Talk:Alcoholism

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Forms of Alcoholism

This article is about Alcoholism. Discussions regarding the Disease Theory of Alcoholism have been moved to their own page, so please discuss that topic on that page, and we will summarize the results in this article.

This article has special considerations because a thorough examination of the available information on alcoholism indicates that there are at least two forms of alcoholism with no professional differentiation between them. Those who study one of them tend to insist that their form is the one and only true alcoholism, and this has resulted in a great deal of professional disagreement. The following few paragraphs are a description of these two forms based on research performed while writing this article. This should not be considered authoritative, and cannot go into the main article due to "original research" limitations, but I am presenting it here as a guide for those who wish to contribute to the article, to help them understand the considerations that have gone into it.

The first is the psychological/social addiction which comes about during a period of a person's life when alcohol consumption is of significant benefit to a person. This period may be a one time thing (like during college or after a divorce), or it may be a recurring thing (like that semi-annual girls night out or company party). This perception of benefit is often carried over for a considerable time after the benefit ceases to exist. This form of alcoholism can run rampant across the person's life until others help them realize that alcohol isn't providing benefit to match the problems it's causing.

The second form of alcoholism is a physiological condition in which the person's endorphin system convinces them that drinking alcohol is beneficial to them. It is essentially identical to a morphine or heroin addiction (endorphin being "endogenous morphine"), but is triggered by the consumption of alcohol (which releases endorphins into our system), and therefore alcohol consumption is the behavior that it reinforces. This form of alcoholism completely defies logic and sensibility, and often requires severely traumatic consequences to occur before the alcoholic is willing to admit that they have a problem. Even then they are often unable to quit drinking without assistance.

This results in several misperceptions of alcoholism. The most damaging one is due to differences in endorphin production and reception. Only about one sixth of the population is susceptible to the second form of alcoholism. This means that the majority of people who have suffered from the first type don't understand why the second type can't just quit.

In any case, the word Alcoholism does apply to both forms without differentiation, and therefore you will notice a few compromises in this article which are designed to reflect that unofficial duality.

Robert Rapplean 21:53, 28 September 2006 (UTC)

genetic testing

At least one genetic test[3] exists for a predisposition to alcoholism and opiate addiction. Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymporphism. Those who possess the A1 allele variation of this polymorphism have a small but significant predisposition towards addiction to opiates and endorphin releasing drugs like alcohol[4]. Although this allele is more common in alcoholics and opiate addicts, it is by itself inadequate to explain the full effect of, or be a reliable predictor of alcoholism.

Which would it be, the small yet significant predisposition, or inadequate to explain/be a predictor to alcoholism? If it isn't significant, the word significant could be removed and it'd be fine. If it is, I'd say how that plays into its role as an indentifier but not a predictor. The wording is just a little ambigious here (one of those wtf moments). JoeSmack ^Talk(p-review!) 15:51, 29 September 2006 (UTC)

I think it's a usage issue. Maybe "small but statistically significant" is the proper phrase. It doesn't explain, predict, or identify an alcoholic. A person with this allele may be able to drink alcohol with no addictive results. However, this allele is slightly more common in those who have shown addiction to alcohol than in those who have shown the lack of this behavior. This suggests that, if all other things are equal the existence of the allele encourages people towards alcoholism, but that there are other factors and/or alleles that have a much stronger effect. Would you care to suggest an alternate phrasing that states this better? Robert Rapplean 19:07, 1 October 2006 (UTC)

i find this a little less cloudy:

At least one genetic test[3] exists for an allele that is correlated to alcoholism and opiate addiction. Human dopamine receptor genes have a detectable variation referred to as the DRD2 TaqI polymporphism. Those who possess the A1 allele variation of this polymorphism have a small but significant tendancy towards addiction to opiates and endorphin releasing drugs like alcohol[4]. Although this allele is slightly more common in alcoholics and opiate addicts, it is not by itself an adequate predictor of alcoholism.

I added the words 'correlated' and 'tendancy' so that the word 'predisposition' isn't used, as later it is stated it isn't an adequate 'predictor'. hope that clears things up. JoeSmack ^Talk(p-review!) 23:41, 1 October 2006 (UTC)

screening

i think that the screening section either should be the CAGE questionnaire and one more example, or they all need to be flushed out in more detail. right now it looks like a bunch of edits people crammed together. JoeSmack ^Talk(p-review!) 16:08, 29 September 2006 (UTC)

P.S. The DSM-IV diagnosis of alcohol dependence represents another approach to the definition of alcoholism, one more closely based on specifics than the 1992 committee definition. - wtf is the 1992 committee definition? not mentioned anywhere else. JoeSmack ^Talk(p-review!) 16:11, 29 September 2006 (UTC)

You've done a very good job of fleshing this out. I think at this point we might want to resort to listing them (like in the terminology section) and making sure we provide them with equal coverage.

The 1992 committee definition refers to something that was pulled out or moved away. Such statements that compare themselves favorably to other statements in the article were fairly common when we had many people contending for dominance on this article, and I haven't fully removed them all yet. This statement should be made to be more self-contained. Robert Rapplean 19:07, 1 October 2006 (UTC)

Done, done. JoeSmack ^Talk(p-review!) 23:29, 1 October 2006 (UTC)

The standard definition for alcoholism in the medical field is the 1992 committee definition that was here when that paragraph was written. The article, "The Definition of Alcoholism," was published in JAMA on 8/26/92 (Vol 268, #8, p1012) and was the result of work by the Joint Committee of the National Council on Alcoholism and the American Society of Addiction Medicine. The entire definition was part of this article originally and probably should be again: "Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions of thinking, most notably denial. Each of these symptoms may be continuous or periodic." The article goes on to define each term within the definition to a greater extent. For the past 14 years, this definition has been accepted by the medical community and provides the descriptive basis upon which physicians treat addictive disease, alcoholism in particular. Drgitlow 00:58, 18 October 2006 (UTC)

Ah, right. That was part of the introduction that we had such extensive disagreement about. For those who are new to this, you can find much of that argument in Archive 3. The short version is that a lot of it was replaced because it used categorizations that are not comprehensible to the average reader. It also resulted in the moving of the disease discussion to its own page. Robert Rapplean 17:04, 18 October 2006 (UTC)

I would like to suggest the addition of Internet-based alcohol screening resources available as a public service, as they can be very useful. One such resource is AlcoholScreening.org, devleoped by Boston University School of Public Health (full disclosure: I helped develop this website). This site provides screening results based on the AUDIT and U.S. Dietary guidelines for alcohol consumption. There is at least one such site in the United Kingdom based on its health service guidelines, one in Australia, and so on. There are a few such commercial services as well, although I am initially inclined to list only those Internet public service (free) screening sites which are sponsored by a credible source, i.e. a University, qualified health facility, or a governmental health agency. These tools do not exclusively screen for alcohol dependence (alcoholism) but also cover hazardously excessive consumption that may cause future problems or put one at risk for immediate consequences such as accidents. The best ones are nonjudgemental and non-labeling. I am quite willing to contribute this content, but I would appreciate guidance on where and how to do so. Should this be a new item under Screening? Should it go at the end under "see also?" Other suggestions? Eric Helmuth 02:39, 15 November 2006 (UTC)

Hello and welcome, Eric. I looked through the screening on alcoholscreening.org and think that it's at least as valid as any other screening I've seen, and would be useful for people to confidentially understand how much of a problem their drinking is from an objective perspective. My view would be to just drop the content at the end of the Screening section, with an introductory sentence something like "Many free screening resources exist online...". It will likely be mulled over after that and may be reformatted. I'm not currently very happy with the "list quality" of that section, and would prefer a short paragraph describing the advantages and disadvantages of each screening type, but feel it's important enough to know that online confidential screening exists for this inclusion. Other opinions? Robert Rapplean 19:03, 15 November 2006 (UTC)

Thanks for the warm welcome, Robert. I can't make the edit right now due to the protected status of the page, so others should feel free to add it if desired; otherwise I'll wait until my account clears. - Eric --WikkiTikkiTavi 02:18, 17 November 2006 (UTC)

I'm now able to edit and have added some minimal information as suggested. Sugggestions for expansion and improvement are welcome. Eric Helmuth

images

i found these two images over in the wikimedia commons [1]:

...and this article could use a little imagery. the top was given from a german contributor, and the bottom from an icelandic (here is a site for its explaination, hope someone speaks the language [2]). either way, i hate to see an article go without images but i also don't know the context of these two pictures too well as they are in a foriegn tounge. anyone game to try and incorporate one or both? JoeSmack ^Talk(p-review!) 20:43, 29 September 2006 (UTC)

I agree strongly that the article needs images. Where would you put these and to illustrate what?--Twintone 21:03, 29 September 2006 (UTC)

There in lies the problem; a simple sentence about the era these images are from in the description of the thumb would do, but both sources are in languages other than english. Anyone know someone who speaks German or Icelandic? Actually, thats a dumb question, i'll look around the Babel categories, unless someone beats me to it. JoeSmack ^Talk(p-review!) 22:19, 29 September 2006 (UTC)

I'm going out for the night, but in case anyone wants to beat me to it before tomorrow, here ya go [3]! :) JoeSmack ^Talk(p-review!) 00:49, 30 September 2006 (UTC)

Look what I foooooound: [4]. JoeSmack ^Talk(p-review!) 18:39, 30 September 2006 (UTC)

I tracked down the original and recropped it to get a bigger picture out of it. I've added it to the article. Here it is:

JoeSmack ^Talk(p-review!) 18:59, 30 September 2006 (UTC)

I like where you put that one, it makes a good opening. I think someone took offense to the images that were in here a while ago, because there used to be many more. I'd really like to see more informational images (like statistical charts or whatnot) because most of the "alcoholism" images tend to be ominous pro-prohibition woodcuts and whatnot, and too much of that can be very offputting to readers. I'll keep an eye out. Robert Rapplean 19:13, 1 October 2006 (UTC)

Tah-rue. Some info graphs on statistics would be excellent. I'll see what I can do too. JoeSmack ^Talk(p-review!) 23:16, 1 October 2006 (UTC)

Rationing section

Some programs attempt to help problem drinkers before they become dependents. These programs focus on harm reduction and reducing alcohol intake as opposed to abstinence-based approaches. Since one of the effects of alcohol is to reduce a person's judgement faculties, each drink makes it more difficult to decide that the next drink is a bad idea. As a result, rationing or other attempts to control use are increasingly ineffective if pathological attachment to the drug develops.

Nonetheless, this form of treatment is initially effective for some people, and it may avoid the physical, financial, and social costs that other treatments result in, particularly in the early phase of recovery. Professional help can be sought for this form of treatment from programs such as Moderation Management.

This section to me seems like a long-winded way of saying there are harm-reduction programs (i.e. non-zero-tolerance approaches). This is mentioned in the Treatments section that is short but done pithily. Anyone object to me removing this section? JoeSmack ^Talk(p-review!) 16:47, 2 October 2006 (UTC)

'Fraid so. Rationing is a viable treatment option that is significantly different from the others mentioned. This section provides a good overview of it, as it describes the advantages and disadvantages of this approach. However, We should seriously consider combining that with the "return to normal drinking" section, since they are functionally identical. Robert Rapplean 17:42, 2 October 2006 (UTC)

This section currently says "While most alcoholics are unable to limit their drinking in this way". Is it really most? Or some? Do we need a citation here? -Brian

Hi, Brian. In reality, the argument tends to be whether the word should be "most" or "all." There's a plethora of evidence that suggests that moderation makes alcoholism worse for most people, and yet there are those for which it works. Some argue that those who can deal with their alcoholism with moderation aren't really alcoholics, but are just people who enjoy alcohol. Even Moderation Management, which leads the call for this form of treatment, insists that their members aren't alcoholics. We actually used to have a citation in here ( Pendery et al. Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study. Science 1982 Jul 9;217 (4555):169-75) ) that states this, but I wouldn't want to further clutter the article by include it in that statement unless the consensus was that this statement was controversial.

So what do we think? Is the statement "most alcoholics are unable to benefit from moderation" controversial? Robert Rapplean 22:23, 22 January 2007 (UTC)

The question comes down to whether an "alcoholic" is anyone who abuses alcohol, or strictly someone with a physical dependence on alcohol. We should avoid the term "alcoholic" and refer directly to the meaning in context, such as "most abusers of alcohol" or "all sufferers of alcohol dependence". --Elplatt 22:36, 22 January 2007 (UTC)

Um, neither. An alcoholic is someone who has extreme difficulty with not drinking, even when it's obviously harmful. People abuse alcohol all the time for perfectly valid social reasons. If it'll allow you to interact socially, or catch they eye of the girl you like, then it sometimes seems like a really good idea to drink until you're passed out in the bushes. Also, physical dependence suggests alcoholism, but it isn't the disease of alcoholism any more than a bunch of red spots are the disease of measles. It's just an effect that the disease causes.

