Alcoholism: No-Responsibility Illness?

Welcome to From Insults To Respect.

Over the years, I have met some pretty decent folks who spent a good part of their earlier life drinking way too much alcoholic beverages, and, at a certain point, found a way to get this under control. Some of these folks believe they took responsibility for their actions, and that was all that was needed. A very different group became engaged in a program, most typically Alcoholics Anonymous (AA), and came to believe the ongoing support that they receive from its peer members has been crucial in their management of this type of problem.

Some in such programs advocate that serious problem drinking be viewed as a no-responsibility illness. The topic is a useful vehicle for clarifying some confusion about the nature of “guilt,” “fault,” “blame,” and “responsibility.” Whether or not folks have a crystal clear understanding of these concepts can be the difference between whether or not others will regard them with respect.  

A Case Study

A useful way to get into this discussion is to take a look at a concrete example of someone who managed to gain control of a severe drinking problem. Mr. S. H. Hadley’s story, who after his recovery became an active helper of others with similar difficulties in New York, serves our purpose particularly well. His story appears in William James’s brilliant book, The Varieties of Religious Experience. I have slightly abridged Mr. Hadley’s account.

“One Tuesday evening I sat in a saloon in Harlem, a homeless, friendless, dying drunkard. I had pawned or sold everything that would bring a drink. I could not sleep unless I was dead drunk. I had not eaten for days, and for four nights preceding I had suffered with delirium tremens, or the horrors, from midnight till morning. I had often said, ‘I will never be a tramp. I will never be cornered, for when that time comes, if ever it comes, I will find a home in the bottom of the river.’ But the Lord so ordered it that when that time did come I was not able to walk one quarter of the way to the river. As I sat there thinking, I seemed to feel some great and mighty presence. I did not know then what it was. I did learn afterwards that it was Jesus, the sinner’s friend. I walked up to the bar and pounded it with my fist till I made the glasses rattle. Those who stood by drinking looked on with scornful curiosity. I said I would never take another drink, if I died on the street, and really I felt as though that would happen before morning. Something said, ‘If you want to keep this promise, go and have yourself locked up.’  I went to the nearest station-house and had myself locked up.

“I was placed in a narrow cell, and it seemed as though all the demons that could find room came in the place with me…. I was finally released, and found my way to my brother’s house, where every care was given me. While lying in bed the admonishing Spirit never left me, and when I arose the following Sabbath morning I felt that day would decide my fate, and toward evening it came to my head to go to Jerry M’Auley’s Mission. I went. The house was packed, and with great difficulty I made my way to the space near a platform. There I saw the apostle to the drunkard and the outcast–that man of God, Jerry M’Auley. He rose, and amid deep silence told his experience. There was a sincerity about this man that carried conviction with it, and I  found myself saying, ‘I wonder if God can save me?’  I listened to the testimony of twenty-five or thirty persons every one of whom had been saved from rum, and I made up my mind that I would be saved or die right there. When the invitation was given, I knelt down with a crowd of drunkards. Jerry made the first prayer. Then Mrs. M’Auley  prayed fervently for us. Oh, what a conflict was going on for my poor soul! A blessed whisper said, ‘Come’; the devil said, ‘be careful.’ I halted but a moment, and then, with a broken heart, I said, ‘Dear Jesus, can you help me?’ Never with mortal tongue can I describe that moment. Although up to that moment my soul had been filled with indescribable gloom, I felt the glorious brightness of the noonday sun shine into my heart. I felt I was a free man. Oh, the precious feeling of safety, of freedom, of resting on Jesus!…

“From that moment till now I have never wanted a drink of whiskey, and I have never seen money enough to make me take one. I promised God that night that if he would take away the appetite for strong drink, I would work for him all my life. He has done his part, and I have been trying to do mine.”

General Discussion

In this example, we see that Mr. Hadley had come to a pretty awful point in his drinking life. Rather than to kill himself, he chose another path.

