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Paper Abstract: Examines theories of disease vs. genetic predisposition. Causes & effects, psycho-social issues, dual diagnosis. Paper Introduction: In the last three decades, the understanding and treatment of alcoholism have come a long way. In fact, most research now classifies alcoholism as a disease. Questions surrounding the hereditary make-up of alcoholic predisposition have also been around for decades, but in recent years there have been a number of studies done to clinically prove that there are certain genetic factors that make alcoholism more or less likely within human populations. Moreover, since different people react in vastly different ways to alcoholic consumption, the idea of alcohol as a "disease" has both proponents and opponents. This paper will critically examine the evidence surrounding both the disease concept of alcohol and the more recent justification of alcoholism as a genetic predisposition. The main focus of the paper will use the seminal work by Elvin Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. Thus, although the use of alcohol in the United States is morewidespread than many sociologists choose to admit, it is sometimesdifficult to find a consummate definition of the problem. (1985). The third model iscalled the psychosocial model. . In fact, it seems far more balanced than Jellinek's diseaseconcept in that it includes medical attention, conditioning, behavioralassessment, assertiveness training, behavioral rehearsal,counterconditioning, and marital therapy, all of which act together to helpthe alcoholic. Jellinek. 5). Time,135, 88. This is thebasis for the social learning theory (SLT) in which consuming alcohol hasnegative reinforcing effects and alcohol is used to overcome aversive,stressful, conditions. Affective disorder is itself genetically influenced, and evaluations of populations with primary alcoholism combined with patients who have primary depressive disorder and secondary alcoholism could make it difficult to disentangle data related to the alcoholism risk itself. (1989). Finally, one can certainly aplaud Jellinek's theoretical assumptions,and still find them wanting and relatively unsophisticated. Even the popular press is reporting thatthere is a chromosomal reason that people desire to drink, and the same istrue for people who seem to handle alcohol to a greater extent (Purvis,199 ). A person may not have ingested more alcohol on this particular occasionthan usual, and may have been able to carry on cogent conversations orcomplicated acts, and yet the following day will have little or no memoryof what happened during this time. (1981). In contrast to Jellinek, some later theorists found that alcoholicsare "people who have acquired, through differential reinforcement andmodeling experiences, alcohol consumption as a widely generalized dominantresponse to aversive stimulation" (Monti, et al., 1989, p. (Eds.). Second isthe rate of absorption in the body. The disease concept of alcoholism. This model has recently enjoyed aresurgence of both interest and research findings. Alcohol addiction. Jones, H. The idea of a genetic predisposition toward alcoholism has seen aresurgence since the later 198 s. At this time, theprospective addict may be drinking daily, and is said to be at the "pre-alcoholic phase." Jellinek further believes that the onset of a number ofsymptoms marks the person's passage into the prodromal phase of alcoholism. 73). DNA and the desire to drink. . The paper will conclude with an assessment of theevidence and an examination of some possible future research trends. Dynamic approaches tothe understanding and treatment of alcoholism. TheJournal of the American Medical Association, 263(April 18), 2 94-5. Mulinski, P. This is important because alcoholism and depressive disorder congregate in different families and show little evidence of genetic linkage (Goedde & Agarwal, 1989, pp. it may be studied as either a psychological or a physiological phenomenon, for these are two aspects of a single process running parallel to each other. S., et al. References Bean, M. This theoretical spectrum increases both the methodologicalframework in conceptualizing alcoholic behavior, and the approach totreatment. 11). Finally, the setand setting are important in that the response to alcohol is influenced bymood and expectation (Goodwin, 1976, pp. Third, the duration of the consumption. In the last three decades, the understanding and treatment ofalcoholism have come a long way. This isan important consideration since the longer there is alcohol in the blood,the more its effects diminish because the body adapts to chemical change.Fourth is the slope effect in which the drinker feels better consumingalcohol than on its "coming down" effects. (Eds.). Denial is exhibited, as are rationalizations, and arguments.However, Jellinek believes that this adaptation to excessive drinking hasnow become so stabilized and part of the person's life that it has nowreached chronic addiction. (Eds.). Goodwin, D. (199 ). Recently I saw an advertisement for a treatment center that spoke about 'Jellinek's disease.' But Jellinek himself recognized the very partial data on which that concept was based, its applicability, even so qualified, to only a portion of those who demonstrated the troubles under concern and the role of 'public relations' in utilizing the disease term. This is the Jellinek model, which we will delve into in greaterdetail in the next section of the paper. Von Wartburg, J. The disease further increases to thepoint where the person's judgment is impaired, and decisions are difficultto make. (196 ). In a way, this idea synthesizes both processesinto a more coherent whole, and the entire treatment program is based onthat very synthesis. He accepts the AmericanMedical Association's definition of disease as "any deviation from a stateof health; an illness or sickness," but tends not to differentiate betweenphysical or psychological causations (Jellinek, 196 , p. M. . New York: Pergammon Press. emphasizes cognitive mediational factors in the explanation of learning and behavior. Serotonin is a neurotransmitterinvolved in sleep and sensory perception, and in a study of over eighthundred alcoholic families, the levels and absorption rates of serotoninwere different than that of the control populations (Goodwin & Gause,199 ). These depressions are likely to appear during abstinence as well as in the context of heavy drinking. Is alcoholism hereditary? The American Journal ofPublic Health, 79(August), 1 11-15. In light of morecontemporaneous developments, Jellinek may have been correct in his basicconstruction, but not sophisticated enough in his analysis of the problemitself. The concoction they drink has otherchemicals, flavors, and the like. New York: OxfordUniversity Press. Some of the most important early work on the subject of alcoholismwas carried out by E.M. Purvis, A. In fact, according to Jellinek, chronic drinkers usually takemore calories in their daily lives from alcohol than from any other food.As a result, they often lose their appetite and signs of malnutrition areevident (Jellinek, 196 ). Thisis important for the considerations in this paper because it points to thenotion that stress levels influence alcoholism more than internal orgenetic factors, an assumption hotly debated in other research (Richards,et al., 1989). Because alcoholism results in a wide variety of clinicalsymptomology, the same gene or group of genes is probably not operative inall family groups (Gordis, et al., 199 ). According to onesource, alcohol forms an almost integral part of modern American culture.Each professional group that has a particular treatment program seems toadopt its own model of what alcoholism is; however there are three modelsthat have proven to gain more widespread acceptance. M., et al. Alcohol consumption and problemdrinking in white male veterans and non-veterans. Currents in alcoholresearch and the prevention of alcohol problems. Recentresearch points out that there may be a number of factors present withinthe framework of alcoholism, and it may indeed be a disease (physical orpsychological) or genetically influenced. The effects of alcohol in humans depend mainly on the dosage. . Alcoholism -biomedical and genetic aspects. Further, research into the physiology of alcoholism suggests thatcertain impulsive and violent behaviors may be associated withabnormalities of serotonin metabolism. Which aspect a scientist chooses to explore depends, then, upon his field of expertise, or upon which he feels will lead most quickly to the discovery of a cure (Jones, 1963, p. (1989). Although there are certain biomedical predispositions present inthis study, it does indicate that a combination of medical screening (aswith the disease concept) and reflective counseling is necessary in orderto provide successful treatment (Mulinski, 1989). The first model, themedical or biomedical model, has three components: an infectious or toxicagent, a host, and a specific degenerative response resulting from theinfection. In fact, most research now classifiesalcoholism as a disease. However,mosthumans do not drink pure alcohol. The main focus of the paper will use theseminal work by Elvin Jellinek, The Disease Concept of Alcoholism (196 ) asa way to critique both past and contemporary evidentiary methodology.After a brief review of the literature, the paper will examine Jellinek'stheory, and then use various material to access its validity in light ofpresent research. P., et al. 4). E. More recent research still begins with Jellinek and posits the notionthat if alcoholism is placed into a medical category it will provide notonly an institutional home but a cultural categorization of the problem.One source notes that, "that medicalization serves to change the perceptionand reception of the alcoholic, substituting a less punitive and condemningtone that had prevailed under a view which saw the chronic inebriate or thehabitual drunkard as sinful" (Von Wartburg, et al., 1985, p. These congeners include varying amounts of amino acids,minerals, vitamins, and different purities of alcohol. When the alcohol concentrationrises above twelve percent, the yeast dies of alcohol poisoning. London: TavistockPublications. Further, thestudy found that a higher portion of white male veterans than white malenon-veterans were heavy drinkers, at least two-and-a-half times more. Berne: Hans HuberPublishers.----------------------- 6 . Goodwin, F., & Gause, E. There is a voluminous amount of literature available on alcoholism.Demographically, the literature ranges from commentary on gender afflictionto microcosmic studies such as those that deal with drinker problems ascompared to veterans and non-veterans. . The second model, called thegenetic or genetotrophic, holds that the development of alcoholism is basedon some specific birth defect; the individual is predisposed to alcoholismdo earlier developmental processes. (199 ). In general, the faster the rate, themore serious the effect. 29 -1).This may mean that it is often difficult to distinguish between the geneticpredisposition toward alcoholism and the genetic predisposition to other,more psychologically related, afflictions. Moreover, since different people react in vastlydifferent ways to alcoholic consumption, the idea of alcohol as a "disease"has both proponents and opponents. Initially, one must look at alcohol from a pragmatic juncture.Alcohol itself is formed when yeast grows in sugar solutions without air.When this occurs, the large percentage of the sugar in the solutionferments into carbon dioxide and alcohol. This paper will critically examine the evidence surrounding both thedisease concept of alcohol and the more recent justification of alcoholismas a genetic predisposition. Richards, M. primary depressive disease with secondary alcoholism). (Monti, et al., 1989, p. Thus, the amountof food in the intestine, as well as the types and alcohol ratio of thedrink, are