Nora Volkow and the National Institute on Drug Abuse (NIDA) insist, based on peering at MRIs, that addiction is a chronic brain disease. You know - you saw it on HBO, and your kids learn this in school.
But, as I point out to Nora, she's looking in the wrong place. If you examine actual human lives, addiction is an interaction between people and their worlds that changes with time.
Now the NIDA's sister organization - the NIAAA or National Institute on Alcohol Abuse and Alcoholism - agrees with me. According to Dr. Mark Willenbring, director of treatment and recovery research at NIAAA, "We're on the cusp of some major advances in how we conceptualize alcoholism." The NIAAA's summary of the situation is titled, "Alcoholism isn't what it used to be."
This discovery, which I have described for decades, is based on the most sophisticated study yet conducted of Americans' drinking histories. Called NESARC (National Epidemiologic Survey on Alcohol and Related Conditions), the study questioned a random national sample of over 43,000 Americans about their lifetime and current drinking.
Of this group, almost 4,500 had been alcohol dependent (read alcoholic) at one point in their lives. And, although 75% had never been treated or gone to Alcoholics Anonymous - and only half of the remainder (13%) received specific alcoholism treatment - three-quarters had ceased their alcoholism. Yet most had not stopped drinking!
About 30% of Americans had experienced some kind of alcohol disorder, including abuse along with dependence, but about 70% of those quit drinking or cut back to safe consumption patterns without treatment after four years or less.
Only a tiny minority (1%) fit the stereotypical image of someone with severe, recurring alcohol addiction that Alcoholics Anonymous, addiction disease proponents like Volkow, and American mythology consider typical. My Life Process Program addresses this 1% of the addicted and is exclusively abstinence based.
Then there are the other 29% of Americans who abuse alcohol at some time. According to Willenbring, "It can be a chronic, relapsing disease. But it isn't usually that."
We know that nonabstinent remission from alcoholism is real in NESARC. In a three-year follow-up of respondents, Dawson and her colleagues (2009) found that alcohol dependence causes significant decreases in mental health and coping, but social functioning and mental health underwent "significant increases among those who achieved full and partial remission from dependence" (including alcoholics who continued drinking with either no, or reduced, problems).
The increases in social functioning and mental health "were equally great for abstinent and nonabstinent remission from dependence, but improvements in bodily pain and general health were associated with nonabstinent remission only" (that means the alcoholics who reduced their drinking).
What's stunning in these results is not any particular finding about controlled drinkers' health outcomes. The remarkable portrait NESARC produces is about how commonplace alcohol use disorders are, how frequently they are overcome by people on their own - including even those scored alcohol dependent - and how often people improve their drinking problems while continuing to drink. THIS is an entirely different alcoholism paradigm from the one we have been oversold.
As Olivia Judson describes the impact of "On the Origin of Species": "Origin changed everything. Before the “Origin,” the diversity of life could only be catalogued and described; afterwards, it could be explained and understood. Before the “Origin,” species were generally seen as fixed entities, the special creations of a deity; afterwards, they became connected together on a great family tree that stretches back, across billions of years, to the dawn of life. Perhaps most importantly, the “Origin” changed our view of ourselves. It made us as much a part of nature as hummingbirds and bumblebees. . ."
NESARC also changes everything.
Dawson, D.A., Grant, B.F., Stinson, F.S., Chou, S.P., Huang, B., and Ruan, W. J. 2005. Recovery from DSM-IV alcohol dependence, United States, 2001–2002. Addiction 100:281–92.
Dawson, D.A., Li, T-K., Chou, S.P., and Grant, B.F. 2009. Transitions in and out of alcohol use disorders: Their associations with conditional changes in quality of life over a 3-year follow-up interval. Alcohol and Alcoholism 44:84-92.