He began by having himself voluntarily locked up at the station house. He then had a very supportive experience when he stayed with his brother, although throughout, it seemed to him he was beset by an admonishing spirit. 

That Mr. Hadley’s brother provided a place for him where every care was given to him may be viewed as a crucial step toward achieving his goal.

General Booth, the founder of the Salvation Army, expressed the opinion that the first vital step in helping people to recover consists in making them feel that some decent human being cares enough for them to take an interest in the question whether they rise or sink. In counseling and psychotherapy research, this component is often referred to as empathic unconditional positive regard. Numerous studies have demonstrated it is a powerful ingredient for success when seeking to provide help.

When Mr. Hadley goes to Jerry M’Auley’s Mission he does not describe this as a choice that he made. Notice his wording. “It came into my head to go… I went.”

As the events unfold at the mission, Mr. Hadley continues to experience his actions, not based on choices that he is making, but a surrendering to what the mission might do to help him. Thus, at one point, he says to himself, “I found myself saying, ‘I wonder if God can save me?'”

As the experience continued, Mr. Hadley heard from many of his peers that they had struggled, like he had, but managed to recover. This, perhaps, provided a certain amount of hope that he, too, might recover. Perhaps, as well, some of his peers that he met at the mission came to provide some kind of support for him during his recovery process, and this too was an essential component for the recovery process.

Mr. Hadley ends up concluding that by surrendering to the will of God, God had taken away his appetite for strong drink and provided him the precious feeling of safety and freedom. At the very end of his shared experience, he does say that he has been “trying” to do his part in his recovery, suggesting that he did view applying some will or effort is, at least for him, part of his recovery process.

Clearly, there is a religious theme throughout Mr. Hadley’s story. A higher helper, as he viewed it, had been helping him. I can clearly see how someone who is religious minded can find some help by this way of construing events.

That said, William James, as he discusses Mr. Hadley’s experience, hastens to point out that there are numerous “cases of drunkards’ conversions which are purely ethical, containing, as recorded, no theological beliefs whatever.” He gives, as an example, the case of John B. Gough, who was an atheist, and neither God nor Jesus is mentioned in his account of his recovery. A restaurant waiter, who had taken a kind interest in Mr. Gough, appears to be a crucial ingredient for that person gaining control over his drinking difficulties.

Some people just don’t have any religious inclinations. Nevertheless, some of these individuals may, as William James explains, “be excellent persons, servants of God in practical manners, but they are not children of his kingdom.”

For many people, in place of a God being the higher power, faith is placed in the “process” that is offered in the recovery plan. A surrendering of the will is still experienced as part of the process, fully knowing that regularly hearing stories of others who recovered, along with ongoing peer support, has worked for so many.

So, in this general discussion of Mr. Hadley’s experience, we can see the outlines of several components that may have been helpful to him. He recognized that he had come to a pretty awful situation as a result of his drinking. He found some people who took some kind interest in him. He began to hear, over and over again, stories of people who had gone through very similar experiences who did have success recovering. He surrendered, at least to some extent, his own will, replacing it in faith in God and the program he had entered into at the mission. He also began to help others who were struggling with similar problems.

Perhaps the reader might have noticed that in Mr. Hadley’s account of his experience, he does not try to make the case that his difficulty controlling his drinking is a no-responsibility disease. There is little doubt that heavy drinking is a risk factor for several diseases, and Mr. Hadley was clearly experiencing some toxic reactions to his heavy drinking. But to certain strict scientific minds, confirming that someone has a disease requires a pathological report that identifies the presence of a lesion, tumor, microbe infection, tissue tear, bone fracture, organ blockage, or physiological poison.

Now some argue that for alcoholics, alcohol is a poison, and therefore this makes it a legitimate disease. But in the disease model of alcoholism, even when a person designated as an alcoholic has not had any alcohol they still have the disease, and always will have the disease, even if they have refrained from drinking for years.

