ALCOHOLISM, THE CAUSE of untold misery and suffering for centuries, remains an enigma. Scientists don't know how best to treat it and can't even decide on how to define it. Is it a true medical disease or a learned behavioral disorder? The research answers aren't in yet, but we may soon have a legal answer.

The largely academic discussions about the nature of alcoholism became glaringly public last December when the Supreme Court heard a case that hinges on the question of whether alcoholism is a disease. The court's ruling is expected by the end of June.

The case involves two veterans who claim they were prevented by alcoholism from taking full advantage of education benefits. Veterans are entitled to use these benefits within 10 years of their discharge, and the time period is only extended if they are ill. The Veterans Administration contends that alcoholism results from "willful misconduct" and does not qualify as an illness that would allow these men to extend their benefit period. The men, who have since stopped drinking, say that alcoholism is a disease. They were joined in friend-of-the-court briefs by the American Medical Association, the Vietnam Veterans of America and the National Council on Alcoholism.

Many scientists, too, are convinced that alcoholism is a disease, or, at least, that it is closer to a disease than a character defect. They frequently point to evidence that children of alcoholics are more likely than children of nonalcoholics to become alcoholics themselves. This indicates, the scientists say, that at least some alcoholics may have inherited a predisposition to abuse alcohol, making alcoholism less than a free choice and more like a disease.

"Some scientists say that the search for a physiological basis for alcoholism is far enough along now that it will be found," says Enoch Gordis, director of the National Institute on Alcohol Abuse and Alcoholism. "In my view," he says, "the disease concept from that point of view makes sense as a very plausible assumption to work with."

Others contend that the very term "disease" is misleading. For example, Herbert Fingarette of the University of California, Santa Barbara, whose book Heavy Drinking: The Myth of Alcoholism as a Disease is causing a stir among alcoholism researchers, says the disease label is "a vague slogan with no particular medical meaning." Fingarette explains that "just about every major belief associated with the idea of alcoholism as a disease has been shown to be wrong. There is no one pattern of drinking that characterizes alcoholics. There is no unique cause of alcoholism. It is not true that an alcoholic who drinks any alcohol automatically loses control. And there is no medical treatment that has been shown to be effective."

But, first, there is the question of who is an alcoholic and what constitutes excessive drinking. The definition of heavy drinking varies from society to society and even from time period to time period within a society. In the past few years, in this country, people have changed substantially their notions of how much drinking is too much.

In movies and books from the 1950s and 1960s, heroes were rarely without a drink in hand. People were portrayed drinking after work, getting drunk at parties and having several martinis at sophisticated business lunches. Now such drinking is considered excessive.

Although no one disputes the idea that there is such a thing as an alcoholic, addiction researchers agree that it can be difficult to decide where heavy drinking ends and alcohol abuse begins. At the extremes, it is easy to tell who is and who is not addicted to alcohol. But there is a wide, fuzzy, gray line in the middle.

Gordis loosely defines an alcoholic as someone in whom "alcohol consumption determines behavior, rather than vice versa." People are alcoholics, he explains, when "they continue to drink despite the consequences" and when "alcohol overwhelms their intelligence and judgment."

Sheila Blume, a psychiatrist at South Oaks Hospital in Amityville, New York, compares the definition of alcoholism to that of high blood pressure. In both cases, the dividing line between normal and high is determined by relatively arbitrary decisions.

"When people have very high blood pressure, there is no doubt about it," Blume says. "But other people have blood pressure that is stable on the border. Some people have drinking patterns that are clearly within the realm of nonproblems. Some are drinking too much but they can pull back. Others have gone over the line." And, she adds, "there are a lot of cases in the middle."

This raises the question of why some people are drawn to and over the border, and here scientists are hopeful that they at least are on the trail of some answers. By studying adopted children, they learned that the offspring of alcoholics are significantly more likely than other people to become alcoholics themselves, regardless of whether their adoptive parents abused alcohol. But genetics is not entirely destiny, since more than a third of alcoholics have no family history of the disorder and only about 30 to 40 percent of the sons of alcoholics become alcoholics themselves.

The next question is if a tendency to become an alcoholic is inherited, what, exactly, do these people inherit? Marc Schuckit of the Veterans Administration Medical Center in San Diego reports that the young adult sons of alcoholics appear to be less responsive to alcohol than sons of nonalcoholic parents. Jack H. Mendelson and Barbara W. Lex of Mclean Hospital in Belmont, Massachusetts, find that the same is true of young adult daughters of male alcoholics. Schuckit estimates that about half of the offspring of alcoholics are relatively insensitive to alcohol's effects, whereas comparatively few offspring of nonalcoholics are similarly insensitive.

This could mean that children of alcoholics have to drink more than normal to feel alcohol's effects, the scientists say, thus paving the way to excessive drinking. "I think that such people probably feel just a little drunk until they are very drunk," Schuckit says. Those who feel the effects of alcohol after just a few drinks may have a built-in protection against heavy drinking that some offspring of alcoholics lack, he suggests.

Henri Begleiter of the State University of New York Health Science Center in Brooklyn has been studying young boys whose fathers are alcoholics and finds that 30 to 35 percent of these boys have brain-wave patterns that resemble those of alcoholics. Yet the boys have never taken a single drink. "In most cases, you wouldn't know anything was wrong until you did the test," Begleiter says. He views his results as evidence that some children of alcoholics may inherit physiological traits that predispose them to abuse alcohol.

These researchers have yet to show, however, that children of alcoholics who have the distinguishing traits are actually the ones who go on to become alcoholics.

The research agenda for alcoholism is immense. Scientists do not yet know, for example, why alcohol damages certain body organs or why only a small proportion of even severe alcoholics suffer these damaging effects. For example, only about 10 percent of very heavy drinkers, those consuming a quart a day, develop cirrhosis of the liver, according to Gordis.

There is also a heated debate over treatment. As state after state in the 1970s required insurance coverage for inpatient alcoholism treatment and employers followed suit with employee assistance programs, treatment centers have proliferated. The federal government estimates that there are more than 9,000 such centers, including inpatient facilities costing anywhere from $3,000 to $20,000 a month. But success rates are hard to come by and even harder to verify. Many alcoholics get better on their own or stop drinking at least temporarily. Critics ask how much better these facilities are than simply doing nothing.

In addition, the standard way of learning whether an alcoholic has stopped drinking is to ask. But "self-reports are frequently unreliable," says Gordis.

Canadian Quotes of The Day ... and more [on the lighter side]

17 Die of Legionnaire's Disease in Canada ~ TORONTO Oct 7, 2005 - An elderly woman died Friday of an apparent outbreak of Legionnaires' disease at an Ontario nursing home, bringing to 17 the number of people fatally infected by the disease at the facility. [read on]

Edition No.41
Insight EFAP International