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Medicalizing alcoholism one hundred years ago.

Today, strictly speaking, “alcoholism” is not a medical term. Instead, the latest versions of the Diagnostic and Statistical Manual of Mental Disorders1 (DSM-IV-TR) and the International Statistical Classification of Diseases (ICD-10) refer to “alcohol dependence,” “alcohol abuse,” and a host of other alcohol-related conditions (the ICD-10 uses “harmful use” instead of “abuse”).2 The behavioral and organic consequences of heavy drinking are well recognized by the medical community, but people with drinking problems are as likely to see a behaviorist or attend Alcoholics Anonymous meetings as they are to visit a physician. Although the policy statement of the American Medical Association–affiliated American Society of Addiction Medicine still affirms that “alcoholism is a complex primary physiological disease, and neither a primary behavior disorder nor a symptomatic manifestation of any other disease process,” lay organizations such as AA provide the strongest contemporary support for the disease concept.3 Disease-concept advocates point to the beneficial destigmatizing effects of the medical label and to the physical and mental disabilities associated with heavy drinking. To declare something a disease in our society, they argue, remains a good starting point that encourages such drinkers to seek help. Some detractors, though, fear that the medical label frees the drinker from responsibility for her condition and its treatment. Others see the changing nosological terrain as symptomatic of a failed intellectual construct that persists primarily for third-party reimbursement purposes.