTC)

The standard definition for alcoholism in the medical field is the 1992 committee definition that was here when that paragraph was written. The article, "The Definition of Alcoholism," was published in JAMA on 8/26/92 (Vol 268, #8, p1012) and was the result of work by the Joint Committee of the National Council on Alcoholism and the American Society of Addiction Medicine. The entire definition was part of this article originally and probably should be again: "Alcoholism 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 impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions of thinking, most notably denial. Each of these symptoms may be continuous or periodic." The article goes on to define each term within the definition to a greater extent. For the past 14 years, this definition has been accepted by the medical community and provides the descriptive basis upon which physicians treat addictive disease, alcoholism in particular. Drgitlow 00:58, 18 October 2006 (UTC)

Ah, right. That was part of the introduction that we had such extensive disagreement about. For those who are new to this, you can find much of that argument in Archive 3. The short version is that a lot of it was replaced because it used categorizations that are not comprehensible to the average reader. It also resulted in the moving of the disease discussion to its own page. Robert Rapplean 17:04, 18 October 2006 (UTC)

I would like to suggest the addition of Internet-based alcohol screening resources available as a public service, as they can be very useful. One such resource is AlcoholScreening.org, devleoped by Boston University School of Public Health (full disclosure: I helped develop this website). This site provides screening results based on the AUDIT and U.S. Dietary guidelines for alcohol consumption. There is at least one such site in the United Kingdom based on its health service guidelines, one in Australia, and so on. There are a few such commercial services as well, although I am initially inclined to list only those Internet public service (free) screening sites which are sponsored by a credible source, i.e. a University, qualified health facility, or a governmental health agency. These tools do not exclusively screen for alcohol dependence (alcoholism) but also cover hazardously excessive consumption that may cause future problems or put one at risk for immediate consequences such as accidents. The best ones are nonjudgemental and non-labeling. I am quite willing to contribute this content, but I would appreciate guidance on where and how to do so. Should this be a new item under Screening? Should it go at the end under "see also?" Other suggestions? Eric Helmuth 02:39, 15 November 2006 (UTC)

Hello and welcome, Eric. I looked through the screening on alcoholscreening.org and think that it's at least as valid as any other screening I've seen, and would be useful for people to confidentially understand how much of a problem their drinking is from an objective perspective. My view would be to just drop the content at the end of the Screening section, with an introductory sentence something like "Many free screening resources exist online...". It will likely be mulled over after that and may be reformatted. I'm not currently very happy with the "list quality" of that section, and would prefer a short paragraph describing the advantages and disadvantages of each screening type, but feel it's important enough to know that online confidential screening exists for this inclusion. Other opinions? Robert Rapplean 19:03, 15 November 2006 (UTC)

Thanks for the warm welcome, Robert. I can't make the edit right now due to the protected status of the page, so others should feel free to add it if desired; otherwise I'll wait until my account clears. - Eric --WikkiTikkiTavi 02:18, 17 November 2006 (UTC)

I'm now able to edit and have added some minimal information as suggested. Sugggestions for expansion and improvement are welcome. Eric Helmuth

[edit] Rationing section

Some programs attempt to help problem drinkers before they become dependents. These programs focus on harm reduction and reducing alcohol intake as opposed to abstinence-based approaches. Since one of the effects of alcohol is to reduce a person's judgement faculties, each drink makes it more difficult to decide that the next drink is a bad idea. As a result, rationing or other attempts to control use are increasingly ineffective if pathological attachment to the drug develops.

Nonetheless, this form of treatment is initially effective for some people, and it may avoid the physical, financial, and social costs that other treatments result in, particularly in the early phase of recovery. Professional help can be sought for this form of treatment from programs such as Moderation Management.

This section to me seems like a long-winded way of saying there are harm-reduction programs (i.e. non-zero-tolerance approaches). This is mentioned in the Treatments section that is short but done pithily. Anyone object to me removing this section? JoeSmack ^Talk(p-review!) 16:47, 2 October 2006 (UTC)

'Fraid so. Rationing is a viable treatment option that is significantly different from the others mentioned. This section provides a good overview of it, as it describes the advantages and disadvantages of this approach. However, We should seriously consider combining that with the "return to normal drinking" section, since they are functionally identical. Robert Rapplean 17:42, 2 October 2006 (UTC)

This section currently says "While most alcoholics are unable to limit their drinking in this way". Is it really most? Or some? Do we need a citation here? -Brian

Hi, Brian. In reality, the argument tends to be whether the word should be "most" or "all." There's a plethora of evidence that suggests that moderation makes alcoholism worse for most people, and yet there are those for which it works. Some argue that those who can deal with their alcoholism with moderation aren't really alcoholics, but are just people who enjoy alcohol. Even Moderation Management, which leads the call for this form of treatment, insists that their members aren't alcoholics. We actually used to have a citation in here ( Pendery et al. Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study. Science 1982 Jul 9;217 (4555):169-75) ) that states this, but I wouldn't want to further clutter the article by include it in that statement unless the consensus was that this statement was controversial.

So what do we think? Is the statement "most alcoholics are unable to benefit from moderation" controversial? Robert Rapplean 22:23, 22 January 2007 (UTC)

The question comes down to whether an "alcoholic" is anyone who abuses alcohol, or strictly someone with a physical dependence on alcohol. We should avoid the term "alcoholic" and refer directly to the meaning in context, such as "most abusers of alcohol" or "all sufferers of alcohol dependence". --Elplatt 22:36, 22 January 2007 (UTC)

Um, neither. An alcoholic is someone who has extreme difficulty with not drinking, even when it's obviously harmful. People abuse alcohol all the time for perfectly valid social reasons. If it'll allow you to interact socially, or catch they eye of the girl you like, then it sometimes seems like a really good idea to drink until you're passed out in the bushes. Also, physical dependence suggests alcoholism, but it isn't the disease of alcoholism any more than a bunch of red spots are the disease of measles. It's just an effect that the disease causes.

In this context, moderation would actually be a good idea for someone who just drinks too much and/or is physically dependent. It would back off of the physical dependence with less damage than detox, and would entirely eliminate excessive drinking. For an alcoholic, though, it increases the urge to drink and results in heavier drinking. -- Robert Rapplean 21:39, 1 February 2007 (UTC)

"someone who has extreme difficulty with not drinking, even when it's obviously harmful" is the definition of abuse. This may be your definition of alcoholism, but some people use other definitions. Whenever possible, we should avoid using the ambiguous term "alcoholism" because things that are true for one definition may not be true for another. --Elplatt 23:37, 1 February 2007 (UTC)

Please read the terminology section of this article, which has been hashed over rather thoroughly, before continuing this argument. I am more than a little aghast at your suggestion that we should avoid using the term "alcoholism" in the article about alcoholism. - Robert Rapplean 02:45, 2 February 2007 (UTC)

I've read the terminology section. Abuse has a precise medical meaning (as I said). The term "alcoholism" is only defined in the intro, and that definition differs from the one used in many scientific papers. I can see how someone would disagree with the suggestion to avoid using the term "alcoholism" but if you are aghast, you should give the topic more thought. Since this subject is only tangentially related to rationing, I'll start a new subheading. --Elplatt 05:02, 2 February 2007 (UTC)

Wikipedia is not a medical text. This is a good thing because the medical community is full of conflicting statements that are absolutely certain that their definition of alcoholism is the One True Definition(tm). As it currently stands, this article has suffered the ravages of a physician, a psychiatrist, a neurobiologist, and several AA enthusiasts all simultaneously insisting that their X++ years of education state that alcoholism must be this one thing. At times it's been extremely frustrating.

Wikipedia attempts to reflect common usage, which includes how people in the non-medical community talk about alcoholism. The definition presented at the beginning of the article is a meticulously gathered consensus based on evidence presented from many perspectives that make use of the word, and represents the operational definition of alcoholism to be presumed throughout the article. Anything else would be nihilism. If you feel that this definition is in error, please review the conversations stored in the archives to identify which specific elements you feel were not adequately explored and present new evidence about them.

In reference to this specific statement, regardless of the definition of alcoholism, we can UNCONDITIONALLY state that those who suffer from alcoholism are called "alcoholics". While it is, of course, bad style to use alcoholism in a self-referential way in the article (e.g., alcoholism is the problem that alcoholics have), providing characteristics of alcoholics is a fully qualified method of describing the characteristics of alcoholism itself. Therefore it is ludicrous to suggest that we should avoid making statements like "alcoholism is..." and "alcoholics are..." in an article about alcoholism. Robert Rapplean 20:33, 2 February 2007 (UTC)

Stepping in here kind of late, MM's position in regards to rationing approaches is somewhat similar to this: If you are currently drinking, and can successfully use their approach to reduce the *harm* that drinking is doing to your life, it might be worth a shot to try MM. However, if you've been abstinent for a number of years, what is most likely to happen at an MM meeting is people congratulating you on your weekly "ration" of zero drinks, and encouraging you to keep at that level. Even Moderation Management, which leads the call for this form of treatment, insists that their members aren't alcoholics. is a tad misleading, as the general MM party line is that if someone *is* totally unable to modify their behavior, they aren't ready for MM approaches yet, as they simply cannot successfully ration their drinking behavior at all (by definition). In addition, the general MM media stance is that if somebody *is* a self-defined AA "alcoholic" (as compared to a peer defined), MM is not an easy excuse to start drinking again, and MM is probably not a choice that they should exercise. Summarized even further, If you truly match step one of the twelve steps, MM simply will not work. Ronabop 05:38, 28 February 2007 (UTC)

[edit] Naltrexone

There are currently two ways that naltrexone is used, and the two are strongly in contention. Naltrexone was ok'd by the FDA for use for alcoholism in 1995.

The FDA site suggests that people not drink when taking naltrexone. It is generally prescribed to alcoholics as a way of helping them maintain abstinance, for which it has a very small effect for some people. There is a great deal of research (see above) that suggests that, on the average, naltrexone has questionable value in maintaining abstinance. As a result most doctors will do one of three things: provide naltrexone with the instructions to avoid drinking, cocktail naltrexone with antabuse to specifically discourage drinking, or avoid naltrexone whatsoever.

Pharmacological extinction specifically requires the alcoholic to drink while on naltrexone, preferably where and when they normally drink. The FDA's standard instructions specifically prevent PE from occuring, and coctailing it with antabuse is even worse. PE has a success rate of about 87% for converting serious alcoholics into people who can forget alcohol exists from one day to the next, and have no problem with drinking socially.

Do you have a reference for this statistic? If true, you would think that the method would be widespread. Thanks.Desoto10 (talk) 06:04, 26 January 2008 (UTC)

Unfortunately, most people think that the drug IS the treatment, and as such the two treatments get confused, very much like what you did in your recent edit. This results in most people thinking that the "naltrexone to maintain abstinence" results reflect on the "naltrexone to cause extinction" treatment. It may take extra explaining to maintain the differentiation. Robert Rapplean 18:07, 2 October 2006 (UTC)

Sorry I screwed up. I hope you fixed whatever it was that I said. Which "recent edit"? Have you found any valid citations for this section?Desoto10 (talk) 22:18, 3 February 2008 (UTC)

[edit] genetic predisposition against alcoholism

i recently was leafing through a gigantic substance abuse manual, and found something pretty similar from what i see over at Effects of alcohol on the body article:

Some people, especially those of East Asian descent, have a genetic mutation in their acetaldehyde dehydrogenase gene, resulting in less potent acetaldehyde dehydrogenase. This leads to a buildup of acetaldehyde after alcohol consumption, causing the alcohol flush reaction with hangover-like symptoms such as flushing, nausea, and dizziness. These people are unable to drink much alcohol before feeling sick, and are therefore less susceptible to alcoholism. [1], [2] This adverse reaction can be artificially reproduced by drugs such as disulfiram, which are used to treat chronic alcoholism by inducing an acute sensitivity to alcohol.

i say this info should be injected into this article. what do we say? JoeSmack ^Talk(p-review!) 06:04, 12 November 2006 (UTC)

I'm inclined to say not. I'm aware of this particular genetic anomoly, and I'm also aware that another side effect is a slightly shorter life expectancy. My thoughts are that, while very interesting, groups who are not effected by alcoholism isn't as germain to the main topic of alcoholism as those who are and why. Also, a genetic anti-predisposition isn't very meaningful to those who are trying to understand the problem. Maybe we can start a branch with this information? Robert Rapplean 19:30, 12 November 2006 (UTC)

I'm with Rob't on this one. The genetic issue isn't relevant to alcoholism directly, but rather to metabolism of alcohol itself. It therefore would fit nicely into the alcohol article (if it isn't already there). I'm not familiar with any studies, however, demonstrating a relationship between this genetic condition and alcoholism. One might speculate, as the person making the statement above did, that individuals with this gene are less susceptible to alcoholism. I suspect that's not the case, however, and would want to see cited studies supporting such a claim before making such a suggestion. Drgitlow 22:33, 29 November 2006 (UTC)

[edit] alcohol abuse costs

Im interested in more country to costs ratios, rather than just that snippet on uk, how about how much alcohol abuse costs other countries Portillo 04:31, 25 November 2006 (UTC)

[edit] Cultural and social causes of alcohol addiction

There's very little information here on the cultural and social causes of alcohol addiction. I'm not able to understand the contribution process once a topic has been closed, but the information page on alcohol addiction is pretty skimpy. It's evident that there are custodians of the topic here, but I'm not sure if this is the way to forward additional contributions.

Hoserjoe 09:06, 5 December 2006 (UTC)

Hi, Joe. The reason why there is very little on cultural and social causes is because this information is extremely subjective and as such couldn't be effectively summarized. There are a massive multitude of theories about which specific cultural elements contribute to alcoholism, but the only real consensus is that (a) alcohol availability contributes to alcoholism, and (b) attempts to limit alcohol availability only act to popularize its use. You may argue with this, and many have, but this many argue in a broad multitude of directions. This extremely broad argument makes this the subject of books, not encyclopedia articles. Robert Rapplean 18:12, 12 December 2006 (UTC)

Joe, you raise an interesting point. Most of us live in societies where alcohol is available whether legally or not. This is a social structure. Without alcohol's availability, alcohol addiction wouldn't arise. One only needs to look at the US history of prohibition to see that although that process failed in many ways, it was an amazing success in terms of reducing the direct and indirect costs, morbidity, and mortality secondary to alcohol intake and addiction. So if you want to indicate that a society that promotes alcohol intake, as America's does through advertising and other measures, is likely to have a higher incidence (rate) of alcoholism than a society that does not promote alcohol use, I think that's a valid point. There are also significant cultural variations; there is a good quantity of literature looking at alcoholism in Jews, in Mormons, and in other groups, for the most part demonstrating significant differences. Part of that may well be genetic, but part may be cultural as well. I'm not sure I'd call these social and cultural issues "causes," but they are most definitely "contributors." Drgitlow 04:16, 19 December 2006 (UTC)

Hey, DG. Although I definitely won't argue about advertising and other forms of popularization increasing the use and secondary problems resulting from use, I can say with considerable authority that the US alcohol prohibion increased both of these instead of decreasing them. In 1918, alcohol use was very much on the decline, and in 1933 is was epidemic. By some estimates alcohol use increased more than ten fold in that time period, and there is nobody who suggests that it actually decreased. Robert Rapplean 18:24, 27 December 2006 (UTC)

Hi, Robert. I'm afraid you're entirely incorrect. I refer you to the American Journal of Public Health, Feb 2006 issue, page 233-243, and JS Blocker's article, "Did prohibition really work? Alcohol prohibition as a public health innovation." I present here a short quote from the article:

"Nevertheless, once Prohibition became the law of the land, many citizens decided to obey it. Referendum results in the immediate post-Volstead period showed widespread support, and the Supreme Court quickly fended off challenges to the new law. Death rates from cirrhosis and alcoholism, alcoholic psychosis hospital admissions, and drunkenness arrests all declined steeply during the latter years of the 1910s, when both the cultural and the legal climate were increasingly inhospitable to drink, and in the early years after National Prohibition went into effect. They rose after that, but generally did not reach the peaks recorded during the period 1900 to 1915. After Repeal, when tax data permit better-founded consumption estimates than we have for the Prohibition Era, per capita annual consumption stood at 1.2 US gallons (4.5 liters), less than half the level of the pre-Prohibition period."

Robert, I've never seen any scientific estimates to indicate that alcohol use increased during prohibition. Everything that I found in a literature search of Medline indicates quite the opposite. Happy New Year! Drgitlow 00:50, 1 January 2007 (UTC)

The information that you're posting isn't an accurate measure of alcohol consumption because it's all based on the perception of the officials, and most of it represents the period immediately after prohibition started. The environment at the time was on the pro-prohibition swing if its 70 year cycle, and most areas of the country were already dry by order of local legislation. What prohibition did was put a blanket on all of the country, which largely prevented the dry areas from bringing alcohol in from the wet areas. In truth, the majority of the country really did support prohibition, and went into it with the best of intentions.

Unfortunately, a significant number of people went into it thinking that it would prevent other people from drinking, which was good, not thinking that it would prevent themselves from drinking, which would be bad. In the years previous to prohibition the writing was on the wall that it was on its way, and there was considerable stock piling of alcohol for personal use, kind of like the runs on supermarkets that happen before a blizzard. The black market on alcohol took a while to build up and establish, partially due to lack of demand and partially because it had to build itself up from scratch from close social connections.

There's no surprise that public drunkenness and hospital admissions decreased throughout the prohibition era. That's actually one of the primary health problems with the current war on drugs, that people are unwilling to call attention to their health problems if they're doing something illegal. People generally don't check themselves into a hospital until it's a choice between jail and death, and even then many cut it too close. Forensics weren't up to today's standards and most families were loath to tell the authorities that Uncle Joe drank himself to death, they just say he had a heart attack.

If you want to talk tax records, probably the most telling statistic comes from a count of the number of drinking establishments. In 1918 there were roughly 800 pubs, taverns, and saloons in New York city. In 1933 after prohibition ended, 20,000 speakeasies made an attempt to convert themselves into legitimate businesses. They almost all folded, however, for two reasons. With the legal restrictions removed an individual drinking establishment could be large and obvious, thus having considerable competitive advantage over small, cramped speakeasies. Second, when prohibition ended many people really did stop drinking. It stopped being as elicit and, after a few dozen celebratory drinks, stopped being exciting.

Unfortunately, the self-reported statistics don't tell a full story of what was going on at the time. A good book that you might want to pick up to help understand that time in history is Prohibition : America makes alcohol illegal by Daniel Cohen. Robert Rapplean 20:05, 11 January 2007 (UTC)

[edit] Costs of Abuse

I'm puzzled as to why the changes were made to the first paragraph as follows: "Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six per cent of a country's GDP [1]. One Australian estimate pegged alcohol's social costs at 24 per cent of all drug abuse costs; a similar Canadian study concluded alcohol's share was 41 per cent[2]."

This is not an article about alcohol abuse, but rather an article about alcoholism (alcohol dependence or alcohol addiction are other names for the same entity). Alcohol abuse is a different animal with some similarities. It's sort of like having a reference to rhesus monkeys in an article about gorillas.

Any disagreements with moving these entries to a point later in the article and indicating the differences between abuse and alcoholism, or in removing these entries? Drgitlow 04:41, 11 January 2007 (UTC)

Hi Drgitlow. The sentence in the first paragraph previously read:

Alcoholism is one of the world's most costly drug use problems; with the exception of nicotine addiction, alcoholism is more costly to most countries than all other drug use problems combined^{[citation needed]}.

Seeing the tag, I went looking for a source for this statement, i.e. something about the costs of alcoholism to society. Hence the reason for the revision. The reason for the wording is simpler – was not aware of the distinction you point out.

Am certainly not wedded to the term alcohol abuse, nor to the placement of the information. Why don't you change "alcohol abuse" to "alcoholism" (perhaps if you click on the reference and look at the terms used there you will be able to decide whether these studies are talking about alcoholism or alcohol abuse)? Or move it elsewhere, I don't mind. HMAccount 15:17, 11 January 2007 (UTC)

Hi, HM, and welcome. When I reviewed that edit, I agreed that filling it in with good statistical data was a good idea. OTOH, Dr. Gitlow does make an excellent point about the difference between alcohol addiction and alcohol abuse. The connection between alcoholism and alcohol abuse is somewhat complicated. Alcoholism wouldn't really be a problem if it didn't result in alcohol abuse, but by the same note alcohol abuse isn't just a result of alcholism. Some alcohol abusers are just people having a good time. I don't think that I've ever seen a statistic that calculates "alcohol abuse, but only by alcoholics", and I doubt I ever will. As a result, if we want to show a statistical demonstration of monetary social damages caused by alcoholism, it would need to be embodied as damages caused by alcohol abuse, with the disclamer that this is not a completely accurate measure, just the best available.

This just leaves the question of where we want to put it. The way the text sits, I have the feel that it's probably too much for the first paragraph. Summaries belong there, not full explanations. Can we move it down to Societal Impacts, and just leave a summary there? Robert Rapplean 20:36, 11 January 2007 (UTC)

Hi Robert, sounds like a great idea! HMAccount 21:14, 11 January 2007 (UTC)

I know I came late to the party, but here is the spectrum as I understand it: Use, Misuse, Abuse, Addiction, Dependancy, Death. Sometimes I see 'heavy use' in there between misuse and abuse, but definitions seem blury. Use is using at all, misuse is using at times that seem inhibitive, abuse is when it starts to infere with daily life/relationships/work, addiction is usually the embodiment of psychological yearnings/feelings of addiction (can be very intense), and dependency is physical addiction/dependence. Death is of course death. JoeSmack ^Talk 22:46, 11 January 2007 (UTC)

Hi, Joe. You use those words as if they exist in a linear continuum, but they don't have the same properties. Misuse and abuse both tend to be subjective judgement calls on a person's behavior. Addiction refers to a psychological inability to not use it, and dependence refers to a condition that leads to negative consequences if a person doesn't use it. This is all layed out pretty well in the terminology section. Robert Rapplean 23:13, 15 January 2007 (UTC)

[edit] Criticism by FutharkRed

This may be the poorest article in Wikipedia, from beginning to end, and that is reflected in the discussion here.

One of the most glaring indicators is the decision to bury the most authoritative definition of alcoholism, that of the Diagnostic and Statistical Manual of Mental Disorders, in a spot 1/3 through the article--"The DSM-IV diagnosis of alcohol dependence represents another approach to the definition of alcoholism"--then asserting that the purpose of the definition is to enable clinical research! No, it is not 'another approach', it is that of the highest level of disease classification, by those specializing in the field, and its purpose is to best enable treating said disease. It is the diagnosis used by most in the field, is used in filing insurance claims for treatment, is what is meant, from a scientific point of view, by 'alcoholism'.

That definition is "...maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae." That is alcoholism, not what has been tossed around either in this article or this discussion.

Alcoholism has been recognized for some time as a primary, progressive disease, involving addiction to alcohol (with both tolerance for and withdrawal from the alcohol as major defining features). The DSM-IV categorizes it, in fact, among the psychotic disorders. There is strong evidence for genetic factors in susceptibility to the addiction, as well as several distinctions in the ways that alcoholics process alcohol, metabolically and physiologically, compared to the general population.

Negative consequences of drinking are not diagnostic of the disease; inability to stop in spite of such consequences may be.

Socially, alcoholism's effects far exceed those of all other drugs combined, especially inasmuch as it is considered among the leading causes of death. ('Nicotine', as opposed to smoking, is not in the same order of magnitude--how the claims of its 'greater cost' is allowed to stand uncited is another mystery.)

As for the range of its effects, the 19th century suggestion that you could study all medicine, simply by studying the one disease of syphillis, is more than matched currently by substituting the study of alcoholism. It has an unparallelled range of effects, physical and mental, and that holds as well in its effects throughout the population. Estimates of susceptibility to the disease itself range as high as 10% of the population (potential alcoholics); and the effects extend to all those in contact with the active alcoholic, an enormous part of the population, compared with that affected by any other disease.

