Alcoholism as an addiction: the disease concept reconsidered

The concept of alcoholism as a disease is compared to the concept of addiction in regard to individual intentionality, the resultant social and legal accountability and especially the total phenomenology of the addictive process. It is held that alcoholism is essentially an addiction like any other that if active, can culminate in various diseases and in death but that its most significant and characteristic volitional disorder: starting to drink when sober, is not explained by the disease concept. The concept of alcoholism as a disease is basically due to a reversal of the perception of cause and effect and has thereby impoverished full understanding and treatment of the entire process of addictive emotionality, addictive relationships and the addictive way of life. The disease concept can contribute best by inclusion to describe the results of active alcoholism but not as an explanation. This means we must turn to the concept of addiction to provide more accurate guidance in the development of adequate domestic and societal responses to alcoholism and especially for more adequate management methods for the physician confronted with the many overt and hidden forms of alcoholism in daily practice.