In this context, moderation would actually be a good idea for someone who just drinks too much and/or is physically dependent. It would back off of the physical dependence with less damage than detox, and would entirely eliminate excessive drinking. For an alcoholic, though, it increases the urge to drink and results in heavier drinking. -- Robert Rapplean 21:39, 1 February 2007 (UTC)

"someone who has extreme difficulty with not drinking, even when it's obviously harmful" is the definition of abuse. This may be your definition of alcoholism, but some people use other definitions. Whenever possible, we should avoid using the ambiguous term "alcoholism" because things that are true for one definition may not be true for another. --Elplatt 23:37, 1 February 2007 (UTC)

Please read the terminology section of this article, which has been hashed over rather thoroughly, before continuing this argument. I am more than a little aghast at your suggestion that we should avoid using the term "alcoholism" in the article about alcoholism. - Robert Rapplean 02:45, 2 February 2007 (UTC)

I've read the terminology section. Abuse has a precise medical meaning (as I said). The term "alcoholism" is only defined in the intro, and that definition differs from the one used in many scientific papers. I can see how someone would disagree with the suggestion to avoid using the term "alcoholism" but if you are aghast, you should give the topic more thought. Since this subject is only tangentially related to rationing, I'll start a new subheading. --Elplatt 05:02, 2 February 2007 (UTC)

Wikipedia is not a medical text. This is a good thing because the medical community is full of conflicting statements that are absolutely certain that their definition of alcoholism is the One True Definition(tm). As it currently stands, this article has suffered the ravages of a physician, a psychiatrist, a neurobiologist, and several AA enthusiasts all simultaneously insisting that their X++ years of education state that alcoholism must be this one thing. At times it's been extremely frustrating.

Wikipedia attempts to reflect common usage, which includes how people in the non-medical community talk about alcoholism. The definition presented at the beginning of the article is a meticulously gathered consensus based on evidence presented from many perspectives that make use of the word, and represents the operational definition of alcoholism to be presumed throughout the article. Anything else would be nihilism. If you feel that this definition is in error, please review the conversations stored in the archives to identify which specific elements you feel were not adequately explored and present new evidence about them.

In reference to this specific statement, regardless of the definition of alcoholism, we can UNCONDITIONALLY state that those who suffer from alcoholism are called "alcoholics". While it is, of course, bad style to use alcoholism in a self-referential way in the article (e.g., alcoholism is the problem that alcoholics have), providing characteristics of alcoholics is a fully qualified method of describing the characteristics of alcoholism itself. Therefore it is ludicrous to suggest that we should avoid making statements like "alcoholism is..." and "alcoholics are..." in an article about alcoholism. Robert Rapplean 20:33, 2 February 2007 (UTC)

Stepping in here kind of late, MM's position in regards to rationing approaches is somewhat similar to this: If you are currently drinking, and can successfully use their approach to reduce the *harm* that drinking is doing to your life, it might be worth a shot to try MM. However, if you've been abstinent for a number of years, what is most likely to happen at an MM meeting is people congratulating you on your weekly "ration" of zero drinks, and encouraging you to keep at that level. Even Moderation Management, which leads the call for this form of treatment, insists that their members aren't alcoholics. is a tad misleading, as the general MM party line is that if someone *is* totally unable to modify their behavior, they aren't ready for MM approaches yet, as they simply cannot successfully ration their drinking behavior at all (by definition). In addition, the general MM media stance is that if somebody *is* a self-defined AA "alcoholic" (as compared to a peer defined), MM is not an easy excuse to start drinking again, and MM is probably not a choice that they should exercise. Summarized even further, If you truly match step one of the twelve steps, MM simply will not work. Ronabop 05:38, 28 February 2007 (UTC)

Detoxification Section

FYI, I feel that it's important to emphisize that detox is not a treatment for alcoholism, but a method for reversing the metabolic imbalance caused by regular alcohol use. It does nothing at all to curb the desire to drink. I'm ok with this statement being dropped to the third paragraph, though. Robert Rapplean 18:15, 2 October 2006 (UTC)

Naltrexone

There are currently two ways that naltrexone is used, and the two are strongly in contention. Naltrexone was ok'd by the FDA for use for alcoholism in 1995.

The FDA site suggests that people not drink when taking naltrexone. It is generally prescribed to alcoholics as a way of helping them maintain abstinance, for which it has a very small effect for some people. There is a great deal of research (see above) that suggests that, on the average, naltrexone has questionable value in maintaining abstinance. As a result most doctors will do one of three things: provide naltrexone with the instructions to avoid drinking, cocktail naltrexone with antabuse to specifically discourage drinking, or avoid naltrexone whatsoever.

Pharmacological extinction specifically requires the alcoholic to drink while on naltrexone, preferably where and when they normally drink. The FDA's standard instructions specifically prevent PE from occuring, and coctailing it with antabuse is even worse. PE has a success rate of about 87% for converting serious alcoholics into people who can forget alcohol exists from one day to the next, and have no problem with drinking socially.

Unfortunately, most people think that the drug IS the treatment, and as such the two treatments get confused, very much like what you did in your recent edit. This results in most people thinking that the "naltrexone to maintain abstinence" results reflect on the "naltrexone to cause extinction" treatment. It may take extra explaining to maintain the differentiation. Robert Rapplean 18:07, 2 October 2006 (UTC)

'result'

the word 'result' is used 18 times in this article. i'll start to try and get the wording more varied, but please for a while hold off on using that danged word. it gets tiring. :) JoeSmack ^Talk(p-review!) 16:41, 4 October 2006 (UTC)

it's now down to 4-5. thats better; it really does make it read a lot nicer. i once had a english teacher who told us to write a 8-10 sentence piece about anything that happened the week before. afterwards he told us to count the uses of the verb 'to be'. replacing this verb with any other verb makes it a much more descriptive piece. this article's removal of the word 'result' is something similar. JoeSmack ^Talk(p-review!) 17:39, 4 October 2006 (UTC)

sinclair method/Pharmacological extinction

There is a lot of professional resistance to this treatment for two reasons. Pendery et al in 1982 demonstrated that controlled drinking by alcoholics was not a useful treatment technique. Many studies have also been done which demonstrate naltrexone to be of questionable value in supporting abstinence.(et. al.) For those who don't understand the mechanism involved, these results have been assumed to demonstrate the ineffectiveness of the two treatments in combination. This logic isn't applicable because it assumes that the two treatments are merely complementary, like two people pushing a car, as opposed to sequential, like turning a doorknob and then pulling on it.

The Finnish study indicated, "Naltrexone was not better than placebo in the supportive groups, but it had a significant effect in the coping groups: 27% of the coping/naltrexone patients had no relapses to heavy drinking throughout the 32 weeks, compared with only 3% of the coping/placebo patients. The authors' data confirm the original finding of the efficacy of naltrexone in conjunction with coping skills therapy. In addition, their data show that detoxification is not required and that targeted medication taken only when craving occurs is effective in maintaining the reduction in heavy drinking."

i'm not sure if this section of the Sinclair Method/Pharmacological extinction is supposed to be a critism aspect or anything, but right now its just a study abstract. the references these studies are connected to might be laced into other places as cites, but i don't think they should be getting 2/3rds of the section - especially as the first is heavily docked for being illogical. JoeSmack ^Talk(p-review!) 16:55, 4 October 2006 (UTC)

The last section can be summed up as "check out the actual studies for proof". It's really too technical for this article, so should be summarized or deleted. I believe it was put in there by a psychiatrist who was editing this article earlier, and was trying to adjust it to appeal better to medical professionals.

The middle paragraph is necessary because it describes the ongoing mental conflict that causes people to disregard a treatment option of unprecedented effectiveness. I'd appreciate an explanation of why you consider it illogical, because it scans pretty logically to me. Robert Rapplean 21:23, 4 October 2006 (UTC)

I'd be for deleting both unless the middle got a re-write. I called it 'illogical' as the final sentence says This logic isn't applicable because... which pretty much dashes some of the afore mentioned studies to the rocks. At least I think what thats refering too (which you might interpret as what X readers are thinking). Also the phrase For those who don't understand the mechanism involved immediately sets up a position of writer vs. reader, which feels, uh, condescending (i'm here to understand the mechanism involved). It is definitely not encyclopedic style writting.

The first paragraph to this section is great and clear, the 2nd and 3rd are foggy. There should be like one paragraph summarizing studies out there, it doesn't have to get too nitty gritty; thats what the sinclair article fork is for. JoeSmack ^Talk(p-review!) 17:02, 5 October 2006 (UTC)

This being the case, could I enlist your help in rewriting? Let me see if I can clarify what I'm trying to describe. Pharmacological extinction is a little like a [Glossary_of_wildland_fire_terms|backfire]. Setting fire to trees is known to make them burn. I don't need a study to prove that. Blowing air at large fires makes them burn faster. Again, easily provable. Each of these by themselves would only make a wildfire spread more quickly, and again, that's readily demonstrable. However, if you find a place where the wind is burning towards the fire and set fire at that place, the backfire will burn towards the main fire and consume all of the fuel in its path. This doesn't contradict our two starting facts, it just invalidates the idea that you can't combine the two in order to fight fire. Could you help me explain this? Robert Rapplean 22:30, 5 October 2006 (UTC)

I steer from the complex metaphor just a bit. Here is how i re-wrote it, tell me how you feel:

There is a lot of professional resistance to this treatment for two reasons. Studies have demonstrated that controlled drinking for alcoholics was not a useful treatment technique[21]. Other studies have also shown naltrexone to be of questionable value in supporting abstinence alone.[22][23][24]. The individual failure of these two separate treatments often lends to the idea that their use in combination is equally ineffective. Some assume that the two treatments are complementary, like two people pushing a car; others feel they are effective as they are sequential, like turning a doorknob and then pulling on it.

maybe throw that Finnish study ref in there as a nail on the coffin (as an inline cite, the last sentence will do as a summary)? JoeSmack ^Talk(p-review!) 05:28, 6 October 2006 (UTC)

I'm good with this, with the exception of others "feeling" that they are effective. Pharmacological extinction makes some pretty bold claims, and I've given it a monumental level of scrutiny, even going so far as to talk on the phone with all of the researchers involved, calling a good dozen treatment agencies, and have a chat with the head of the research department at the NIAAA. The comments about it tend to fall into one of three categories. (a) it's obviously proven to work, (b) studies show naltrexone is a waste of money and letting an alcoholic drink is like trying to put a fire out with gasoline, or (c) I haven't looked at it before, but it sure seems to make sense. I've examined studies out the wazoo (I'll give you a list if you like), and everything done on opiate antagonists and alcoholism either supports it or completely fails to address it. The only room for feeling here is those who don't feel that it's worth their time to look into, which unfortunately is damn near everyone. I think we'd be doing our readers a disservice by making such a weak statment about it. Robert Rapplean 22:02, 6 October 2006 (UTC)

Hmm, that last sentence still kinda bothers me too. The important thing to remember here is no original research (although it sounds like you've taken the time to be extremely erudite on the subject), and to be NPOV. I think you can explain the con side's shortcomings without making it unbalanced. Take a cut at that last sentence (try removing the metaphor, although good) and try to articulate the point in another way perhaps. UPDATE: Whoop, looks like you're doing that right now. JoeSmack ^Talk(p-review!) 22:13, 6 October 2006 (UTC)

Perhaps saying people presume that the effects are 'additive', where adding together two failure still means failure. However research shows the effects tend to be 'synergetic'; where each fails alone both can succeed together. JoeSmack ^Talk(p-review!) 22:17, 6 October 2006 (UTC)

It's a little more complicated than that. Attempting to moderate alcohol use actually enhances the addiction by increasing the endorphin conditioning, although more slowly than for excessive drinking. Similarly, naltrexone all by itself has no notable effect on the actual addiction if you don't drink. It slightly decreases the urge to drink while you're taking it, but there's a rebound effect when you stop taking it and the sum total results in effects slightly worse than if you don't take it at all. Synergy suggests that the two effects are minor on their own, but significant when used together, and that isn't the case. The two are actually negative when used alone.

I have to disagree with you there, [5]. 'Synergy' the word doesn't mean the two effects alone are minor, just that when the two combine the effect is greater than the sum of their individual effects.

Ok, strike "minor" insert "lesser". Nonetheless, in synergy the effect is only changed in magnitude, not in direction. That is where the difference lies. Robert Rapplean 19:10, 15 October 2006 (UTC)

The door example helps describe this. You turn the knob and pull on it, the door opens towards you. But let's say that the door is hinged to swing both ways, and there's a wind at your back. If you turn the knob without pulling on it under those conditions, the door will open away from you instead of toward you. Similarly if you pull on it without turning the knob you wedge the pin against the side of its hole, making it harder to turn the knob and open the door. Individually, the two efforts have a negative effect on the goal of getting the door to open towards you, but taken sequentially they work with little effort. 198.152.13.67 16:38, 13 October 2006 (UTC)

the metaphor is fine and good, but doesn't sound encyclopedic and gets kinda like 'wait, what was he talking about again?' towards the end. personally it looses me. JoeSmack ^Talk(p-review!) 17:22, 13 October 2006 (UTC)

I can't disagree with you there, but I'm still at a loss for how to describe it in the article in a way that doesn't violate some principle, and yet actually describes it accurately. Robert Rapplean 19:10, 15 October 2006 (UTC)

peer review/copy editing

Originally finding edge into this article via it's Peer Review request, i've finally finished and even done a good deal of copyediting along the way. Some overall comments:

• This article needs forked articles; identification/diagnosis, effects and treatment are all too long & multifacited to not do so. I meant, this article is big, like 30k, and it gets a little tough to stick with the article when it's this daunting. It took me like a week to get through it myself for Peer Review/Copyedit.