Given this, how one can choose to seriously discuss alcoholism, the disease, while moving the 'disease theory' elsewhere, escapes me. Who on earth authorized any such travesty? To discuss 'two (professionally undifferentiated) forms' of alcoholism, as is done in this discussion, is nonsense ... to anyone who does know the disease. The former version mentioned here is not considered alcoholism at all, 'professionally'. It may be a problem, true, and one that can use some treatment or prevention (as is an issue, for instance, on many college campuses), but this is not alcoholism in itself. The very way of phrasing much of this, referring to "professional disagreement", leads to the question, as to whence the greater expertise of the current authors arises.

As one among many non-professional indicators, I'd point out that 'endorphins' (which are not morphine-related) have virtually nothing to do with alcohol or alcoholism, popular though the notion may be. Alcohol has its own neurochemical effects, in the first place. The process of alcohol addiction has to do with conversion of alcohol metabolites in the alcoholic to THIQs (tetrahydroisoquinolines), quite similar in fact to the structure of morphine. The addiction itself becomes self-propelling, and requires no positive motivator the further it progresses ... other than the negative one of staving off withdrawal.

Likewise, the notion that the turning point in the disease is when "others help them realize" the negative road they are on, is spectacularly untrue to life. One of the most glaring features of alcoholism, is its long-term imperviousness both to consequences and to the input of others. The single most effective agent in recovering from alcoholism, Alcoholics Anonymous, is in no way based on helping alcoholics realize the negatives involved, which they are all too often aware of (though they may be unaware that alcohol is the cause of the trouble, rather than a failing solution.) It is based on showing that there is a real, positive alternative, such as their own alcoholic thinking suggests is impossible.

As with most diseases, the primary question for most people is, what can be done about it. Here the article is woefully poor. The authors list 5 'mutual help' organizations, for instance, as though they were of equivalent value, although only one has any substantial rate of success in dealing with the disease. Likewise, suggesting 'group therapy or psychotherapy' for "underlying psychological issues" both implies that the alcoholism may be a secondary rather than primary disease, contrary to current thinking, and overlooks the history of failure in that area--aside from such specialized treatment as is aimed entirely at abstention, and generally recommends participation in A. A.

The notion that "the American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of alcoholism are no longer evident, regardless of whether or not the person is still drinking" (emphasis mine) is uncited, unlikely, and contrary to virtually every current thought on the subject. Agreement is effectively universal that an alcoholic cannot drink safely at all, ever again, that the first remedy is complete abstinence--except for the opinion of the authors here. In fact, they uncritically list Moderation Management as a 'resource', along with Alcoholics Anonymous, MM taking the position that alcoholics can learn to drink safely--without noting that MM's founder is herself in prison due to subsequent vehicular double manslaughter, while having a blood alcohol level 3 times the legal limit.

In fact, the entire discussion which is entertained on that question, under the heading of 'Rationing and Moderation', runs counter to any professional notion of alcoholism. There may indeed be "harm reduction" in other areas of drug abuse and addiction--much of the harm of heroin addiction, for instance, is not directly caused by the chemical, as by all that goes with it. In the case of alcohol and the alcoholic, it is the alcohol 100%, and there is no such thing as 'harm reduction' by any form of controlled drinking.

It is a truism that non-alcoholics never even think about "controlling their drinking" ... and that alcoholics, as the disease progresses, do think about it, and can't. At this point, for the authors to even be discussing the issue for more than one sentence, indicates that it is not alcoholism they are speaking of. They should not be writing about alcoholism, at all. FutharkRed 04:04, 3 February 2007 (UTC)

You know, I don't even know where to start on this. You are so thorougly woefully uninformed about alcoholism that you could only be a medical professional or an AA councilor. Possibly a psychiatrist, as they are the ones who usually insist that the DSM knows all. Pretty much everything in this entire article has been backed up one side and down the other by papers, books, and studies. At one point we had to start clearing off the references because some sentances had more reference marks than they did words. It's not like all of this information was made up by somebody. Please take a look in the archives, and present your own evidence that conflicts with what you see here. We all had to.

For starters, cigarette smoking kills an estimated 440,000 americans each year, whereas alcohol only kills 80,000 by the same (NIDA) accounting. No, I'm not going to start tallying up wife beatings and drunken bar fights. Endorphin release is a well known effect of alcohol consumption, although most people attribute its addictive effects to the dopamine that the endorphins trigger the release of. By anyone who's actually looked at the statistics, AA is less effective than no treatment whatsoever. Even playing patty-cake has higher success rates than AA meetings. - Robert Rapplean 07:59, 3 February 2007 (UTC) Most people that are in jail are in there for dealing with drugs. 5 February 2007

Robert, your comment, "You are so thorougly woefully uninformed about alcoholism that you could only be a medical professional or an AA councilor," is hostile and uncalled for. You're better than that! Drgitlow 19:00, 11 February 2007 (UTC)

*sigh* Ok, I'll agree that it was hostile and unproductive. Having put untold hours into reconciling the highly varied ideas of what alcoholism is, and having someone spout This may be the poorest article in Wikipedia at us kind of puts me on edge. Nonetheless, I do owe FurtharkRed an apology, that was very unprofessional of me.Robert Rapplean 19:33, 14 February 2007 (UTC)

FutharkRed, I agree with 96% of what you wrote, and indeed the version of this article that I wrote many months ago reflected the standard understanding of the scientific and medical communities that you accurately represent. I was broadly attacked by others here and after several months we compromised on the entire article, which as it stands is tolerable by many but I don't think any of us would say it is accurate from any single perspective. Part of the compromise, which I still strongly disagree with (but I was firmly outvoted), involved the removal of the entire medical understanding of alcoholism as a disease. Ridiculous, I know, but that's the way Wikipedia works.

By the way, the area where we disagree, and I'll be as clear as I can be here: As defined by DSM-IV, there are a variety of symptoms that constitute the disease of alcohol dependence. Note that quantity and frequency of use are not included within these symptoms. That is critically important, as it reflects the fact that alcohol dependence is not defined by amount of use or frequency of use. Now look at how DSM-IV defines remission on p. 196 of the TR edition. Remission refers to the criteria for dependence or abuse, not to amount of use. As a result, one can continue to have substance use but also have remission. That is the way the definition is generally understood by addiction medicine specialists. That said, I of course agree with you that abstinence is required for recovery. The psychiatric definition of disease remission is not equivalent to the medical definition of recovery. In fact, many of us in the medical addiction field don't use the psychiatric definition but rather use the medical one (JAMA 1992 article referred to elsewhere here). So I suspect that you and I completely agree on what's necessary to treat patients, but we appear to disagree on the meaning and intent of the DSM definition, and that's simply an academic question, no? Drgitlow 18:56, 11 February 2007 (UTC)

Dr. G., thank you very much. Not just for your kind remarks, and your thoughts on the subject in question ... but for restoring mine to the discussion page in the first place! They were originally appended to the discussion of the lead paragraph, and almost immediately removed by the author of that paragraph, as being beyond discussion!

Actually, I moved it to the bottom of the discussion page, where it now resides. As mentioned in the comment in history, it opens numerous new discussions based on one that was archived quite a long time ago, and as such deserved its own heading.Robert Rapplean 19:33, 14 February 2007 (UTC)

That removal, with the remover's comments, would have had me avoiding work on the article for a long while. I don't refer to the personal slant, but to the absolute lack of objectivity, from what would appear to be the article's lead author! To cite "a medical professional or an AA councilor. Possibly a psychiatrist" as certain sources of ignorance on the subject; to claim that "AA is less effective than no treatment whatsoever"; to remove the disease concept, AMA or APA or otherwise, from the article--all of these indicate an extraordinarily prejucidial approach. And removing criticism in such a manner indicated little chance for a direct approach to the article.

As evidensible here, this is a collection of things that need to be argued individually.

To cite "a medical professional or an AA councilor. Possibly a psychiatrist" as certain sources of ignorance on the subject

We get a very broad selection of people here who insist that their perspective on alcholism is the only possible one. These range from a variety of medical professionals (mental and physical health) to alcoholism councilors, religious fanatics, and outright bigots. There is a lot of vertical information passed within these groups, but not a whole lot of horizontal information passed between them. Those with the largest and most professional groups are the ones who most strongly insist that their view of alcoholism is the one and only true view of alcoholism, and they generally take the greatest amount of evidence to convince them that it isn't as black and white as all that. They take their professional perspective and years of experience as a bedrock to insist that no other group could possibly have a clue about the topic. The resulting arguments can be very frustrating and time consuming.

to claim that "AA is less effective than no treatment whatsoever"

You should have a look at the Orange Papers, specifically their page on effectiveness. I'm not going to say that this is the only perspective that's valid - we try to recognize all perspectives, including this one. Among the many peer reviewed studies that he sites, there's one where they had the patients gather in an AA-like meeting and play Patty Cake. This "treatment program" had statistically identical results to the AA meetings. So I was exagerating when I said "less effective", my apologies, please replace that with "no more effective".

A fair accounting of AA indicates a dropout rate of about 95%. AA doesn't consider these dropouts to be part of their failure rate, but they are nonetheless people for whom the AA program was a failure. This 5% success rate is roughly equivalent to the rates for spontaneous remission, which suggests that AA has no meaningful effect at all. There is an immense body of evidence that supports this idea, and as such we aren't really swayed by arguments that AA is the only effective treatment option. Robert Rapplean 19:33, 14 February 2007 (UTC)

Just a few notes about this depiction of A. A., and the methods of the article and the discussion.

It appears that declarations by the American Medical Association and the American Psychiatric Association, with only slight differences in terms and detail, to the effect that alcoholism is a primary disease, are considered of dubious value "for definitive or treatment purposes". On the other hand, something like the anonymous "Orange Papers" web site qualifies for authoritative citation.

Do we have to go through this every four months? FYI, the definition of "Alcoholism is a primary, chronic disease..." was one originally proposed for the opening definition in this article. It was altered severely to what it currently is because anybody who understood the terms primary and chronic probably wouldn't be going to Wikipedia for their information. Unsuitability for the audience had more to do with it than medical, clinical accuracy. As you seemed to have completely missed (and I'm REALLY not enjoying repeating myself today), I didn't say that this is the only perspective that's valid - we try to recognize all perspectives, including that of the AMA and APA. Put another way, we cannot dismiss any of these perspectives if they are supported by multiple clinical studies.

How does Wikipedia go about weighing sources? Surely there should be something a little better, for such strong declarations? Perhaps the original "peer-reviewed" research papers, if really meaningful and verifiable?

The Orange Papers are really nothing more than a convenient way of referencing a large number of these kinds of papers. I'll make it easy on you and copy the citations that answer the many accusations that you make, making it obvious that you really have no intention of actually considering anyone else's perspective.

Bearing in mind of course that some of the most famous such 'research' of the past, especially that devoted to proving that alcoholics could learn to drink safely, turned out to be fraudulent.

Logic foul: Hasty Generalization

But can the "Orange Papers" be considered objective by any standards? ýAgent Orangeý, indeed.

Logic foul: Ad Hominem attack

Regarding our standards for objectivity, and the citing of sources when a matter might be questioned, how does the expression "a fair accounting" serve for a question such as the effectiveness of A. A? Who is doing the accounting, of what, and how & and, perhaps, why? More bluntly, A. A. being what it is, how could any such "accounting" be done at all? The only records A.A. keeps are of groups that have registered, and a rough survey every few years, to estimate the global numbers and composition of those attending meetings at the time, at the request of social scientists for their own research. The surveys appear to show a fairly steady 2 million people world-wide at an A. A. meeting on a given day, 1.25 million living in the U. S. and Canada. No records of individual attendance or membership are kept at all.

That is, at no level does A. A. keep the kind of records, or set criteria for 'membership' (which a person might then be said to "drop out" of), or track people that do or don't go to meetings, or set standards of success and failure, that would make any such "accounting" possible, "fair" or otherwise. So on what could such a statement possibly be based? And why is it put in these terms, of ýdropping outý and ýfailureý?

I do wish you would actually read the Orange Papers before maligning them so thoroughly. I quote:

For many years in the 1970s and 1980s, the AA GSO (Alcoholics Anonymous General Service Organization) conducted triennial surveys where they counted their members and asked questions like how long members had been sober. Around 1990, they published a commentary on the surveys: Comments on A.A.'s Triennial Surveys [no author listed, published by Alcoholics Anonymous World Services, Inc., New York, no date (probably 1990)]. The document has an A.A. identification number of "5M/12-90/TC". Averaging the results from the five surveys from 1977 to 1989 yielded these numbers:
* 81% are gone (19% remain) after 1 month;
* 90% are gone (10% remain) after 3 months,
* 93% are gone (7% remain) after 6 months,
* and 95% are gone (5% remain) at the end of one year.

Along the same lines, how on earth do we know how many people have gone into "spontaneous remission" with "no treatment at all", as specified here? Who are they going to tell, and why? And do they even know it themselves, or consider anything of the sort to have happened? (If it were actually "spontaneous", how would anybody know? And how does one "spontaneously" remit from this sort of condition? It isn't malaria.) There is no science in this at all, no real foundation, just made-up numbers and polemics attacking A. A., which should have no part in framing such an article.

Spontaneous remission is measured by a person not drinking based on their own decision to not drink. Not as scientific as a thermometer, but it's a pretty clear indicator that a person has gotten their cravings under control.

One of the sad facts is that there is little hard information on treatment "results", period. A. A.ýs survey (which doesnýt measure total membership, just meeting makers that day), is still one of the few such measures around. A study has been underway at Staten Island University Hospital in New York for the past 5 years, but no results are available as yet ý and such a study is a novelty in the field. Very few treatment facilities do any serious follow-up, and such responses as they may get are hardly definitive, even in the short run, let alone life-long. And that is in cases where hard records are kept, where tracking and follow-up would seem natural ... as opposed to the autonomous, amorphous 80,000+ A. A. groups, which keep no such records at all. Yet all of this is being expressed as though there were real research involved.

Aside from exaggeration in the early days as to its effectiveness ý including plain exaggeration of its members ('100' sounded better than 78 or so, and "rarely ... fail" was meant to be encouraging to the newcomer) ý A. A. claims no "success rate". How can they, when success is measured "one day at a time", and when the active alcoholic population remains so huge? Above all, A. A. most certainly does not claim to be "the only effective treatment option." Where did that come from? And how does it enter this discussion?

Your original statement was "The single most effective agent in recovering from alcoholism, Alcoholics Anonymous...". Others have suggested that it's the only effective treatment option. Neither of these is even close to true. For starters, the doctors in the Contral clinic in Finland are seeing 25% of their patients in complete abstinence and 87% of their patients reduce use below cellular damage levels after a three month treatment, with a 99+% retention rate, and a 50% maintenance rate in five-year follow up studies. AA doesn't even retain 25% much less have them all be abstinant at three months.

This is the whole problem with all of these criticisms. You cite a single clinic in Finland and unsubstantiated percentage rates, and hocus pocus like "below cellular damage levels". I am sure the founder of MM had usage "below cellular damage levels" for a while, but she ended up back in prison. AA, on the other hand, has 73 years of proven recovery by its programs adherents. Many who stay sober for a lifetime. No other program can say the same. To equate short-lived and minor recovery programs with a phenomenon like AA, which has spawned literally hundreds of groups patterned after it, is patently ridiculous.

AA doesn't lend itself to scientific study, because unlike other programs it 1) doesn't take attendance, 2) relies on self-diagnosis, 3) takes all comers, and 4) doesn't follow up or measure anything. This makes it easy to shoot at for pompous academics. And boy do they shoot. That is OK, because AA doesn't care. But it makes Wikipedia look stupid to have an article equate a worldwide organization with millions of members with splintered personality cults having a few thousand.

But most professionals in the field do seem to find A. A. the best available choice for their clientele.

Logic foul: argument Ad Populum (appeal to popularity)

People who don't go to meetings are not considered "failures" by A. A. ý why should they be? And how do our "fair accountants" know whether they (A. A. or individual) have "failed" in any given cases? Who is keeping count, and what are the standards? If they had gone to meetings, but stopped going and stayed sober, they are successes. If they didn't stay sober (after going to A. A., and then "dropping out"), perhaps they should have stayed!

Actually, that's one of the funniest things about AA effectiveness, is that the various studies indicate that staying in AA has absolutely no effect on a person's likeliness to fall off the wagon, and those who stay in AA are more likely to engage in binge drinking.

"A Controlled Experiment on the Use of Court Probation for Drunk Arrests", Keith S. Ditman, M.D., George G. Crawford, LL.B., Edward W. Forgy, Ph.D., Herbert Moskowitz, Ph.D., and Craig MacAndrew, Ph.D., American Journal of Psychiatry, 124:2, August 1967, Page 163
"A RANDOMIZED TRIAL OF TREATMENT OPTIONS FOR ALCOHOL-ABUSING WORKERS", The New England Journal of Medicine, Volume 325, pages 775-782, September 12, 1991
Jim Orford and Griffith Edwards, 1977, Alcoholism : a comparison of treatment and advice, with a study of the influence of marriage, Oxford [England] and New York : Oxford University Press, ISBN: 0-19-712148-9
The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, George E. Vaillant, Harvard University Press, Cambridge, MA, 1983, pages 283-286.

It would make more sense, come to think of it, to cite as A. A. "failures" those who did not "drop out", but still drank with disastrous consequences!

Odd that you should mention that...

Outpatient Treatment of Alcoholism, by Jeffrey Brandsma, Maxie Maultsby, and Richard J. Welsh. University Park Press, Baltimore, MD., page 105

In fact, A. A. is generally not considered "treatment" at all, but mutual help, a very different thing. (Which has been known to upset some treatment professionals over the years.) Given that the only membership requirement is that a person want to stop drinking, and that the central method (according to the A. A. Preamble) is that they do it together ... the real test with the "Patti-cake" group would not have been, how they "succeeded" as compared to A. A., but as opposed to trying to stay sober alone, presuming they really wanted to do so. With something as blatantly insulting as this 'experiment', though, I can't even imagine the patients' state of mind. And to cite this nonsense as meaningful here, with "statistically identical results" ... for how long did they continue to play Patti-cake? for how long did they not drink? And again, statistics "identical" to what ý since we've already seen that the A. A. statistics were themselves made up out of thin air?

Evaluating the "success" of A. A. is difficult as can be, but evaluating its "failure" is absurd, and useless. A few fairly objective statements can be made, I believe, on the positive side.

In the first place, a great many people obviously have gotten sober in some part through A. A., in addition to whatever "spontaneous remissions" there may have been in the past 71 years, compared to the dismal prospects for recovery before that time. Whatever addition A. A. made to that recovery rate, certainly merits some serious investigation. There has been nothing else comparable.

Yet another quote from the Orange Papers:

The first mistake was in assuming that because some people recover in A.A. rooms, that they recover because of Alcoholics Anonymous. That is assuming a cause-and-effect relationship where none may exist. We can, with equal validity, say, "I know that people recover in hospital rooms that are painted green -- I've seen it with my own eyes. So the healing effects of green rooms are an established fact."

Second, A. A.'s notion that some sort of disease was involved in the alcoholic condition, and their success in using that concept to maintain sobriety, has led not only to basic research confirming the idea, but above all to treatment of many sorts, such as was not the case before. [As a corollary consideration, just as the tobacco companies hired scientists to prove that smoking was a "life style choice", rather than a profound nicotine addiction over which they had no real control, there is a great deal of insurance money at stake, in denying that alcoholism is "really" a disease.]

"AA said alcohol is a disease first, therefore AA is an effective organization"? Are we still talking about their effectiveness in curing alcoholism, or just listing their glories?

Third, well before the advent of group therapy, A. A. showed the great usefulness of such "mutual help", in dealing with what had been considered a hopeless condition, and which since has proved applicable to almost anything.

Fourth, A. A. inspired, informed and helped populate the treatment field, with its contributions to successfully treating alcoholism and other addictive diseases.

Fifth, the members of A. A. are simply a tremendous resource, for dealing with this disease. Given the profound despair that alcoholism instills in those who suffer from it, the members of A. A. give living proof that living sober is attainable for anyone that wants it. That is, seeing is believing, and especially in the numbers and variety that A. A. affords. And since the members' understanding of the key to staying sober is to help others do so as well ý the famous 12th Step ý this fits together quite well. FutharkRed 11:15, 15 February 2007 (UTC)

Logic foul: Begging the Question. The last three statements suggests that AA is a great organization because its model of treatment is so effective. The effectiveness of the treatment is the primary issue that we are arguing.

[Here continueth the entry by Futharkred of 2/12/07:]

On the other hand, once calmed down and objective again myself, and willing to put the necessary work into the subject, I would have approached Wikipedia's overseers directly, to remedy the situation. The subject is too important to leave it in such a condition; and that very importance could also reflect on Wikipedia's own reputation as a source of objective knowledge.

Quite aside from the usual measures of the importance of alcoholism--morbidity, mortality, economic impact, social consequences, and so forth--I recently came across a novel indicator, which really puts it in perspective. That is, the author of a book on using English around the world offhandedly presents the statement: "the word drunk holds the record for having the greatest number of synonyms--2,231." [Dickson's Word Treasury (Paul Dickson, Wiley, 1992), as cited in Do's and Taboos of Using English Around the World, p. 20 (Roger Axtell, Wiley, 1995)] World-wide, it appears, this has been the human condition most on people's minds, for a long time.

As for our 4% 'disagreement', there really should have been none. I apologize for not having re-checked the DSM before adding that statement; it's been several years since I looked at it. I agree with your view, that there does seem to be a peculiarity in perspective and terminology on the part of the APA, with its phantom "remission", which does reduce its usefulness in treating the disease. Perhaps they also suffer constraints, though, in being used for insurance purposes ... such as a qualified version of "remisson" would not have served? And on the matter of frequency and quantity of drinking, as diagnostic requirements, I likewise agree completely, they are not of the essence, just potential clues.

You seem to have an excellent approach to this subject, and I'd be glad to work with you on improving the article. Previously, there seemed no useful point in even reading it in detail, let alone thinking of how to re-work it. Who else is currently engaged in this? You speak of a 'majority' decision to exclude the disease concept, even as a working definition of what "alcoholism" is. In rejecting the majority views in the treating fields of medicine, psychiatry, counseling, and A. A., on what higher authority does this majority base its claims?

