By William L White.
It is difficult to pick up a book advocating or attacking the disease concept of alcoholism/addiction without having Alcoholics Anonymous credited as the source of the modern disease concept of alcoholism. Yet considerable evidence challenges this popular belief. When AA co-founder Bill Wilson was asked in 1960 about AA’s position on the disease concept, he offered the following response:
“We have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore, we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore, we always called it an illness, or a malady – a far safer term for us to use.”
AA’s use of medical terms reflects not an observation on the source or nature of alcoholism but its belief about the solution. When Wilson asked Dr. Bob Smith, AA’s other co-founder, to comment on the accuracy of referring to alcoholism as disease or one of its synonyms, Smith scribbled in a large hand on a small sheet of his letterhead: “Have to use disease – sick – only way to get across hopelessness.” AA’s use of medical metaphors served as a reminder of its belief that the alcoholic could never again safely drink alcohol. In a paper that looks specifically at whether AA was the source of the disease concept, historian Ernest Kurtz, author of Not God: A History of Alcoholics Anonymous, summarizes his review of AA literature and practices:
“On the basic question, the data are clear: Contrary to common opinion, Alcoholics Anonymous neither originated nor promulgated what has come to be called the disease concept of alcoholism. In the major texts of AA, there appear no discussions and bare mention of “disease,” much less of the disease concept of alcoholism. Its paucity of mention in the officially published works suggests that this understanding is hardly central to the thought of Alcoholics Anonymous. Yet its members did have a large role in spreading and popularizing that understanding. Most AA members, in the year 2000 no less than in 1939, will tell an inquirer that their alcoholism has physical, mental, emotional, and spiritual dimensions. The contribution of Alcoholics Anonymous is not the idea of disease but of threefold disease – the realization that the alcoholic had problems in the physical, the mental, and the spiritual realms, the clear understanding that alcoholism is, as described on page 44 of Alcoholics Anonymous, ‘an illness which only a spiritual experience will conquer.’ Did AA’s use the disease concept of alcoholism? Yes. Did AA’s or AA originate or rediscover or dogmatically push the disease concept of alcoholism? Clearly, No.”
What AA did contribute inadvertently to the disease concept – its goal was not to understand alcoholism but to help alcoholics – was its members’ collective experience. This experience reflected:
the reality that alcoholism had a physical, as well as a mental and a spiritual, component
the potential helpfulness of medical metaphors (“illness,” “allergy”) in making sense of drinking experiences
the portrayal of alcoholism as an accelerating process
the importance of concentrating on drinking behavior rather than searching for underlying causes
a belief that loss of control over alcohol could be contained only by complete abstinence from alcohol.
AA was not the source or promoter of the disease concept that emerged in the 1940s as a public policy slogan and an organizing construct for alcoholism treatment. AA’s peripheral use of such medical metaphors was not a declaration of science but a simple statement of collective experience. (“It explains many things for which we cannot otherwise account.” Alcoholics Anonymous, xxiv)