• More cites. It isn't usually an NPOV thing, but alcoholism is a very studied condition, and there just isn't any excuse not to have a shit-ton of sources to this baby. Someone might also look around userpages for a substance abuse counselor or something to help with these.

• A lot of the sections seem sort of disconnected; i even caught a few repeats of something that had been said in a previous part of the article. Like a good essay, each needs to lead into each other to make a better flow.

• Stop using that damn word 'result'. ;) Getting 'results' is one thing, but having everything 'the result of this' and 'resulting in that' makes this article seem like a robot.

• As previously mentioned, more diagrams and images would better this article. Also, i know there is a ton of statistics out there, and it'd be great to have this article peppered in them.

Anyways, i've really enjoyed working on this baby, and i'll be around to help it out. JoeSmack ^Talk(p-review!) 17:55, 4 October 2006 (UTC)

Thanks, Joe. Your input has been a great help. This article tends to get smacked around a lot by POV hacks, and it's good to get unbiased input on the content.

Glad to help. :)

BTW, there's a perfectly good excuse for not having a shit-ton of statistics. The majority of these statistics are performed by someone who's trying to prove their personal theory correct, and they often conflicting with other people's statistics. Reconciling those statistics is something that's of very little interest since there's no hard evidence one way or another and no money to be made by it. Because of this, any comparison of statistics has to be done on the fly, and gets labeled "original research". Not neccessarily a good reason, but a pretty damn good excuse. I'll keep working on it.

Robert Rapplean 21:26, 4 October 2006 (UTC)

You might put a little bit in about statistics being varied, and perhaps include a range of them a demonstration of such. Again, don't worry about 'original research' interpretations so much. I think you do a great job, be bold and see where it goes. :) JoeSmack ^Talk(p-review!) 17:05, 5 October 2006 (UTC)

Semi-protection?

As this page seems to be a common target for vandals and we're spending half our time just reverting their nonsense, can we get it semi-protected to reduce the rate of vandalism? Nunquam Dormio 18:11, 24 October 2006 (UTC)

I second this request. Who should we talk to about this? It seems that everyone with a bone to pick wants to tell everyone that their personal annoyance is a pathetic drunk, and everyone with an idea to sell to alcoholics wants to hawk it on this page. Robert Rapplean 21:58, 31 October 2006 (UTC)

I support the idea of semi-protecting this page, at least temporarily. There has also been a problem here and on related pages with linkspammming. WP:ANI might be the place to bring it up; I'll take a look around and post a request for Sprotect. --Doc Tropics ^{Message in a bottle} 22:01, 31 October 2006 (UTC)

I posted an Sprotect request here --Doc Tropics ^{Message in a bottle} 22:13, 31 October 2006 (UTC)

• This is getting silly. The page got vandalized multiple times...while I was requesting protection! --Doc Tropics ^{Message in a bottle} 22:50, 31 October 2006 (UTC)

Thanks, Doc. I seconded your request (dunno if that'll help or even matter), and moved it to the top of the sprotect list, where the administrators can find it. Robert Rapplean 22:58, 31 October 2006 (UTC)

Thanks RR. It was the first time I've filed a request and I automatically put it at the bottom, just like we post on Talkpages. I'm glad you caught that :) --Doc Tropics ^{Message in a bottle} 23:06, 31 October 2006 (UTC)

• Many Thanks to Centrx for the Sprotect! --Doc Tropics ^{Message in a bottle} 05:18, 1 November 2006 (UTC)

Seconded! Nunquam Dormio 19:00, 1 November 2006 (UTC)

Adjusting long-term physical health effects

I've had my eye on this section for a while. The article Alcohol consumption and health describes this in great detail, and it really isn't germain to alcoholism so much as extended alcohol consumption. Unless someone has a good reason not to do it, I'd like to shorten it to read as follows:

It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumtion are described in Alcohol consumption and health, but may include cirrhosis of the liver, pancreatitis, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources.

I'll let this sit for a week before taking the scissors to the article. Robert Rapplean 02:01, 2 November 2006 (UTC)

A link to the alcohol consumption article is reasonable. The vast majority of those with alcohol intake related physical disease also suffer from alcoholism, but you're right that it's the alcohol intake itself which is the cause, not the alcoholism. Drgitlow 04:42, 4 November 2006 (UTC)

Hi, sorry I'm coming so late to this discussion (my Watchlist is clogged and this got lost). I think RR's assesment is correct and the suggestion is a good one. As pointed out in the Peer Review, the article is excessively long. Whenever it's possible to streamline a section that can be linked to an independent article, we should certainly consider it. Please note, this is mostly "moral support"; I simply don't feel qualified to make decisions about specific content within those sections. --Doc Tropics ^{Message in a bottle} 20:28, 8 November 2006 (UTC)

Now that Alcoholism has settled down a lot since we semi-protected it, could some of the regulars turn their attention to Alcohol consumption and health? Although long, it's incomplete and not very balanced. Nunquam Dormio 18:51, 15 December 2006 (UTC)

genetic predisposition against alcoholism

i recently was leafing through a gigantic substance abuse manual, and found something pretty similar from what i see over at Effects of alcohol on the body article:

Some people, especially those of East Asian descent, have a genetic mutation in their acetaldehyde dehydrogenase gene, resulting in less potent acetaldehyde dehydrogenase. This leads to a buildup of acetaldehyde after alcohol consumption, causing the alcohol flush reaction with hangover-like symptoms such as flushing, nausea, and dizziness. These people are unable to drink much alcohol before feeling sick, and are therefore less susceptible to alcoholism. [6], [7] This adverse reaction can be artificially reproduced by drugs such as disulfiram, which are used to treat chronic alcoholism by inducing an acute sensitivity to alcohol.

i say this info should be injected into this article. what do we say? JoeSmack ^Talk(p-review!) 06:04, 12 November 2006 (UTC)

I'm inclined to say not. I'm aware of this particular genetic anomoly, and I'm also aware that another side effect is a slightly shorter life expectancy. My thoughts are that, while very interesting, groups who are not effected by alcoholism isn't as germain to the main topic of alcoholism as those who are and why. Also, a genetic anti-predisposition isn't very meaningful to those who are trying to understand the problem. Maybe we can start a branch with this information? Robert Rapplean 19:30, 12 November 2006 (UTC)

I'm with Rob't on this one. The genetic issue isn't relevant to alcoholism directly, but rather to metabolism of alcohol itself. It therefore would fit nicely into the alcohol article (if it isn't already there). I'm not familiar with any studies, however, demonstrating a relationship between this genetic condition and alcoholism. One might speculate, as the person making the statement above did, that individuals with this gene are less susceptible to alcoholism. I suspect that's not the case, however, and would want to see cited studies supporting such a claim before making such a suggestion. Drgitlow 22:33, 29 November 2006 (UTC)

Blossoming list of detox drugs

This is largely addressed to Dr. Gitlow because of his contributions of information regarding barbituates' value in the detox process. It's also addressed to PointlessForest, whose addition looks an aweful lot like an advertisement. Because of criticism from the recent peer review we are currently attempting to decrease the total length of the article. Creating lists of specific drugs and going into detail about their prevalance and comparative benefits is not condusive to this goal, and is kind of tangential to the general topic. Unless you're looking for a primer on how to drug someone who is going through detox, it's not very useful. I'd like to find a way of summarizing that entire section. Robert Rapplean 19:30, 12 November 2006 (UTC)

I read through this section, and I'm somewhat on the fence. There is some good info there, but from a layman's point of view I'm not sure that all the specific references add much to the article itself. Perhaps a general summary, rather than detailing the individual drugs in such depth? As Robert points out, some of them sound rather like advertising blurbs. --Doc Tropics ^{Message in a bottle} 19:40, 13 November 2006 (UTC)

There's no question that it's all too easy for an encyclopedia article about a subject to expand, especially when the topic is covered by textbooks, each hundreds of pages long. When I've made entries, I've tried to incorporate answers to questions that patients most frequently ask. Patients often ask about detox...is it safe or dangerous to do on one's own...is it painful or painless...what process is followed...and so on. There are quite a number of protocols out there, but they can be boiled down to two drug classes (barbiturates and benzodiazepines) and two intervention methods (drug challenge followed by taper; CIWA, which is a screen for withdrawal symptoms that will be repeatedly processed with the patient). Treatment is comfortable when correctly carried out and takes a few days. It is not safe to do this alone, though it is safe in an outpatient setting with proper oversight. Obviously, this brief explanation might lead to other questions: what do I mean by drug challenge, for instance, or what are the differences encountered between barbs and benzos. This is where the line might be drawn regarding the scope of the article. Drgitlow 02:08, 25 November 2006 (UTC)

Given the technical nature of the subject, a certain level of precision is required, and this further implies a certan level of necessary detail. Something that might help keep the article clean would be to write the entry as sparely as possible, while liberally linking to the important related concepts. For example, drug challenge might be an important concept, but explaining it within the article itself is sub-optimum. However, a very reasonable stub article for drug challenge could be created; it need be no more than 2 or 3 paragraphs to start. If Dr. G, or anyone else, would enter a block of relevant text, I would be happy to wikify it and add appropriate links. We could do the same for Treatment diffs of barbs and benzos, or any other important facts/concepts. This would not only streeamline the article, it would improve coverage in the med/sci articles and provide room for future expansion. I'll do the grunt-work if someone will give me the raw material to start with. Just let me know. Doc Tropics 23:38, 29 November 2006 (UTC)

I agree with Doc Tropics on this. DrGitlow's statements within his paragraph are adequate to summarize everything that people need to know on this subject. We can move the specifics to their own articles. This is central to the wiki medium. I think, though, that we need to make a firm statement about which drugs we want to list. I think we can limit it to just naming the general classes of the drugs benzoidazepine and barbituate without going into specific drug names. These should be sufficient for the reader to get an understanding of the process if linked to the appropriate pages. We have to draw a line somewhere, and that seems like a logical spot. How does that sound? Robert Rapplean 18:20, 12 December 2006 (UTC)

It sounds reasonable to me, but as always, I would defer to the consensus of our local experts : ) Doc Tropics 18:47, 12 December 2006 (UTC)

alcohol abuse costs

Im interested in more country to costs ratios, rather than just that snippet on uk, how about how much alcohol abuse costs other countries Portillo 04:31, 25 November 2006 (UTC)

Cultural and social causes of alcohol addiction

There's very little information here on the cultural and social causes of alcohol addiction. I'm not able to understand the contribution process once a topic has been closed, but the information page on alcohol addiction is pretty skimpy. It's evident that there are custodians of the topic here, but I'm not sure if this is the way to forward additional contributions.

Hoserjoe 09:06, 5 December 2006 (UTC)

Hi, Joe. The reason why there is very little on cultural and social causes is because this information is extremely subjective and as such couldn't be effectively summarized. There are a massive multitude of theories about which specific cultural elements contribute to alcoholism, but the only real consensus is that (a) alcohol availability contributes to alcoholism, and (b) attempts to limit alcohol availability only act to popularize its use. You may argue with this, and many have, but this many argue in a broad multitude of directions. This extremely broad argument makes this the subject of books, not encyclopedia articles. Robert Rapplean 18:12, 12 December 2006 (UTC)

Joe, you raise an interesting point. Most of us live in societies where alcohol is available whether legally or not. This is a social structure. Without alcohol's availability, alcohol addiction wouldn't arise. One only needs to look at the US history of prohibition to see that although that process failed in many ways, it was an amazing success in terms of reducing the direct and indirect costs, morbidity, and mortality secondary to alcohol intake and addiction. So if you want to indicate that a society that promotes alcohol intake, as America's does through advertising and other measures, is likely to have a higher incidence (rate) of alcoholism than a society that does not promote alcohol use, I think that's a valid point. There are also significant cultural variations; there is a good quantity of literature looking at alcoholism in Jews, in Mormons, and in other groups, for the most part demonstrating significant differences. Part of that may well be genetic, but part may be cultural as well. I'm not sure I'd call these social and cultural issues "causes," but they are most definitely "contributors." Drgitlow 04:16, 19 December 2006 (UTC)

Hey, DG. Although I definitely won't argue about advertising and other forms of popularization increasing the use and secondary problems resulting from use, I can say with considerable authority that the US alcohol prohibion increased both of these instead of decreasing them. In 1918, alcohol use was very much on the decline, and in 1933 is was epidemic. By some estimates alcohol use increased more than ten fold in that time period, and there is nobody who suggests that it actually decreased. Robert Rapplean 18:24, 27 December 2006 (UTC)

Hi, Robert. I'm afraid you're entirely incorrect. I refer you to the American Journal of Public Health, Feb 2006 issue, page 233-243, and JS Blocker's article, "Did prohibition really work? Alcohol prohibition as a public health innovation." I present here a short quote from the article:

"Nevertheless, once Prohibition became the law of the land, many citizens decided to obey it. Referendum results in the immediate post-Volstead period showed widespread support, and the Supreme Court quickly fended off challenges to the new law. Death rates from cirrhosis and alcoholism, alcoholic psychosis hospital admissions, and drunkenness arrests all declined steeply during the latter years of the 1910s, when both the cultural and the legal climate were increasingly inhospitable to drink, and in the early years after National Prohibition went into effect. They rose after that, but generally did not reach the peaks recorded during the period 1900 to 1915. After Repeal, when tax data permit better-founded consumption estimates than we have for the Prohibition Era, per capita annual consumption stood at 1.2 US gallons (4.5 liters), less than half the level of the pre-Prohibition period."