The key ingredient, I do believe, would be restoring the primacy of the disease concept, both for definitive and organizational purposes. Without that disease concEpt, aside from lack of scientific objectivity and practical usefulness, you wind up with an incoherent mess, encyclopedically! FutharkRed 23:01, 12 February 2007 (UTC)

The argument of whether or not to classify alcoholism as a disease has absolutely no impact on identification or treatment. Which label we happen to stick on it is tangetial to the understanding of the problem. It's actually a mostly political issue, argued in congress to determine if they're going to provide funding for treatment. Personally, I believe that it's a disease. Regardless, the argument about it was completely consuming the alcoholism article, distracting from the things that would actually be useful to people suffering from the problem. It deserved it's own article, and you can argue the point till your blue in that location. If you can come to a solid conclusion there, then you have my word that this article will reflect the results of that argument. Robert Rapplean 19:33, 14 February 2007 (UTC)

I agree that classification has political ramifications, but there are health and societal ramifications as well. For example, if alcoholism is a disease, then it should be treated by physicians and other healthcare professionals just as any other disease is. If alcoholism is a disease, then an individual would not be blamed by society for having that disease. Of course, personal responsibility is important for this as for other chronic disease states (e.g. someone with juvenile diabetes needs to monitor their blood sugar, eat properly, take insulin as necessary, etc.). If alcoholism is NOT a disease, then there's little reason for these individuals to be medically monitored and treated, and society can attach responsibility fully to the individuals so afflicted. We wouldn't be having this discussion for any other disease; that alone indicates that alcoholism still carries a great deal of misplaced stigma. Drgitlow 20:48, 14 February 2007 (UTC)

Ok, I've done some thinking, and here's the problem. We have to produce a peice of text that faces up to the dual nature of the word alcoholism. From my perspective, the success of pharmacological extinction in Finland pretty effectively demonstrates that for your archetypical alcoholic, the problem is very much a physiological condition that can be treated medically. Thus, it is a disease. And yet there are also numerous people out there who have sensibly done the cost/benefit analysis, and are continuing to drink irresponsibly large amounts because they don't want to admit that the problems it's causing have increased beyond a managable level. For these people, it's not a medical problem - it's a behavioral maladjustment. Not all people have the strong endorphin response that results in the first type of alcholism, but some of those who don't will still wind up drinking beyond the reasonable level. How do we reflect this? Robert Rapplean 15:48, 15 February 2007 (UTC)

I completely agree. I think the first step is to compile a list of distinct usages of alcoholism that are common enough to mention. Perhaps a new section would be best for this? --Elplatt 22:18, 15 February 2007 (UTC)

I'd love to, Elplatt, but anybody of any professional standing who has anything to say about alcohol pretty well insists that it must be one or the other. More to the point, they state that their thoughts on the matter are the only ones that make any sense. This makes the idea "original research", which is verboden on Wikipedia. Even if we could find someone who professed this philosophy, it would still be a drop in the ocean of disagreement. I'm open to ideas for remedying this. Robert Rapplean 03:57, 16 February 2007 (UTC)

Let's have some optimism. We don't need to resolve the disagreement, just represent it. I've come across plenty of published discussions of the conflicting views on alcoholism. If different authorities make different claims about alcoholism, presenting them separately shouldn't count as original research. In any case, creating a list of the different views can't hurt. I'll begin a new section on the discussion page for it, but I'm open to further suggestions about if and how they should be incorporated into the article. --Elplatt 04:55, 16 February 2007 (UTC)

[edit] Suggested Terminology Changes

As most contributors to this article know, terminology is a serious obstacle in writing intelligibly about alcoholism. The general public, the scientific community, and different portions of the medical community all have their own definitions of alcoholism, which are largely incompatible with each other.

The approach taken by the authors of this article so far has been to present "a meticulously gathered consensus based on evidence presented from many perspectives" according to Robert Rapplean. Such an approach is at best misleading.

A consensus on the definition of "alcoholism" does not exist. Any reference material used to support the statements in this article was written with a particular definition of alcoholism in mind, and the statements they make may or may not be true for the definition used in this article. The fact is, any statement about alcoholism can only be understood in the context of the author's definition of alcoholism.

For instance, a 1989 study by the Canadian government found that 77% of alcoholics recovered without treatment. However, when one reads the study it becomes clear that their definition of alcoholic was a problem drinker, or someone meeting the DSM IV criteria for alcohol abuse (rather than alcohol dependence). This information is vital to interpreting the results of the study.

There is an easy way to please everyone and present accurate information. The article should accurately reflect the common usage of the term, and plainly acknowledge that there are many common usages, not construct an artificial and misleading consensus definition.

Furthermore, although definitions of alcoholism vary, the definitions are based on factors with much more well accepted definitions. These factors are the ones described in the Terminology section of the article. In the past I've suggested that the current authors stick to these well defined terms and avoid making statements about "alcoholics" or "alcoholism," and have been met with some opposition. However, if you can't understand why I would recommend against saying "alcoholics are..." please first ask yourself why the Nigger article doesn't contain the phrase "niggers are..." (I don't intend this statement to be derogatory towards anyone, but rather to point out that some terms can't be used to make factual claims). --Elplatt 21:49, 6 February 2007 (UTC)

You make some very valid ponts, Elplatt, but I'd disagree that there is no consensus on the definition of alcoholism. In fact, there is broad consensus within the medical community (the 1992 JAMA article referred to in the text is one of the better examples of this, as is DSM-IV itself) as to what alcoholism is. What you are, I believe, referring to, is the lack of understanding of that consensus outside the professionals and organizations that came together to settle upon this definition. And as you point out, even in the scientific community there are many who lack understanding. This isn't totally unusual, and other well-defined diseases like diabetes and hypertension have both broad consensus and many who disagree with or who lack understanding of that consensus. Indeed, even in the alcoholism treatment community, we often gather to discuss our differing perspectives and views regarding definition, treatment, prognosis, and so forth. That is routine for any science where understanding is gradually improving as technology and research advance. Indeed, though, we can make broad statements based upon available research that indicates typical disease course for those with alcoholism; the statements won't apply to all, but will apply to a majority. It's like saying that the blue spruce grows to 50-100'. Not all of them will, but that's a typical final height for the tree. Drgitlow 18:45, 11 February 2007 (UTC)

Regarding the terminology, and whether to change it, Dr. Jellinek apparently proposed at one time to introduce the term "Jellinek Syndrome" as a clinical-sounding replacement for "alcoholism", precisely to avoid the negative connotations of that name. This was a good many years ago, when "alcoholic" was still mainly pejorative rather than diagnostic, but even then the notion was politely put aside ... by the sober alcoholics. Being sober, they felt no such opprobrium in the name, and in fact felt it helped to hit the issue directly, rather than try a euphemistic finesse.

This sense seems to have been correct. These days, objection to the term is more commonly confined to those who object: "But that would mean I couldn't drink any more!" For those who want to stop, it is more often accepted with a sense of relief. [A sense of delight in the case of one young fellow, whose first experience with it was hearing an attractive nurse refer to him as "acute alcoholic". He opted to stay for treatment, and then to stay sober, even after getting the terms straightened out.]

On a lighter note, in the 1940s there apparently was some strain between A.A.'s New York office and some West Coast members, the latter feeling they weren't getting the proper sort of support ... at which point some of the latter threatened to set up on their own, under the name of "Dipsomaniacs Anonymous". "Alcoholic" looks better all the time! FutharkRed 11:53, 15 February 2007 (UTC)

[edit] Forms of Alcoholism Revisited

Different authorities in the field of alcoholism use the term "alcoholism" to mean different things. This discussion topic has been created to compile a list of the many definitions of alcoholism. This section is not for proposing new terms or debating which definition is best, or "correct," which would be original research. So please feel free to add or correct definitions to best match what you have come across in the published literature.

In my reading, I've come across the following different uses of the term alcoholism:

A - Any drinking in spite of negative consequences, including by choice, referred to as "problem drinking" in some medical literature.

B - Drinking despite negative consequences because of a compulsion / loss-of-control. This is more or less equivalent to DSM-IV "alcohol abuse."

C - Drinking progressively more despite negative consequences to relieve withdrawal symptoms. This is more or less equivalent to DSM-IV "alcohol dependence."

In my reading, every description of alcoholism has fallen pretty close to one of these three categories. Please suggest any changes or additions that might be necessary. --Elplatt 05:40, 16 February 2007 (UTC)

Thanks for getting this started. I would be elated if this could be incorporated in the article. For easier reference, I have labeled each of the three conditions A, B and C.

What you've laid out in A, B, and C correspond to psychological, neurochemical, and physical addiction to alcohol. Each of these is a real and demonstrated phenomena, and needs to be dealt with individually when treating a patient. It can be very confusing because the three are mutually self supporting. Neurochemical addiction, for instance, will artificially enhance a drinker's perceptions of the positive aspects of drinking resulting in a strengthening of the psychological addiction. Physical addiction will prevent a drinker from digging in their heels and halting the addiction process through a cold turkey technique. Psychological addiction will convince the drinker that drinking is beneficial, allowing the other two to get their foothold.

I agree with A and B, but most of the doctors I've talked to insist that C just doesn't happen unless A and/or B exist first. Essentially, C becomes a secondary reinforcer for A and/or B. Also, I don't think that anyone considers an alcoholic to be cured of alcoholism once they've gone through detox, which does effectively cure C. I believe that the DSM refers to both A and B as dependence, whereas physical medicine refers to C as dependence. Dr. Gitlow, can you weigh in here? Robert Rapplean 17:17, 16 February 2007 (UTC)

It's quite possible that there is some overlap between these different definitions, I didn't mean to give the impression that there wouldn't be. I'm more concerned with identifying different meanings of "alcoholism" and there may not be a one-to-one correspondence between a meaning and a particular physical/psychological condition.

Type A was meant to include all kinds of problematic alcohol use. It certainly includes what you call "psychological addiction" but it also includes people who aren't addicted at all, and simply drink in spite of negative consequences by choice. For instance, plenty of people willingly drink to get drunk throughout college (often with negative consequences), and "settle down" after graduating.

I think type B would include both the psychological and neurochemical addiction you referred to. My main point with B was that the drinker's body responds normally to the alcohol, but for some reason they still have extreme difficulty controlling their drinking. When psychologists write papers comparing "internet addiction" to alcoholism, this is what they're talking about. This also seems to be Dr. Gitlow's definition. Are there groups that refer to psychological addiction but not neurochemical addiction as alcoholism (or vice versa)?

Which brings me to C. I meant C to specify that the drinker's body responds differently to alcohol. Some references refer to alcoholics as having an marked higher tolerance to alcohol right off the bat. You're right that this should include recovering alcoholics. So perhaps it's not the state of dependence, but the inability to drink without becoming physically dependent.

Thoughts? --Elplatt 18:21, 21 February 2007 (UTC)

A few thoughts. (A) seems to me to be a parent category of (B) and (C). I wouldn't say that (B) necessarily involves a difficulty in controlling drinking, as it's often the result of a lack of recognition that drinking is a problem for them. It's more of a grand state of denial. (C) is also known for denial, but mostly because it is usually found with (B) in its earlier stages and provides (B) with chemical reinforcement. Robert Rapplean 02:49, 26 February 2007 (UTC)

I agree with the comments on denial. I'm beginning to think that both B and C fall into the AMA definition of alcoholism, while A is the common usage. Perhaps the big distinction in the article should be between common alcholism and AMA alcoholism. Further info about different views and subclasses of AMA alcoholism could go in an AMA alcoholism section. I also think that facts about studies and reasearch should be classified under AMA alcoholism, while most history should be under common alcoholism. Does that sound reasonable? --Elplatt 19:36, 26 February 2007 (UTC)

Revised list, 02/26/07, per RR:

A - Any drinking in spite of negative consequences, including by choice, referred to as "problem drinking" in some medical literature. This includes both addicted and non-addicted states.

B - Drinking despite negative consequences. A normal physical response to alcohol, but denial of negative consequences.

C - Drinking despite negative consequences. Extreme difficulty controlling drinking augmented by a tendency to become physically dependent.

There are still a few holes in the plan. I don't think that B falls into the AMA alcoholism category. For medical practitioners, there is a very strong delineation between B and C. Those that fall into B generally don't require much treatment because consuming neuroinhibitors is a self correcting behavior. Because of differences in body chemistry it's a self reinforcing behavior for those in category C. You can see the biggest difference in non-social drinking habits. Those in category B will readily overdrink around others, but generally don't drink much when alone unless there's something like depression triggering it. For those in category C, drinking is valuable as a solitary activity with no need for other contributing factors. Drinking results in an endorphin/dopamine "pleasure response", and may result in neurochemical conditioning.

I agree, though, that A probably constitutes a common understanding of alcoholism. That is to say, the typical person doesn't differentiate between B and C. My conversations with Dr. Gitlow are convincing me, however, that the AMA only considers C to be alcoholism at all. Robert Rapplean 20:44, 26 February 2007 (UTC)

[edit] Forms of Alcoholism Debate

I believe that Elplatt is essentially correct. Let me provide a different analogy. The t-shirt is a well known part of our culture. Let's say some corporation came out with a line of garments in this category that they named "The T-Shirt". They could do their darndest to insist that everyone stop calling the rest of those garments t-shirts, but they probably wouldn't have much impact. A better analogy would probably be the astronomers trying to tell Roman mythology buffs that they can't use the name "Pluto" for the Roman god of the underworld any more.

Alcoholism is similar in that the AMA has taken a subset of those things that we call alcoholism and decided that this is the one and only true alcoholism, and everyone else is just plain wrong for calling the rest of it alcoholism. The rest of the world continues to turn at its own pace in complete ignorance of the AMA's decree. Those not in the medical profession really don't bother themselves with such details until it becomes a problem to them.

What those not in the medical profession do pay attention to is what others not in the medical profession call those who regularly fail to control their drinking. On those occasions when alcoholic is used beyond its purely derogatory sense, it is generally used to describe someone who the listener does not have a close association with. All they can see is the behavior, not its causes. From this perspective the AMA's alcoholism is completely undifferentiable from any other form of drinking that can cause problems.

So people with non "AMA alcoholism" drinking problems will get told that people with matching symptoms are alcoholics, or even told that they themselves are alcoholics. Since alcoholism really is what we call that kind of problem, then the person will reasonably be convinced that he has alcoholism. Most of them will react to this by deciding to cut down on their drinking. It isn't until this point that we are able to differentiate AMA alcoholics from "common" alcoholics. The common alcoholic will reduce their drinking sensibly, maybe only getting into trouble at big parties, while the AMA alcoholic will regularly find their resolve to be inaccessible while they get worse and worse over time.

The result of this is a society-wide case of equivocation, where group X says something about alcoholism, and then group Y gets to agree with or dispute the statement based on which definition they chose to pick. This is especially true for people's subconscious perception of alcoholics. The recovered common alcoholic can say to himself that he got over his alcoholism, so it must not be as bad as this other alcoholics, the AMA, or someone asking for money makes it out to be. This is a HUGE social problem, and one that I would very much like to take a step towards correcting in this article. Robert Rapplean 01:14, 26 February 2007 (UTC)

I agree with you both that all of the major definitions need to be incorporated into the article. Robert has hit on something with his terminology of AMA alcoholic versus common alcoholic. What he means, I think, is that there are the people who have the disease, as the medical community defines it, and there are people who get in trouble with alcohol, as the overall population defines it. There is obviously overlap between these two groups. Some folks who get into trouble with alcohol and who are seen as alcoholic by a bystander would also be seen as alcoholic by a physician. But some are not. And some alcoholics, diagnosed as such by a physician, do not regularly have trouble with alcohol and might not be recognized as alcoholic by a layperson. I very much agree that when a physician says "alcoholic" and a "person on the street" says "alcoholic," they are likely referring to two different groups of people. It is important that we recognize this within the article and describe the two perspectives. And I think we all agree on this point, yes? Drgitlow 04:31, 1 March 2007 (UTC)

Yay! I think we understand each other now. Now we just have to figure out how to incorporate it into the article. Robert Rapplean 23:01, 1 March 2007 (UTC)

[edit] Now that we've come to an agreement, How do we alter the article?

I've been putting some thought to this, and I'm not sure how to handle a word that truly has two definitions, but for which everyone insists that there is really only one definition. We can't do a disambiguation page because people wouldn't know which one to look at, and it would encourage special pages where they define alcoholism as a curse by god upon the unworthy. Maybe we could start off the article "Alcoholism is any of a collection of conditions, all of which are characterized by a continued use of alcohol in spite of negative consequences," and then follow up with the types of things which are considered by alcoholism by various people. If we do this, we would be required to include AA's definition of "the desire to drink that persists long after a person stops drinking". Maybe it would be best to ask Wikipedia specialists and see if there are any similar situations, and how they've handled them. Ideas? --Robert Rapplean 01:22, 3 March 2007 (UTC)

Pretty much agreed on all points. I would really like to find out if this kind of situation has come up on wikipedia before. I think the approach of saying it is a collection of conditions is more or less the right idea, except I think it might be better to say it is one general condition that different groups attribute more specific meanings to. --Elplatt 07:00, 4 March 2007 (UTC)

I'm reposting this from the village pump, and he's the only respondant. Let's go ahead and act on it. --Robert Rapplean 16:22, 5 March 2007 (UTC)

Probably explain which definitions are held by which major groups, which are generally assumed by news media, etc. Be sure to include lots of references and take care to avoid implying that one group's view is the "right" one. --Random832 18:38, 3 March 2007 (UTC)

Here's the JAMA definition again:

Alcoholism 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 impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.

For reference, here's the AA definition of alcoholism:

Alcoholism is a progressive illness, which can never be cured but which can be arrested. The illness represents the combination of a physical sensitivity to alcohol and a mental obsession with drinking, which, regardless of consequences, cannot be broken by willpower alone.

There's also the DSM definition. DSM-IV does not specifically define alcoholism, referring readers instead to their definition of substance dependence. Here is their definition of substance dependence, where I've inserted the word alcohol for substance where appropriate:

The essential feature of Alcohol Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of alcohol despite significant alcohol-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior.

There is also the American Society of Addiction Medicine definition of addiction, a subset of which would apply to alcoholism:

Addiction is a disease characterized by continuous or periodic impaired control over the use of drugs or alcohol, preoccupation with drugs or alcohol, continued use of these chemicals despite adverse consequences related to their use, and distortions in thinking, most notably denial.

I'm going to include a couple definitions from people who are more attempting to characterize how we use the word than attempting to solve alcoholism as a problem. This should provide us with a basis for the "common" definition.

n. A disorder characterized by the excessive consumption of and dependence on alcoholic beverages, leading to physical and psychological harm and impaired social and vocational functioning.

– alcoholism. (n.d.). The American Heritage® Dictionary of the English Language, Fourth Edition

1. habitual intoxication; prolonged and excessive intake of alcoholic drinks leading to a breakdown in health and an addiction to alcohol such that abrupt deprivation leads to severe withdrawal symptoms
2. an intense persistent desire to drink alcoholic beverages to excess [syn: dipsomania]

– alcoholism. (n.d.). WordNet® 2.1

I think we have enough to get a start. If other essential definitions crop up, we can see how much of them needs incorporating. The bottom two seem to match well with Elplatt's (A) case of definition, don't you think? I'm tempted to say that alcoholism is a collection of disorders, all of which are characterized by either habitual intoxication or an intense, persistent desire to drink alcoholic beverages. I don't think that "collection" is the proper word, though. --Robert Rapplean 18:46, 10 March 2007 (UTC)

More thoughts. How about "Alcoholism refers to any condition which results in habitual intoxication or causes an intense, persistent desire to drink alcoholic beverages despite adverse consequences related to their use."? --Robert Rapplean 22:41, 10 March 2007 (UTC)

Pretty good, how about: "Alcoholism generally refers to any condition which results in the consumption of, or desire to consume, alcoholic beverages despite adverse consequences."? --Elplatt 02:48, 16 March 2007 (UTC)

The two of you have just provided your own definitions of alcoholism, which I don't think is the point of an encyclopedic article. Our job, if you will, isn't to define the term, but to report upon how the term is defined. The term is defined in multiple ways, as we see above, and we should refer to each of these. But we still need to open the article with a statement.

We might therefore do one of the following: 1) Pick the definition from the boxes above that we feel merits prominence based upon its being attributable to a reliable source. 2) State that alcoholism is described and defined differently by different groups.

Robert, your statement that alcoholism is a collection of disorders would not be accepted by the medical community, which clearly feels that alcoholism is a single entity. Elplatt, your statement that alcoholism refers to any condition resulting in the consumption of or desire to consume alcoholic beverages despite adverse consequences also is problematic. Let's say that a patient has a sudden head injury after which he develops an intense desire to drink alcohol heavily. Is this alcoholism? Or is this an organic brain disorder, a behavior which results from traumatic brain injury? Most docs, I suspect, would say the latter, particularly if the patient drank without difficulty prior to the incident. So alcoholism does not refer to "any condition" which results in the given behavior.

Again, I don't think our job is to redefine the term, but rather to summarize knowledge already gathered and studied by others. Drgitlow 05:49, 19 March 2007 (UTC)

I don't believe it's the case that we gave our own definition for it. What we've done is created a "least common denominator" definition, which is a starting point from which we can differentiate the varying definitions of alcoholism. You are right, though, that head trauma resulting in alcoholic cravings probably wouldn't be called alcoholism by anyone who understands it. No, the medical community wouldn't accept "collection of conditions" as they only recognize the one true medical alcoholism. We've been through that, and we've already established that alcoholism is more than what medical science thinks of as alcoholism. So maybe we can call it "any naturally occuring condition"? Besides that, I do like Elplatt's wording. Robert Rapplean 06:45, 19 March 2007 (UTC)

Dr. Gitlow's statment brings up an important distinction. We are not creating a new definition of alcoholism, but making a neutral statement about the usage of the word alcoholism. I agree that saying "any condition" is too strong a statement, but "naturally occuring" could be confusing. Maybe we can just make a weaker statement and say something like "a condition" and elaborate on specific (such as JAMA) and general definitions in the following sentences. --Elplatt 19:15, 20 March 2007 (UTC)

We're really getting into semantics here. Unless we take someone else's definition word for word, we are technically coming up with our own definition. Our charge as responsible Wikipedizens is to make the Wikipedia definition reflect all known usages that aren't covered on a different page, and there are no other alcoholism pages. Therefore the definition that we produce has to cover all the bases.

I'm not sure I agree with "a condition" because it's really multiple conditions. The "lapse in judgement" condition is entirely differentiable from the "genetic endorphin release induced neurochemical addiction" condition. I've taken a survey of about a dozen people at random, and nine of them say that they would consider excessive drinking to be alcoholism even if it were induced by brain trauma, so once again we can't stand on ceremony on the AMA definition. One person gave me the reasoning "if it looks like a duck and quacks like a duck, I'm gonna call it a duck." It's really an uphill battle getting past people's insistence on stuffing it all into a single mold. I actually do now thing that "any condition" works, or maybe "a set of conditions"? Group? Also, could we strike "generally" from the beginning? I don't think it's necessary, and encourages people to think "what does it refer to the rest of the time?".

I can accept either "any condition" or "a set of conditions" and you can strike "generally" if you'd like. I don't think it's ideal, but it's an improvement. My concern is with differentiating between two cases: 1) alcoholism means the same thing to everyone and encompasses many conditions, and 2) alcoholism means different specific conditions to different people. I think it's clear from our discussion that 2) reflects reality, but I think it's possible to misunderstand our working description to mean 1). --Elplatt 02:46, 2 April 2007 (UTC)

Sorry, got hung up with other projects for a bit. Elplatt definitely identified an important point. With that in mind, I'd like to propose this as a straw man. I don't like "segment of population", and hope that someone can come up with something better. After this opening paragraph, I'd like to see a separate paragraph for each identifiably distinct definition that we can find. Robert Rapplean 18:51, 8 April 2007 (UTC)

[edit] A new beginning

I've broken this section off because the above section was getting too long, and I think we have a decent break point. Here is the current best effort at a starting paragraph. Robert Rapplean 00:58, 14 April 2007 (UTC)

The definition of alcoholism varies depending on the segment of population that is using the word. For common usage, it refers to any condition that results in continued consumption of alcohol despite negative consequenses. Medical definitions specify those conditions in the above group which developed from the consumption of alcohol and which involve a loss of control over usage. The medical definitions invariably describe alcoholism as a disease. Definitions of alcoholism commonly refer to a loss of control over one's alcohol consumption, a preoccupation or obsession with alcohol and drinking, and an impaired ability to recognize the effects of alcohol consumption. Some definitions specify a current use of alcohol and include the effects of long-term heavy alcohol use, including dependence and withdrawl.

Is good! --Elplatt 22:17, 8 April 2007 (UTC)

Continuing on to a second paragraph.

The variation in definitions is caused by an inability to identify clinical alcoholism except through tertiary effects on the sufferer. Clinical alcholism is an unusually strong craving for alcohol. The craving results in drinking, and the drinking results in a negative impact on the person's life that exceeds the positive benefits of alcohol drinking.