indicative of the type and severity of the effects. Some alcohol is absorbed through the stomachbut most reaches the body through intestinal absorption. The person then is likely to sneakextra drinks at social gatherings and the drinking is becoming moreaddictive in the sense that more and more of the person's life revolvesaround alcohol. SLT suggests that drinking is acquired and maintained by reinforcement, modeling, conditioned responding, expectations about alcohols effects, and physical dependence . It includes a variety of topics such as:the vulnerability of particular personality types and the influence ofchildhood activities; different attitudes and customs of alcohol use indifferent regions; the use of alcohol in different ethnic groups; and theway economic circumstances impact on alcohol usage (Bean & Zinberg, 1981). Jellinek continually refers to alcoholism as a disease, yet his bookseems more of a description of the symptomology and a desire to makealcoholism a legitimate concern for medical personnel than to help withchanges in concepts or theoretical constructs. Fifth, tolerance is an issuesince people need to drink more to feel the same effect. The sameauthor (Von Wartburg, et al., 1985, p. M. . Even studies from the 196 s point out that: If alcoholism is a psychosomatic condition . From the alcohol, drug abuse,and mental health administration. Although scientists have suspected for the past two or three decadesthat alcoholic behavior does have some inheritable patterns, recentresearch has found that it is likely that alcoholism is a condition thatinvolves several genes, therefore tracing the genetic basis may bedifficult. The idea of psycho-social causes for alcoholism also has a long andvaried historiography. (1963). Treating alcohol dependence. at least 5% of alcoholic males and up to 15% of alcoholic females may have an independent affective disorder (i.e. Thus, one may see that: . P. Monti, P. NewHaven: Hillhouse Press. This also implies that all drinking behavior, frommoderate to chronic, is governed by the same set of sociologicalprinciples. H., & Zinberg, N. Alongwith the amount consumed, there are at least six other effects of alcohol.First, the vital determiner of alcoholic poisoning is how much alcohol getsinto the human bloodstream. The theory postulates that an individuals expectations about alcoho's effects will influence his/her behavior when intoxicated. (1989). Thedisease concept of alcoholism has been useful, according to the literature,in changing the perception of the problem, yet there still remains themethodological problem that there are so many mechanisms that control thealcoholic that the disease concept may be too limiting. For instance, a 1989 study foundthat after age, geographical region, urbanization, ethnicity, maritalstatus, education and income were taken into account, the idea of veteranstatus becomes an important influence in alcohol consumption. The Journal of the American MedicalAssociation, 263(January 19), 352. . The consumption of alcohol is no longerconfined to convenient periods such as evenings or weekends, and bouts ofdrinking may last for several days. NewYork: The Guilford Press. Goedde, H. Finding the genes for alcoholism. Instead, the SLT, . In 1989, an article was published on the dual diagnosis ofalcoholism, taking part of its methodology both from the Jellinek frameworkand the SLT conception. New York: The Free Press. There is ample evidence from family, twin, and adoption studies thatalcoholism is a genetically influenced disorder. At first they seek this relief in alimited fashion, but over a long period of time (up to two years) theyincrease the frequency and amount of consumption - becoming less and lessable to face up to the reality of the modern world. . Jellinek, E. Questions surrounding the hereditary make-up ofalcoholic predisposition have also been around for decades, but in recentyears there have been a number of studies done to clinically prove thatthere are certain genetic factors that make alcoholism more or less likelywithin human populations. This stage may continue for a varied amount of time,usually from six months to five years, before the more crucial phase isrealized when the individual learns they no longer have control over theirdrinking. (1976). W., & Agarwal, D. 158). The added chemicals, in total, arecalled congeners. 8-17). Jellinek believed that prospectiveaddicts discover, that they can obtain relief from their own problems andinner tensions through drinking. One of these symptoms, for instance, is the alcoholic amnesia or blackout. Although drinking behaviors vary as to the setting and timethey occur, there is no fixed graduation of stages (as suggested byJellinek) and no fixed personality traits that encumber all alcoholicpersonalities. Nevertheless, evenin small quantities, alcohol is poisonous, and part of the intoxicationresults from various body cells being killed by the liquid (Goodwin, 1976). (199 , April 3 ). Dual diagnosis in alcoholic Clients: Clinicalimplications. More studiesneed to be carried out on brain physiology, and as more sophisticatedtechniques are developed in that area, it is likely that more answers willbe forthcoming in the study of alcoholism. 73) continued by saying that: Yet the conception of alcoholism as a disease has not been a reflection of new discoveries that uncovered an organic source of the troubles. Contemporary Social Work, 7 (June), 333-9. (1989). Gordis, E., et al. Instead of looking upon alcoholism as either adisease or a predisposition, this theory holds that the causation of theaffliction is of secondary importance to the adequate and speedy treatmentof it. It is likely, however, that itis a combination of all of the theoretical constructs, and it seems as ifit would be far more profitable for researchers to provide a more synthetictheory than to limit their perceptions of the affliction. There are, however, problems with Jellinek's conception. 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