Robert, I've never seen any scientific estimates to indicate that alcohol use increased during prohibition. Everything that I found in a literature search of Medline indicates quite the opposite. Happy New Year! Drgitlow 00:50, 1 January 2007 (UTC)

The information that you're posting isn't an accurate measure of alcohol consumption because it's all based on the perception of the officials, and most of it represents the period immediately after prohibition started. The environment at the time was on the pro-prohibition swing if its 70 year cycle, and most areas of the country were already dry by order of local legislation. What prohibition did was put a blanket on all of the country, which largely prevented the dry areas from bringing alcohol in from the wet areas. In truth, the majority of the country really did support prohibition, and went into it with the best of intentions.

Unfortunately, a significant number of people went into it thinking that it would prevent other people from drinking, which was good, not thinking that it would prevent themselves from drinking, which would be bad. In the years previous to prohibition the writing was on the wall that it was on its way, and there was considerable stock piling of alcohol for personal use, kind of like the runs on supermarkets that happen before a blizzard. The black market on alcohol took a while to build up and establish, partially due to lack of demand and partially because it had to build itself up from scratch from close social connections.

There's no surprise that public drunkenness and hospital admissions decreased throughout the prohibition era. That's actually one of the primary health problems with the current war on drugs, that people are unwilling to call attention to their health problems if they're doing something illegal. People generally don't check themselves into a hospital until it's a choice between jail and death, and even then many cut it too close. Forensics weren't up to today's standards and most families were loath to tell the authorities that Uncle Joe drank himself to death, they just say he had a heart attack.

If you want to talk tax records, probably the most telling statistic comes from a count of the number of drinking establishments. In 1918 there were roughly 800 pubs, taverns, and saloons in New York city. In 1933 after prohibition ended, 20,000 speakeasies made an attempt to convert themselves into legitimate businesses. They almost all folded, however, for two reasons. With the legal restrictions removed an individual drinking establishment could be large and obvious, thus having considerable competitive advantage over small, cramped speakeasies. Second, when prohibition ended many people really did stop drinking. It stopped being as elicit and, after a few dozen celebratory drinks, stopped being exciting.

Unfortunately, the self-reported statistics don't tell a full story of what was going on at the time. A good book that you might want to pick up to help understand that time in history is Prohibition : America makes alcohol illegal by Daniel Cohen. Robert Rapplean 20:05, 11 January 2007 (UTC)

Costs of Abuse

I'm puzzled as to why the changes were made to the first paragraph as follows: "Estimates of the economic costs of alcohol abuse, collected by the World Health Organization, vary from one to six per cent of a country's GDP [1]. One Australian estimate pegged alcohol's social costs at 24 per cent of all drug abuse costs; a similar Canadian study concluded alcohol's share was 41 per cent[2]."

This is not an article about alcohol abuse, but rather an article about alcoholism (alcohol dependence or alcohol addiction are other names for the same entity). Alcohol abuse is a different animal with some similarities. It's sort of like having a reference to rhesus monkeys in an article about gorillas.

Any disagreements with moving these entries to a point later in the article and indicating the differences between abuse and alcoholism, or in removing these entries? Drgitlow 04:41, 11 January 2007 (UTC)

Hi Drgitlow. The sentence in the first paragraph previously read:

Alcoholism is one of the world's most costly drug use problems; with the exception of nicotine addiction, alcoholism is more costly to most countries than all other drug use problems combined.

Seeing the tag, I went looking for a source for this statement, i.e. something about the costs of alcoholism to society. Hence the reason for the revision. The reason for the wording is simpler – was not aware of the distinction you point out.

Am certainly not wedded to the term alcohol abuse, nor to the placement of the information. Why don't you change "alcohol abuse" to "alcoholism" (perhaps if you click on the reference and look at the terms used there you will be able to decide whether these studies are talking about alcoholism or alcohol abuse)? Or move it elsewhere, I don't mind. HMAccount 15:17, 11 January 2007 (UTC)

Hi, HM, and welcome. When I reviewed that edit, I agreed that filling it in with good statistical data was a good idea. OTOH, Dr. Gitlow does make an excellent point about the difference between alcohol addiction and alcohol abuse. The connection between alcoholism and alcohol abuse is somewhat complicated. Alcoholism wouldn't really be a problem if it didn't result in alcohol abuse, but by the same note alcohol abuse isn't just a result of alcholism. Some alcohol abusers are just people having a good time. I don't think that I've ever seen a statistic that calculates "alcohol abuse, but only by alcoholics", and I doubt I ever will. As a result, if we want to show a statistical demonstration of monetary social damages caused by alcoholism, it would need to be embodied as damages caused by alcohol abuse, with the disclamer that this is not a completely accurate measure, just the best available.

This just leaves the question of where we want to put it. The way the text sits, I have the feel that it's probably too much for the first paragraph. Summaries belong there, not full explanations. Can we move it down to Societal Impacts, and just leave a summary there? Robert Rapplean 20:36, 11 January 2007 (UTC)

Hi Robert, sounds like a great idea! HMAccount 21:14, 11 January 2007 (UTC)

I know I came late to the party, but here is the spectrum as I understand it: Use, Misuse, Abuse, Addiction, Dependancy, Death. Sometimes I see 'heavy use' in there between misuse and abuse, but definitions seem blury. Use is using at all, misuse is using at times that seem inhibitive, abuse is when it starts to infere with daily life/relationships/work, addiction is usually the embodiment of psychological yearnings/feelings of addiction (can be very intense), and dependency is physical addiction/dependence. Death is of course death. JoeSmack ^Talk 22:46, 11 January 2007 (UTC)

Hi, Joe. You use those words as if they exist in a linear continuum, but they don't have the same properties. Misuse and abuse both tend to be subjective judgement calls on a person's behavior. Addiction refers to a psychological inability to not use it, and dependence refers to a condition that leads to negative consequences if a person doesn't use it. This is all layed out pretty well in the terminology section. Robert Rapplean 23:13, 15 January 2007 (UTC)

Link somewhat odd

I followed the link to http://www.downyourdrink.org.uk and was curious what their criteria were, so answered the 3-question questionnaire with: three times a week drinking a single alcoholic beverage (i.e., similar to the amount promoted currently as a heart disease prevention.) Their website produced a "possible increased risk of alcohol affecting your health" and a join-up form. I don't know that this is a useful informational link, for that reason. Edit to comment: I just looked into it some more and it seems that these are the first three questions of the AUDIT screening from the World Health Organization. A full online version of it is available at [8]. I think it seems reasonable to replace the site that gives minimal information without a sign-up with the site that has information freely available, so I'm going to do that. A. J. Luxton 07:57, 17 February 2007 (UTC)

Thanks for doing that research, AJ. That would make "downyourdrink.org.uk" link spam. Robert Rapplean 18:32, 17 February 2007 (UTC)

Criticism by FutharkRed

This may be the poorest article in Wikipedia, from beginning to end, and that is reflected in the discussion here.

One of the most glaring indicators is the decision to bury the most authoritative definition of alcoholism, that of the Diagnostic and Statistical Manual of Mental Disorders, in a spot 1/3 through the article--"The DSM-IV diagnosis of alcohol dependence represents another approach to the definition of alcoholism"--then asserting that the purpose of the definition is to enable clinical research! No, it is not 'another approach', it is that of the highest level of disease classification, by those specializing in the field, and its purpose is to best enable treating said disease. It is the diagnosis used by most in the field, is used in filing insurance claims for treatment, is what is meant, from a scientific point of view, by 'alcoholism'.

That definition is "...maladaptive alcohol use with clinically significant impairment as manifested by at least three of the following within any one-year period: tolerance; withdrawal; taken in greater amounts or over longer time course than intended; desire or unsuccessful attempts to cut down or control use; great deal of time spent obtaining, using, or recovering from use; social, occupational, or recreational activities given up or reduced; continued use despite knowledge of physical or psychological sequelae." That is alcoholism, not what has been tossed around either in this article or this discussion.

Alcoholism has been recognized for some time as a primary, progressive disease, involving addiction to alcohol (with both tolerance for and withdrawal from the alcohol as major defining features). The DSM-IV categorizes it, in fact, among the psychotic disorders. There is strong evidence for genetic factors in susceptibility to the addiction, as well as several distinctions in the ways that alcoholics process alcohol, metabolically and physiologically, compared to the general population.

Negative consequences of drinking are not diagnostic of the disease; inability to stop in spite of such consequences may be.

Socially, alcoholism's effects far exceed those of all other drugs combined, especially inasmuch as it is considered among the leading causes of death. ('Nicotine', as opposed to smoking, is not in the same order of magnitude--how the claims of its 'greater cost' is allowed to stand uncited is another mystery.)

As for the range of its effects, the 19th century suggestion that you could study all medicine, simply by studying the one disease of syphillis, is more than matched currently by substituting the study of alcoholism. It has an unparallelled range of effects, physical and mental, and that holds as well in its effects throughout the population. Estimates of susceptibility to the disease itself range as high as 10% of the population (potential alcoholics); and the effects extend to all those in contact with the active alcoholic, an enormous part of the population, compared with that affected by any other disease.

Given this, how one can choose to seriously discuss alcoholism, the disease, while moving the 'disease theory' elsewhere, escapes me. Who on earth authorized any such travesty? To discuss 'two (professionally undifferentiated) forms' of alcoholism, as is done in this discussion, is nonsense ... to anyone who does know the disease. The former version mentioned here is not considered alcoholism at all, 'professionally'. It may be a problem, true, and one that can use some treatment or prevention (as is an issue, for instance, on many college campuses), but this is not alcoholism in itself. The very way of phrasing much of this, referring to "professional disagreement", leads to the question, as to whence the greater expertise of the current authors arises.

As one among many non-professional indicators, I'd point out that 'endorphins' (which are not morphine-related) have virtually nothing to do with alcohol or alcoholism, popular though the notion may be. Alcohol has its own neurochemical effects, in the first place. The process of alcohol addiction has to do with conversion of alcohol metabolites in the alcoholic to THIQs (tetrahydroisoquinolines), quite similar in fact to the structure of morphine. The addiction itself becomes self-propelling, and requires no positive motivator the further it progresses ... other than the negative one of staving off withdrawal.

Likewise, the notion that the turning point in the disease is when "others help them realize" the negative road they are on, is spectacularly untrue to life. One of the most glaring features of alcoholism, is its long-term imperviousness both to consequences and to the input of others. The single most effective agent in recovering from alcoholism, Alcoholics Anonymous, is in no way based on helping alcoholics realize the negatives involved, which they are all too often aware of (though they may be unaware that alcohol is the cause of the trouble, rather than a failing solution.) It is based on showing that there is a real, positive alternative, such as their own alcoholic thinking suggests is impossible.

As with most diseases, the primary question for most people is, what can be done about it. Here the article is woefully poor. The authors list 5 'mutual help' organizations, for instance, as though they were of equivalent value, although only one has any substantial rate of success in dealing with the disease. Likewise, suggesting 'group therapy or psychotherapy' for "underlying psychological issues" both implies that the alcoholism may be a secondary rather than primary disease, contrary to current thinking, and overlooks the history of failure in that area--aside from such specialized treatment as is aimed entirely at abstention, and generally recommends participation in A. A.

The notion that "the American Psychiatric Association considers remission to be a condition where the physical and mental symptoms of alcoholism are no longer evident, regardless of whether or not the person is still drinking" (emphasis mine) is uncited, unlikely, and contrary to virtually every current thought on the subject. Agreement is effectively universal that an alcoholic cannot drink safely at all, ever again, that the first remedy is complete abstinence--except for the opinion of the authors here. In fact, they uncritically list Moderation Management as a 'resource', along with Alcoholics Anonymous, MM taking the position that alcoholics can learn to drink safely--without noting that MM's founder is herself in prison due to subsequent vehicular double manslaughter, while having a blood alcohol level 3 times the legal limit.

In fact, the entire discussion which is entertained on that question, under the heading of 'Rationing and Moderation', runs counter to any professional notion of alcoholism. There may indeed be "harm reduction" in other areas of drug abuse and addiction--much of the harm of heroin addiction, for instance, is not directly caused by the chemical, as by all that goes with it. In the case of alcohol and the alcoholic, it is the alcohol 100%, and there is no such thing as 'harm reduction' by any form of controlled drinking.

