In a previous column, we wrote about a child's concern over her mother's drinking. A reader wrote to express confusion about the definition of "alcoholism." Here is an excerpt from that letter:
Q: Dear Drs. Wilson and Joffe:
Can you please explain how diseases like diabetes and arthritis are comparable to a chronic condition like alcoholism? I know of no one person who has chosen to put something into their body to cause them to get diabetes or arthritis. The pancreas chooses not to work properly -- for whatever reason. Also, it is unknown that anyone deliberately chooses to try to have arthritis. I know of no advertising promoting any substance for one to ingest in order to get diabetes or arthritis!
Advertising of alcohol is nationwide. If this liquid causes a disease, then why do we advertise? Comparing any illness that is biologically caused, physical or organic, to alcoholism is quite foolish. We, in this country, promote what you call a disease through our advertising. I am stymied.
A: As we wrote previously, we would argue that alcoholism is in fact a disease. If the definition of disease is that of a condition, which if unchecked, can lead to destruction of the body, then surely alcoholism qualifies as well as diabetes or arthritis. If one argues that diseases must have a biological basis, then alcoholism fits this model as well. Research has shown that offspring of alcoholics (especially male offspring) are much more likely to develop alcoholism than children born of nonalcoholic parents. This is true even for children who are reared apart from their alcoholic parents, which supports the genetic (biologic) basis of this disease.
If we were to accept the premise that alcoholism is not a disease because it is caused by an individual's choice of lifestyle, then how would one characterize such conditions as heart disease or lung cancer? In the former case, the illness is often caused by eating a diet too high in fats and by not exercising on a regular basis. In the latter case, the most common cause of lung cancer is cigarette smoking. We would argue that both of these conditions are diseases, even though individual behavior may have contributed to the occurrence of the disease.
It is true that no one deliberately set out to get diabetes, just as it is true that a smoker did not set out to get lung cancer. Similarly, individuals who develop alcoholism did not choose to do so as they started to drink and wound up losing control.
We would concur with the reader's concerns about advertising. The glorification of alcohol in the print and visual media sends the wrong message to young people and may, in part, be responsible for the enormous popularity of alcohol among our nation's high school students. Again, however, one could make the same argument about the extensive advertising of high-fat, high-calorie products on TV, especially during Saturday morning cartoons when many children are watching.
Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.