For common usage, a person is considered an alcoholic any time the person using the word percieves serious negative consequences in the drinker's life. This consideration may not take into account positive effects, and may not consider craving or the lack thereof.

How's that? This brings us to a description of the medical version of alcoholism. We can use the AMA definition, but really should accumulate definitions from international sources.Robert Rapplean 00:58, 14 April 2007 (UTC)

I've done some editing of the extant paragraphs, as you can see, rather than embarking on a solo wholesale revision. I think you will find that we are all moving in a similar direction. My sense is that the current intention to be more precise in the opening paragraph is a good one.

Cheers! Empacher 10:54, 14 April 2007 (UTC)

[edit] Commentary on The Alcoholism Revolution by Dr. James R. Milam

Also, are you familiar with the Dr. James R Milam? What is your opinion of articles such as this? --Elplatt 18:33, 21 February 2007 (UTC)

Elplatt, the Milam article is interesting. Give me a little while to digest it and I'll get back to you. At first glance, Dr. Milam uses some terminology that isn't often used in the field, but he defines his terms well. It's interesting that he says, "Psychiatrists have always been regarded as the ultimate authorities on alcoholism." That's not at all the case, and in fact the majority of those who treat alcoholism are not psychiatrists (I'm a psychiatrist, by the way). The American Society of Addiction Medicine's membership is about 1/3 psychiatrists. Psychiatrists through the 1950s and 60s ignored addictive disease entirely, and for the most part those who specialized in the field were internists. Milam also suggests that the disease concept is equivalent to the thought that alcoholism is caused by excessive 'relief drinking.' That's not the case at all. Those nitpicks (and some others) aside, I agree with his approach with respect to alcoholism being of biologic origin. But that's not a new approach at all...that's something that's been general knowledge within the field for 50 years. But I think this article was written around 1990, and it may well be that within the context of the field two decades ago, some of his arguments are more pertinent. Take a look at Milam's follow up at http://www.lakesidemilam.com/drmdcc.htm. Here he certainly echos many of my own concerns about how easily the general public has been duped by misguided pundits who have absolutely no research skill or scientific background yet are quite skilled at garnering publicity for themselves because they're saying exactly what the public wants to hear. Drgitlow 02:41, 22 February 2007 (UTC)

[edit] Addiction Medicine specialists

There has been some editing recently which removed a reference to Addiction Medicine specialists. I've noted that most of the disease entries on Wikipedia include a reference to the physician specialty "responsible" for treatment of that illness. Schizophrenia refers to psychiatrists; cancer refers to oncologists; etc. There are a number of specialties responsible for treatment of alcoholism, as with other illnesses, but the primary one is addiction medicine. Is there a specific reason we should not include such a reference with alcoholism as we do for other illnesses? Drgitlow 02:05, 24 February 2007 (UTC)

I'm all for putting the info back in. --Elplatt 21:28, 25 February 2007 (UTC)

I didn't remove it, I moved it to its own paragraph. That paragraph is a stub, feel free to expand on it. In your original edit you stated that Addiction Medicine Specialists have tools for identifying alcoholism. This is somewhat misleading, suggesting that Addiction Medicine Specialists are the ONLY ones who have these tools. Considering that later in the article we list numerous online resources, I felt that we were contradicting ourselves. Nonetheless, I agree that the specialists should be mentioned as a way of letting people know the specific words they should look for when trying to find a medical professional to help them with the problem. I think you two will do an excellent job at explaining why such specialists have the best qualifications for treating alcoholism. --Robert Rapplean 01:31, 26 February 2007 (UTC)

OK...I'll take another look at that. By the way, what you say is often true, at least in the medical field. For example, a patient with diabetes can be treated by an endocrinologist, a family practice specialist, an internist, or a pediatrician (if a younger patient). The medical literature generally supports the concept that the best outcomes exist when patients are seen by clinicians who specialize in the field of interest. My usual recommendation is that a patient with a chronic illness be seen at least once by the specialist, then followed by the clinician of their choosing. Drgitlow 04:35, 1 March 2007 (UTC)

[edit] I love what you've done with this place!

Every so often I swing back by this article, and it seems better and better each time. I recall a time period when for a months or so it would be AA based, then some odd chelation/dietary/astro-healing based, then some unsightly abomination attempting to preserve all the original text... and now it seems to be encyclopedic, non-biased, and pretty much backed up by verifiable citations! Kudos, Folks! Ronabop 05:07, 28 February 2007 (UTC)

[edit] Funny Pair of Phrases

It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption are described in Alcohol consumption and health, but may include cirrhosis of the liver, pancreatitis, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources.

How often to people continue to drink after the physical health effect of, uhm, death? :D Ronabop 05:45, 28 February 2007 (UTC)

Hi, Ronabop, and thanks for the props! This comment gave me a good chuckle, but I'd have to say that when death occurs, the physical health effects of drinking alcohol have stopped manifesting. Robert Rapplean 18:36, 28 February 2007 (UTC)

[edit] Wish to contribute

I'd like to contribute to this article, at the very least at the level of general editing for flow and readability. If I am a registered user, why can't I edit under the semi-protection policy. Empacher 21:14, 9 April 2007 (UTC)

Welcome! Semi-protection limits users with accounts less than four days old from making changes. There's currently an ongoing discussion about the article in this section. You should at least read through that section before making any changes, but the more of the discussion you can read the better. --Elplatt 21:39, 9 April 2007 (UTC)

[edit] "Most people" cannot drink alcohol without risk of becoming an alcoholic

Please clarify the following statement in the article itself:

"While alcohol abuse is a prerequisite for what is defined as alcoholism, the biological mechanism of alcoholism is uncertain. For most people, alcohol consumption poses little or no danger of addiction. Other factors generally contribute for alcohol use to develop into alcoholism. These factors may include a person's social environment, emotional health and genetic predisposition."

The above statement re: "most people" is not true and cannot be substantiated by any facts or analysis. In fact, anyone that consumes alcohol can be susceptible to the addiction; that is a fact. If, as a matter of fact, most people do not drink alcohol, then the statement can be assumed to be true. We, however, know that the vast majority of adults alive today (within the U.S. at least) consume alcohol on a regular basis. Therefore, the statement should be changed.

Further illustration and very much to the point of my discussion here: e.g., most American Indians cannot drink alcohol without becoming addicted and alcoholic. The above statement in the article of "most people" is misleading and highly inaccurate.

I think the statement in the article gives the general public a poor mis-understanding of how critical it is that even moderate drinking can lead to full blown alcoholism at any time. W.O.W. 67.163.34.18 18:38, 1 May 2007 (UTC) I quote the above user.^ 67.163.7.227 02:36, 2 May 2007 (UTC)W O W 03:32, 16 May 2007 (UTC)

Alcoholism is an obssessive-compulsive (read: psychosocial) paradigm, that is driven by biologicial and gentic components attached to both the alcoholic behavior and the OC behavior. To contend that the "most people" statement is untrue is contradictory to the documented position of most academic and clinical experts in the field. (Go to scholar.google.com and type in 'alcohol and biology')

Plainly put, if one has no predisposition to a number of co-occurring factors, the liklihood that one's drinking, no matter how excessive, will escalate into clinically defined alcoholism, is pretty slim. DashaKat 12:13, 2 May 2007 (UTC)

• I was blessed with sobriety in 1994, and I have attended AA for nearly 13 years. After working with families, friends, relatives, class-mates, going to medical school; studying the disease, I contend that you are not correct in your assumptions. Anyone can become addicted to alcohol, just as is the case with nicotine. It is not an exclusive club. You can use semantics and try to fine tune the definitions of what is related to cause but to say "most people" is simply not correct. That statement presupposes that you can find the predisposition or that there is a finite set of factors involved. I believe anyone over the age of ? (call it 25) that still sees a need to go out and get drunk, is an "alcoholic." There are millions of people that get drunk. Why? Why do those same people do it throughout a lifetime? It is habitual. Why? Because they cannot help themselves. In varying degrees, anyone that gets "high" is using the same paradigm as I did before I was blessed with sobriety. Your "most people" should be re-worded, or that sentence should be taken out. It is an invitation to experiment with a potential disaster. The predisposition theories are valid and I do believe their is a genetic inheritance (of genetic code.)

However, we are co-mingling that code everyday. It is a time bomb. It is somewhat akin to wondering if I am almost pregnant. The codes are so powerful in certain ethnic groups that to say "most Irish people can become alcoholic" is a truth. For that reason, your "most people" should be changed. Am I one of the "other" most people, or part of your "most people" ? 67.163.7.227 14:03, 2 May 2007 (UTC)W O W 03:32, 16 May 2007 (UTC)

Ah, now I understand your adamant positionality. As someone sheperding his/her sobriety, and working with in the confines of the AA program, you are completely correct. As a clinician, I am completely correct. Let's agree to disagree, based on our individual points of reference, shall we? DashaKat 20:23, 2 May 2007 (UTC)

Yes, the A.A. program is a blessed spiritual experience for millions of fortunate people, albeit I am also a student of science and medicine. I do not see a need to pretend that millions of individuals that could otherwise be forewarned of a very real peril should be told that "chances are" "most people" will not become alcoholic. The statement is simply not true. That is the very problem found in Sweden, the former Soviet Union, etc. etc. Entire nations have toppled from such a lack of wisdom. I know that "most" Irish people will have a predisposition to alcoholism. So the generality using "most" is not seemly. I will agree to disagree, and kindly ask that the wording be changed. If it saves but one 6 year old from an untimely drunk driving death, it would be worth it. 67.163.7.227 00:29, 3 May 2007 (UTC)W O W 03:32, 16 May 2007 (UTC)

A cooperative compromise. Find a source that sites statistics and correct the statement as you see fit. Although your 'position' is reasonable, making a black-and-white claim in this forum, without supporting evidence, is as pernicious as making a gross generalization, as you suggest this statement is...

On the other hand, you can just change it yourself, and see how the other editors react, as it appears this conversation is between only the two of us! Cheers... DashaKat 10:03, 3 May 2007 (UTC)

I agree that the statement is not verifiable. As far as I know, there isn't a reliable measure of any individual's risk of developing alcoholism. I've made what I feel to be an appropriate change. --Elplatt 06:53, 6 May 2007 (UTC)

Thank you Elplatt. I am grateful to see the change. 67.163.7.227 20:11, 6 May 2007 (UTC)W O W 03:32, 16 May 2007 (UTC)

[edit] Today's modification

I made some modification to the opening paragraph this evening. Among other changes, I fixed a typographical error. I also elaborated upon the typical medical definition. It's important to recognize that from a medical perspective, alcoholism isn't about the alcohol, but rather is about the patient's life within the context of alcohol use. That's why we have the expression "dry drunk." One can be abstinent but still have many of the symptoms of alcoholism.

While I left the line in about "loss of control," it's important to realize that this isn't part of the classic medical definition. In fact, patients with alcoholism are the only ones trying to control their alcohol intake. Those without alcoholism don't have to. Alcoholics often have rules about when they drink - only after noon, only when I'm alone, only when I'm with others, only at the bar, etc. These attempts at control are one of the hallmarks of the disease. So it's not the loss of control which defines the illness, but rather the effort to control which often is successful for a long period of time. The loss of control is one of the last things to happen before significant complications take place.

The "use despite oneself" is a standard line in most of the medical texts on the topic and represents the quick method that students are taught as a way to make rapid diagnoses of the illness. Drgitlow 02:31, 12 May 2007 (UTC)

Thanks for the medical perspective. Actually, I'd like to see a paragraph in the intro dedicated to the current medical perspective, and the first paragraph sufficiently general to include all perspectives. What do you think?n --Elplatt 03:58, 14 May 2007 (UTC)

Comment: I do not fully agree with the above statements and having gone to A.A. meetings without a relapse for nearly 13 years, I must say that from my perspective, I knew I was an alcoholic for at least 10 years and I tried quitting for all of those years, before being "blessed with sobriety." I agree that understanding the concept behind "dry drunk" is an important element of alcoholism and without surrender and acceptance of my own alcholism, I was a dry drunk many times. However, the medical concept that "it isn't about the alcohol" is absolutely incorrect, in my opinion. I became addicted to a drug called alcohol. I became addicted to a drug called nicotine. I have been without both for 13 and 14 years, respectively. They are both very powerful drugs and both are highly addictive. If I had not had the experience of drinking, I might have had psychological problems of one sort or another, but I would not have had the experiences I did as an active alcoholic. It is about the alcohol. It is about the drugs.

It was surrender to a power greater than me, that helped me; it was acceptance that alcohol is and was more powerful than I am. It was a spiritual experience that saved my life. It is the common mis-conception of clinicians that alcoholics are consciously "ok" with scheduled drinking. That behavior, is clearly not anything save for a behavioral form of denial or attempt at denial that a problem exists. It was one way for me to state emphatically that "I cannot be an alcoholic if I don't drink before 5 p.m." ...or whatever the time frame is/was. "Functioning alcoholics" thrive in our world today, all living in a private hell because of some of the above mis-conceptions.

Again, there are more addicts of alcohol than we could possibly understand because of the way we define the behavior of alcoholics. Not all alcoholics end up with DUI convictions or lost jobs. On the contrary, the above are only a small percentage of the alcoholics I see in the A.A. program. Thank you for your time. 63.93.197.67 21:13, 15 May 2007 (UTC)W O W 03:33, 16 May 2007 (UTC)

This looks very good. Thanks, Dr. Gitlow. As mentioned above, we can work to refine it from there. I agree that we should follow this up with a paragraph that specifically focuses on the medical definition(s) of alcoholism. We may add paragraph describing other perspectives as necessary. If the number of perspectives become bulky, we may break that off into the first section. For now, though, let's address a few of the concerns presented. Here's what we're working with:

The term alcoholism is used to mean various things in different contexts. For common and historical usage, it refers to any condition that results in continued consumption of alcoholic beverages despite negative consequences.

This is very good, but I think the first sentence can be simplified to "The meaning of term alcoholism varies considerably in different contexts." Second sentence is spot on.

Medical definitions invariably describe alcoholism as a disease and addiction.

This feels like sticking a label on it. Can we expand that to "Medical definitions describe alcoholism as a disease, addiction, or dependence that results in difficulty with controlling one's alcohol consumption."? this also gets rid of the maligned "invariably". We can expound upon this in a later section.

I'm going to cut a piece out here, see below.

It is sometimes referred to as a loss of control over one's alcohol consumption, a preoccupation with or compulsion for alcohol, and an impaired ability to recognize the effects of alcohol consumption.

Adjusting the wording to avoid redundancy, "Alcoholism can also refer to as a loss of control over one's alcohol consumption, a preoccupation with or compulsion for alcohol, and an impaired ability to recognize the effects of alcohol consumption." Yes?

Some definitions specify a current use of alcohol and include the effects of long-term heavy alcohol use, including dependence and withdrawal.

I want to start this sentence with "Some but not all" and then break a paragraph off. This concludes our rundown of the many things that alcoholism can mean, and we can move on to the perceived effects.

Definitions of alcoholism commonly refer to use of alcohol despite one's own best interests. This generally refers to the development of medical complications, occupational or educational loss, or interpersonal complications as a result of continued alcohol use.

I think that this would be more palatable if we started this by saying "Alcoholism is characterized by...". This tells the audience that we are definitely talking about how people recognize alcoholism in themselves and others. I also want to address the subjectiveness of "ones own best interests," since those are externally undeterminable. Thus, "Alcoholism is characterized by the continued use of alcohol despite harm to the drinker. This harm may include the development of medical complications, occupational or educational loss, or interpersonal complications."

While alcohol use is necessary to develop alcoholism, many people consume alcohol without developing alcoholism.

Unless someone objects, I'd like to elaborate on this a little: "While alcohol use is necessary to develop alcoholism, the reverse is not true. Use of alcohol does not necessitate the development of alcoholism."

Although the biological mechanism of alcoholism is uncertain, some risk factors for alcoholism have been identified. These factors may include a person's social environment, emotional health and genetic predisposition.

This works well for me. I'm going to make my edits on the main page now, please smite me with your constructive criticism. - Robert Rapplean 22:13, 15 May 2007 (UTC)

Looks good. Drgitlow 03:58, 16 May 2007 (UTC)

[edit] Summarized new contributor guidelines

I summarized the new contributor guidelines in some bulleted lists. I think new contributors are more likely to read it that way. Feel free to add/remove/discuss as necessary. --Elplatt 04:34, 14 May 2007 (UTC)

This certainly works for me. We can add more items as we feel they are necessary - Robert Rapplean 21:36, 15 May 2007 (UTC)

[edit] New intro...

The new intro is not only poorly written, it posits several untenable, as well as untrue, statements. 69.120.121.25 19:58, 14 May 2007 (UTC)

Maybe with such scathing comments, you might provide some 'what' and 'why' to your disappointment with the introduction? :) JoeSmack ^Talk 20:10, 14 May 2007 (UTC)

The term alcoholism is used to mean various things in different contexts. - not true...alcoholism is a diagnosis, not a colloquial reference to behavior.

For common and historical usage, it refers to any condition that results in continued consumption of alcoholic beverages despite negative consequences. This assumes that there is an element of choice in the consumption of alcohol to the point of medical peril.

Medical definitions invariably describe alcoholism as a disease and addiction. Invariably suggests hard eveidence...there is no evidence to firmly support either of these contentions.

Definitions of alcoholism commonly refer to use of alcohol despite one's own best interests. - POV, at the vary least ^{[citation needed]}.

This generally refers to the development of medical complications, occupational or educational loss, or interpersonal complications as a result of continued alcohol use. This is the clinical definition of alcohol as a disorder.

It is sometimes referred to as a loss of control over one's alcohol consumption, a preoccupation with or compulsion for alcohol, and an impaired ability to recognize the effects of alcohol consumption. - Loss of control again suggests that there is an element of free will involved. This is true, when a person decides on sobriety. Until then, it's not. The rest is mixed with a clinical definition.

Some definitions specify a current use of alcohol and include the effects of long-term heavy alcohol use, including dependence and withdrawal. - more clinical stuff.

In an effort to "soften" the definition, or, at least its presentation, the whole thing has become muddled. It's neither clinical, nor non-clinical, but a hybrid weakened by the half-nod to both, and solid positionality of neither.

As a long-time clinical, I have my own opinions about how this article should be written. I have to agree with the comments above. And, with all due respect, I would gather that the individual who wrote this is in recovery, not a medical or clinical professional. DashaKat 21:28, 14 May 2007 (UTC)

Before everyone dives into responses on content, i'd just like to say that this article was written by many, many, many people as the history tab portrays. Presumptions and judgements about who the major contributors were/are and what their background is, be it recovery, alcoholism, medical, clinical, or all four should have nothing to do with this conversation. This talk page is about the article and not the editors, all due respect too. :) JoeSmack ^Talk 23:29, 14 May 2007 (UTC)

The major contributor to the revised intro was one person. Background presumes positionality. The positionality of this article has moved from informational to POV, based on personal experience versus professional distance.

Nice try at displomacy, but you're off base. DashaKat 01:38, 15 May 2007 (UTC)

DashaKat... first, please leave out the personal judgments and stick to the facts. Second, the new intro is the result of a lot of discussion on this page between many contributors over the past several months, a discussion which you offered no input on and, apparently, have not read. If you would like to read this discussion and offer your input now, you are certainly welcome to (it begins with Forms of Alcoholism Revisited).

Some of the points you bring up are new and worthy of discussion, others have been gone over again and again. I'm going to address each of your points with an open mind, and I request you consider my responses with a similar open-mindedness. I agree that the intro is not perfect, but I think it is a step in the right direction, and if you feel you can improve it, by all means make a suggestion or a well-considered change. Now, my responses:

"The term alcoholism is used to mean various things in different contexts. - not true...alcoholism is a diagnosis, not a colloquial reference to behavior."

False. The term alcoholism has been around longer than it has been recognized as a medical issue, let alone a diagnosis.

For common and historical usage, it refers to any condition that results in continued consumption of alcoholic beverages despite negative consequences. This assumes that there is an element of choice in the consumption of alcohol to the point of medical peril.

I see no such assumption in that statement (does anyone else?), can you point it out or recommend an alternative?

Medical definitions invariably describe alcoholism as a disease and addiction. Invariably suggests hard eveidence...there is no evidence to firmly support either of these contentions.

We could easily cite the JAMA, the DSM-IV, and a number of other medical documents that describe alcoholism as a disease. Or is your issue with calling it an addiction? If so, what change would you suggest? I do agree that "invariably" is not verifiable, would changing it to "usually" satisfy you?

Definitions of alcoholism commonly refer to use of alcohol despite one's own best interests. - POV, at the vary least

Regardless of whether it's POV, I do think this phrase is not quite accurate and the "despite negative consequences" line suffices.

This generally refers to the development of medical complications, occupational or educational loss, or interpersonal complications as a result of continued alcohol use. This is the clinical definition of alcohol as a disorder.

As I've said earlier in the discussion, I'd like to see a distinct paragraph in the intro dedicated to the medical/clinical perspective.

It is sometimes referred to as a loss of control over one's alcohol consumption, a preoccupation with or compulsion for alcohol, and an impaired ability to recognize the effects of alcohol consumption. - Loss of control again suggests that there is an element of free will involved. This is true, when a person decides on sobriety. Until then, it's not. The rest is mixed with a clinical definition.

DrGitlow made a good point against the loss of control line earlier, and I'm certianly willing to part with it.

In an effort to "soften" the definition, or, at least its presentation, the whole thing has become muddled. It's neither clinical, nor non-clinical, but a hybrid weakened by the half-nod to both, and solid positionality of neither.

I agree that a hybrid definition should not be used. However, doctors, researchers, studies, newspaper articles, and news stories, all call a wide range of things "alcoholism" and it is important to make that very clear. It is possible to describe both the generalities that all definitions have in common, and to describe the "solid positionalities" of all definitions. Much of the article hasn't been written with this in mind, but the intro is the first step.

--Elplatt 06:18, 15 May 2007 (UTC)

Comment: Also please see my comment above, from a different IP. (13 years of sobriety.) 63.93.197.67 21:13, 15 May 2007 (UTC)

I believe it is imperative to understand the addiction process and that we define alcoholism as an addiction, much like we define an addiction to nicotine. To take a different perspective than what I experienced with both drugs, is a mistake and very suspect at best, in my opinion. I am always fearful that the alcohol and tobacco companies can seemngly change the way people think about their drugs, much like oil comapanies can change the way we think about alternate fuels. Both alcohol and nicotine are highly addictive drugs.

The cold hard fact is this: alcoholism has nothing to do with willpower or "self control." There is the addiction and getting help with same. The addict many times will deny the addiction all the way to the grave. However, the addiction is there. 67.163.7.227 21:58, 15 May 2007 (UTC) signed later... W O W 18:19, 16 May 2007 (UTC)

Hey, there, Mr. 13years. I would like it if you could create an account so we can refer to you as something that doesn't sound like a reply in a "Dear Abby" column. I am completely convinced that you are correct about alcoholism being an addiction. We'll go into that in more detail in the next section I'm proposing on the medical perspective of alcoholism. Medical science has a much better grasp on the problem than your typical Joe. As mentioned above, though, that won't prevent the typical Joe from using the word incorrectly, and some of those typical Joes are responsible for creating legislation that effects the rest of us, including the medical community. I'll say it as often as necessary: It is our job to describe all perspectives to the use of the word Alcoholism, including those that are misguided. When Aunt Rita calls your cousin Tom an alcoholic, it is necessary for our readers to be able to see that Aunt Rita may be exercising a usage that isn't in line with the professional medical perspective. - Robert Rapplean 22:34, 15 May 2007 (UTC)

• Yes indeed...I can creat an account, albeit I have not had the best of experiences with some of the "cabals" of administrators here.