It is a truism that non-alcoholics never even think about "controlling their drinking" ... and that alcoholics, as the disease progresses, do think about it, and can't. At this point, for the authors to even be discussing the issue for more than one sentence, indicates that it is not alcoholism they are speaking of. They should not be writing about alcoholism, at all. FutharkRed 04:04, 3 February 2007 (UTC)

You know, I don't even know where to start on this. You are so thorougly woefully uninformed about alcoholism that you could only be a medical professional or an AA councilor. Possibly a psychiatrist, as they are the ones who usually insist that the DSM knows all. Pretty much everything in this entire article has been backed up one side and down the other by papers, books, and studies. At one point we had to start clearing off the references because some sentances had more reference marks than they did words. It's not like all of this information was made up by somebody. Please take a look in the archives, and present your own evidence that conflicts with what you see here. We all had to.

For starters, cigarette smoking kills an estimated 440,000 americans each year, whereas alcohol only kills 80,000 by the same (NIDA) accounting. No, I'm not going to start tallying up wife beatings and drunken bar fights. Endorphin release is a well known effect of alcohol consumption, although most people attribute its addictive effects to the dopamine that the endorphins trigger the release of. By anyone who's actually looked at the statistics, AA is less effective than no treatment whatsoever. Even playing patty-cake has higher success rates than AA meetings. - Robert Rapplean 07:59, 3 February 2007 (UTC) Most people that are in jail are in there for dealing with drugs. 5 February 2007

Robert, your comment, "You are so thorougly woefully uninformed about alcoholism that you could only be a medical professional or an AA councilor," is hostile and uncalled for. You're better than that! Drgitlow 19:00, 11 February 2007 (UTC)

*sigh* Ok, I'll agree that it was hostile and unproductive. Having put untold hours into reconciling the highly varied ideas of what alcoholism is, and having someone spout This may be the poorest article in Wikipedia at us kind of puts me on edge. Nonetheless, I do owe FurtharkRed an apology, that was very unprofessional of me.Robert Rapplean 19:33, 14 February 2007 (UTC)

FutharkRed, I agree with 96% of what you wrote, and indeed the version of this article that I wrote many months ago reflected the standard understanding of the scientific and medical communities that you accurately represent. I was broadly attacked by others here and after several months we compromised on the entire article, which as it stands is tolerable by many but I don't think any of us would say it is accurate from any single perspective. Part of the compromise, which I still strongly disagree with (but I was firmly outvoted), involved the removal of the entire medical understanding of alcoholism as a disease. Ridiculous, I know, but that's the way Wikipedia works.

By the way, the area where we disagree, and I'll be as clear as I can be here: As defined by DSM-IV, there are a variety of symptoms that constitute the disease of alcohol dependence. Note that quantity and frequency of use are not included within these symptoms. That is critically important, as it reflects the fact that alcohol dependence is not defined by amount of use or frequency of use. Now look at how DSM-IV defines remission on p. 196 of the TR edition. Remission refers to the criteria for dependence or abuse, not to amount of use. As a result, one can continue to have substance use but also have remission. That is the way the definition is generally understood by addiction medicine specialists. That said, I of course agree with you that abstinence is required for recovery. The psychiatric definition of disease remission is not equivalent to the medical definition of recovery. In fact, many of us in the medical addiction field don't use the psychiatric definition but rather use the medical one (JAMA 1992 article referred to elsewhere here). So I suspect that you and I completely agree on what's necessary to treat patients, but we appear to disagree on the meaning and intent of the DSM definition, and that's simply an academic question, no? Drgitlow 18:56, 11 February 2007 (UTC)

Dr. G., thank you very much. Not just for your kind remarks, and your thoughts on the subject in question ... but for restoring mine to the discussion page in the first place! They were originally appended to the discussion of the lead paragraph, and almost immediately removed by the author of that paragraph, as being beyond discussion!

Actually, I moved it to the bottom of the discussion page, where it now resides. As mentioned in the comment in history, it opens numerous new discussions based on one that was archived quite a long time ago, and as such deserved its own heading.Robert Rapplean 19:33, 14 February 2007 (UTC)

That removal, with the remover's comments, would have had me avoiding work on the article for a long while. I don't refer to the personal slant, but to the absolute lack of objectivity, from what would appear to be the article's lead author! To cite "a medical professional or an AA councilor. Possibly a psychiatrist" as certain sources of ignorance on the subject; to claim that "AA is less effective than no treatment whatsoever"; to remove the disease concept, AMA or APA or otherwise, from the article--all of these indicate an extraordinarily prejucidial approach. And removing criticism in such a manner indicated little chance for a direct approach to the article.

As evidensible here, this is a collection of things that need to be argued individually.

To cite "a medical professional or an AA councilor. Possibly a psychiatrist" as certain sources of ignorance on the subject

We get a very broad selection of people here who insist that their perspective on alcholism is the only possible one. These range from a variety of medical professionals (mental and physical health) to alcoholism councilors, religious fanatics, and outright bigots. There is a lot of vertical information passed within these groups, but not a whole lot of horizontal information passed between them. Those with the largest and most professional groups are the ones who most strongly insist that their view of alcoholism is the one and only true view of alcoholism, and they generally take the greatest amount of evidence to convince them that it isn't as black and white as all that. They take their professional perspective and years of experience as a bedrock to insist that no other group could possibly have a clue about the topic. The resulting arguments can be very frustrating and time consuming.

to claim that "AA is less effective than no treatment whatsoever"

You should have a look at the Orange Papers, specifically their page on effectiveness. I'm not going to say that this is the only perspective that's valid - we try to recognize all perspectives, including this one. Among the many peer reviewed studies that he sites, there's one where they had the patients gather in an AA-like meeting and play Patty Cake. This "treatment program" had statistically identical results to the AA meetings. So I was exagerating when I said "less effective", my apologies, please replace that with "no more effective".

A fair accounting of AA indicates a dropout rate of about 95%. AA doesn't consider these dropouts to be part of their failure rate, but they are nonetheless people for whom the AA program was a failure. This 5% success rate is roughly equivalent to the rates for spontaneous remission, which suggests that AA has no meaningful effect at all. There is an immense body of evidence that supports this idea, and as such we aren't really swayed by arguments that AA is the only effective treatment option. Robert Rapplean 19:33, 14 February 2007 (UTC)

Just a few notes about this depiction of A. A., and the methods of the article and the discussion.

It appears that declarations by the American Medical Association and the American Psychiatric Association, with only slight differences in terms and detail, to the effect that alcoholism is a primary disease, are considered of dubious value "for definitive or treatment purposes". On the other hand, something like the anonymous "Orange Papers" web site qualifies for authoritative citation.

Do we have to go through this every four months? FYI, the definition of "Alcoholism is a primary, chronic disease..." was one originally proposed for the opening definition in this article. It was altered severely to what it currently is because anybody who understood the terms primary and chronic probably wouldn't be going to Wikipedia for their information. Unsuitability for the audience had more to do with it than medical, clinical accuracy. As you seemed to have completely missed (and I'm REALLY not enjoying repeating myself today), I didn't say that this is the only perspective that's valid - we try to recognize all perspectives, including that of the AMA and APA. Put another way, we cannot dismiss any of these perspectives if they are supported by multiple clinical studies.

How does Wikipedia go about weighing sources? Surely there should be something a little better, for such strong declarations? Perhaps the original "peer-reviewed" research papers, if really meaningful and verifiable?

The Orange Papers are really nothing more than a convenient way of referencing a large number of these kinds of papers. I'll make it easy on you and copy the citations that answer the many accusations that you make, making it obvious that you really have no intention of actually considering anyone else's perspective.

Bearing in mind of course that some of the most famous such 'research' of the past, especially that devoted to proving that alcoholics could learn to drink safely, turned out to be fraudulent.

Logic foul: Hasty Generalization

But can the "Orange Papers" be considered objective by any standards? “Agent Orange”, indeed.

Logic foul: Ad Hominem attack

Regarding our standards for objectivity, and the citing of sources when a matter might be questioned, how does the expression "a fair accounting" serve for a question such as the effectiveness of A. A? Who is doing the accounting, of what, and how … and, perhaps, why? More bluntly, A. A. being what it is, how could any such "accounting" be done at all? The only records A.A. keeps are of groups that have registered, and a rough survey every few years, to estimate the global numbers and composition of those attending meetings at the time, at the request of social scientists for their own research. The surveys appear to show a fairly steady 2 million people world-wide at an A. A. meeting on a given day, 1.25 million living in the U. S. and Canada. No records of individual attendance or membership are kept at all.

That is, at no level does A. A. keep the kind of records, or set criteria for 'membership' (which a person might then be said to "drop out" of), or track people that do or don't go to meetings, or set standards of success and failure, that would make any such "accounting" possible, "fair" or otherwise. So on what could such a statement possibly be based? And why is it put in these terms, of “dropping out” and “failure”?

I do wish you would actually read the Orange Papers before maligning them so thoroughly. I quote:

For many years in the 1970s and 1980s, the AA GSO (Alcoholics Anonymous General Service Organization) conducted triennial surveys where they counted their members and asked questions like how long members had been sober. Around 1990, they published a commentary on the surveys: Comments on A.A.'s Triennial Surveys [no author listed, published by Alcoholics Anonymous World Services, Inc., New York, no date (probably 1990)]. The document has an A.A. identification number of "5M/12-90/TC". Averaging the results from the five surveys from 1977 to 1989 yielded these numbers:

* 81% are gone (19% remain) after 1 month;
* 90% are gone (10% remain) after 3 months,
* 93% are gone (7% remain) after 6 months,
* and 95% are gone (5% remain) at the end of one year.

Along the same lines, how on earth do we know how many people have gone into "spontaneous remission" with "no treatment at all", as specified here? Who are they going to tell, and why? And do they even know it themselves, or consider anything of the sort to have happened? (If it were actually "spontaneous", how would anybody know? And how does one "spontaneously" remit from this sort of condition? It isn't malaria.) There is no science in this at all, no real foundation, just made-up numbers and polemics attacking A. A., which should have no part in framing such an article.

Spontaneous remission is measured by a person not drinking based on their own decision to not drink. Not as scientific as a thermometer, but it's a pretty clear indicator that a person has gotten their cravings under control.

One of the sad facts is that there is little hard information on treatment "results", period. A. A.’s survey (which doesn’t measure total membership, just meeting makers that day), is still one of the few such measures around. A study has been underway at Staten Island University Hospital in New York for the past 5 years, but no results are available as yet – and such a study is a novelty in the field. Very few treatment facilities do any serious follow-up, and such responses as they may get are hardly definitive, even in the short run, let alone life-long. And that is in cases where hard records are kept, where tracking and follow-up would seem natural ... as opposed to the autonomous, amorphous 80,000+ A. A. groups, which keep no such records at all. Yet all of this is being expressed as though there were real research involved.

Aside from exaggeration in the early days as to its effectiveness — including plain exaggeration of its members ('100' sounded better than 78 or so, and "rarely ... fail" was meant to be encouraging to the newcomer) — A. A. claims no "success rate". How can they, when success is measured "one day at a time", and when the active alcoholic population remains so huge? Above all, A. A. most certainly does not claim to be "the only effective treatment option." Where did that come from? And how does it enter this discussion?

Your original statement was "The single most effective agent in recovering from alcoholism, Alcoholics Anonymous...". Others have suggested that it's the only effective treatment option. Neither of these is even close to true. For starters, the doctors in the Contral clinic in Finland are seeing 25% of their patients in complete abstinence and 87% of their patients reduce use below cellular damage levels after a three month treatment, with a 99+% retention rate, and a 50% maintenance rate in five-year follow up studies. AA doesn't even retain 25% much less have them all be abstinant at three months.

But most professionals in the field do seem to find A. A. the best available choice for their clientele.

Logic foul: argument Ad Populum (appeal to popularity)

People who don't go to meetings are not considered "failures" by A. A. — why should they be? And how do our "fair accountants" know whether they (A. A. or individual) have "failed" in any given cases? Who is keeping count, and what are the standards? If they had gone to meetings, but stopped going and stayed sober, they are successes. If they didn't stay sober (after going to A. A., and then "dropping out"), perhaps they should have stayed!

Actually, that's one of the funniest things about AA effectiveness, is that the various studies indicate that staying in AA has absolutely no effect on a person's likeliness to fall off the wagon, and those who stay in AA are more likely to engage in binge drinking.

"A Controlled Experiment on the Use of Court Probation for Drunk Arrests", Keith S. Ditman, M.D., George G. Crawford, LL.B., Edward W. Forgy, Ph.D., Herbert Moskowitz, Ph.D., and Craig MacAndrew, Ph.D., American Journal of Psychiatry, 124:2, August 1967, Page 163
"A RANDOMIZED TRIAL OF TREATMENT OPTIONS FOR ALCOHOL-ABUSING WORKERS", The New England Journal of Medicine, Volume 325, pages 775-782, September 12, 1991
Jim Orford and Griffith Edwards, 1977, Alcoholism : a comparison of treatment and advice, with a study of the influence of marriage, Oxford [England] and New York : Oxford University Press, ISBN: 0-19-712148-9
The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery, George E. Vaillant, Harvard University Press, Cambridge, MA, 1983, pages 283-286.

