Academic Engagement Series

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Our Misguided Discussion of Alcohol Addiction

Ben Whiddon
Austin American-Statesman
Wednesday, December 8, 2004

Recent articles in the New York Times and USA Today have highlighted student deaths from alcohol poisoning and new campus initiatives to reduce binge drinking. These deaths have spring-boarded alcohol abuse into the public eye. Public discussion, however, has so far ignored alcoholism, especially among younger populations.

The reason for this omission seems clear; much of the public believes that addiction is a problem of will power, that addicts are bad, crazy or stupid. They believe that a "good" person would just quit, so there is no danger of them becoming true addicts.

The terrible irony here is that the most up-to-date scientific research shows that drug dependence is a disease, like diabetes or asthma. According to the National Institute of Medicine, about 15 percent of people who use alcohol will become medically dependent, afflicted with a brain disease.

There is a glaring disconnect between the public perspective and scientific understanding. This problem requires academic engagement by citizen-scholars -- as advocated by University of Texas professor Rick Cherwitz. In hopes of bridging the gap between public perception and scientific knowledge, let me add my voice to that call for engagement.

Why are alcoholism and addiction so misunderstood? One reason may be that the term "addiction" has lost specific meaning. People talk about being addicted to cell phones, chocolate, sex or video games. But none of these obsessions meet the medical criteria for true addiction (dependence).

Furthermore, people use the term alcoholism to refer to anyone with problem drinking. Drinking too much, too often, however, is not enough for a person to be truly addicted (dependent). Doctors can distinguish between a problem of will power -- "drug abuse" -- and the disease "alcohol dependence" (true addiction). I shall use the meaningful term "dependence" to refer to the clinically defined brain disease.

Scientists have found that specific brain regions are impaired in drug dependents. These regions are responsible for conscious decision-making. Thus, when people become drug dependent, their brain's ability to make decisions about further drug use is lost. It might be helpful to begin thinking of alcohol dependence as a sort of self-inflicted lobotomy. A common understanding is that lobotomies permanently and drastically change a person's personality and decision-making abilities.

In addition, dependence develops after prolonged, excessive exposure to a drug. The more inebriated you get, the more often, the more likely you are to become dependent. So the habits that college students acquire often continue the rest of their lives. The take-home-lesson is that students should limit their alcohol intake while they still can.

Think of diabetes. If you eat too much sugar, too often, you are at a large risk for getting the disease. The same applies to alcohol and alcohol dependence. Like diabetes, people can be genetically predisposed to alcohol dependence, and many other factors besides excess consumption play a role in susceptibility. Scientists are actively trying to identify reliable markers for predisposition to drug dependence.

While family history can give you an inkling of your risk for drug dependence, it alone is not sufficient for an accurate prediction. Healthy people with no family history of drug dependence can and do become drug dependent.

Interestingly, some people may object that drug dependence cannot be a brain disease, citing programs like Alcoholics Anonymous that produce successful recoveries without medical treatment. Scientists, however, are beginning to see that behavioral therapies, like other medical interventions, probably affect brain chemistry. Furthermore, Twelve Step programs treat both abusers and dependents. Even if medical treatment could be more effective for dependents, behavioral therapy remains a powerful approach to drug abuse.

Drug addiction is a complicated and confusing problem that has wide social impact. Every year, drug abuse (including alcohol) costs the United States about $245 billion. The public's perception, however, is misguided. Among the "addicts" cast off by society as depraved miscreants are individuals stricken with a true disease, drug dependence. These people need medical care and sympathy.

Perhaps even more tragic is the fact that most people think they are immune from this problem, believing that alcohol dependence is not a disease. Students and the community must fight not only to prevent alcohol poisoning from reckless binge drinking, but must also teach society that excessive drinking puts one at significant risk for developing a brain disease.

Whiddon is a senior in biochemistry at the University of Texas. This essay was written for a Dean's Scholars Seminar on the "Interaction of Scientific and Public Perspectives" taught by Professors Adron Harris, Rick Cherwitz and Carlton Erickson. The course was developed in conjunction with UT's Intellectual Entrepreneurship initiative and the American-Statesman's Academic Engagement series.