In my view, there are many mis-conceptions about alcoholism, not the least of which is the idea that "control" or "willpower" come into play when discussing what to do with alcoholics. "If only he could drink like a man." Meaning? Like the guy that can "hold his liquor."? "One too many"? My original point in all of this was to eliminate the notion that "most" people can drink alcohol without developing an addiction to alcohol. There is no such proof to substantiate such a claim. There is also no proof that says any amount of alcohol is required to become alcoholic, any more than there was an amount of nicotine required for me to become addicted to nicotine. Further, the notion that harm to the alcoholic is a top priority as part of the definition, is nonsense. Many alcoholics do not care if they are killing themselves, say nothing about what they are doing to their families. Many do not even know what they are doing; they live in a constant state of memory loss. I have known many alcoholics that have put their children and their family in grave peril without any thought to the consequences. They then proceeded to kill themselves in a car, or by other means, many times taking other people with them. It is my firm belief that alcohol, in various amounts, becomes a "moral inhibitor" to the point that the full blown alcoholic lacks most, if not, all morals. Selfish and delusional; lacking in any capacity to be honest with the self or others. That, my friends, is an alcoholic. For some it takes but a drop to get started. For others, it only takes the right genetic coding, or "ethnic background." In any event, alcohol is a drug and it is highly addictive. W O W 03:27, 16 May 2007 (UTC)

Thanks for creating an account, Whispers. I'm afraid that your idea that there is no proof of people being able to drink alcohol without addiction doesn't match the reality. 89% of adults in the United States will drink alcohol this year. That's about 162 million. Only about 15 million will suffer from an addictive state because of it. It isn't terribly PoV to say that 147 million is "most". Other countries have other statistics, but nowhere does the addiction rate exceed half, which would be necessary for the "most" statement to be inaccurate.

• Except that if you use American Indians, for example, your number is absurd. How about people from Irish genetic code?

I am afraid your brush paints a far different picture than mine. I know the numbers in the U.S. are slanted toward what the alcohol industry would like us to believe; that it is not worthy of a discussion or debate, herein. I live it; breath it. I have studied it. W O W 16:30, 16 May 2007 (UTC)

I can definitely see your point about "harm to the drinker" being inadequate. In a lot of cases, the harm is definitely to others. We should incorporate that into our definition.

I'd be very hesitant to state that alcohol is a moral inhibitor. Morality is very subjective. I would say that it supresses judgement. There's a misperception of the cause/effect relationship between alcohol and irresponsible behavior. You can't say that alcohol makes people irresponsible, but you can say that irresponsible people are prone to alcoholism. You are making an unsupported blanket statement about alcholics to say that they are all selfish and delusional. Some are, I am certain, but there are plenty of others who know that they have a problem and don't know how to fix it.

• Totally disagree... you are now entering the chicken and egg area that is not seemly for an encyclopedia. I also do not hold any view that resembles yours on this topic. Alcoholics are not, at birth, somehow less moral or less responsible than other people. On the contrary, many of my closest friends are alcoholics and nearly all are from professional parents, good homes, highly educated families /ancestors, and all are quite "affluent." Hardly the "types" that would fall into your category of deviates, before the alcohol use. It is my opinion that the drug addiction is the precursor of bad behavior, not the other way around.W O W 16:30, 16 May 2007 (UTC)

The point that I'm trying to make is that there is no such thing as a cookie cutter alcoholic. Trying to die-stamp them all into a single solution is a mistake that's been made over and over again in the treatment community. It's only by recognizing the differences between the forms of alcoholism that we can start to understand the complexity of the problems, and start to solve each in a way that's appropriate to it. - Robert Rapplean 16:03, 16 May 2007 (UTC)

• Agreed. However, the reason why A.A. works, in my opinion, is because it is a spiritual program that is literally free and run by people that are, in fact, alcoholics. It sometimes "takes one to know one." There is no financial incentive to abuse A.A., or take it pubic, (i.e., to Wall Street.)W O W 16:30, 16 May 2007 (UTC)

[edit] Adjusting the new intro for readability

I rewrote the intro for style. I tried to keep the content essentially the same with the exception of adding some citations. --Elplatt 08:19, 23 May 2007 (UTC)

I'm going to revert your changes, Elplatt. You made significant changes to the content, not just the style. Alcoholism isn't that simple and can also refer to a strong desire to drink, not just the actual drinking. If you'd like to revisit the opening paragraph I'm up for that, but please don't make a wholesale change to the opening statements without discussing it on this page first. - Robert Rapplean 17:13, 26 May 2007 (UTC)

I hope you'll agree that the readability of the intro needs work. I worked quite hard to change the content as little as possible, and I'd like to know what you think the major differences between the current version and my revision are. My revision has a better flow, identifies the ambiguity of "alcoholism" and cites reliable sources for the most accepted definitions, so I'd prefer to work on revisions to it rather than to abandon it altogether. Regarding the desire to drink, that's included in the JAMA definition, and was in my second paragraph. If you'd prefer, I'm fine with including all four characteristics of the JAMA definition (including preoccupation with alcohol) in the intro. So aside from that, what specifically didn't you like about the revision? --Elplatt 17:46, 26 May 2007 (UTC)

I'm doing a formal disection of the two offline, and will get back to you. The major point is that Alcoholism does not refer to the continued use of alcoholic beverages, medically speaking. It actually refers to the urge to drink alcohoic beverages. The actual consumption of the beverages is the expression of the condition - an optional effect - not the condition itself. Other less professional definitions do consider the actual drinking to be alcoholism, and we have to reflect those also, but we can't start with a statement that is medically inaccurate. I'll get back to this tomorrow. - Robert Rapplean 17:06, 27 May 2007 (UTC)

Just gonna interject here - I might suggest using a SMOG calculator like the one here to help out on readability. JoeSmack ^Talk 17:17, 27 May 2007 (UTC)

Thanks, Joe. The existing version rates 17.01 whereas Elpatt's proposal rates 21.77. I think that most of this is because he used a lot of medical terms in his medical description. Here's the breakdown of what's said in the two. You'll see the current version in blue and his version in green. I hope none of you are more colorblind than I am. I'll default my comments to black for readability. - Robert Rapplean 17:57, 31 May 2007 (UTC)

In general the two versions imply different approaches. The original lumps all definitions together, and the revision identifies individual definitions. If we're going to give any actual information, I think we need to identify the specific definitions as best we can while still acknowledging that several exist. With that said, my specific comments are below. --Elplatt 19:37, 31 May 2007 (UTC)

This is essentially true. When we went through the list, we wound up with six paragraphs worth of discrete definitions, and this is too much for an intro. We can identify the specific definitions, but attempting to throw them all into the intro would just confuse the reader. Attempting to compress all of the definitions into two primary definitions requires prioritizing some definitions and discarding others. We can't do that. We can't define and describe alcoholism in two paragraphs without increasing misunderstanding. The best we can do is state that there are many highly varied definitions of alcoholism, and describe how those definitions vary. We can get into more detail later in the article. - Robert Rapplean 18:45, 4 June 2007 (UTC)

As far as I can tell, there are at most 3 verifiable definitions for alcoholism: what we have been calling the "common" definition, the contemporary medical definition (from the JAMA), and an older medical definition found in many dictionaries. Given that the JAMA definition is a replacement for the older medical definition, that leaves two. If there are other, significantly different definitions, I would like to see references for them. I think we absolutely can give the gist of the accepted definitions for alcoholism in the intro, but if there are too many definitions to do so, perhaps we should consider forking the article. --Elplatt 03:05, 5 June 2007 (UTC)

What about the DSM-IV definition, or the AA definition? I'll accept that the American Society of Addiction Medicine definition is really just a subset of the DSM-IV definition, but that still leaves us with four. To complicate matters, most of them use terminology that is incomprehensible to the general population.

I did give forking the article serious consideration. When examining this concept, I took my guidance from trademark disputes. Trademarks only cover a specific type of product. If the consumer is capable of differentiating between the two products (i.e., fast food vs. law services), then the trademark does not apply. Wikipedia definitions are similar. The typical person can differentiate (for instance) between Tokamak, the fusion energy generation device, and Tokamak, the computer physics simulation. When we're talking about alcoholism, however, not medical science, congress, or any one else who considers themselves in charge is capable or even willing to differentiate between someone who's having too much fun at frat parties to graduate from college and someone who is neurochemically driven to their next bottle. Most groups, in fact, consider it to be anathema to even admit that other definitions exist. In this environment, forking is impossible because we're not talking about two different things, but two different ways of describing and categorizing the same thing. Robert Rapplean 17:44, 9 June 2007 (UTC)

I want to start by saying that I'm aware that we lose Wikipedia Points for not starting our article with "Alcoholism is...". This was a necessary tradeoff because there is no single correct definition of alcoholism. This is an extremely important point when describing alcoholism, and it's beneficial to call attention to this point by not starting the article with "Alcoholism is...". With that in mind...

---

The meaning of the term alcoholism varies considerably in different contexts.

Various specific definitions of alcoholism exist, and the exact meaning of the term can depend upon context.

These two say essentially the same thing. My preference would be with the first version because it's more concise, but I helped write it so OF COURSE that's my preference. Any comments? Robert Rapplean 17:57, 31 May 2007 (UTC)

I'm really fine with either of these statements. My main concern is not starting the article with one of them. I agree that we can't say "alcoholism is..." but we should be able to say something substantive, like "alcoholism can refer to..." or something of the sort. --Elplatt 19:37, 31 May 2007 (UTC)

I wish we could, but the medical definition of alcoholism specifically excludes some cases that are tangibly included in the common definition. Any "alcoholism refers to" definition that we could apply to it would be either excessively inclusive or excessively exclusive by someone's standards. One of the primary issues with alcoholism is that we all think we SHOULD be able to say something substansive about it, but when we do we invariably exclude cases that exist in the real world, but don't fit our personal criterion. Physiological definitions tend to exclude those who drink out of self delusion. The AA definition excludes those who can be cured. The DSM-IV definition over-reaches and encompasses even those who do get valid benefit from drinking, and which most common definitions wouldn't include. The point I keep trying to get across is that we have multiple conflicting attempts to say something substansive, and adding one to the list would only make it more nebulous in the real world. - Robert Rapplean 18:45, 4 June 2007 (UTC)

---

refers to
- any condition that results in continued consumption of alcoholic beverages despite negative consequences.
- a loss of control over one's alcohol consumption
- a preoccupation with or compulsion for alcohol
- an impaired ability to recognize the effects of alcohol consumption.
Characterized by
- the continued use of alcohol despite harm to the drinker and people associated with the drinker.
Some but not all definitions specify
- a current use of alcohol
- the effects of long-term heavy alcohol use

refers to
- the continued excessive or compulsive consumption alcoholic beverages, or
- a chronic disease characterized primarily by the use of alcohol despite adverse consequences.

Here we have the essential definitions of alcoholism. This is where my primary concern with the proposed version exists. I think that the version we accepted better reflects the full spectrum of meanings that people apply to the term alcoholism. I believe that the editors would disagree about which of them should be more prominent, but probably agree on content. Robert Rapplean 17:57, 31 May 2007 (UTC)

The main difference between the two is that the original lists the characteristics from many definitions in a single list while the revision summarized two well-accepted definitions. I personally think it's better to present distinct definitions rather than one combined list of attributes. That way someone reading the first paragraph can identify an actual definition without reading the rest of the article. --Elplatt 19:37, 31 May 2007 (UTC)

---

Medical definitions describe alcoholism as a disease, addiction, or dependence that results in difficulty with controlling one's alcohol consumption.

In medicine, alcoholism is defined as a primary, chronic disease characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking. Some specific medical definitions also specify a current use of alcohol, development of a tolerance for alcohol, or the development of withdrawal symptoms on the cessation of drinking.

The proposed version has a much more complete version of the medical definition of alcoholism. This is definitely a judgement call. There is an immense amount of medical information that could be plugged into the medical definition of alcohol, and the direction we were headed was to put all of this information in its own section and summarize it in the opening. Also, as mentioned above, this includes numerous words that will have most readers eyes going blurry. The medical definitions of primary and chronic, for instance, aren't in most people's vocabulary. Robert Rapplean 17:57, 31 May 2007 (UTC)

Most of the research on alcoholism is done with the medical definition in mind, so it's very important to make sure that definition is on this page and accurate. In the original version, the medical definition varies significantly from the actual accepted definition so it is at best unverifiable. I'm all for using simpler language as long as it more accurately reflects the medical definition. --Elplatt 19:37, 31 May 2007 (UTC)

I agree that the medical definition requires stonger representation in this page. Could we start fleshing out the section on "the medical perspective"? - Robert Rapplean 18:47, 4 June 2007 (UTC)

---

This harm may include the development of medical complications, occupational or educational loss, or interpersonal complications.

The adverse consequences associated with alcoholism may include medical complications, problems at work or school, and relationship problems.

I definitely feel that the proposed version is more clear here, and should probably replace the existing. Robert Rapplean 17:57, 31 May 2007 (UTC)

---

While alcohol use is necessary to develop alcoholism, use of alcohol does not necessitate the development of alcoholism. The amount of alcohol consumption required to develop alcoholism varies greatly from one person to the next. Although the biological mechanism of alcoholism is uncertain, some risk factors for alcoholism have been identified. These factors may include a person's social environment, emotional health and genetic predisposition.

The risk of developing alcoholism from drinking is believed to vary with the individual based on such factors as social environment, and emotional health, and genetic predisposition.

These two are only vaguely analogous. I think that the level of detail that we decided on was due to a high level of misunderstanding that occurs when you try to be less specific. Maybe we should revisit this. Again, I'm going to request commentary from the rest of you. Robert Rapplean 17:57, 31 May 2007 (UTC)

In my opinion, most of this information is too tangential to be in the opening paragraph. At very least, there is little reason to state that "alcohol use does not necessitate the development of alcoholism" in the intro. --Elplatt 19:37, 31 May 2007 (UTC)

My thinking on this is that one of the most common misunderstandings about alcoholism is that its addictive nature is similar to an opiate. People who use opiates regularly will become addicted to opiates, with extremely few exceptions. That perception leads those who don't get addicted to alcohol to believe that alcohol doesn't have an addictive nature, which is an even more harmful perspective. I seem to be in the minority here, though, so I'll accept DashaKat's removal of those sentences. - Robert Rapplean 18:45, 4 June 2007 (UTC)

[edit] Medical Perspective

I would like to suggest that we create a section entitled "Medical Perspective" directly underneath the terminology section. There is much to be said about how medical science perceives alcoholism that is well documented and highly objective, and we should summarize it there. If nothing else, so that it stops trying to creep in everywhere else. - Robert Rapplean 22:46, 15 May 2007 (UTC)

I want to work in this a lot to be more authoritative, but here's a straw model.

The medical use of the word alcholism refers to an abnormal physical or mental condition in which a person is driven to consume alcohol beyond the point at which it causes harm to the person or those around him.

[edit] Terminology

It's interesting that this group is heading in the same direction as the American Society of Addiction Medicine (ASAM) has been of late with respect to terminology issues. ASAM is in the midst of re-establishing a terminology committee because it has become clear that addiction specialists, psychiatrists, other physicians, other non-MD/DO clinicians, governmental agencies, and the general public all are using a different terminology set with respect to alcoholism.

From my perspective, as an addiction medicine specialist, alcoholism is a condition in which the afflicted individual feels subjectively better, temporarily, as a result of sedative use (alcohol being one of a group of sedatives available); and that the individual will then chase that feeling as a result of an irresistible urge akin to hunger. The condition, then, is something that I start treating once the alcohol use has stopped. The actual act of drinking isn't a real measure of alcoholism because that exists in individuals who don't have the illness.

Again, from my perspective, you can be alcoholic without drinking alcohol, but drinking alcohol doesn't make you alcoholic. The majority of folks who have "difficulty with alcohol" such as a single DUI, a single arrest, etc., probably aren't alcoholic. It's those who repeat their behavior despite themselves who likely have the disease. In other words, everyone is permitted a mistake.

Our Wiki entry for alcoholism is one which will undoubtedly always lead to discontent and disagreement, in part because of the strong feelings people have about the topic, in part because we don't always speak the same language, and in part because we simply disagree at times.

I'm not sure how to best solve this problem. Drgitlow 04:10, 16 May 2007 (UTC)

• I agree with your analysis re: addiction is like hunger. I do not pre-suppose to know all there is to know about alcoholism, but I do know that there is no such thing as being "a little pregnant." I am not an alcoholic on rare occasions. I am an alcoholic, everyday. A single DUI, or a single arrest? I would say the above are very clear signs of a problem with alcohol. If a 40 year old man gets into a car while drunk, the man has a problem with alcohol. "A problem with alcohol" and alcoholism are one in the same thing. Once a problem is diagnosed, or recognized, the rest is history. If I think I have a problem, I do. I do not see a difference between problem drinking and alcoholism. Our society allows for an abundance of denial. I also see many alcoholics "get away" with their addictions for an entire lifetime. Clinically, I believe there are millions of alcoholics frequenting bars and established drinking holes, or drinking in the privacy of a home, that will never admit to the problem and our society will ignore the obvious symptoms.

The U. S. Department of alcohol, tobacco and firearms will have the power to self perpetuate the disaster because of the money involved --- the business of selling addictions. We have a right to be drunks and we have industries that thrive on the addictive power of many different drugs, alcohol being one of them. W O W 14:46, 16 May 2007 (UTC)

• It is difficult for many people to understand the concept of "dry drunk," and you are not likely to gain much of an audience about the topic, although I happen to know exactly what a "white knuckled" garden variety dry drunk is. I was one for a long time. Therefore, your notion about alcoholics before or without the drink in hand should most likely be relegated to a psychological term; unrelated to alcohol. Most medical people and clinicians want to use a term that is more palatable and consequently more apt to be utilized by a consensus of their associates. W O W 18:33, 16 May 2007 (UTC)

WOW, you've struck at the heart of the matter here. From a medical perspective, the disease entity of alcoholism isn't really about alcohol. It would take quite a few paragraphs to explain that, but the bottom line is that alcohol is what the individual with alcoholism seeks in order to feel better. What it is that they're trying to feel better from is the disease itself. That said, naturally there are all the issues secondary to the use of alcohol that also represent factors in the disease course. I'd go back to the desert island concept - what happens if you take an alcoholic and put them on a desert island where there is no alcohol? The individual would be quite uncomfortable, would have difficulty relating to the other people on the island, and would have to find other methods in order to feel better. Many - probably most - clinicians use the term alcoholism to refer to the drinking itself, just as most clinicians use diabetes to refer not to the underlying disease process but to elevated glucose and related morbidity (the final result of the underlying disease process).Drgitlow 17:30, 27 May 2007 (UTC)

Actually, WoW, there is a such thing as degrees of alcoholism. When studying the effects of various treatments, the folks in Finland have a technique that is very effective. They tell the patient "Image that you are in your favorite drinking establishment. How much, on a scale of 1 to 10, would you like to take a drink of alcohol?" This method produces a very reliable and deterministic curve of how effective the treatment is in relieving a person of those cravings. There are shades of grey to almost everything - even pregnancy. Believe it or not, 50% of all fertilizations don't adhere to the uterous wall, resulting in a failed pregnancy. Even if the egg is fertilized, a woman could only be considered half pregnant until after their next menstrual period is due.

Back on the topic of alcoholism, I personally could be considered a small percent of an alcoholic. I personally have a hard time tolerating alcohol. I usually get sick to my stomache before I get drunk. On the other hand, it's an excellent social lubricant, and I feel uncomfortable, ill at ease, and unable to function in a situation where other people are drinking if I'm not drinking myself. This is a small fraction of what a "full blown alcoholic" feels under those circumstances, but it's still a meaningful percentage. - Robert Rapplean 20:14, 16 May 2007 (UTC)

• Errr, actually, Robert, I am a "full blown" alcoholic and I was blessed with sobriety in December 1994.

I have not had a desire for a drink of alcohol and I have not had a drop of alcohol in 12 1/2 years. For me, it isn't the 4th or 5th or whatever drink that gets me sick, or drunk, that is the problem, it is the 1st drink that is the problem. If you still get drunk or sick when drinking, you are not a partial, you are the real thing. Sorry. You are an example of the vast majority of drinkers in our world that think that you are only partially alcoholic......and yet you are 100 % in denial. "Degrees of alcoholism" confirm(s) the need to teach total separation from the drug.

It does not get better and it does not get easier. The end result is never pretty. It is powerful and it is baffling. W O W 23:50, 16 May 2007 (UTC)

Ok, what we've hit upon here is an excellent example of how people differ in how they use the word alcoholism. You tell me that I'm 100% alcoholic in denial because I occasionally crave alcohol. Most doctors would say that I am 0% alcoholic because that craving never exceeds my desire to avoid consequences like drunk driving and whatnot. Personally, I feel I am not an alcoholic because I can sit with a bottle of alcohol on the table in front of me and forget that the bottle is there. - Robert Rapplean 14:57, 17 May 2007 (UTC)

Me too. The difference is, (God willing) I will never take a drink, never get sick, and never get drunk. Alcohol sitting in front of me or around me, is not a problem. It is only a problem if I drink it. I do not think about drinking any more than I think of hitting myself in the head with a hammer. 12 years and a lot of prayer saved me from the torture many people go through. Enough said. W O W 15:14, 17 May 2007 (UTC)

• I made a couple of small edits for "flow" and clarification, and a couple of changes to correct grammar errors. W O W 15:44, 17 May 2007 (UTC)

Thanks, WoW. That looks good. I did a little rearrangment of your third edit, again for flow purposes. - Robert Rapplean 16:18, 17 May 2007 (UTC)

• Thanks to all and God bless. It looks spot on to me. W O W 17:17, 17 May 2007 (UTC)

Alcoholism is like pregnancy in that you either have it or you don't, but I do think there are variations in disease intensity, as with almost any disease. You can have cancer that is easily removed, or cancer that will kill you; you can have a cold which you barely notice due to a runny nose, or a cold that leaves you in bed for a week; you can have diabetes that's easily controlled with diet, or diabetes that requires constant monitoring and even then remains brittle. In alcoholism, you can get into recovery after one detox, or you might go through 20 detoxes and still not truly understand what you need to do to stay sober. Same disease, but different levels of severity. Drgitlow 17:30, 27 May 2007 (UTC)

This appears to be an intractable problem. I occasionally crave tofu (of all things). Am I a tofu-aholic? "Tofu-aholism is like pregnancy in that you either you have it or you don't." I can't see the difference. Also, pregnancy is not a disease, and it is binary. It is a weak analogy. It would be more correct to say "Alcoholism is like pregnancy in that you either have it or you don't, but there are numerous differences."

This is not entirely accurate. We think of pregnancy as binary because we are never exposed to any of the edge cases. When does a pregnancy start? Just after sex? At fertilization? When the fertilized egg embeds itself in the wall of the uterus? Most people would say that it's at fertilization, but there is no physical or chemical change in the actual female at that point. Although the embryo is fertilized, there is no pregnancy yet any more than there would be if the fertilization happened in vitro. The moment of embedding itself doesn't actually trigger a change in the female, just in the tissues that will eventually become the placenta. If the pregnancy "doesn't take", then those tissues and the egg will slough off during the next menstrual period.

I would say that alcoholism is like pregnancy in that there is a distinct threshold at which you definitely have it, but it can also exist in a continuum of sub-threshold states. Frankly, there are numerous people who are not actually addicted to alcohol, but just haven't received enough evidence that alcohol is all that bad for them. This is an edge case. Robert Rapplean 21:35, 22 June 2007 (UTC)

"Alcoholism is like pregnancy in that you either have it or you don't" is clever rhetoric because it implies the absurdity of the common joke "being a little bit pregnant." One could also say "Alcoholism is unlike pregnancy in that it doesn't apply only to women and you don't end up with a baby in 9 months."