It would make more sense, come to think of it, to cite as A. A. "failures" those who did not "drop out", but still drank with disastrous consequences!

Odd that you should mention that...

Outpatient Treatment of Alcoholism, by Jeffrey Brandsma, Maxie Maultsby, and Richard J. Welsh. University Park Press, Baltimore, MD., page 105

In fact, A. A. is generally not considered "treatment" at all, but mutual help, a very different thing. (Which has been known to upset some treatment professionals over the years.) Given that the only membership requirement is that a person want to stop drinking, and that the central method (according to the A. A. Preamble) is that they do it together ... the real test with the "Patti-cake" group would not have been, how they "succeeded" as compared to A. A., but as opposed to trying to stay sober alone, presuming they really wanted to do so. With something as blatantly insulting as this 'experiment', though, I can't even imagine the patients' state of mind. And to cite this nonsense as meaningful here, with "statistically identical results" ... for how long did they continue to play Patti-cake? for how long did they not drink? And again, statistics "identical" to what — since we've already seen that the A. A. statistics were themselves made up out of thin air?

Evaluating the "success" of A. A. is difficult as can be, but evaluating its "failure" is absurd, and useless. A few fairly objective statements can be made, I believe, on the positive side.

In the first place, a great many people obviously have gotten sober in some part through A. A., in addition to whatever "spontaneous remissions" there may have been in the past 71 years, compared to the dismal prospects for recovery before that time. Whatever addition A. A. made to that recovery rate, certainly merits some serious investigation. There has been nothing else comparable.

Yet another quote from the Orange Papers:

The first mistake was in assuming that because some people recover in A.A. rooms, that they recover because of Alcoholics Anonymous. That is assuming a cause-and-effect relationship where none may exist. We can, with equal validity, say, "I know that people recover in hospital rooms that are painted green -- I've seen it with my own eyes. So the healing effects of green rooms are an established fact."

Second, A. A.'s notion that some sort of disease was involved in the alcoholic condition, and their success in using that concept to maintain sobriety, has led not only to basic research confirming the idea, but above all to treatment of many sorts, such as was not the case before. [As a corollary consideration, just as the tobacco companies hired scientists to prove that smoking was a "life style choice", rather than a profound nicotine addiction over which they had no real control, there is a great deal of insurance money at stake, in denying that alcoholism is "really" a disease.]

"AA said alcohol is a disease first, therefore AA is an effective organization"? Are we still talking about their effectiveness in curing alcoholism, or just listing their glories?

Third, well before the advent of group therapy, A. A. showed the great usefulness of such "mutual help", in dealing with what had been considered a hopeless condition, and which since has proved applicable to almost anything.

Fourth, A. A. inspired, informed and helped populate the treatment field, with its contributions to successfully treating alcoholism and other addictive diseases.

Fifth, the members of A. A. are simply a tremendous resource, for dealing with this disease. Given the profound despair that alcoholism instills in those who suffer from it, the members of A. A. give living proof that living sober is attainable for anyone that wants it. That is, seeing is believing, and especially in the numbers and variety that A. A. affords. And since the members' understanding of the key to staying sober is to help others do so as well — the famous 12th Step — this fits together quite well. FutharkRed 11:15, 15 February 2007 (UTC)

Logic foul: Begging the Question. The last three statements suggests that AA is a great organization because its model of treatment is so effective. The effectiveness of the treatment is the primary issue that we are arguing.

[Here continueth the entry by Futharkred of 2/12/07:]

On the other hand, once calmed down and objective again myself, and willing to put the necessary work into the subject, I would have approached Wikipedia's overseers directly, to remedy the situation. The subject is too important to leave it in such a condition; and that very importance could also reflect on Wikipedia's own reputation as a source of objective knowledge.

Quite aside from the usual measures of the importance of alcoholism--morbidity, mortality, economic impact, social consequences, and so forth--I recently came across a novel indicator, which really puts it in perspective. That is, the author of a book on using English around the world offhandedly presents the statement: "the word drunk holds the record for having the greatest number of synonyms--2,231." [Dickson's Word Treasury (Paul Dickson, Wiley, 1992), as cited in Do's and Taboos of Using English Around the World, p. 20 (Roger Axtell, Wiley, 1995)] World-wide, it appears, this has been the human condition most on people's minds, for a long time.

As for our 4% 'disagreement', there really should have been none. I apologize for not having re-checked the DSM before adding that statement; it's been several years since I looked at it. I agree with your view, that there does seem to be a peculiarity in perspective and terminology on the part of the APA, with its phantom "remission", which does reduce its usefulness in treating the disease. Perhaps they also suffer constraints, though, in being used for insurance purposes ... such as a qualified version of "remisson" would not have served? And on the matter of frequency and quantity of drinking, as diagnostic requirements, I likewise agree completely, they are not of the essence, just potential clues.

You seem to have an excellent approach to this subject, and I'd be glad to work with you on improving the article. Previously, there seemed no useful point in even reading it in detail, let alone thinking of how to re-work it. Who else is currently engaged in this? You speak of a 'majority' decision to exclude the disease concept, even as a working definition of what "alcoholism" is. In rejecting the majority views in the treating fields of medicine, psychiatry, counseling, and A. A., on what higher authority does this majority base its claims?

The key ingredient, I do believe, would be restoring the primacy of the disease concept, both for definitive and organizational purposes. Without that disease concEpt, aside from lack of scientific objectivity and practical usefulness, you wind up with an incoherent mess, encyclopedically! FutharkRed 23:01, 12 February 2007 (UTC)

The argument of whether or not to classify alcoholism as a disease has absolutely no impact on identification or treatment. Which label we happen to stick on it is tangetial to the understanding of the problem. It's actually a mostly political issue, argued in congress to determine if they're going to provide funding for treatment. Personally, I believe that it's a disease. Regardless, the argument about it was completely consuming the alcoholism article, distracting from the things that would actually be useful to people suffering from the problem. It deserved it's own article, and you can argue the point till your blue in that location. If you can come to a solid conclusion there, then you have my word that this article will reflect the results of that argument. Robert Rapplean 19:33, 14 February 2007 (UTC)

I agree that classification has political ramifications, but there are health and societal ramifications as well. For example, if alcoholism is a disease, then it should be treated by physicians and other healthcare professionals just as any other disease is. If alcoholism is a disease, then an individual would not be blamed by society for having that disease. Of course, personal responsibility is important for this as for other chronic disease states (e.g. someone with juvenile diabetes needs to monitor their blood sugar, eat properly, take insulin as necessary, etc.). If alcoholism is NOT a disease, then there's little reason for these individuals to be medically monitored and treated, and society can attach responsibility fully to the individuals so afflicted. We wouldn't be having this discussion for any other disease; that alone indicates that alcoholism still carries a great deal of misplaced stigma. Drgitlow 20:48, 14 February 2007 (UTC)

Ok, I've done some thinking, and here's the problem. We have to produce a peice of text that faces up to the dual nature of the word alcoholism. From my perspective, the success of pharmacological extinction in Finland pretty effectively demonstrates that for your archetypical alcoholic, the problem is very much a physiological condition that can be treated medically. Thus, it is a disease. And yet there are also numerous people out there who have sensibly done the cost/benefit analysis, and are continuing to drink irresponsibly large amounts because they don't want to admit that the problems it's causing have increased beyond a managable level. For these people, it's not a medical problem - it's a behavioral maladjustment. Not all people have the strong endorphin response that results in the first type of alcholism, but some of those who don't will still wind up drinking beyond the reasonable level. How do we reflect this? Robert Rapplean 15:48, 15 February 2007 (UTC)

I completely agree. I think the first step is to compile a list of distinct usages of alcoholism that are common enough to mention. Perhaps a new section would be best for this? --Elplatt 22:18, 15 February 2007 (UTC)

I'd love to, Elplatt, but anybody of any professional standing who has anything to say about alcohol pretty well insists that it must be one or the other. More to the point, they state that their thoughts on the matter are the only ones that make any sense. This makes the idea "original research", which is verboden on Wikipedia. Even if we could find someone who professed this philosophy, it would still be a drop in the ocean of disagreement. I'm open to ideas for remedying this. Robert Rapplean 03:57, 16 February 2007 (UTC)

Let's have some optimism. We don't need to resolve the disagreement, just represent it. I've come across plenty of published discussions of the conflicting views on alcoholism. If different authorities make different claims about alcoholism, presenting them separately shouldn't count as original research. In any case, creating a list of the different views can't hurt. I'll begin a new section on the discussion page for it, but I'm open to further suggestions about if and how they should be incorporated into the article. --Elplatt 04:55, 16 February 2007 (UTC)

Suggested Terminology Changes

As most contributors to this article know, terminology is a serious obstacle in writing intelligibly about alcoholism. The general public, the scientific community, and different portions of the medical community all have their own definitions of alcoholism, which are largely incompatible with each other.

The approach taken by the authors of this article so far has been to present "a meticulously gathered consensus based on evidence presented from many perspectives" according to Robert Rapplean. Such an approach is at best misleading.

A consensus on the definition of "alcoholism" does not exist. Any reference material used to support the statements in this article was written with a particular definition of alcoholism in mind, and the statements they make may or may not be true for the definition used in this article. The fact is, any statement about alcoholism can only be understood in the context of the author's definition of alcoholism.

For instance, a 1989 study by the Canadian government found that 77% of alcoholics recovered without treatment. However, when one reads the study it becomes clear that their definition of alcoholic was a problem drinker, or someone meeting the DSM IV criteria for alcohol abuse (rather than alcohol dependence). This information is vital to interpreting the results of the study.

There is an easy way to please everyone and present accurate information. The article should accurately reflect the common usage of the term, and plainly acknowledge that there are many common usages, not construct an artificial and misleading consensus definition.

Furthermore, although definitions of alcoholism vary, the definitions are based on factors with much more well accepted definitions. These factors are the ones described in the Terminology section of the article. In the past I've suggested that the current authors stick to these well defined terms and avoid making statements about "alcoholics" or "alcoholism," and have been met with some opposition. However, if you can't understand why I would recommend against saying "alcoholics are..." please first ask yourself why the Nigger article doesn't contain the phrase "niggers are..." (I don't intend this statement to be derogatory towards anyone, but rather to point out that some terms can't be used to make factual claims). --Elplatt 21:49, 6 February 2007 (UTC)

You make some very valid ponts, Elplatt, but I'd disagree that there is no consensus on the definition of alcoholism. In fact, there is broad consensus within the medical community (the 1992 JAMA article referred to in the text is one of the better examples of this, as is DSM-IV itself) as to what alcoholism is. What you are, I believe, referring to, is the lack of understanding of that consensus outside the professionals and organizations that came together to settle upon this definition. And as you point out, even in the scientific community there are many who lack understanding. This isn't totally unusual, and other well-defined diseases like diabetes and hypertension have both broad consensus and many who disagree with or who lack understanding of that consensus. Indeed, even in the alcoholism treatment community, we often gather to discuss our differing perspectives and views regarding definition, treatment, prognosis, and so forth. That is routine for any science where understanding is gradually improving as technology and research advance. Indeed, though, we can make broad statements based upon available research that indicates typical disease course for those with alcoholism; the statements won't apply to all, but will apply to a majority. It's like saying that the blue spruce grows to 50-100'. Not all of them will, but that's a typical final height for the tree. Drgitlow 18:45, 11 February 2007 (UTC)

Regarding the terminology, and whether to change it, Dr. Jellinek apparently proposed at one time to introduce the term "Jellinek Syndrome" as a clinical-sounding replacement for "alcoholism", precisely to avoid the negative connotations of that name. This was a good many years ago, when "alcoholic" was still mainly pejorative rather than diagnostic, but even then the notion was politely put aside ... by the sober alcoholics. Being sober, they felt no such opprobrium in the name, and in fact felt it helped to hit the issue directly, rather than try a euphemistic finesse.

This sense seems to have been correct. These days, objection to the term is more commonly confined to those who object: "But that would mean I couldn't drink any more!" For those who want to stop, it is more often accepted with a sense of relief. [A sense of delight in the case of one young fellow, whose first experience with it was hearing an attractive nurse refer to him as "acute alcoholic". He opted to stay for treatment, and then to stay sober, even after getting the terms straightened out.]

On a lighter note, in the 1940s there apparently was some strain between A.A.'s New York office and some West Coast members, the latter feeling they weren't getting the proper sort of support ... at which point some of the latter threatened to set up on their own, under the name of "Dipsomaniacs Anonymous". "Alcoholic" looks better all the time! FutharkRed 11:53, 15 February 2007 (UTC)

Forms of Alcoholism Revisited

Different authorities in the field of alcoholism use the term "alcoholism" to mean different things. This discussion topic has been created to compile a list of the many definitions of alcoholism. This section is not for proposing new terms or debating which definition is best, or "correct," which would be original research. So please feel free to add or correct definitions to best match what you have come across in the published literature.

In my reading, I've come across the following different uses of the term alcoholism:

A - Any drinking in spite of negative consequences, including by choice, referred to as "problem drinking" in some medical literature.

