Is Alcoholism a Progressive Disease? What’s the Evidence?

Alcoholics Anonymous (AA) and some others think alcoholism a progressive disease. They believe the alcoholic has no control over it. So the only effective treatment is complete abstention from all alcohol.

The Theory

The theory that alcoholism is a progressive disease is the foundation upon which AA and other 12 step programs are based.

Writing about alcoholism, AA states this. “Because the illness progresses in stages, some alcoholics show more extreme symptoms than others. Once problem drinkers cross over the line into alcoholism, however, they cannot turn back.”1 Or as AA usually says more simply, “Once a pickle, never a cucumber.”

We are told that “Addiction and alcoholism are progressive. Use behaviours and symptoms will over time always intensify, and the problem always grows worse.”2 As a result, alcohlism always gets worse. It can never get better.

AA insists that there is only one treatment for alcoholism. That’s complete abstinence from alcohol for life. Failure to abstain completely will always end in premature death.

Evidence

Yet a half century ago contrary scientific evidence began to emerge. Researchers found that some alcoholics can learn to drink in moderation, Of course, that’s contrary to AA’s theory. A study was made of alcoholism treatment program. It found that 7 to 11 years later, 11 of the 93 patients (about 12%) had returned to moderate drinking

These surprising findings led psychologists Mark and Linda Sobell to conduct a famous study. They taught alcoholics how to control their drinking. The researchers found that some alcoholics were successful in doing so.

The findings of the Sobell’s, along with the earlier findings, challenged the very foundation of AA. And of other 12 step programs. These are all based on the disease progression theory. They also challenged the theory that complete abstinence from alcohol was needed. That is, to avoid descending ever deeper into alcohol abuse and a premature death.

Responses

Responses to the Sobell’s evidence were heated and even viscious. Opponents charged them with misrepresenting their findings. They also even accused them of falsifying their results. How else, some asked, could these heretical claims be explained?

alcoholism a progressive diseaseThe attacks were emotional. It’s as if a religious doctrine had been challenged. In a way, it was. Federal courts have long held that AA is religious in nature.

Five different panels of inquiry examined charges of scientific misconduct. Panels even represented the U.S. Congress and the American Psychological Association (APA). The verdicts? There was no evidence of fraud or misrepresentation. Thus, science won over ideology.

In spite of strong opposition, evidence has continued to grow that alcoholism isn’t a progressive disease. A disease that, in the absence of complete abstinence from alcohol, leads to premature death.

For example, a federal agency (NIAAA) conducted a nation-wide study of 43,000 diagnosed alcoholics in the US. They found that 17.2% were drinking alcohol in a controlled and moderate way. About the same proportion (18.2%) were abstaining. Only 25% of the alcoholics had not moderated their alcohol consumption.

The NIAAA findings, and those of many other studies, are completely inconsistent with the disease theory. That includes the idea of disease progression. The need of all alcoholics to abstain. And of their inability to ever drink in moderation

AA insists that alcoholics must completely abstain from all alcohol. Some alcoholics who’ve never attended AA are able to drink in moderation. AA beliefs are actually counter productive. They harm most alcoholics.

Options

Now the good news. Not all programs for alcohol problems accept the disease theory. Nor the mistaken beliefs of the 12 steps. They include these and others.

Alcoholism a Progressive Disease

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Footnotes
    1. The Progressive Nature of Alcoholism.
    2. Ibid.