It may seem that whether or not some believe in this disease notion is of little import. However, some feel so very strongly about this issue that it has an effect on how much respect is afforded to people depending on what side they have come to accept. And because this blog is particularly interested in the nature of respect, let’s delve into this issue.

Guilt, Responsibility, and Drinking Problems As No-Responsibility Disease

Over the years, I have met AA members who refer to their drinking problem as a disease. I have also witnessed some members getting very angry and defensive when someone in front of them questioned whether or not their problem is a real disease.

Upon doing some research on this topic, I found a write-up in Wikipedia on AA, and a section within the write-up titled, “Disease Theory Of Alcoholism.” There I learned the following:

“More informally than not, AA’s membership has helped popularize the disease concept of alcoholism, though AA officially has had no part in the development of such postulates which had appeared as early as the late eighteenth century.^[58] Though AA initially avoided the term ‘disease’, in1973 conference-approved literature categorically stated that “we had the disease of alcoholism.”^{[59][better source needed]} Regardless of official positions, from AA’s inception most members have believed alcoholism to be a disease.^[60]

“Though cautious regarding the medical nature of alcoholism, AA has let others voice opinions. The Big Book states that alcoholism “is an illness which only a spiritual experience will concur.” Ernest Kurtz says this is “The closest the book Alcoholics Anonymous comes to a definition of alcoholism.”^[60] In his introduction to The Big Book, non-member William Silkworth said those unable to moderate their drinking have an allergy. Addressing the allergy concept, AA said “The doctor’s theory that we have an allergy to alcohol interests us. As laymen, our opinion as to its soundness may, of course, mean little. But as ex-problem drinkers, we can say that his explanation makes good sense. It explains many things for which we cannot otherwise account.”^[61] AA later acknowledged that “alcoholism is not a true allergy, the experts now inform us.”^[62] Wilson explained in 1960 why AA had refrained from using the term “disease.”

“Nevertheless the medical and scientific communities now join with AA’s 1930s disease hypothesis and use scientific criteria to confirm that alcoholism is an “addictive disease” (aka Alcohol Use Disorder, Severe, Moderate, or Mild)^[64].”

Regarding this last sentence of the above Wikipedia quote, the claim that there now exists scientific criteria to confirm that alcoholism is an “addictive disease” is misleading. The sentence provides one citation that leads us to the two major mental and behavioral disorder classification systems. One of them (DSM-5) has been criticized by scientists for being heavily funded by the pharmaceutical industry seeking to classify as many psychological concerns as diseases to legitimize the prescribing of psychiatric drugs. Another one of the classification systems describes it as follows:

“Disorder” is not an exact term, but it is used here to imply the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions.”

Such classification systems too vaguely define their terms to be viewed as scientific. Relying on the descriptors of “distress” and “functioning” as central to the definition of disease simply doesn’t work. Distress is as natural a part of human life as breathing, and we all have levels of functioning that gets interfered with by numerous aspects of living. Accepting alcoholism as a scientifically validated disease requires that we accept it is as “disease” with no requirement that a valid test has identified a positive pathology result. Rather, a distressing behavior pattern becomes sufficient. For a complete description of the unscientific nature of these types of classifications systems, see HERE.

But outside of the strict scientific realm, if someone wants to view their alcohol drinking as a disease, why in the world would anyone really care? And why should anyone who believes that alcoholism is a disease get all worked up if they hear from someone who disagrees?

Delving Deeper Into This Issue

As I mentioned at the beginning of this post, there is a subgroup of folks who got there drinking problem under control and believe they did so because they took responsibility for their actions, and that was all that was needed. Some of these folks also believe there is a certain strength and dignity to handling their problems in this way, and those who don’t handle their problems in this way are weak, shameful, and maybe even deserving of punishment.

Some people, despite their efforts to handle their drinking problem by an act of will, find they have been unable to make it work. For them, they may have been spending substantial periods of time agreeing that they are indeed weak, shameful, deserving of punishment, that their negative drinking pattern is their fault, and the insults directed at them because of their drinking problem are well deserved and accurate.