B - Drinking despite negative consequences because of a compulsion / loss-of-control. This is more or less equivalent to DSM-IV "alcohol abuse."

C - Drinking progressively more despite negative consequences to relieve withdrawal symptoms. This is more or less equivalent to DSM-IV "alcohol dependence."

In my reading, every description of alcoholism has fallen pretty close to one of these three categories. Please suggest any changes or additions that might be necessary. --Elplatt 05:40, 16 February 2007 (UTC)

Thanks for getting this started. I would be elated if this could be incorporated in the article. For easier reference, I have labeled each of the three conditions A, B and C.

What you've laid out in A, B, and C correspond to psychological, neurochemical, and physical addiction to alcohol. Each of these is a real and demonstrated phenomena, and needs to be dealt with individually when treating a patient. It can be very confusing because the three are mutually self supporting. Neurochemical addiction, for instance, will artificially enhance a drinker's perceptions of the positive aspects of drinking resulting in a strengthening of the psychological addiction. Physical addiction will prevent a drinker from digging in their heels and halting the addiction process through a cold turkey technique. Psychological addiction will convince the drinker that drinking is beneficial, allowing the other two to get their foothold.

I agree with A and B, but most of the doctors I've talked to insist that C just doesn't happen unless A and/or B exist first. Essentially, C becomes a secondary reinforcer for A and/or B. Also, I don't think that anyone considers an alcoholic to be cured of alcoholism once they've gone through detox, which does effectively cure C. I believe that the DSM refers to both A and B as dependence, whereas physical medicine refers to C as dependence. Dr. Gitlow, can you weigh in here? Robert Rapplean 17:17, 16 February 2007 (UTC)

It's quite possible that there is some overlap between these different definitions, I didn't mean to give the impression that there wouldn't be. I'm more concerned with identifying different meanings of "alcoholism" and there may not be a one-to-one correspondence between a meaning and a particular physical/psychological condition.

Type A was meant to include all kinds of problematic alcohol use. It certainly includes what you call "psychological addiction" but it also includes people who aren't addicted at all, and simply drink in spite of negative consequences by choice. For instance, plenty of people willingly drink to get drunk throughout college (often with negative consequences), and "settle down" after graduating.

I think type B would include both the psychological and neurochemical addiction you referred to. My main point with B was that the drinker's body responds normally to the alcohol, but for some reason they still have extreme difficulty controlling their drinking. When psychologists write papers comparing "internet addiction" to alcoholism, this is what they're talking about. This also seems to be Dr. Gitlow's definition. Are there groups that refer to psychological addiction but not neurochemical addiction as alcoholism (or vice versa)?

Which brings me to C. I meant C to specify that the drinker's body responds differently to alcohol. Some references refer to alcoholics as having an marked higher tolerance to alcohol right off the bat. You're right that this should include recovering alcoholics. So perhaps it's not the state of dependence, but the inability to drink without becoming physically dependent.

Thoughts? --Elplatt 18:21, 21 February 2007 (UTC)

A few thoughts. (A) seems to me to be a parent category of (B) and (C). I wouldn't say that (B) necessarily involves a difficulty in controlling drinking, as it's often the result of a lack of recognition that drinking is a problem for them. It's more of a grand state of denial. (C) is also known for denial, but mostly because it is usually found with (B) in its earlier stages and provides (B) with chemical reinforcement. Robert Rapplean 02:49, 26 February 2007 (UTC)

I agree with the comments on denial. I'm beginning to think that both B and C fall into the AMA definition of alcoholism, while A is the common usage. Perhaps the big distinction in the article should be between common alcholism and AMA alcoholism. Further info about different views and subclasses of AMA alcoholism could go in an AMA alcoholism section. I also think that facts about studies and reasearch should be classified under AMA alcoholism, while most history should be under common alcoholism. Does that sound reasonable? --Elplatt 19:36, 26 February 2007 (UTC)

Revised list, 02/26/07, per RR:

A - Any drinking in spite of negative consequences, including by choice, referred to as "problem drinking" in some medical literature. This includes both addicted and non-addicted states.

B - Drinking despite negative consequences. A normal physical response to alcohol, but denial of negative consequences.

C - Drinking despite negative consequences. Extreme difficulty controlling drinking augmented by a tendency to become physically dependent.

There are still a few holes in the plan. I don't think that B falls into the AMA alcoholism category. For medical practitioners, there is a very strong delineation between B and C. Those that fall into B generally don't require much treatment because consuming neuroinhibitors is a self correcting behavior. Because of differences in body chemistry it's a self reinforcing behavior for those in category C. You can see the biggest difference in non-social drinking habits. Those in category B will readily overdrink around others, but generally don't drink much when alone unless there's something like depression triggering it. For those in category C, drinking is valuable as a solitary activity with no need for other contributing factors. Drinking results in an endorphin/dopamine "pleasure response", and may result in neurochemical conditioning.

I agree, though, that A probably constitutes a common understanding of alcoholism. That is to say, the typical person doesn't differentiate between B and C. My conversations with Dr. Gitlow are convincing me, however, that the AMA only considers C to be alcoholism at all. Robert Rapplean 20:44, 26 February 2007 (UTC)

Forms of Alcoholism Debate

I've split this discussion into two parts. One to discuss different definitions of alcoholism, and one to assess their relevance and validity. --Elplatt 17:34, 21 February 2007 (UTC)

Elplatt is correct that various forms of literature have various definitions for alcoholism. The same can be said for many things. Sociologists might approach an issue from one perspective, while politicians would use another approach, and engineers a third. That doesn't mean that any one approach is wrong, but as I've said before in these pages, if I want an opinion rendered on the condition of my home's roof, I don't really give a darn what the attorney next door thinks. I want an expert roofer's opinion. Here, we're talking about a medical condition, and what readers want is the current medical consensus (though it would be appropriate to refer to and cite relevant disagreements). The current medical consensus was published in 1992 (JAMA 8/26/92): "Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic." There's nothing in any medical definition that distinguishes between or among psychological, neurochemical, and/or physical addiction, though Robert's point here is an important one that each of these areas represent a contributing factor to the development of the disease. Alcoholism is called alcohol dependence within DSM-IV - same disease, and the psychiatrists have a somewhat different mechanism for diagnosis based upon a set of criteria that is consistent with psychiatric diagnostic routine. Alcohol abuse is another illness in the psychiatric literature, but is generally viewed as being a mild form of the same thing, just as one can have mild hypertension or severe hypertension. "Problem drinking" is something else entirely, and is actually under current discussion within the medical community - it's not a medical term but is used frequently within the political community to a great extent. I'm hard-pressed to tell you how to differentiate problem drinking from alcoholism. But I don't know that everyone using the term is trying to refer to people who require medical attention to address an illness.

By the way, alcohol dependence as defined in DSM-IV has little or nothing to do with drinking to relieve withdrawal symptoms though such individuals will often do so by drinking in the morning to get rid of their alcohol withdrawal tremors from their use the night before. Drgitlow 03:47, 18 February 2007 (UTC)

Again, we go back to the JAMA definition of alcoholism. It suffers from the primary problem that it doesn't differentiate between psychological and neurochemical addiction. Although it's common to find the two together, each can exist independently of each other, and it effects the kind of treatment which is effective. Those who are psychologically addicted to it will continue what they're doing until hit upside by reality hard enough. No amount of chemical treatment is going to dissuade them, they just have to come (or be lead to) their own conclusions. There are no shortage of the neurochemically addicted who are thorougly undeluded about how damaging alcohol is to their lives, and yet still can't resist drinking. These people can be helped a little by those who can teach them that they can live a nearly normal life while avoiding alcohol like the plague, but after ten years of abstinance a single drink can still wind them up in a ditch a month later.

This would be the crux of the problem. Both of these conditions exist, and we need a definition that recognizes both of them. JAMA doesn't, they take the standard line of "we know all, here's the one true answer". They've pretty well demonstrated that taking that tactic does nothing to quell those who have evidence that the JAMA answer doesn't tell the whole story. I want to tell the whole story in this article. Robert Rapplean 07:19, 18 February 2007 (UTC)

Robert, if the JAMA article were one person's opinion, or if it failed to reflect consensus of the medical community, I'd agree with you. But the article wasn't written by one person. It was the result of several work groups coming together over many years, incorporating the National Council on Alcoholism's definition from 1972 and the medical specialty's definition that was prepared in 1976. It was, and remains, the primary definition for alcoholism, as agreed upon by all those in the medical community who have interest in the field. Naturally, there are those outside of the healthcare profession who have differing opinions and differing perspectives. Those opinions and perspectives have their place, just as they would in any article, but need to take a backseat to the primary definition as developed by those who have expertise in the field. There are also secondary definitions within the field of medicine, such as the one in DSM-IV. That material also needs to be covered within the article, and should probably be presented alongside the overall medical consensus material.

The medical community as a whole doesn't disagree with you regarding what you said about "No amount of chemical treatment...." Physicians don't generally use chemical treatment to treat alcoholism. While there are several drugs which have indications for use in alcoholism, they haven't been demonstrated to be of particular value and prescription rates remain quite low. I recognize that you have a perspective about alcoholism in which you've separated it into various forms of addiction. It's an interesting perspective, and to my mind reflects important points about alcoholism; your thoughts are probably going to be reflected within some of the discussion taking place at the American Society of Addiction Medicine's annual conference this May. But as yet your perspective isn't shared by the medical profession as being part of the alcoholism definition. While I recognize that you want to tell "the whole story" in the article, your whole story isn't the same as others', and I'm uncertain as to how that should be dealt with during the formulation of an article like this. Drgitlow 19:31, 18 February 2007 (UTC)

So the medical community has this alcoholism thing all cured, do they? They know what causes it? They have a high success rate for treatment? When you can answer yes to these questions, then I will consider the medical community's opinion more significant than anyone else's. Until then, please recognize that maybe there's a thing or two that they don't know or aren't admitting. Robert Rapplean 04:39, 20 February 2007 (UTC)

Robert, your questions are important ones, but your argument isn't logical. Many illnesses can't be cured and have unknown etiologies and poor rates of treatment success. We can't cure juvenile diabetes, aren't exactly sure why some people get it and some don't, and treatment requires complex daily attention. Many forms of cancer are incurable, of uncertain origin, and can't be treated. Nevertheless, the medical community is going to be the appropriate source for expert information on those illnesses. I've never suggested that doctors have alcoholism licked, and while there is a strong indication that there are both environmental and genetic causes for alcoholism, the precise nature of those causes has yet to be elucidated. Treatment success by addiction specialists runs about 70-80%. Treatment success by non-physicians runs in the high 40's. There have been no head-to-head comparison studies, however, so those two figures may not be entirely comparable. But there remains much that physicians don't know.

If I want my car engine rebuilt, I will base my decision upon knowledge presented to me by a mechanic with expertise in rebuilding car engines, not upon someone without such expertise. If I want to read about how to rebuild a car engine, I'll read a book written by or under the guidance of a real mechanic. There may well be people who think that mechanics in general are out to sell their services to those who haven't a clue as to what their car really needs. And that may indeed happen from time to time. But it doesn't change the fact that actual expertise and information about engines has to come from people who know engines.

The article about Star Wars doesn't need to be written by George Lucas, and in fact it could be argued that it would be better if it weren't. The article about the Ford Mustang doesn't need to be written by someone at Ford because there are people with more overall knowledge about the car outside the manufacturer's doors. By the same token, the article on alcoholism doesn't need to be written by an alcoholic; rather, it needs to be written by someone who has broad knowledge of the condition.

In this case, we're talking about a medical condition, one which is directly associated with related illnesses and death. The group with the greatest understanding of medical conditions are physicians. In the US, we spend an enormous percentage of our tax dollars on medical training, and physicians spend a minimum of 11 years in training after high school just to get to the point where they can start their work. So you and I have bought that expertise. If you want to ignore it, you have that right, but I don't think it's appropriate to simply say that they're wrong. Drgitlow 06:42, 20 February 2007 (UTC)

For starters, the mechanic analogy is inapplicable. Engines are something designed by humans, and the mechanics base their knowledge on documents created by those who designed the engines, but doctors don't get their knowledge from the entity that designed humans, assuming there even is one. There's a joke where a mechanic is telling a surgeon how he's better at his job because he can make any engine run perfectly. The surgeon tells the mechanic "Sure, but let's see you do that without turning the engine off to work on it." It's apples and oranges, really.

The Star Wars and Mustang examples are invalid because I could readily use it to support my side. If you want the full perspective on something, it's important to get the perspective of those who deal with it outside of a professional environment.

Diabetes and cancer are things that medicine has a pretty good handle on. Diabetes is caused because the pancreas is behaving in a way that causes it to be targeted by our own immune system. We can't cure it because we don't know how to make our immune system "unlearn" an enemy. Cancer is caused by errors in cell division that "turn off" our mitochondria and result in the cells multiplying in an uncontrolled fashion. It's looking like a treatment of dichloroacetate can turn the mitochondria back on, resulting in the self-destruction of cancer cells. We agreed a long time ago that alcoholism is the inability for a person to not drink alcohol. We're not certain why the person can't just not drink alcohol, and the answer lies within our sense of self, which is still described in terms of pixie dust and superstrings even by the experts in the field.

