It is sort of difficult to talk about people and their lifestyles without understanding where they have traveled and what experiences may have led them to the places they find themselves. For the moralist it may be the issue of sin, being the major player in the ensuing scenarios; it may be just the persons' nature for the determinist but whatever the semantic gymnastics we wish to employ we cannot deny the polarities that exist in life.
The constant struggle between good and evil, sickness and well-being, faith and doubt and absolute and relative are manifestations of these polarities which find expression on this journey called life. This became more evident to me while on and after my visit to a group known as Alcohol Anonymous (AA).
On this visit, I heard the story of six different individuals and how they began using alcohol and their subsequent struggles with being consumed by it and trying to stop. However different their individual background was, there was a commonality with their experiences. At first, I wondered how could these people who, for the most part, looked like they are from well-to-do families and had good educational backgrounds have been addicted to alcohol? Then it began to sink in as the meeting went on that there is something that puts all of us on a leveled playing field and that is the power of sin.
Additionally, as I listened to their 12 steps, it seemed, at first, to be reminiscent of the moral model with all of the admissions of accepting responsibility that they needed God’s (or the help of some entity bigger and more powerful than themselves; however anyone chose to call him/her/it) help and power to restore them to sanity. That seemed to be that they were accepting that they did something wrong and were at fault for the lifestyle that they had lived. However, it was not so. Later on I realized that their acceptance of responsibility was for the treatment. Deciding that they can live healthy even with the disease of alcoholism – after all, for them, the only treatment for alcoholism is abstinence and that takes admitting the truth and deciding to get better.
Though it is accepted by AA and by many that alcoholism is a disease, one also sees clearly, from what was shared by the individuals that there are processes and actions that can cause the disease to manifest greater in some while it lies dormant in others. For example in one of the gentlemen’s experience, he was exposed to alcohol very early, which later on led to use while an early teen, then intoxication, then dependency and then addiction. Though he had a genetic pre-disposition for the disease, early exposure and subsequent abuse may have resulted in him developing the disease.
The persons who spoke of their experience all agreed fundamentally, that they felt powerless against the disease. They assert that it was the very first drink that triggered of the pattern, behavior and then lifestyle of alcoholism. Some are not of the view that they were born with a gene that made them an alcoholic and they do not deny that alcoholism is not a disease. This assertion may seem paradoxical, especially in a context where the notion that their evil desires to go against God has brought this sinful bahaviour, which is a matter of choice, upon them. I too am of the view that there is no alcoholic gene. I believe that socialization impacts upon the choices person make to use alcohol. This does not mean that choice to use alcohol has abolished the concept of alcoholism as a disease. There are lifestyle diseases that are as a result of choices persons have made. Does it make the disease any less a disease?
With the disease model, the theory is that the behaviours of alcoholics change but the disease, alcoholism is what is responsible for those behavioural changes. In other words, the reason why alcoholics drink is because they have the disease called alcoholism.
The contention between those who purport the disease model and those who hold steadfastly to the moral model is, fundamentally, the cause of the disease or behavior. Each perspective may seem as opposite to the other but each of them look at the same problem from a different perspective and bear some truth. I have selected these two models because I contend that both have some relevance to the treatment of alcoholism.
I am of view that as a disease, Alcoholism is as a result of lifestyle decisions, much like one who has predisposition to diabetes or anemia or hypertension. The presence of a gene in my opinion is secondary and maybe irrelevant. The predisposition does not pose a threat to us unless we make certain decisions that impact on how we live. Our lifestyle will determine whether or not we develop the disease to which we are predisposed; unless, of course, one uses the terms disease and predisposition simultaneously and that might be quite impossible to do. In viewing the disease model like I have just proposed, human responsibility is not abolished.