Perhaps a more accurate analogy is "Alcoholism is like baldness in that you either have it or you don't." This analogy covers the spectrum of the argument far better, from the guy that's lost a few hairs and convinced he's bald to the guy who everybody in the world knows is bald but he's in denial about it. 76.80.81.61 14:41, 24 June 2007 (UTC)

[edit] Incidence

I stopped by here in the course of researching something, and can't find anything on the page that would tell me the incidence of alcoholism in the general population. That might be something worth adding by someone more knowledgeable than I.

I didn't really have time to read the whole article, but I searched for "incidence," "population," "percent," and "percentage," without seeing relevant text. Now, I might just have missed it, but if I didn't then perhaps someone could add information about that for future readers.

*Septegram*Talk*Contributions* 20:17, 6 June 2007 (UTC)

A 2001-2002 study by the NIAAA estimated that 3.81% of the US population suffered from alcohol dependence, and 4.65% suffered from alcohol abuse. One thing I'm unsure about is whether the latter group includes the former, according to the DSM-IV a person can't be diagnosed with both, but I would double check it before putting it in the article. With that said, I've seen estimates from other sources ranging from 1% to 10%. It's very difficult to discuss the incidence because there is no single definitive "alcoholism test" partly because there's some disagreement about what alcoholism means. --Elplatt 21:27, 6 June 2007 (UTC)

NIAAA's figures differ significantly from those generally reported in the medical literature, which show a range from 5-15% of the US population as suffering from alcoholism. You're right about DSM-IV making it clear that people can't have both alcohol abuse and alcohol dependence, but I'm not sure NIAAA recognizes that either. Drgitlow 22:31, 9 June 2007 (UTC)

[edit] Glutamine amino acid supplementation as treatment

There are studies showing that glutamine supplementation can dramatically reduce alcohol cravings and consumption. Where should this be added to the page?
Rogers LL, Pelton RB. Glutamine in the treatment of alcoholism. Q J Stud Alcohol 1957;18:581-587.
Rogers LL, Pelton RB, Williams RJ. Voluntary alcohol consumption of rats following administration of glutamine. J Biol Chem. 1955;214:503-506.
Frank L. Siegel,* Mary K. Roach, and Leon R. Pomeroy. PLASMA AMINO ACID PATTERNS IN ALCOHOLISM: THE EFFECTS OF ETHANOL LOADING Proc Natl Acad Sci U S A. 1964 April; 51(4): 605–611.
Wchatcher 15:07, 21 June 2007 (UTC)

Sounds like it belongs in the Treatment section. Go ahead and plug one in and we'll work on wording and accuracy. Robert Rapplean 16:54, 22 June 2007 (UTC)

[edit] Citation request examination

This may become a permanent main section of the alcoholism discussion page because we are regularly beset by people who say "Oh, yea? Prove it!" to the most obvious statements simply because they conflict with their personal philosophy. We are also occasionally in need of debunking something that doesn't make much sense. While it is necessary for us to make sure that everything we say is well backed, it is also a bad thing for every sentence to have two or three reference links following it.

When something gets marked "citation needed" I'm going to try to create a subsection here in which for each citation we will determine:

1. the reason for requesting citation,
2. whether the statement is well enough supported to stay there, and
3. whether or not a statement is adequately well established in common knowledge that a citation is unnecessary.

[edit] In addition, although the biological mechanisms underpinning alcoholism are uncertain, some risk factors, including social environment, emotional health and genetic predisposition, have been identified

What is being questioned here? Do they not believe that a person's social environment contributes to the development of alcoholism? Do they not believe that a person's emotional health contributes to the development of alcoholism? We already have a section that describes at least one genetic factor for development of alcholism, and it's well established that alcoholism can be passed down through male lineage. Could someone illuminate me, or can we remove this request? Robert Rapplean 01:01, 11 June 2007 (UTC)

[edit] Naltrexone is a competitive antagonist for opioid receptors, effectively blocking our ability to use endorphins and opiates. It also appears to act on glutamate neurotransmission.

I have no basis for this one. Who suggested that it acts on glutamate transmission, and where did they get that information? Robert Rapplean 17:02, 22 June 2007 (UTC)

Robert, I suggest you read "Pharmacological mechanisms of naltrexone and acamprosate in the prevention of relapse in alcohol dependence" in Am J Addict. 2003;12 Suppl 1:S3-11. Drgitlow 04:50, 2 July 2007 (UTC)

Thanks, Doc. Unfortunately, I don't have a subscription to the American Journal of Medicine, and couldn't write off the $275/year for a subscription even if I could afford it. Could you summarize it for us? Or, better yet, is this an adequate citation to get rid of the dreaded cite mark? - Robert Rapplean 03:51, 4 July 2007 (UTC)

[edit] The COMBINE study was unable to determine the presence of efficacy for Acamprosate

What is the COMBINE study, who did it, what is its impact, and how much authority does it have? Robert Rapplean 17:04, 22 June 2007 (UTC)

Robert, the COMBINE study was a tens-of-millions of dollars study that is fully explained here: http://www.niaaa.nih.gov/NewsEvents/NewsReleases/COMBINERelease.htm -- the study was published in JAMA. A reading of the study makes it clear that there were a number of problems, including poor inclusion criteria, irrelevant outcome measures, and questionable controls (IMO), but all agree that the study whether poorly done or not, was unable to show any significant value in the use of Acamprosate. Drgitlow 04:48, 2 July 2007 (UTC)

[edit] Dashkat: consistency of alcohol consumption?

I challenge you to produce any evidence that a person who drinks Friday, Saturday and Sunday is more or less likely to become an alcoholic than someone who drinks Monday, Wednesday, and Friday. I have never seen any evidence to demonstrate that consistency is a factor in the development of alcoholism. I've also never seen any evidence that a person who drinks eight drinks in four hours is more likely to aquire alcoholism than someone who drinks eight drinks in eight hours. If a person gets sober in between then it falls under the heading of "frequency" not degree.

I'm happy to let it stand, but please supply evidence so we don't get any more of the dreaded "Cite" marks. Robert Rapplean 03:10, 26 June 2007 (UTC)

Actually, I don't understand what "consistency of alcohol consumption" means. Maybe "regularity" would be a better term. --Elplatt 04:21, 26 June 2007 (UTC)

To the first writer...the issue is not timing, or amount...it is a breakdown of impulse control. The person you are describing...3 times a week, 8 drinks in 4 hours...has a drinking problem, and exhibits the psycho-social markers for the development of alcoholism. Whether or not that person actually develops alcoholism by clinical definition depends considerably on several other mitigating and co-occurring factors. Further, the person described as 3 times a week, 8 drinks in 8 hours would be classified as a "maintenance drinker". In either case, the habit of drinking consistently and regularly presents as a dysregulation of some ilk, and one that likely needs attention.

To Elplatt...done. If the language is not immediately understandable, it probably needed to be fixed. --DashaKat 12:52, 26 June 2007 (UTC)

Sorry, that was me typing without logging in. I'm fixing the sig. My point was that we have four descriptions on there: degree, quantity, frequency and regularity. How does degree differ from quantity? How does frequency differ from regularity? If we're going to throw qualitative descriptive words at the reader they need to be readily differentiable or they won't add to the reader's understanding. If we can't differentiate between them, how do we expect the reader to?

Once we've differentiated, we also must determine if that level of detail is appropriate for the opening paragraphs. The current phrasing is already quite verbose, and we have to draw the line somewhere. If we want to split hairs, let's do it in the body of the article, not in the introduction. - Robert Rapplean 16:28, 30 June 2007 (UTC)

I agree with RR; the intro already borders on excessive. I would strongly suggest that any additional material be incorporated in the main body rather than the opening. Also, to reiterate a point I've made about this article before...it needs to be written in a fashion that is accesible to a typical high school senior, which means that all terms need to be defined as simply and clearly as possible, especially when we introduce terms that average readers won't understand the clinical significance of, as in RR's example above. All things considered however, I think this article has shown great progress over a rather long period of time : ) Doc Tropics 17:13, 1 July 2007 (UTC)

OK...this is my world...

• degree - do you drink to get drunk, to pass out, to black out?
• quantity - how much...I have some clients who black on two Tequilas...others can drink a gallon of whisky over the course of 12 hours and function.
• frequency - are you a consistent drinker, a maintenance drinker, a night-time drinker, a binge drinker?
• regularity - what's your drunk/sober cycle (if you have one), if your a binger, once a week, once a month...sober or at least dry for 3-4 weeks, then lit up for 6 months?...

It's like the rest of the conversation...messy.

By these descriptions, the only difference between degree and quantity is the tolerance of the drinker, or the speed at which their system metabolizes alcohol. My wife takes three drinks in an evening and gets about as tipped as I do drinking eight. This is due mostly to body mass and genetic heritage. From alcoholism's perspective, these are equivalent. The actual quantity doesn't matter so much as the amount of drunk you get. Please correct me if I'm wrong. I'm not sure which of the two is the correct term, but one of them is redundant.

Frequency and regularity, by that definition, seem to have a distinction, but it may be too subtle for the readers to grasp quickly. Can we just say "how often you drink and how drunk you get when you drink"? - Robert Rapplean 23:01, 1 July 2007 (UTC)

What you're talking about here is USE, not alcoholism. Alcoholism is based upon a physiologic process and is defined based upon signs and symptoms that are related to use but are not defined by use. That alone is a complex issue that is difficult to portray within a few sentences. Let's look at gambling as an example: many people gamble. Some people gamble a little, while some make it their life's work. Gambling addiction is independent of those issues. There are some who make gambling their life's work, sometimes making money and sometimes losing money, who have no disease. There are others who gamble despite extreme hardship clearly resulting from their gambling, and who persist in gambling nevertheless even when a naive bystander would look at them and say, "Why are you doing this? You've destroyed everything in your life that is typically important to people - your relationships, your financial status, your very existence - and yet you continue to take the same action repetitively while saying to yourself, 'Next time will be different.' What is wrong with you?" Extending the analogy to alcohol, one must differentiate Lifestyle Choice with Health Consequences (USE) from a physiologic or disease entity (ADDICTION). Complicating matters is the terminology in which one can have physiologic dependence (e.g. tolerance and withdrawal) without having an addictive disease like alcoholism. I can give any mammal sufficient alcohol to produce tolerance and withdrawal, but that doesn't mean they're alcoholic. The line is crossed when one uses in a manner that produces obvious and clear deterioration in various functional abilities (interpersonal relating, ability to concentrate and focus, brain injury as evidenced by blacking out, etc.), then persists in using despite these consequences when rational thought would lead the majority to determine that such a course of action will produce negative outcomes. Drgitlow 19:03, 4 July 2007 (UTC)

[edit] The Binge Trend

This section reeks of personal reasearch or copyright violation. There is no justification for repritning in toto someone's essay about alcoholism. This section needs to be wikified or removed and any relevant information in it should be referenced in the appropriate section of the article. Filam3nt 16:59, 1 July 2007 (UTC)

Good call, Filam3nt. I think we all agree with you, and Dashkat has removed the chunk of which you speak. - Robert Rapplean 23:02, 1 July 2007 (UTC)

Sigh, it came back. I'll post a message on his user page, and we'll give him one more chance. - Robert Rapplean 03:52, 4 July 2007 (UTC)

[edit] JAMA Access

This is a note in response to RR's comment to the drgitlow. Robert, you can get a guest subscription to JAMA [3] for free. It's very useful. Best --DashaKat 12:43, 5 July 2007 (UTC)

[edit] Prevention

Despite the fact that alcoholism is treated by many communities as a disease, prevention is infrequently discussed. There are a few prevention programs or suggestions that are advocated by the medical community, but frequently it is up to the person who identifies the early signs of alcoholism in themselves, to come up with their own prevention methods.

1. Some in the psychiatric community advocate total abstinence as the best way to prevent alcoholism. While the most effective method, it is difficult, however to convince a patient not suffering from alcoholism to abstain from alcohol.
2. Awareness is the key to any prevention program. Various organizations work to educate the youth and parents about the dangers of alcohol and alcoholism. Alcoholics anonymous publishes recognizable warning signs of alcoholism. As is the case with many diseases, an aware community is far less at-risk for alcoholism. Also an aware community is more likely to recognize the signs of alcoholism in loved-ones and to help them seek assistance. If the medical community, formal health education in schools and public health campaigns all address the symptoms, risk-factors, negative implications, prevention and correction of alcoholism, the public is more likely to take preventative measures.
3. Delaying the first drink until later in life may prevent later alcoholism.
4. Some individuals create programs such as "three rules" to stem less serious alcoholism. Albeit not accepted by the medical community, moderation according to rules tends to be both acceptable to at-risk patients and rigorous enough to induce behavioral changes. This is similar to the need for obese people to have regimented diets in order to control their weight.

Rose French July 14, 2007 RoseFrench 00:35, 18 July 2007 (UTC)

Hi, Rose. Welcome, and thanks for contributing. You make some good points, and there are a few things there that we can incorporate. Others are not so good, and I'll explain why. I'm going to take your points in reverse order.

The three rules page has some excellent points, and does not advertise or link to advertisement, so I believe we can safely include it as an informational page. It very thoroughly falls under the heading of "moderation" as a method of treating alcoholism. Most people in Moderation Management feel that they are not full alcoholics, but they are people who need to intelligently control their drinking habits as described on that page. I'd say that for those types, the three rules are probably a better bet than the twelve steps.

When you talk about awareness, you're really talking about two different concepts. The first is helping people understand the kinds of problems that alcoholism and excessive drinking can cause. This might deserve a nod in our text, but our culture is brimming full of people who are willing to make examples of themselves in public, and our film and video culture provides copious examples.

The second form of awareness that you mention is probably more significant because it's suggesting methods for determining if you have a problem with alcoholism. Drinking alone, hiding your drinking from others, and similar metrics are commonly known. We might consider publishing a sampling of that kind of thing on the "diagnosis" section, but those are the kinds of questions that usually wind up in one of the professional questionnaires. I agree that it would be valuable to let people know the warning signs so they can stop early, or at least know to look into it as a possible problem before it causes detrimental life problems.

I also believe that our young people would benefit from education on how to handle their liquor. I expect that most of them are just going to have to find out for themselves even if you DO tell them in advance, but maybe providing them with good information in advance will limit the number of people who have to do it several times in order to make sure it was so bad the first time. As for inclusion in this article, that's going to require a discussion of scope. Wikipedia in general is a place where information is provided, not a place where we tell people how information should be used.

Finally, an abstinence based approach to alcoholism has numerous problems that make it a non-starter. As a social policy it has already been demonstrated to be disasterous by our attempts during prohibition.

For the majority of us there just is no meaningful danger of alcoholism, and not drinking just as a matter of policy can be a seriously socially limiting move in most environments. People perceive it as a blatant statement that you're too good for them when you don't drink, even if you don't intend it as a statement of comparison. Considering that alcohol consumption does have beneficial effects when performed in moderation, it also tends to be perceived as an act of phobia more than one of caution, or a statement that the non-drinker perceives him/herself as being weak willed.

My argument against inclusion would be that suggesting abstinence as a method of preventing alcoholism is kind of like suggesting avoiding high places as a way of preventing disastrous falls. We already state in our second paragraph that you can't develop alcoholism if you don't drink, and I think that this is adequate.

Did I miss anything? Again, thanks for dropping in. - Robert Rapplean 14:30, 19 July 2007 (UTC)

[edit] Latest edits by Badgettr

We've had another highly knowledgeable person add a pile of stuff to the detox section. I'm starting to believe that we need to create a separate article on Alcohol detoxification. There's an immense amount of information that people seem to feel belongs in Wikipedia, but which keeps winding up here for a better place. Any yea's or nay's? - Robert Rapplean 17:31, 5 August 2007 (UTC)

[edit] What about Kudzu to treat alcoholism?

Should Kudzu, a herbal supplement, be included in the section on the treatment of alcoholism? At the Kudzu page, there are many links that support the theory that kudzu can be used to treat the cravings for alcohol. It can be easily purchased at almost any vitamin store in the USA.204.80.61.110 20:51, 13 August 2007 (UTC)Bennett Turk

By all means, yes, but there have to be reliable sources for reference, e.g. reputable academic or news source. The Kudzu page, also, should only have external links that meet the criteria. —DavidMack 00:52, 14 August 2007 (UTC)

MSNBC reported at their website that: The Harvard Medical School is studying kudzu to reduce alcohol cravings based on tests with animals and humans that showed taking kudzu can help to limit the amount of alcohol a person drinks. I think kudzu should be added to the section on herbal therapy as: "a promising method that is currently being studied to treat alcoholism". [4]204.80.61.110 Here's another link, from the Harvard University Gazette. It states; 'that the person who takes kudzu, will still drink alcohol, but, they will consume less than if they had not taken kudzu prior to drinking'. [5] 16:24, 14 August 2007 (UTC)Bennett Turk

Further Reading

Herbert Fingarette, Heavy Drinking: The Myth of Alcoholism as a Disease, University of California Press, 1989 - ISBN 978-0520067547

A very importand--albeit controversial--study! —The preceding unsigned comment was added by 83.76.116.35 (talk) 19:10:45, August 19, 2007 (UTC)

There are many elixirs that may result in a decreased quantity of alcohol intake. Unfortunately, decreasing alcohol intake doesn't help the alcoholic. Alcoholism isn't defined based upon how much someone drinks and therefore modifying alcohol intake doesn't change the disease severity. By the same token, if you have someone with tuberculosis, one of their big symptoms is often cough. If you decrease cough, you haven't done anything for their TB. Drgitlow 15:21, 11 September 2007 (UTC)

Well said, DrG. My first reaction to that book reference, though was to direct them to the page on Disease Theory of Alcoholism - Robert Rapplean 21:33, 18 September 2007 (UTC)

[edit] First paragraph changes

I made a few changes to the first paragraph today. The first sentence didn't make any sense as it referred to formal recognition of differing perspectives. What would that be? The medical disease concept sentence was inaccurate and now reads correctly. Drgitlow 15:17, 11 September 2007 (UTC)

Hi, Dr. Gitlow. Sorry, got busy again. What would what be? What are the differing perspectives? I agree with your changes on the disease statement. I think we phrased it as "could result in" because the factors that cause the disease can exist without the person suffering from heavy drinking if other counter-factors exist. I think your simplification is probably appropriate. -Robert Rapplean 21:31, 18 September 2007 (UTC)

[edit] Moderation Management go bye bye

As you can see from [6], MM was hit with a CSD:A7. I dropped a note on the admin's user talk page [7]. As far as why MM was picked off, but not HAMS, I have no idea, other than maybe MM was what the admin landed on (HAMS is the result of an MM schism, more specifically, a single MM person starting his own mailing list). Ronabop 04:36, 21 September 2007 (UTC)

I was wondering why the Wikipedia articles about Moderation Management, LifeRing Secular Recovery, and SMART Recovery have been removed. They seem to be removed by the same person. These are all fairly large organizations alternatives to AA. I don't understand why they are removed from Wikipedia.: —Preceding unsigned comment added by 67.183.217.27 (talk) 23:16, 27 September 2007 (UTC)

Hey, folks. Yes, I find these deletions disturbing. They are significant and notable, and the wholesale removal of three of them suggests that someone was removing any of them that they knew about. Unfortunately, Coelacan seems to have stopped logging in to Wikipedia, so I'll need to dig up another admin and figure out how to get them reinstated. Robert Rapplean 17:24, 11 October 2007 (UTC)

Alright, I've initiated a deletion review for these three pages. Please let me know if you spot any others. Robert Rapplean 18:37, 11 October 2007 (UTC)

• "Moderation Management, LifeRing Secular Recovery" are still bad links. whassup?--71.97.134.76 (talk) 14:15, 16 February 2008 (UTC)

Herein lies an epic tale. I called the three organizations described here. Moderation Management gave me no reply, so I decided that they didn't want to be helped. I spoke with the guy in charge of LifeRing, and he thanked me quite a bit for letting them know about the problem, and assured me that he would put the issue to a committee to decide what to do about it. I later saw an entry under a different name appear in Wikipedia, but can't find it now. No telling what happened to them.

I did get hold of the people at SMART Recovery, and after a couple of months of working with them managed to produce something that was factual, well researched, non-advertising, and demonstrating of the organization's significance in the world. It seems to be holding its own against the overzealous admins at this point. -- Robert Rapplean (talk) 22:05, 19 February 2008 (UTC)

[edit] Augusten Burroughs interview

I've included a Wikinews interview with Augusten Burroughs on the article. I specifically and at length discuss with Burroughs, perhaps one of the most famous alcoholics in the country, his alcoholism, his sobriety, the reaction he has received from addicts...all topics that are relevant to this page, talked about in an interview done by a sister Wikimedia project. It's not spam, it's enlightening and relevant. --David Shankbone 04:51, 12 October 2007 (UTC)

It certainly can't be described as spam, SqueakBox 04:55, 12 October 2007 (UTC)

Hi, David. It's interesting and relevant, but it doesn't have persistent relevance. Our forum is an encyclopedia, not a periodical or a catalog, and we don't have room to support a catalog of human interest stories even if they are relevant. Reviewing and highlighting individual timely articles would be a huge resource drain, and outside of Wikipedia's policies.

HOWEVER, in the interest of helping the advancement of another wiki project, I'd be willing to make a one-time exception and leave that article announcement there for two weeks, ending 10/26/2007 as soon as anyone gets on and deletes it, presuming that nobody complains for any reason besides out of habit. I may get in trouble for this, but we'll just see what happens. Robert Rapplean 16:19, 12 October 2007 (UTC)

I disagree, it isn't relevant. The last thing this page needs is more anecdotal information about alcoholism. If it were an article about alcoholism, rather than one person's experience with alcoholism, it would be relevant, but it's not. --Elplatt 19:00, 12 October 2007 (UTC)

• I understand the argument against. I disagree with it more in the sense of the notability of the subject and that he has written about his alcoholism in a widely-read novel; but if it's removed again I won't argue. --David Shankbone 20:09, 12 October 2007 (UTC)

Ok, we've got one for, one against, plus David's plea. I agree that the notice isn't encyclopedic, and doesn't belong in the article. However, it isn't in the article. It's in a little box to the left of the article 3/4s down the page, similar to an image, and this makes a difference. My strongest criterion for inclusion in the Alcoholism page is and continues to be whether or not information in an inclusion would be valuable to people attempting to understand alcoholism. The article fits that criterion, thus my short-term exception. If others would like to present their opinions, we can go with majority rule. Robert Rapplean 22:53, 12 October 2007 (UTC)

An alternative would be a "See also" in this vein:

• Augusten Burroughs discusses his alcoholism and sobriety

Just an alternative suggestion. I will let you all decide. Cheers! --David Shankbone 23:01, 12 October 2007 (UTC)

[edit] Restructuring Discussion

I've been thinking about ways to best represent all of the conflicting views and definitions of alcoholism without mashing them up into a single uber-definition, and I've come up with a recommendation. I'd love to get everyone's feedback on this, I'm not demanding that it happens immediately or anything, but I do think it represents the best option for the progress of this article.

I think this article should be divided into three articles, one about the word "alcoholism" and two about the things called alcoholism. The article about the word "alcoholism" would cover the history of the word and how the meaning has changed over time, as well as briefly discuss and link to other articles on the current meaning. My inspiration for this page is the Gay article, which does an excellent job of describing a word's complex history.