The “sins” which they are eager to escape from almost exclusively engrosses their attention, so their efforts at recovery is a process of struggling away from the “sins,” rather than of striving for the positives that can be achieved. For William James, it would be far better for them to lay less stress on their various social miseries, the harm they are doing to their family, stomach, kidneys, and nerves, and far more on “the blessings of having an organism kept in lifelong possession of its full youthful elasticity by a sweet, sound blood, to which stimulants and narcotics are unknown, and to which the morning sun and air and dew comes as sufficiently powerful intoxicants.” 

When one’s will had done its uttermost toward bringing the drinking problem under control, oftentimes one becomes exhausted. This can be a time when suicide is considered, or one decides to surrender to a faith in a process that has worked for others. The personal will is given up, and the person ceases to resist. Sometimes this process includes religious or spiritual themes.

What value might this surrendering approach serve? William James explains it this way:

“You know how it is when you try to recollect a forgotten name. Usually you help the recall by working for it, by mentally running over the places, persons, and things with which the word was connected. But sometimes this effort fails: you feel then as if the harder you tried the less hope there would be, as though the name were jammed, and pressure in its direction only kept it all the more from rising. And then the opposite expedient often succeeds. Give up the effort entirely; think of something altogether different, and in half an hour the lost name comes sauntering into your mind, as Emerson says, as carelessly as if it had never been invited. Some hidden process was started in you by the effort, which went on after the effort ceased, and made the result come as if it came spontaneously.”

Depending on such a process is particularly valuable when individuals had been spending a great deal of time and effort insulting themselves and hearing insults from others. For such people, exercising their personal will has them living in the region where their imperfect self is the thing most emphasized.

Self-surrender is less tension provoking, thus providing for people with drinking problems more of their personal mental resources for doing the work necessary to make a valued change in their lives. This frees up the subconscious forces to take the lead for a period of time. Instead of trying to force themselves to become alcohol free, by falling back on some larger power, the work that had begun by their will is further worked on in this subconscious incubated process, and, if the soil is right, finally burst forth into flower!  

Returning to the Issue of Guilt, Responsibility and Drinking Problems As No-Responsibility Disease

To some folks, in addition to self-surrendering, there is another way for folks with drinking problems to put aside the notion that they are weak, shameful, deserving of punishment, that their negative drinking pattern is their fault. This other way has them becoming convinced that those with drinking problems have a no-responsibility disease. By framing drinking problems as a disease, it is hoped that people will respond altruistically toward those struggling with this issue in a manner analogous to what happens when a mother’s altruistic emotions spring up when her baby is stricken with an illness. With this line of thinking, instead of laying fault, guilt, insults, or punishment upon the drinker, the focus, it is hoped, is upon a plan to help the drinker deal with the disease.

This strategy, however, is far from perfect. By calling serious drinking problems a disease leads some people losing respect for you. Those who took responsibility for their drinking problems and managed, through an act of will, to free themselves from its clutches will feel you are dodging responsibility where it rightfully belongs.

Now I fully recognize that it is grossly unfair for people to assume that just because they managed to get control over their drinking problems by an act of will, everyone should be just like them. Their belief is self-centered, and they fail to recognize that not everyone is the same regarding biology and environmental life circumstances. Getting people with such self-centered views to better appreciate the grand sweep of humanity is a worthwhile goal, but seeking such a goal may be better advanced by avoiding the disease concept, and recognizing up front that you recognize that people with drinking problems are better off if they do take some responsibility for their problems.         

This view that people with drinking problems have at least some responsibility for their actions is common even for people who never gained control of their own drinking problem by their own act of will, and also for people who never had a drinking problem. A major reason for the conflict between those who are motivated to hang onto the no-responsibility disease concept, and those who insist on at least some responsibility, is the confusion about the concept of responsibility.  

