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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)

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)

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)

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)

Removed Statistics

I removed the following statistics:

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

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)

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)

Template:Infobox Disease

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

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)

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)

Rational Recovery is not a group, it is simply a privately-held for-profit concern that advertises that Rational Recovery has made groups "obsolete". Yet, it seems that RR keeps getting listed as a group, when it's more a product offering than anything else.

Many of the former groups of RR eventually became SMART Recovery, and there are no RR-endorsed groups. Oldefarquer (talk) 18:53, 25 November 2008 (UTC)

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)

to be as neutral as possible as informative as i am able "Eskapa, Roy. The cure for alcoholism. Benbella." , you'll find all the verifiable facts in regards to your direct questions. Im sorry its not full MLA format but I cant get to the book right now, given the significance of the problem and the immediate socio-economic impact of these findings, it is at the least a good starting place, the back end of the book has all of the well documented studies.

Schulte123 (talk) 08:35, 27 February 2009 (UTC)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

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)

Created Stub

I changed this article from a redirect to a stub. The psychiatric diagnosis of alcohol dependence is distinct from the vague term "alcoholism," and is the primary usage of the phrase in medicine and science. Furthermore, the alcoholism article does not adequately discuss the topic. I have linked to alcoholism in the intro which should allow people to find it if that is what they're really looking for. --Elplatt 18:40, 8 February 2007 (UTC)

I changed the sentence about alcohol abuse / dependence and "alcoholism". I don't know if that is what the original author meant, but given the Alcohol Abuse entry, it makes things a little more consistent.Desoto10 (talk) 06:09, 6 May 2008 (UTC)

I suggest that everything below the first two paragraphs gets deleted. It is just a recapitulation of the first paragraph.Desoto10 (talk) 06:20, 6 May 2008 (UTC)

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)

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)

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)

Epidimeology

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

Tests

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

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)

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

Disease Theory

I am confused about what is meant by this:

A small minority within the field, notably Herbert Fingarette and Stanton Peele, argue against the existence of this disease. However, critics of the disease model acknowledge that the word "alcoholism" refers to a disease, and use the term "heavy drinking" when discussing the negative effects of alcohol consumption.

The way I read it two critics of the disease model, Fingarette and Peele, say alcoholism is not a disease. OK, fine. But then it goes on to say that critics of the disease model, perhaps meaning "other critics?" acknowledge that the word alcoholism refers to a disease. How can critics of the disease model acknowledge a disease?Desoto10 (talk) 03:44, 21 June 2008 (UTC)

Critics of the disease model, such as Fingarette, don't say "alcoholism is not a disease," they say "the disease known as alcoholism doesn't exist." --Elplatt (talk) 14:30, 23 June 2008 (UTC)

Effectiveness (of Treatments)

The opening sentence of this section states: "The effectiveness of alcoholism treatments varies widely." but provides no reference. Who says they vary widely? Who even knows? I am removing it.Desoto10 (talk) 05:02, 18 September 2008 (UTC)

Jellenek's Classifications

I've removed the following selection from the Etymology section. Although the information is potentially relevant, it isn't relevant to the history of the word "alcoholism" itself, so it belongs in a different section. --Elplatt (talk) 04:02, 10 October 2008 (UTC)

Jellinek came up with the idea of grouping different drinking patterns and naming them by giving each a Greek letter. One might think that the purpose of such a classification is to expand the range of alcoholism and include as many people as possible under the "disease concept"; but, contrary to what the title suggests, Jellinek's 1960 magnum opus in fact tries to limit the scope of the "disease concept", stating that most of the types described might be alcoholics, but they are not diseased — because they do not suffer from "loss of control".

• Alpha alcoholism: the earliest stage of the disease, manifesting the purely psychological continual dependence on the effects of alcohol to relieve bodily or emotional pain. This is the "problem drinker", whose drinking creates social and personal problems. Whilst there are significant social and personal problems, these people can stop if they really want to; thus, argued Jellinek, they have not lost control, and as a consequence, do not have a "disease".
• Beta alcoholism: polyneuropathy, or cirrhosis of the liver from alcohol without physical or psychological dependence. These are the heavy drinkers that drink a lot, almost every day. They do not have physical addiction and do not suffer withdrawal symptoms. This group do not have a "disease".
• Gamma alcoholism: involving acquired tissue tolerance, physical dependence, and loss of control. This is the AA alcoholic, who is very much out of control, and does, by Jellinek's classification, have a "disease".
• Delta alcoholism: as in Gamma alcoholism, but with inability to abstain, instead of loss of control.
• Epsilon alcoholism: the most advanced stage of the disease, manifesting as dipsomania, or periodic alcoholism.

Terminology

"The fellowship known as Alcoholics Anonymous does not use the term "remission" because AA's basic text, which was first published in 1939, uses the terms "recover" and "recovered" to describe those who have stopped consuming alcohol by addressing their underlying problem"

Does AA really ever use the term "recovered" (past tense)? I thought that AA did not recognize the "recovered" state--only that the alcoholic could reach the state of "being in recovery".Desoto10 (talk) 01:45, 19 October 2008 (UTC)

I have another terminology issue. Under "Identification and Diagnosis", the article says "While there are many cases where an alcoholic's life has been significantly and obviously damaged, there are always borderline cases that can be difficult to classify. Unless they have M.C. type symptoms, and in these cases are probably alcoholics, no diagnosis needed.". I don't know what "M.C. type symptoms" are, even after searching Google a bit. The only medical abbreviation I could find was "motor control", which doesn't quite make enough sense. From context, I would perhaps expect "delerium tremens" to appear here, but I don't know how to get "M. C." to stand for "delerium tremens". 64.161.114.2 (talk) 02:53, 29 January 2009 (UTC)