One of the other articles would be called "Alcoholism (medicine)" or "Clinical alcoholism" and would cover the current medical and scientific consensus on the disease alcoholism, with a brief criticism section. The third would either be called "Alcoholism (behavior)" or "Heavy drinking" and would discuss problematic alcohol use outside the disease model and non-medical treatment programs. I'd actually prefer "Heavy drinking" for the name of that article, because most people who criticize the disease model avoid the term "alcoholism." The split between these two topics is inspired by Depression (mood) and Clinical depression which do a good job of separating two different meanings of the word, one, a behavior, and two, a meaning that doctors assigned when they appropriated the word, a case quite analogous to alcoholism.

Thoughts? --Elplatt 13:40, 15 October 2007 (UTC)

This is a good thought, Elplatt, and the idea of splitting the Alcoholism article keeps cropping up because of the divergent understandings of it. I'm going to have to examine how they did it under Gay and depression and give it some thought.

My initial reaction to this is that what you're splitting it by isn't really two different alcoholisms (like a run in your stocking and a run in baseball), but two different aspects or perspectives on alcoholism (like Stonehenge being a tourist exhibit and Stonehenge being an ancient calendar). If there really were two separate problems, both of which happened to be called alcoholism, then it would make sense. For the typical alcoholic, however, they are almost invariably suffering from multiple forms of addiction to alcohol, the combined effect being called alcoholism. Like I said, though, I'll look into the pieces you suggest and see if it would work for us. Robert Rapplean 15:50, 15 October 2007 (UTC)

The purpose should definitely not be to split it into perspectives on the same thing, but I think there are really two things. One is a physical and psychological state, and the other is a set of behaviors. The two things are sometimes related, but they are definitely separate entities. The depression analogy is really quite apt. --Elplatt 23:38, 15 October 2007 (UTC)

Can you separate the behavior from the underlying condition? This would be like having a separate article for smallpox, the virus, and a separate one for the red sores that it causes. There are certainly people who do drink more than is good for them out of stupidity, immaturity or irresponsibility, but for all purposes of description they are identical to the endorphin addiction form of alcoholism. For anyone who would need to turn to Wikipedia for a description of alcoholism, they would have the same treatment path. Robert Rapplean 01:53, 16 October 2007 (UTC)

The behavior is absolutely separate from the underlying condition.

There are certainly people who do drink more than is good for them out of stupidity, immaturity or irresponsibility, but for all purposes of description they are identical to the endorphin addiction form of alcoholism.

That is your opinion, but volumes of scientific research disagree. That research has resulted in a coherent body of knowledge about a particular physical condition which should have its own page.

For anyone who would need to turn to Wikipedia for a description of alcoholism, they would have the same treatment path.

This is not a treatment guide, this is an encyclopedia. The current structure prevents useful information that has been a scientific consensus for years from being coherently represented here, and as I see it, that is the bottom line. --Elplatt 02:35, 16 October 2007 (UTC)

The problem with this thinking is that alcoholism is NOT just a medical condition. Even where the medical condition is present, there is almost invariably a psychological condition overlaying it, and a physiological dependence underlying. The entire ball of wax is that which is alcoholism. You can't just separate off the physical, psychological or neurochemical parts of it and say "We're just going to call this part alcoholism. The rest of it isn't our problem." This mode of thinking originally resulted in putting people through detox and then calling them cured. Later, when we saw that wasn't working, we put them through all sorts of torture tests to "toughen up their resolve", on the thought that just that part was the alcoholism. People continue to only deal with one part of the problem, and continue to fail because the other factors aren't dealt with. It is my ongoing concern that splitting the alcoholism article based on these factors would mislead people into thinking that their limited techniques are valid.

Furthermore, people will continue to want to split it. We'll have articles on Alcoholism (psychiatric diagnosis) and Alcoholism (medical condition) and Alcoholism (AA's story) and who knows how many others. Regardless on how many perspectives there are on the problem, there is only one alcoholism. The problem isn't that we're trying to treat different problems, it's that everyone looks at it through their own filters, sees one facet of the problem, presumes that the one facet is the whole problem, and stops looking.

Now I will admit that this article bends over backwards to encompass all perspectives. I really wish we could just present a scientific perspective of the entire alcoholism concept. The problem with this is that, for all their decades of scientific consensus, the scientific community has FAILED to develop a treatment that actually works. In scientific terms, this means that their consensus is non-operable, in human terms it means that it's no more functional than any other theory. While they really want us to believe they have all the answers, their answers don't actually add up to fixing the problem at hand. Until they can do better, we have to take all perspectives into account. Robert Rapplean 16:45, 16 October 2007 (UTC)

I'd like to point out something you said that doesn't make much sense to me: "For all their decades of scientific consensus, the scientific community has FAILED to develop a treatment that actually works." Following this line of thought, would you say that the scientific community has also FAILED to explain medical phenomena such as cancer, AIDS, albinism, Down's syndrome, etc., for which there are no treatments developed (yet)?

Hi, Mellerina, welcome to the discussion. I like the blue, but shifted to green because wikilinks don't show up very well over the blue. Oh, when experimenting with color, please take advantage of the "Preview" button *grin*.

You present an interesting group of analogies. Cancer is an excellent example because we still aren't entirely certain what causes cancer. We know what LEADS to cancer, but not what actually causes our own cells to flip their genetic switches and go rogue on us. This is why all sort of claims are made every year about new things that theoretically cause cancer. We also don't know why every now and again chromosome 21 doesn't split correctly when an egg is made, resulting in Down's syndrome. Albinism isn't a disease, it's a genetic condition. We know which genes are responsible. There isn't a treatment for albinism or Down's syndrome because we don't yet know how to rewrite someone's genetics after the cells have started to divide.

In all of these cases, however, we have a distinct culprit - genetic mutation or viruses. We have no culprit for Alcoholism. People have theorized causes, and they have developed treatments for those causes, and none of those treatments have worked. (with the exception of Pharmacological Extinction, but that's not currently popular, so we'll skip that one for now). This would be like completely eliminating the AIDS virus from someone's system, and still having their immune system fail. If that were to occur then we might scratch our heads and ask again if the virus really was at fault here. With alcoholism we have a few theories, but treatments based on these theories have success rates suspiciously close to the rates of natural remission.

The history of alcoholism treatment is really just a process of elimination of things that don't work. The failure of antabuse is such an excellent example. People figured that making drinkers miserable when they drank would make them stop. Instead they found that people would hospitalize themselves trying to get their fix. Some people think that group counseling is the answer, but anything beyond anecdotal evidence indicates that it's no better than nothing. And yet people hang onto the idea that they know something about this for dear life. Anyone who has thought that they've really understood alcoholism and proposed a treatment has been dead wrong, and refused to admit it even under fire of mountains of scientific studies. Robert Rapplean 21:26, 17 October 2007 (UTC)

I'm also curious about your distinction between medicine and psychology. It's true that the question of whether or not our souls are governed by non-physical, paranormal factors is a philosophical problem, but would you deny that the brain is also a part of the body, and may be subject to conditions that affect the rest of the body? ~ Mellerina 04:53, 17 October 2007 (UTC)

• ya, i don't understand the med vs psych thing. i dont belive in 'souls' but i would think a psych problem is, at its roots, a medical problem. maybe i'm splitting hairs here.--71.97.134.76 (talk) 14:22, 16 February 2008 (UTC)

Exempli gratis: Someone gives you the option of jumping off a cliff, or getting shot by a bullet and then thrown off the cliff. Even though it's harmful to you, jumping off of the cliff is the sensible option. This is not a physical condition, it's a mental one. The gun might not be loaded, or might be a hairbrush in a pocket or a convincing stick, but the mental condition is real and has real effects.

If someone thinks that drinking alcohol to excess is better than social isolation, then this is a mental condition, not a physical one. If someone's judgment regarding the relative values of those two is unduly clouded by endorphin conditioning, THEN it becomes a physical condition AND a mental condition. If a person has the realization that drinking to excess isn't helpful but they can't stop doing it anyway, then it's purely physical. -- Robert Rapplean (talk) 22:33, 19 February 2008 (UTC)

Longer answer: Medicine is all about physical phenomena. This includes anything from a cut to a neurochemical imbalance like exists with schizophrenia. It doesn't include cases where someone has misinterpreted information and come to valid conclusions based on bad data. Psychology is mostly the study of how bad data gets into our system, and how we avoid coming to conclusions that we don't like. This isn't a physical or even a chemical process, it's more like debugging software than repairing faulty hardware. Robert Rapplean 21:26, 17 October 2007 (UTC)

Your argument is based on your personal opinions, false assertions (Even where the medical condition is present, there is almost invariably a psychological condition overlaying it, and a physiological dependence underlying.), and the assumption that the purpose of this page is to treat people with alcohol problems. None of these are valid. My argument is based on the FACT that when researchers and doctors discuss alcoholism, they are referring to a particular physical state. The behavior of drinking too much, and the associated problems are sometimes caused by this condition, but not always. If you want to call all problems associated with drinking "alcoholism" fine, but they are distinct from the conditions that researchers and doctors refer to. --Elplatt 00:55, 17 October 2007 (UTC)

For starters, and I will be clear about this, this is NOT a forum for medical researchers. This is not a place where researchers talk to researchers. This is a place where non-doctors (and some doctors) write stuff for general consumption. We are not defining terms, we are explaining how the terms are used. Second, and I'll say this over and over again, the concept and term of "alcoholism" precedes medical science by a long margin. Doctors and researchers have no more right to tell people how to use it than astronomers have to tell people they can't use "Pluto" to refer to the god of the underworld any more.

It would be nice if we could just divide it cleanly as they do with planets and gods, but there is no such clean division. Alcoholism occurs when the desire to drink exceeds the will to not drink. This is a physiological condition contending with a psychological capability/desire. These two always exist in an alcoholic, even if the desire to stop drinking is weak or crippled. Most treatments out there (AA or antabuse, for example) treat alcoholism by attempting to shore up the will to stop drinking. This is sometimes effective. A few (like acamprosate) try to treat the desire to drink, but with little success thus far. Most of these concentrate on eliminating the pleasurable sensation that dopamine provides, and they have yet to suggest something that continues to work after you stop taking the drugs. If doctors and researchers insist on just concentrating on one side of the equation then this probably explains why they haven't found a solution yet.

Elplatt, if you want to continue this, could you kindly tell me what consensus medical science has come to in regards to the culprit behind alcoholism, and what the major obstacles are to developing a treatment? Robert Rapplean 21:26, 17 October 2007 (UTC)

To answer your first question: the consensus on alcoholism is that it is an addiction, and that the primary cause of all addictions is altered brain structure and function in the mesolimbic pathway, part of the brains dopamine system associated with learning and craving. I have plenty of references if you'd like to read about it. I don't see anything productive that could come out of continuing this discussion without some form of mediation. --Elplatt 01:55, 18 October 2007 (UTC)

I regret that you're probably right. Hopefully some of our regular contributors could chime in with alternate ideas on this.

I'll agree that alcoholism is an addiction, and that we're definitely talking about an alteration in "brain structure", but the same can be said of normal learning. The hard part is differentiating normal learning from pathological learning. What we're not so certain of is what heightened endorphin and dopamine levels actually do in order to make an experience addictive, overriding logic. We also don't know if it's the dopamine that causes it, or if the endorphins cause it directly in addition to triggering the dopamine release.

I have been saying for some time, though, that we need to expand the scope of medical information on alcoholism that exists in this article. Maybe there's enough material regarding this topic to warrant its own page, simply because the page would be too long with its inclusion. We could definitely argue a lack of notability for most of the other definitions. If you want to create a page for Alcoholism (disease) and fill it with the fruits of medical research then I'd support that. Robert Rapplean 22:27, 19 October 2007 (UTC)

Some of the comments above suggest that alcoholism isn't easily treated. In fact, numerous studies have demonstrated that better than 75% of patients with alcoholism, when treated by addiction specialist physicians, have successful long term outcomes. The airlines, when they discover a pilot with alcoholism, send them off to FAA-approved treatment. Better than 75% of them eventually get their license back and remain abstinent and in recovery. The Navy has had even better long term results. I have at least a 75% recovery rate among my patients, not an unusual figure among outpatient addiction specialists. Those who argue that overall recovery rate among our population is lower are correct, but I'd state that is because much of the "treatment" being delivered is not by physicians. If we sent people with cancer out to get treatment from bachelor level counselors, I wouldn't expect a very good success rate. Cancer, like alcoholism, is a medical illness, one we don't expect to be treated successfully by non-MD/DO's. Drgitlow 18:36, 23 October 2007 (UTC)

To elucidate on this, my statement is that no single treatment has very good recovery rates. This is because alcoholism has many causes, and you have to figure out which ones (note the plural) applies to any specific alcoholic, and treat them. Your typical alcoholic will shift from one treatment to another until they find one that works. Something like 10% of all alcoholics spontaneously quit on their own each year, just because their resolve exceeds the level of addiction. I continue to be highly resistant to claims that alcoholism is "just this one thing", or that treating it in just this way is highly effective. History ensures a great deal of skepticality on that issue. Robert Rapplean 16:05, 24 October 2007 (UTC)

Alcoholics quit drinking all the time, Robert. But stopping alcohol intake doesn't have very much to do with it. Alcoholism isn't defined by quantity and frequency of alcohol intake. So it's not abstinence that is the goal, but rather recovery. The alcoholics who spontaneously quit on their own usually fall into one of several groups: a) not alcoholic, b) they relapse, typically within 6-12 months, c) really alcoholic and really stopped drinking for good. Those in group (c) are likely very rare. Your point is well taken that alcoholism is multifactorial in origin. In any one person, the originating causes may have substantially different distribution than one might find in any other person. And it's intuitive that the focus of treatment may be quite different between those two individuals. Of course, all of medicine is individualized because we're all different. If you and I both get the flu, we'll likely have different disease courses because we're different. Our treatments may therefore have some similarities and some differences. Alcoholism treatment is no different. Drgitlow 04:33, 29 October 2007 (UTC)

[edit] Restructuring, cont.

Robert, alcoholism has many causes... the thing you call alcoholism has many causes. DrGitlow, Alcoholism isn't defined by quantity and frequency of alcohol intake... the thing you call alcoholism, isn't defined by quantity and frequency of alcohol intake. You two are working off different definitions of what alcoholism is, so you'll never agree, because you're talking about two different things. Let's stay focused, the question on the table is whether the word alcoholism has multiple meanings different enough to warrant multiple articles. --Elplatt 13:21, 29 October 2007 (UTC)

Actually, Dr. Gitlow and I have been going around about alcoholism for long enough that we've had to shift to fine distinctions to find things to disagree on.

The word alcoholism, as used by the typical guy on the street, refers to any condition that causes a person to drink alcohol beyond the point that it causes negative life consequences. We've pretty well established that with surveys of the media and various informal polls.

The question that we keep butting up against is whether you can limit the definition to a purely physiological or neurochemical condition, or if you need to include psychological factors like environment, bad judgment, and a difference in perception between the drinker and people who watch him/her get drunk. I contend that treating the physical condition without also having the person alter other things (like environment or perspective) will not result in people who are no longer addicted to alcohol. They'll just re-establish the physical portion of the addiction when the opportunity arises and, as such, must be included as part of the condition called "alcoholism". Even if we drop the colloquial and derogatory sense of the word from our definition, the psychological factors need to be preserved. Robert Rapplean 18:13, 30 October 2007 (UTC)

Elplatt, yes, some circular reasoning comes across in an article like this, especially when contributors are coming from different directions. Rob't Rapplean and I have had some offline discussions and have come a long way in reaching what I suspect is a comfort zone for both of us that isn't exactly what we would each say individually but yet serves the purpose of being a useful reference source for others. The battles that took place here a year or two ago were pretty crippling - and the article back then was terrible. Drgitlow (talk) 18:57, 24 November 2007 (UTC)

I'll be first to admit that this article is chock full of compromises. I've done immense amounts of research, and I have yet to find a treatment that is universally accepted as effective, even among the medical community. This article represents an immense effort at coalescing multiple opposing views in the face of a flurry of conflicting medical studies and statistical data. I've personally had to decide that alcoholism is really a cluster of mutually supporting conditions all with a single virtually identical symptom, but I've given up trying to find citable sources for this opinion. This makes it difficult because alcoholism truly is an medical addiction, and it truly is a psychological addiction, and it truly is a social maladaption (I draw the line at it being a moral corruption because that's just name calling). It is a continual struggle against people who insist that it's only one of these. Thus the compromises. Robert Rapplean (talk) 16:53, 26 November 2007 (UTC)

[edit] Star Sailor?

Is there anyone who would object to my deletion of the notice about Star Sailor's song called Alcoholism? I don't think it has adequate significance. If there's a lot of this kind of thing, we should create a disambiguation page. Robert Rapplean 02:01, 16 October 2007 (UTC)

[edit] Self Test Suggestion

Hello, brand new to this so hope this is in the right place, apologies if not.... I noticed that you have some self tests at the bottom in the external links section. I propose another one, the SPQ, which is jointly developed by the Kent University, UK, and PROMIS clinics, a UK based practice. This is a 160 question questionnaire directed at various addictions including alcohol. The SPQ was created with a lot of background research and is now available in quite a few languages. Marcus Sykes 10:07, 18 October 2007 (UTC)

Hi, Marcus, and welcome to the alcoholism page. I think that the primary question for inclusion would be a matter of prevalence. Who uses this test? If nobody has heard of it, then it probably won't be kept by future editors even if we do put it in. Robert Rapplean 18:16, 30 October 2007 (UTC)

[edit] Removed Statistics

I removed the following statistics:

An estimated 15 million Americans aged 18 and older are alcoholics.^[1] Worldwide, there are an estimated 140 million people who are dependent on alcohol.^[2]

Although references are cited, those references are not from a peer reviewed journal and do not discuss the data, methods, or statistics used to reach these conclusions, and do not cite their sources. --Elplatt (talk) 02:10, 27 November 2007 (UTC)

[edit] History entry in Genetic Predisposition testing

I was idly reading through the article today and noticed a huge chunk in the Genetic Predisposition Testing section that describes the history and philosophy behind the theory that we should be able to spot alcoholics by checking their genetics. While very interesting and accurate, I think that it's out of place in that particular location in the article, maybe belonging under the category of "risk factors" or something. It's good content, I'd hate to delete it, but it's badly out of place. Thoughs? Robert Rapplean (talk) 20:10, 20 December 2007 (UTC)

I agree that it kind of looks out of place but if you think of it as sort of a counter-point to the rest of the discussion about the definition of alcoholism it fits. I think that we do need to include genetic aspects somewhere.Desoto10 (talk) 20:09, 30 January 2008 (UTC)

[edit] Template:Infobox Disease

Should we put this template on this article; Template:Infobox Disease? Jet (talk) 21:42, 6 January 2008 (UTC)

[edit] Treatments / Medicines

Would it be useful to have the success rates (referenced) for the various pharmacological treatments summarized here? I am doing the research for another project, but could put the results in here. I am talking about short one sentence additions to each drug.

I would also argue to remove the last line in the Antabuse section as it is not cited, and adds nothing. You can get sick and die while doing lots of things.Desoto10 (talk) 04:25, 26 January 2008 (UTC) —Preceding unsigned comment added by Desoto10 (talk • contribs) 07:10, 22 January 2008 (UTC)

[edit] Group therapy and psychotherapy

Are Al-anon and Alateen really "most common ways of helping alcoholics maintain sobriety"? I thought that they were support groups for the families of alcoholics, not the alcoholics themselves.Desoto10 (talk) 04:07, 26 January 2008 (UTC)

You are correct. I removed them from the list. I also right-sized the different groups, since it is ridiculous to place "LifeRing Secular Recovery" and others with the exact same emphasis as Alcoholics Anonymous. Including for-profit groups, by the way -- one might examine the motives of those trying to elevate these tiny, eclectic, self-interested groups to the same level as the completely non-profit and non-aligned AA. —Preceding unsigned comment added by Mckyj57 (talk • contribs) 04:10, 11 February 2008 (UTC)

Well, you may not like these alternative groups, but I think that your wording trivializes these other groups. Plus, you would need to present a reference for the numbers. I think that you are correct, that AA has more members than all the others combined, but just thinking that is correct does not make it encyclopedic. I thought that Rational Recovery was the only for-profit group. SmartRecovery split from RR partially over that issue, I think.Desoto10 (talk) 07:16, 22 February 2008 (UTC)

[edit] Medications

I removed the beginning clause for this section which claimed "Although not necessary for treatment of alcoholism,". I can see the point of the clause, in that, sure, some people do not believe that medications have a place in alcoholism treatment, but I suspect that just as many do see a role for pharmacotherapy. The wording suggested to me that, well, you don't really need to use these drugs, but here is a list of them, anyway.Desoto10 (talk) 04:25, 26 January 2008 (UTC)

Then I rewrote it to make the section more neutral and to separate the medications used for detox from those used for long-term effects. Desoto10 (talk) 04:40, 26 January 2008 (UTC)

Out of curiosity, was there some rationale for the choices of these drugs? The benzodiazepams are the most widely used for withdrawl, but are not mentioned. I don't know anybody using paracitem.Desoto10 (talk) 04:59, 26 January 2008 (UTC)

There was a huge discussion (probably in the archives) about which medicines should be included for treatment of alcholism. In the body of the article, this resulted in a proliferation of descriptions of the various drugs which could be used to treat withdrawal, their prevalence, benefits, and drawbacks. The section attempted to completely overwhelm the remaining article. Since detoxification is not actually a treatment for alcoholism (just a treatment for physical alcohol addiction), it was merged with Alcohol detoxification.

The remaining section that you have added a bunch to was originally designed to just list the drugs which are used for long-term alcohol treatment, like antabuse or naltrexone. These are drugs that treat ALCOHOLISM, not alcohol WITHDRAWAL. I strongly recommend maintaining that line of differentiation to avoid redundant information. Robert Rapplean (talk) 21:20, 11 February 2008 (UTC)

Thanks for the history. Should we then take out all of the medications under "Medications for Withdrawal and Detoxification (Delirium tremens)"? I agree that they should be in wherever detox is.Desoto10 (talk) 04:38, 13 February 2008 (UTC)

I'd say so, yes. With that in mind, I've merged that content into the alcohol detoxification page, and will remove it from our page.Robert Rapplean (talk) 22:56, 13 February 2008 (UTC)

[edit] Pharmacological extinction

I followed the link to Sinclair Method and found an extremely poor entry with no references and claims of extremely high success rates. Does anybody know about this technique? Are there any references that describe real studies that demonstrate these great numbers?Desoto10 (talk) 05:34, 26 January 2008 (UTC)

I took a look at the references that were provided for this section and they are:

33 ^ a b Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. An Invited Review by Sinclair

34 ^ ContrAl Clinics ContrAl Results. A website advertising Sinclair Method services

35 ^ The Sinclair Method. A website advertising Sinclair Method services

36 ^ University of Pennsylvania Health System. Defunct.

None of these, except possibly #33 provide any information at all and none provide evidence for the claimed high degrees of success. I am inclined to remove the whole thing, since there isn't really any documentation, but I was accused of vandalising the Sinclair Method entry for just removing one section. If this technique actually works as well as Sinclair says it does and this success can be backed up, then that is fantastic. Otherwise, not so much.Desoto10 (talk) 05:58, 26 January 2008 (UTC)

Well, nobody seems to know much about this entry so I am going to delete it. Perhaps, if someone is motivated they could put in a sentance about it but they will have to find the references.Desoto10 (talk) 06:01, 29 January 2008 (UTC)

Hi, Desoto. As the previous heavy editor of this page, I'd like to welcome you to the Alcoholism page. I see you've rolled up your sleeves and started giving the page a good working over. It was a bit overdue for that, as most of the editors around here (including myself) have gotten a bit complacent.