The actor Will Smith, in his popular YouTube video titled “Fault Vs Responsibility” tries to clarify this (see HERE). He begins by telling us that he was having a debate with a friend of his on the difference between fault and responsibility. His friend kept saying, “It’s somebody’s fault!” He replied that it doesn’t matter if it’s somebody’s fault if it’s your responsibility to fix it. He goes on to say,

“If it’s somebody’s fault, we want them to suffer, we want them punished, we want them to pay…. As long as we are pointing the finger at whose fault it is, we’re jammed and trapped into victim mode. The road to power is in taking responsibility! Your heart, your life, your happiness is your responsibility and your responsibility alone…. taking responsibility is not admission of guilt. You are not admitting it is your fault. Taking responsibility is a recognition of the power that you see when you stop blaming people. It’s not like letting people who wronged you off the hook, but taking responsibility is an emotional self defense; it is taking your power back.”  

I largely agree with this statement, and if I had a direct conversation with Will Smith I suspect we would come to fully agree with one another. His statement in the video was brief, thus making it hard to get into any nuanced meanings of what he was trying to say in a simple, easy to understand manner. Nevertheless, let me point out two points that I at least appear to disagree.

First, when Mr. Smith says, “Your heart, your life, your happiness is your responsibility and your responsibility alone,“ I actually believe there is often a shared responsibility in the types of situations that he is referring to. That is, whenever those of us in our communities begin to see some folks getting into some serious trouble, it is a sign of wisdom if we take some responsibility to try to find ways, out of kindness, to be helpful in some way. For example, many communities, recognizing that problems with addiction is a problem for the whole community, have worked together to provide places for peer support groups to meet at no cost to the support groups.

Second, when Mr. Smith says, “It’s not like letting people who wronged you off the hook,” I’m not quite sure what he means by this. However, just to clarify my own position, I believe that there are times when a person who is having difficulty getting a drinking problem under control, and has tried all of the admonishments, and blaming that often goes along with the frustration of not succeeding, there may come a time when putting aside these negative approaches, and replacing them with something different, makes a world of sense. 

Now, I well understand that when someone has been self-admonishing and self-blaming for quite some time, to suddenly stop doing it is often difficult. Here’s a simple technique for learning to replace this habit with something far more helpful, and it does not cost even a penny.

As soon as you notice that you are saying to yourself insulting, self blaming words, if you happen to be alone, for a minute or so, observe in a nonjudgmental manner what words are coming to you. Observe them like you were a scientist objectively observing a flock of birds flying by, off in the distant sky.

After about a minute of this, for another minute, turn your attention to the physical sensations that you are experiencing as these words fly by. If you wish to linger, that’s fine. Then, for another minute, imagine what good things would come about if you did manage to solve your drinking problem.

By doing this exercise for two months, the old insulting, blaming habit will occur far less frequently. When it does occur, it will contain far less of an emotional sting. And, in the end, you will observe a new, more helpful pattern emerge. It is wonderfully freeing.

Of course, there will be times over the course of your two months of utilizing this approach when you will begin to notice that you are saying insulting, self blaming words about yourself while other people happen to be present. As soon as you notice you have begun to do this, excuse yourself, and find a place to be alone–even a bathroom will do. Once you are alone, do the practice session as described above. It only takes about three minutes. 

Well, in conclusion, I encourage you to consider whether or not it is wise for you to tell others that serious drinking problems is caused by the disease of alcoholism. It seems to me that even if you do believe that it is a disease, there are enough people promoting this idea so for those who are open to that belief, they already believe it is a disease and need no further push in that direction from you. However, each time you tell people you think it is a disease, you risk the possibility that some who hear will lose respect for you because they will view your attitude as a base attempt at eliminating essential responsibility from people who would be far better off accepting responsibility for their actions. 

Okay then, that’s my post today. I know some of what I’ve written is very controversial. Whether you agree or disagree, I encourage you to give me a piece of your mind in the comment section at the very bottom of this page. In any case, I hope you have found in what I have written some food for thought. And please do join us again right here at From Insults to Respect. 

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

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