Women and Alcoholism

Hello, I have recently been doing a very comprehensive literature review about the differences between how women and men experience alcoholism. The differences range from the biological/ chromosomal level, to societal predisposition and treatment barriers. I propose a new section on Women and alcoholism because it is in fact very different than a man's experience and there is currently no distinction on this page. I hope to be posting my information within a few days with references but I welcome any feedback/ suggestions. --Sierraj21 (talk) 05:12, 12 November 2008 (UTC)

I think that's an excellent idea. The new edition of "Alcoholism (The Facts)" has a section on women and alcoholism that might be helpful, however it unfortunately doesn't cite sources. --Elplatt (talk) 05:31, 12 November 2008 (UTC)

Thanks for the feedback, I will be posting relatively soon (within the next week or so). Thanks again for the support! --Sierraj21 (talk) 02:54, 13 November 2008 (UTC)

Why was this page unprotected?

We got this page semi-protected some time ago because it was continually being vandalised several times a day (typically, someone saying their friend was a notorious alcoholic). Why has this page been unprotected without any discussion? Nunquam Dormio (talk) 18:12, 16 November 2008 (UTC)

Mental Health Effects

Somebody put in some text referencing a short "case study" article by Cohen relating to anxiety and alcohol and benzo co-addictions. While this might be interesting to add, the contributer needs to find better sources. Cohen makes a lot of claims in this paper without reference to the literature. Since the paper itself is a list of case descriptions, it carries very little weight. I deleted the paragraph. Please feel free to add it back with appropriate references. It is an interesting topic.Desoto10 (talk) 04:36, 22 December 2008 (UTC)

Stereotypes

This section needs some valid references. The two that are given for Irish drinking do not talk about stereotypes, but present valid data suggesting that, in fact, binge drinking is a major problem in Ireland. The book reference seems to also be about actual drinking problems of Irish emigrants in the USA. This section should be deleted unless better refs can be found. I'll look around.Desoto10 (talk) 20:59, 22 December 2008 (UTC)

All the data I seem to find indicates that the "heaving drinking Irish" stereotype is actually true. Since many people have the mistaken idea that "stereotype" suggests that something is not true, perhaps there should be a section for "high-alcoholism populations populations" or some-such where this info can be added.99.142.20.47 (talk) 00:46, 29 June 2009 (UTC)

This information would be an excellent addition to the [Alcoholism#Epidemiology Epidemiology] section. We've actually been looking for a solid source of per-capita statistics for alcoholism for a while, but it's been blocked by people's disagreement about how to define alcoholism. Maybe we could create a special "Alcoholism per capita table" page here and work it up from there. Does anyone know the standard form that Wikipedians use for that kind of page?

A stereotype, btw, isn't necessarily something that isn't true. It's usually an existing feature of a segment of a population that is exaggerated to cover all (or a larger percentage) of that population. It may or may not be something that is unusually prevalent in that segment, but it is generally something that is more notable when it does exist in that segment. Thus, the "drunk Irish" as a stereotype may be something that exists in more Irish than in the average of New York population, creating the stereotype that all Irish are a bunch of drunks. Robert Rapplean (talk) 18:22, 11 July 2009 (UTC)

Texas Tech

The references for the Texas Tech are from their website and they do not detail how they assess success.Desoto10 (talk) 23:48, 29 January 2009 (UTC)

Schick Shadel Hospital of Seattle

I think that we should have a section titled "Aversion Therapy" under Treatments and discuss the Schick method. I'll do it in a while, but if anybody has any references that would be great.Desoto10 (talk) 03:56, 17 February 2009 (UTC)

New Lead Sentence is Factually Inaccurate

The current lead off sentence is "Alcoholism is a term with multiple and sometimes conflicting definitions to describe the detrimental effects of alcohol intake." This is unfortunately not accurate. The medical definition accepted by the entire field of medicine has to do with the addictive disease of alcoholism, in which one CAN have detrimental effects of alcohol intake, but people with alcoholism are often in recovery and not experiencing any detrimental effects of alcohol intake. It would be better if the lead sentence simply reads: "Alcoholism is a term with multiple and sometimes conflicting definitions."

That can then lead into the paragraph which currently follows. Drgitlow (talk) 00:56, 26 March 2009 (UTC)

Good call, Doc. Robert Rapplean (talk) 23:19, 2 April 2009 (UTC)

Corrected Dual Addiction Section

I made some corrections to this section, which made the statement that alcoholics can be dually addicted to benzodiazepines. This is incorrect from a definition standpoint. Alcoholism's medical definition has always referred to all cross-tolerant sedatives of which alcohol is merely a prototype. Alcohol Dependence, however, is defined differently. This is why the research has changed so much if you compare outcomes of studies from the current period to those from the decades prior to the DSM's altered definition and approach. In alcohol dependence, one can be addicted to alcohol ONLY. If you switch from Bud to Valium, you have a different disease under DSM-IV. You now have sedative dependence. In alcoholism, the switch is meaningless, and any combination of solid and liquid sedatives is included in the alcoholism rubric. Drgitlow (talk) 01:09, 26 March 2009 (UTC)

But when you're talking about alcoholism, you aren't just talking about the chemical dependence. You're also talking about the urge to continue drinking after you've completed detoxification. Does the DSM-IV rubric cover that? Robert Rapplean (talk) 22:37, 31 March 2009 (UTC)