Is Alcoholism a Mental Disorder?

A report and comment on religious trends and events being covered by the media.  Tom and the Bobgans will discuss several news items regarding Twelve-Step programs.

Tom:

Rather than our usual discussion of a news article that has some religious relevance, I picked some brief news reports reprinted in the psyche notes section of Martin and Deidre Bobgans’ Psychoheresy Awareness letter.  Their newsletter, by the way, is free and at the end of the program Gary will give you the information necessary to receive it.  This article comes originally from The Harvard Mental Health Letter, and because alcoholism, like all addictions is a disorder of motivation, a full commitment to change is not only a cause of recovery by often the largest part of recovery itself.  In a sense, all addiction treatments are ways of improving motivation.  After the treatments are described what everyone wants to be told is, which ones are most effective.  The short answer, unfortunately, is that no one knows.  The National Institute on Alcoholism and Alcohol Abuse sponsored a nation-wide study called, Project Match, in an attempt to answer this crucial question.  The experiment, which lasted 8 years and recruited more than 1600 patients, was one of the largest clinical studies ever conducted.  One-third of the participants were given a session of cognitive behavioral therapy once a week for three months.  One-third received twelve steps facilitation to prepare them for AA and also in one session a week for three months.  The last group received a motivational enhancement therapy for four sessions over a three-month period.  Controversy is sure to continue, but one implication of Project Match is that for many alcoholics brief treatments are just as good as lengthier ones.  Martin and Deidre, two aspects of this note: motivation, that certainly doesn’t sound like disease.

Martin:

Yeah, there is a real contradiction there, isn’t there?  We talked about disease on the one hand and the twelve steps and on the other hand, when we look into these various programs, the number one factor, if you will, is motivation and the programs that are directed at motivation are the ones that are the sensible ones because somebody does have to choose.  They have to make a decision to stop drinking and motivation is a very important factor.

Deidre:

I think this is why people do need one another as a means of encouragement.  In other words, to help them remain motivated.  A lot of people though will say, I really want to stop, I really want to stop drinking, I just can’t.  But there is something in them, there is something about them that they really like something about it, and so there is this motivational aspect.  Here again, do we want our motives to be biblical motives? Do we want to have the Lord direct us in what we are to do? Or are we going to try to fix ourselves?  You know, when I talk to people I find out that, just as with myself, the flesh never really changes.  It is the Lord who works in our spirit, it’s the Lord who has to work, and so I do believe the Lord does work with motivation.

Tom:

You know, Deidre, I think you guys are aware of this, but I’ll just lay it out for our listeners.  My father was a psychiatrist, he was the head of mental institutions, I grew up in that community, but he was also a drunk.  He was a binge drinker and you know, I remember times, especially as a teenager, times when he was sober I said, Dad, why do you do this?Look what it has done to the family, look what it is doing to the family.  And he thought about it and he gave me a really sincere answer.  He said because I like it.  He liked to drink.  It wasn’t because his family, or because he had this problem and so on.  This is sin and the scripture says there is pleasure in sin for a season.  Now, we all had to reap what he had sown in the family and it led to his early death, he died at about the age of 53.  I am going to jump from this to another note that you have in your newsletter.  Some people think that we are not sensitive, we don’t have empathy, we’re not sympathetic toward people who have these sin problems and especially alcoholism, but it is a serious problem!  And, one of the reasons we are doing this program on this issue is we want to see the problems solved!  Let me quote this other article that’s found in your newsletter which is from again, The Harvard Mental Health Letter.  Alcoholism is notoriously America’s and the world’s most serious drug problem.  About fourteen million people in the United States suffer from alcohol abuse or dependence and half of us have a close relative with a drinking problem.  I just mentioned I grew up with that.  Alcohol accounts for 15% of our medical costs and a hundred thousand deaths annually.  Drinking is involved in one-third of child abuse cases and drunk driving alone, causes two to three times more deaths than all illicit drug use combined.  But there are reasons for optimism in recent trends; the average consumption of alcohol is falling, more people than ever are trying to change their drinking habits in a variety of treatments are more widely available than ever before.  So in no way, and I know you guys agree, are we diminishing the problem here.