For future reference, three days is a very short period of time to give people to respond to a suggestion for deletion, especially for a large section. You probably want to give it a week in the future, as this is part of Wikipedia standard for resolution of questions. Unfortunatley, I have a new manager who thinks that it should always be crunch time, and haven't been back to the page in a while. The section on Pharmacological Extinction was actually derived from a (double-blind, placebo controlled, peer reviewed) study performed by the National Public Health Intitute of Finland (http://www.ktl.fi/portal/english/).

Item #33 in your list provides numerous studies that back it up (including reference to the original), if you happen to have access to the publications that they were printed in. Unless you're a doctor you probably don't, so instead I provided links to the ContrAl clinics in Finland, who use those studies to back up their use of the treatment. I believe I still have a digital version of the original study, so if you'd like to let me know what your email address is I'll send it to you.

There are numerous reasons why the Sinclair Method isn't in more popular. The first is that Alcoholism has many causes, and SM only treats the primary physical one. Unless the person is thoroughly convinced that alcohol is bad for them, the physical side of the addiction will just be re-established via the mechanisms inherent in the psychological side. Identifying people who really wanted to stop drinking was part of the selection process for the primary cited study. This is in keeping with the psychological precident that you can't help people who don't think they have a problem. Other studies haven't included this in their selection process, and have achieved less decisive results.

Another factor is that the majority of institutions aren't in the business to cure alcoholics, they're in the business to treat them. If you actually cure them, you lose all your business. The very people who would be responsible for rolling out this treatment have strong incentive not to. In conversations with representatives of Alcoholics Anonymous, I've discovered that this isn't limited to entities with financial incentive. Contrary to popular belief, AA doesn't exist to cure alcoholics, it exists to spread the popularity of the AA 12-step program. Again, curing alcoholics is contrary to that purpose. Nonetheless, the WHO is currently extending the treatment to countries that can't afford large brick-and-mortar detox centers.

Short for time today (getting to be a bad habit), I'll run over your edits, questions, and reviews and get back to you with more commentary.

Cheers, Robert Rapplean (talk) 19:46, 11 February 2008 (UTC)

Thanks for the pointers and comments Robert. Yes, I am an egg. I want to make it clear that I have no opinion as to whether pharmacological extinction is a viable alcoholism treatment or not. I understand the concept well and I have read a few references on the issue. I was just struck by the fantastic claims and when I went to the websites it just seemed like an advertisement. I missed the references that you mentioned entirely, sorry. If these claims can be substantiated by reasonably well constructed studies, then, by all means we should include them.

As for the time for response, what, you mean you aren't all just sitting on the edges of your seats waiting for my comments????

FYI, I run in other circles where the "deffinition of alcoholism" is hotly debated. I ofter refer some of these folks to this discussion page just to see how contentious it is.

Best, Desoto10 (talk) 22:03, 11 February 2008 (UTC)

Ok, the actual name of the study is Targeted Use of Naltrexone Without Prior Detoxification in the Treatment of Alcohol Dependence: A Factorial Double-Blind, Placebo-Controlled Trial (Pekka Heinälä, MD1,2, Hannu Alho, MD, PhD1,3, Kalervo Kiianmaa, PhD1, Jouko Lönnqvist, MD, PhD1, Kimmo Kuoppasalmi, MD, PhD1, and John David Sinclair, PhD1) If you can find it in the Journal of Psychopharmacology. Please download the informational packet that I've compiled (yes, I researched that one pretty well). It includes the invited interview from the Oxford Journal, the full study (with all those statistics that sound too good to be true), a compilation of all studies that have been done before about 2004 on endorphin blockers and alcoholism, and how they impact PE, and an article from the Italian Journal of Addictions which describes how people are being misinformed about the use of these drugs. Robert Rapplean (talk) 15:01, 12 February 2008 (UTC)

[edit] Disulfiram

I added the results of a recent long-term study on supervised disulfiram and the reference and took out the inflamatory and uncited sentance about death and illness from disulfiram and heavy drinking.Desoto10 (talk) 05:57, 29 January 2008 (UTC)

The bit about Disulfiram causing illness and death doesn't need to be cited. This is like asking if the flu causes illness and death. Part of the standard precautions state "It produces an unpleasant reaction of flushing, headache, nausea, vomiting, dizziness, sweating, pounding heart (palpitations), blurred vision or weakness when even small amounts of alcohol are ingested." It prevents the elimination of aldehydes that are created when we process alcohol, and these aldehydes can build up to a fatal level.

The reason that this was included is that disulfiram doesn't decrease the desire to drink, it just increases the penalties. Drunks in gutters around the world have proven again and again that penalties don't always prevent people from drinking. Because of that, it should always be distributed with that caution in mind.

Robert Rapplean (talk) 21:30, 11 February 2008 (UTC)

With all due respect, you have not kept up with disulfiram research, particularly in Europe. Much of the "common knowledge" about the drug is, in fact, anecdotal, particularly where death is concerned. In addition, most studies on disulfirm relied on unsupervised administration and self-reporting, both of which are known to not work so well. The same goes for people "drinking through" disulfiram. Disulfiram, when given under supervision, as in the OLITA program in Germany provides for excellent long-term outcomes with minimal adverse effects. I totally agree with you that you cannot just hand an alcoholic a script for disulfiram--that just does not work. Interestingly, disulfiram has a pretty good effect on cocaine addiction through an entirely different pathway. Disulfiram also blocks dopamine beta hydroxylase.Desoto10 (talk) 04:51, 13 February 2008 (UTC)

I'm definitely in favor of listing disulfiram as one of the drugs used to treat alcoholism. We're here to tell people all the options, not to make judgements about which one is the best for them. What would be the minimum information that we should provide? Can we authoritatively state success levels for each treatment? Probably not, because as your OLITA example describes, success is highly varying with how the drug is administered. Robert Rapplean (talk) 22:34, 13 February 2008 (UTC)

Yeah, I don't know either. Maybe just the briefest description of the most common medications and hope that they all have entries elsewhere with more extensive information about study results. We would get bogged down for sure if we tried to summarize it here. I would say we should list disulfiram, naltrexone (including Vivitrol), and acomprosate. I suspect those account for virtually all of the prescriptions filled for alcoholism.Desoto10 (talk) 04:42, 17 February 2008 (UTC)

[edit] Nutrition

I moved one vitamin from this uncited section to the Treatment / Withdrawl treatment section. The rest was unsubstantiated and not peer reviewed.Desoto10 (talk) 06:11, 29 January 2008 (UTC)

[edit] Prevalence

We really need some statistics about prevalence in this article. I see that the numbers that were given have been removed (see Rmoved Statistics, above) due to inadequate references. There is the NIAAA sponsored study:

An estimated 17.6 million American adults (8.5 percent) meet standard diagnostic criteria for an alcohol use disorder* and approximately 4.2 million (2 percent) meet criteria for a drug use disorder. Overall, about one-tenth (9.4 percent) of American adults, or 19.4 million persons, meet clinical criteria for a substance use disorder--either an alcohol or drug use disorder or both--according to results from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) reported in the current Archives of General Psychiatry [Volume 61, August 2004: 807-816].

I have not read the study, but it is reported in a peer-reviewd journal where the methods, presumably, are described. Assuming that I can get this paper would this be something to add? I understand that it is just US.Desoto10 (talk) 19:34, 30 January 2008 (UTC)

It turns out that the article is freely available at the Archives of General Psychiatry website. The article was peer-reviewed. I downloaded it and read it. The methods are clearly described and, although the thrust of the paper and the study was to determine the co-occurance of "independent mood and anxiety disorders" and "substance use disorders", the numbers for both were presented. I understand that there is argument over the relationship between "substance use disorder" and "alcoholism", but if this were made clear, is this a useable study for the prevalence statistic?Desoto10 (talk) 19:55, 30 January 2008 (UTC)

OK it has been quite a while and nobody seems to object, so I will add this paragraph and the reference.Desoto10 (talk) 04:53, 13 February 2008 (UTC)

[edit] Moderation

There is a new study out, using the same NESARC subjects relating to the rates of return to drinking following a period of "remission":

Dawson DA, Goldstein RB, Grant BF. 2007. Rates and correlates of relapse among individuals in remission from DSM-IV alcohol dependence: a 3-year follow-up. Alcohol Clin Exp Res. 2007 Dec;31(12):2036-45.

I can't edit the main page for some reason right now, but when I can I will add this. The results are essentially that the abstinent group in remission had the best chance of not reverting to problem drinking compared with low- and high-risk drinkers.66.120.181.218 (talk) 23:40, 2 February 2008 (UTC)Duh! I was not logged in.Desoto10 (talk) 23:42, 2 February 2008 (UTC)

I replaced the NIAAA press release with the actual study described in the press release:

Dawson DA, Grant BF, Stinson FS, Chou PS, Huang B, Ruan WJ. 2005. Recovery from DSM-IV alcohol dependence: United States, 2001-2002.  : Addiction. Mar;100(3):281-92

I suggest that press releases be the reference of last choice because they are often as much propaganda as they are accurate descriptions of the actual study. Every NIAAA-funded and NIAAA intramural study will be available in a Medline indexed journal.Desoto10 (talk) 23:59, 2 February 2008 (UTC)

[edit] Deleted External Link

I found a website that offers an unbiased view of addictions and recovery. It is large, well documented, non-commercial, and complements the information on this page. The link is: www.addictionsandrecovery.org. But it has been deleted. I would like members thoughts on whether this would be a good external link. Tony8ha (talk) 18:37, 11 February 2008 (UTC)

Articles on larger topics often attract far too many links to be useful. Wikipedia is not a collection of links. The open directory project (www.dmoz.org) is and they categorize and screen the links. It is fairly widely accepted practice to replace link farms with links to dmoz and direct any suggested links to them for evaluation.

Similar situations are occuring with your adding the same link to Post Acute Withdrawal Syndrome‎, Benzodiazepine withdrawal syndrome‎, and Addiction‎

Mdsummermsw (talk) 21:00, 11 February 2008 (UTC)

The link www.addictionsandrecovery.org is obviously not a link farm. It is a resource that does not duplicate the information on this page, but instead complements it. This is exactly what external links are meant to do. Tony8ha (talk) 21:39, 11 February 2008 (UTC)

It's what links were meant to do, but not what Wikipedia was meant to do. There are many places that accumulate information about addiction and recovery, and the best way to find them is to use Google. If Wikipedia attempted to list all of them, then the factual information would be overwhelmed by the links to other people's information. It's also not feasible for Wikipedia to play judge and jury by arguing among ourselves which sites are the "best". As such, we are required by the laws of competition to include none of them.

If a link doesn't specify an information source whose authority supersedes Wikipedia's own, we cannot include that link. Merely cross-linking to other places where information might exist isn't a practical measure. There's just too many of them. Sorry, Tony. Robert Rapplean (talk) 22:08, 11 February 2008 (UTC)

I am with Robert on this one. www.addictionsandrecovery.org IS an excellent relatively non-biased information-rich website run by an excellent clinician in Toronto. It will be easily found by anyone using an normal search engine.Desoto10 (talk) 02:11, 20 February 2008 (UTC)

[edit] Citation for term "Big Book"

Under "Etymology", I see you noted a need for a citation related to the term "Big Book".

That term was first used in reference to the first edition of "Alcoholics Anonymous", the book, because it had been printed on heavy paper with a large border so purchasers might feel their money was well-spent.

In the Preface to its third edition, the term "Big Book" actually appears within itself:

"All changes made over the years in the Big Book (A.A. members' fond nickname for this volume) have had the same purpose: to represent the current membership of Alcoholics Anonymous more accurately, and thereby to reach more alcoholics."

```` —Preceding unsigned comment added by Leejosepho (talk • contribs) 00:30, 16 February 2008 (UTC)

[edit] Alcoholism, not alcohol dependence

Some of the comments above refer to recent research on alcohol dependence. Please recognize that alcoholism is not entirely equal to alcohol dependence. For example, alcoholism has always been defined by the medical community as incorporating use of any sedative agent despite one's best interest. So, for example, an alcoholic can use Jack Daniels, Budweiser, or Valium - all of these would still fall within the context of alcoholism. However, that's not the case for alcohol dependence, which is defined based upon alcohol specifically. Sedative dependence is the illness that would be applicable if the patient is using Valium or other benzos. Another significant difference between the two is the issue of recovery. For alcoholism, recovery includes abstinence from alcohol plus improvement of function in various domains. For alcohol dependence, one can be in remission without necessarily being abstinent from alcohol use (see DSM-IV criteria).

Here's the bottom line: research which applies to alcohol dependence might not be of value in the study of alcoholism. From a medical perspective, there should probably be another Wiki entry that specifically addresses Alcohol Dependence, the disease state defined within DSM-IV, and which is considered separately from Alcoholism, the disease state well characterized within the medical literature overall. Drgitlow (talk) 05:30, 16 February 2008 (UTC)

I'm all for this, but we'd have to be careful with our terminology. Alcohol dependence = "addiction" in psychology; alcohol dependence = physiological addiction (that which must be withdrawn from) in medicine. This is DEFINITELY something that should have two separate pages, disambiguated.

I'd also like to see an article that describes the purely medical/physiological side of alcoholism. This is not to be confused with the medical effects of heavy drinking, but the neurochemical addiction that continues even after the physical dependence goes away. -- Robert Rapplean (talk) 21:48, 19 February 2008 (UTC)

[edit] Remission

The last sentence in this section states:

"Others (most notably Alcoholics Anonymous) use the term recovery to describe those who have completely stopped consumption of alcohol, and have begun a process of addressing the underlying emotional and social predisposing factors."

I believe that AA would not go along with this description of what they think "recovery" is. My understanding is that the AA concept of "recovery" is to be free from alcohol consumption AND be adhering to the 12 steps of AA. If someone wants to demonstrate that following the 12 steps gives rise to a "process of addressing the underlying emotional and social predisposing factors" then please do. Otherwise, the sentence should be corrected.Desoto10 (talk) 03:10, 20 February 2008 (UTC)

Yea, this one probably warrants a little research. As far as I know, AA doesn't believe that alcoholics every recover, they just go into remission. They don't believe that alcoholism is curable, just controllable. I'll mark this as needing citation and look into it.

As a side note, the entire Terminology section is currently uncited, so we should probably work on finding creditable references for those terms. -- Robert Rapplean (talk) 17:43, 28 February 2008 (UTC)

I went through the big book and the AA website and the only references to "recovery" involve the 12 steps and abstinence. I suggest that we remove "recovery" for now (from this entry: it should probably be in the AA entry) and let somebody who can interpret and reference the term recovery add it in later.Desoto10 (talk) 05:50, 11 March 2008 (UTC)

The Wiki entry for AA describes recovery for AA adherents: "The suggested AA recovery program for alcoholics includes not drinking alcohol one day at a time, following Twelve Steps,[15] helping with duties and service work in AA,[16] and regular AA meeting attendance[17] or contact with AA members.[15]"Desoto10 (talk) 06:02, 11 March 2008 (UTC)

[edit] Screening

The Alcohol Dependence Data Questionnaire and The Michigan Alcohol Screening Test (MAST)entries have been deleted. Do we then remove the links to those articles? Also the ADDQ reference goes nowhere.Desoto10 (talk) 03:40, 20 February 2008 (UTC)

I would say no. Wikipedia is undergoing a process of over-zealous deletions at the moment where admins are deleting articles because it's a topic that they personally have never heard of, and the person who wrote it didn't include a statement that X million people are effected by it. That doesn't mean that it's not significant to our article. By leaving the red links in our articles, it's a statement that we feel these things are significant enough to warrant their own entries.

I believe that we vetted our selected questionnaires pretty well before including them, so I have no problem with leaving the links in. Any other comments, suggestions, ideas? -- Robert Rapplean (talk) 17:40, 28 February 2008 (UTC)

I think as long as the actual references are intact and valid, then leaving the red is fine.Desoto10 (talk) 04:30, 6 March 2008 (UTC)

[edit] Polluted water substitute

This paragraph, which references comments from a book on another disease seemed out of place. Upon scanning the rest of the article I notice that there is not a section describing the causes of alcoholism. There is a lot of information in the discussion page about brain chemicals and so forth, but nothing in the article itself. If I were researching alcoholism, one of the first things I would want to know is what causes it. If cause is unknown or controversial, then that should be stated. Uh oh, I should go look at the "Disease concept of Alcoholism" entry to see if causes are treated there. In any case, are there references for the polluted water hypothesis?Desoto10 (talk) 03:51, 20 February 2008 (UTC)

I would LOVE it if we could list a cause of alcoholism. As things stand, we can't even say "the cause of alcoholism is highly debated", because that very statement can't be cited. In order to have a cause, you have to be able to define what something is. There's a psychological, neurochemical, and physiological component to alcoholism. Most people (especially professionals in the field) like to insist that just one of the three is the entirety of the condition, so there is HUGE debate about what specifically causes it. If you can find a citation for THAT statement, though, I'll shower you with rose petals and call you "sir".

I agree that the polluted water paragraph should go. Besides the lack of citation, it really describes why we started drinking alcohol, not actually saying anything about alcoholism itself. If the people from "alcoholic beverages" want it, they can readily dig it out of our history. -- Robert Rapplean (talk) 20:10, 22 February 2008 (UTC)

I removed the paragraph.Desoto10 (talk) 05:11, 27 February 2008 (UTC)

[edit] Article references gone

Is it just me or did the article just lose a bunch of references? I see several sentences without references now despite them being there a few days ago. —Preceding unsigned comment added by 213.161.187.254 (talk) 08:27, 28 February 2008 (UTC)

This article has undergone significant trimming and rephrasing in the past few months. Could you be more specific about which sections you feel have lost their references? -- Robert Rapplean (talk) 17:33, 28 February 2008 (UTC)

[edit] AA definition of recovery in Terminology

Does this section really add anything to the entry? Nothing is referenced and not much is said. I think it should go.Desoto10 (talk) 06:20, 11 March 2008 (UTC)

Sorry, didn't see that you were discussing that last sentence in the "remission" section. I believe that this was added to point out that AA refers to similar condition under a different name. There are a lot of viewers and editors out there who really only know the AA view of alcoholism, so this helps them to relate to what we are telling them. -- Robert Rapplean (talk) 21:29, 12 March 2008 (UTC)

I would like to note that the Book Alcoholics Anonymous in the forward to the 1st Edition page xiii states "We of Alcoholics Anonymous, are more than one hundred men and women who have recovered from a seemingly hopeless state of mind and body. To show other alcoholics precisely how we have recovered is the main purpose of this book." In the 164 pages that make up the program of action, from 165 to the end is personal stories, the word recovery is used 21 times pages 30, 31, 59, 72, 73, 90, 94, 96, 2X on 97, 2X on 99, 113, 120, 125, 139, 143, 145, 147, and 153. On those pages never does the book describe those that have completed the 12 steps and had a spiritual awakening as "recovering".

I feel that the following words should be replaced; "these groups use" should be replaced with "this group uses" (it's one group, Alcoholics Anonymous, not many groups) "recovery" should be replaced with "recovered" and "completely stopped consumption of alcohol" should be replaced with "completed the 12 steps, had a spiritual awakening".

It would read as follows.

Instead, this group uses the term recoved to describe those who have completed the 12 steps, had a spiritual awakening and are addressing underlying emotional and social factors. Trub68 (talk) 22:29, 5 June 2008 (UTC)

[edit] Medications

Refs 25 and 26, which are supposed to relate to combination therapy of Campral + Naltrexone do not support the statment to the effect that the combination gives excellent results. Ref 25 actually has nothing to do with combination therapy and ref 26 does NOT show a significant effect. The abstract is misleading in the statement:

"Across medication groups, CBT + combined medication produced the greatest improvement across all outcome measures. Although a trend favoured the CBT + combined group, differences did not reach statistical significance."

Many people do not understand the critical distinction between a "trend" and "statistical significance". Typically, studies are set up so that, in the end, conclusions can be made with a degree of certainty. It really does not matter if one treatment resulted in a better outcome if the degree to which it was better was not statistically significant. The true result of the ref 26 study was that CBT+combined group did NOT result in statistically significant improved outcome. In other words, Acomprasate + Naltrexone was no better than Naltrexone alone, similar to the finding of the COMBINE study.Desoto10 (talk) 21:54, 13 March 2008 (UTC)

Good spotting, Desoto. Your posting was on March 13th, so let's give it until April 13th for anyone to respond, and then pull the statement. - Robert Rapplean (talk) 04:54, 1 April 2008 (UTC)

[edit] Effectiveness

Our current definition is:

Effectiveness The effectiveness of alcoholism treatments varies widely. When considering the effectiveness of treatment options, one must consider the success rate based on those who enter a program, not just those who complete it. Since completion of a program is the qualification for success, success among those who complete a program is generally near 100%. It is also important to consider not just the rate of those reaching treatment goals but the rate of those relapsing. Results should also be compared to the roughly 5% rate at which people will quit on their own.[19]

This has some truth to it and is obviously an oblique reference to the argument over at the AA page about attrition. I believe that we are talking about two different issues, one is compliance and the other is success. In a typical well-designed clinical trial for a treatment, these issues are considered separately. Compliance refers to how many people who start a treatment, actually comply with the treatment and finish it. Success refers to how well those who actually finish a treatment in full compliance do during and after the treatment. A treatment can fail for at least two major reasons, (1) the success rate as measured by outcomes of those who comply with a treatment is low or (2) the number of non-complieant subjects is so high as to make the treatment impractical for the general patient population. A prime example for failure due to non-compliance is the drug Antabuse (disulfiram). If patients are forced to take Antabuse, virtually all of them remain sober and so, in that respect, it is an extremely successful drug. However, under normal conditions, where the patient is free to choose whether or not he/she will take Antabuse, virtually all patients stop taking it and return to their old ways. And so, in this respect, Antabuse is a huge failure.

I would like to chage the Effectiveness section to be consistent with this. I can provide references from something like Gilman and Goodman for the definition of success and compliance and there is lots on Antabuse.

However, if I do so, then we will have to change the AA page about attrition to reflect these issues.Desoto10 (talk) 23:05, 5 April 2008 (UTC)

[edit] Epidimeology

Added the interesting fact from that NIAAA report that only 25.5% of the 4000 had received any treatment.

[edit] Tests

Qualified this section to state that the tests are not as sensitive as questionnairs.Desoto10 (talk) 06:14, 8 April 2008 (UTC)

[edit] Picture

That picture of the 2 laying on the floor has little or nothing to do with alcoholism. It has more to do with homeslessness. Theres not even a beer can or liquor bottle near them. Remove that picture or do something with it. —Preceding unsigned comment added by FlushinQwnzNyc (talk • contribs) 22:30, 1 May 2008 (UTC)

I agree. The picture adds nothing.Desoto10 (talk) 02:10, 3 May 2008 (UTC)

I tried to remove it, but the entry page appears locked.Desoto10 (talk) 02:13, 3 May 2008 (UTC)

Removed it and the one of some nondescript buildings that added nothing to the entry. Images are nice, for sure, but they are a waste of bandwidth unless they add something to the articles.Desoto10 (talk) 08:29, 4 May 2008 (UTC)

I restored the AA regional service center - it illustrates AA and that there is a network or an organization dedicated to alcoholism. "Takes up bandwidth" is not an argument to remove content. --David Shankbone 12:41, 4 May 2008 (UTC)

This article is "Alcoholism" not "Alcoholics Anonymous". I am going to remove this image of non-descript buildings that add nothing to the article. If you feel you must put it somewhere, try the AA entry, although I don't see value in it there, either. If you feel compelled to indicate that AA has regional centers, why not write a sentence or two, cite it and put it into the AA article?Desoto10 (talk) 05:46, 6 May 2008 (UTC)

[edit] Directory Of Alcohol Escape

== Hi everyone,it is hot here in my vacation in Bali here with I have little clue about making up the way out from being slave by alcohol and drug abuse.it is more directory then searching it out in google, completly arrange just for the problem of alcohol and drug abuse == Bold text

---

Garineko