Similarly, your estimates of treatment success are in question. Almost every treatment facility measures their success based on the percentage of those who complete and continue the treatment. This means that the majority of those for which the treatment doesn't work are removed from the original percentage. This is kind of like a workshop claiming zero accidents because it retroactively fires people the moment an accident happens. Additionally, most don't consider the long-term relapse rates. Even for that, the treatments don't actually cure the root cause of the alcoholism - the desire to drink - it just teaches the person how to cope with it. This is analogus to providing a person with pain killers instead of figuring out why they hurt.

Dr. Gitlow, can you honestly say that there are no people who continue to perceive positive value in drinking beyond the point where damage exceeds values for those with other perspectives, or even an objective perspective? This is an extremely common condition, but it's a condition that most people are capable of overcoming without treatment. It's much more common than the clinical disease that you refer to, it's the only form of alcoholism that most people have any personal experience with, and it is what most people are thinking of to when they talk about alcoholism.

This is the alcoholism that makes people insist that it isn't a disease, and this is the alcoholism that Congress refuses to pay for the treatment of in VA hospitals. It is a real phenomena, and your insistance that the AMA doesn't recognize it won't make it go away. If we're going to illuminate the public about alcoholism it is necessary to hold the two up for comparison so people realize that the AMA's alcoholism isn't the same thing as Congress's alcoholism.

Wikipedia is a reference of human usage of words and terminology. Even dictionaries recognize when usage of a term is different from their definitions, and they change their definitions to match the usage. The AMA didn't invent the term 'alcoholism' and they aren't the majority user of it. While their definition is relevant, it isn't decisive except among AMA members. The Wikipedia definition of alcohol has to take into account all of the usages, and possibly shed light on how connected these usages are with reality, but we can't just wholesale ignore the ones we don't agree with. Robert Rapplean 01:46, 21 February 2007 (UTC)

You asked, "can you honestly say that there are no people who continue to perceive positive value in drinking beyond the point where damage exceeds values for those with other perspectives, or even an objective perspective?" In some respects, that's the disease. From a subjective vantage point, the alcoholic always perceives positive value in drinking alcohol even when the negative value is clearly greater from an objective perspective. If I were to light a match under my fingers, burning them, there is obvious negative value to the exercise. And if I continue to do so, despite increasingly severe injury to my hands, simply because I get subjective pleasure from the match lighting/burning, there's something wrong with me. That would be clear to any objective and unbiased observer even if not clear to me.

We could expand this argument, and perhaps we need to. In suicide, an individual feels that the positive benefit of killing himself outweighs the negative value of the action. An outside observer would say that individual needs treatment of some form and that the individual is suffering from a disease state. (If someone who is suicidal isn't having a sense of dis-ease, I'm not sure anyone could be defined as falling into such a category).

If you agree that suicidal intent and plan is a disease state, then you must agree that alcoholism is as well. In both cases, individuals harm themselves despite their best interest as determined by a neutral and unbiased third party. If you do not agree that suicidal intent and plan is a disease state, then we're obviously looking at this from very different perspectives or otherwise don't understand one another's terminology. Drgitlow 04:32, 21 February 2007 (UTC)

Suicide is an extreme case, and happens to be on for which I have plenty of experience. I can definitely disagree that the mindset that results in it is necessarily a diseased state. Having been there a couple times in my life, I can specifically look back and identify it as a misplacement of weightings between current circumstances and future possibilities. Time and experience fixed the problem with no medical treatment. This is a lapse in judgement, not a disease. If you're going to call that a disease then it isn't much of a stretch to call voting for a bad candidate a disease. Fearing terrorists is certainly a dis-ease, but it isn't a medical condition. Chronic depression, on the other hand generally is a disease. Specifically, it's usually a misadjustment of the brain chemicals which affect our mood. Depression can result in suicide, but that doesn't make suicidal intent a disease.

Alcoholism is similar, but because one of alcohol's functions is to degrade a person's judgement faculties the lapse in judgement can sometimes last years. This is different from the opioid addiction that results in people who have a difficult or impossible time in kicking the habit even after they've realized the disasterous consequences that have befallen them. Two different phenomena - one a lapse in judgement, one a disease - both with the same symptoms.

Is it possible that you think that all alcholism is just a lapse in judgement? That the neurological affinity for alcohol consumption doesn't exist? Robert Rapplean 17:59, 21 February 2007 (UTC)

Dr. Gitlow, I second Robert's question, in your opinion how is alcoholism different from a lapse in judgement. --Elplatt 18:33, 21 February 2007 (UTC)

Robert, you and I have differing definitions for "disease," so it may be that is the context within which our disagreement is based. Fearing terrorists, for instance, creates a dis-ease, and it becomes a medical condition if the fear is great enough that functional impairment results. Look at people with PTSD, a disease that impacts many as a result of an experienced traumatic event. The same event might be experienced by others who have no disease and no symptoms as a result. There may be no biochemical difference at all. It might simply be that some people have it and some don't, for whatever reason. That lack of knowledge doesn't prevent us from saying that some have a disease and some don't.

I do not think that alcoholism represents a lapse in judgment. I've never said that. The choice that the alcoholic has is whether to obtain treatment or not. (Treatment, in this case, meaning any form of help outside oneself). Lapses in judgment: going through a red light at 2am because you guess that there won't be anyone else in the intersection at the same time. You will eventually get hurt, after which you probably won't do it again. Shoplifting as a teenager. That's something many teens do, until they get caught, after which , for the most part, they don't do it again. Lapses in judgment happen once, or happen until something bad results, after which there are typically no further equivalent lapses. That's part of maturation, part of wisdom, and explains why as we get older we get more conservative. In high school or college, many adolescents get drunk and have a bad experience which follows, after which they don't bother doing that again. About 10% of the population gets drunk, has a bad experience, and yet returns to repeat the experience. That's not a lapse of judgment, but rather represents a failure to learn something that is obvious to 90% of the population on experiencing the same thing. It represents a failure to interpret the collection of inputs that the brain is receiving in a "normal" manner, where normal is defined by that which allows the organism to have an increased lifespan. This has nothing to do with a lapse of judgment. There's something broken in the brain of people with this illness, just as there is in Major Depression, PTSD, Schizophrenia. They're all brain-based diseases that result at least in part from genetic underpinnings. It's too bad folks don't have a choice in the matter. I assure you that 100% of my patients, given the choice, would all choose not to have it. Drgitlow 02:21, 22 February 2007 (UTC)

Ok, so given that we have varying definitions of the word disease. I think that voting yourself into decades of debt and a murderous and pointless war is a pretty serious impairment, but that's just me. We can revisit that one later, as I consider it dangerous to believe that coming to a different (if illogical) conclusion should be considered a treatable illness.

I think that you have an effective basis for what I'm trying to explain. You state that, for 10% of the population, that the normal clues provided by problem drinking are inadequate for them to realize how alcoholism is harming them. I find myself unable to dig out my reference for the 17% number that I've been using, so we'll go with your 10%. We both agree that these are diseased people, who are generally in need of some kind of outside intervention to correct their behavior.

Regarding the other 90%, it isn't as cut and dry as you describe. Some of them have a single traumatic experience that causes them to realize how problematic alcoholism can be. Sometimes that experience is so traumatic that it causes everyone around them to be more careful about their drinking. More often, though, the information feeds in over years. Little things that just mount up. They may convince themselves "yes, it was a problem then, but I learned from it and it won't happen next time". People underestimate their inability to monitor their own drinking all the time. Sometimes observers perceive the problems caused as more significant than the one who actually experienced them. Sometimes the drinker perceives benefits (like social accumen) from drinking that far exceed the true benefits. Sometimes the observers feel that their personal distain should be enough to discourage drinking, and are driven to name calling in their frustration. This isn't a chemical imbalance in the mind of the drinker so much as a failure of effective information gathering, a (possibly reasonable) belief in ability to deal with things, or even just a difference of opinion.

Nonetheless, these things are all referred to as alcoholism, and have been referred to as alcoholism for centuries. You, the AMA, and I could probably agree that it isn't the true disease of alcoholism, but is instead an uninformed public applying the label to a more common and less dangerous behavior. Our agreement won't change the way the word is used, and won't prevent people from deciding that others are drinking irresponsibly, even in the absence of the psychological disorder.

The unfortunate reality is that this non-medical definition is the majority usage of the word alcoholism. It's a real phenomena and they have to call it something. They're not likely to give up the term alcoholism, and as of the authoring of this article they certainly haven't yet.

Can you see the difference? Robert Rapplean 21:26, 22 February 2007 (UTC)

Yes. Millions of people have been taught that Pluto is a planet. Astronomers recently decided that Pluto isn't a planet. Rather it is a dwarf planet. Who's right? The millions of people who think Pluto is a planet? Or the much smaller group of experts in the field who have redefined the term? The correct answer, in my mind, is that the latter group is correct and that the literature will gradually be updated in support of their definition.

You're absolutely right that most people think of alcoholism in a way that is variably different from how the experts in the field define the term. Nevertheless, the correct definition is that which is most up to date and which is supported by the consensus of physicians who treat the illness and clinical researchers who evaluate the illness. It may well be our role to indicate that the definition has changed over the centuries, or to indicate that many remain uninformed as to the current scientific perspective on the illness, but there is a current and correct definition as established by experts in the field.

Even HBO for their upcoming Addiction special, has said in their promotional material:

---

Countless television shows, both fictional and real, have captured the seemingly hopeless downward spiral of the drug addict or alcoholic. But, they have failed to explain to the public:

What addiction really is (a brain disease); What causes it (a variety of genetic and psychosocial factors); and How to get the best available treatment (by seeking out evidence-based medical and behavioral treatments).

---

They're right. The public, as a group, is uneducated regarding this illness. That's why "majority rules" aren't used to determine scientific accuracy or encyclopedic perspective. Most people think the Earth is spherical, but that's not the reason we include that in the Earth's description in its Wiki entry. Drgitlow 02:01, 24 February 2007 (UTC)

It seems everyone agrees to some extent that the medical description of alcoholism should go into the article. I personally agree that it should be a primary focus. However, the one disagreement we seem to have is whether the other descriptions of alcoholism are relevant to the article. I really hope I can convince you that they are, because I think we could greatly improve the article.

This is as clear an argument as I can make, so please give it some thought:

Inspired by your Pluto analogy, consider if an astronomer discovered a new comet, named it Jupiter and then claimed "Jupiter is not a planet because it is a comet." That statement would be correct by their definition of Jupiter, but not by the definition everyone else was used to. This is a better analogy for alcoholism.

The "alcoholism" that has been in our language for hundreds of years refers to a social state and a behavior. This continues to be the primary usage among most people. However, doctors quite reasonably concluded that in many cases the behavior was really a symptom of a disease. Unfortunately they decided to call that disease by the same name as the symptom (compare this to hepatitis, although named after the same symptom, hepatitis a and hepatitis b are completely distinct diseases, furthermore if I punched myself repeatedly in the abdomen I could develop a non-disease form of "hepatitis").

Alcoholism, using your def, is a disease influenced by heredity. However, anyone can decide to drink to the point of it being problematic, though that doesn't necessarily make them an alcoholic (again, by your def). The behavior that most people call alcoholism can exist outside of the disease, although there is considerable overlap.

So, as I've said many times. To describe AMA alcoholism to the public, it is necessary to explain that it is not to be confused with colloquial alcoholism. --Elplatt 21:24, 25 February 2007 (UTC)

I believe that Elplatt is essentially correct. Let me provide a different analogy. The t-shirt is a well known part of our culture. Let's say some corporation came out with a line of garments in this category that they named "The T-Shirt". They could do their darndest to insist that everyone stop calling the rest of those garments t-shirts, but they probably wouldn't have much impact. A better analogy would probably be the astronomers trying to tell Roman mythology buffs that they can't use the name for the Roman god of the underworld any more.

Alcoholism is similar in that the AMA has taken a subset of those things that we call alcoholism and decided that this is the one and only true alcoholism, and everyone else is just plain wrong for calling the rest of it alcoholism. The rest of the world continues to turn at its own pace in complete ignorance of the AMA's decree. Those not in the medical profession really don't bother themselves with such details until it becomes a problem to them.

What those not in the medical profession do pay attention to is what others not in the medical profession call those who regularly fail to control their drinking. On those occasions when alcoholic is used beyond its purely derogatory sense, it is generally used to describe someone who the listener does not have a close association with. All they can see is the behavior, not its causes. From this perspective the AMA's alcoholism is completely undifferentiable from any other form of drinking that can cause problems.

So people with non "AMA alcoholism" drinking problems will get told that people with matching symptoms are alcoholics, or even told that they themselves are alcoholics. Since alcoholism really is what we call that kind of problem, then the person will reasonably be convinced that he has alcoholism. Most of them will react to this by deciding to cut down on their drinking. It isn't until this point that we are able to differentiate AMA alcoholics from "common" alcoholics. The common alcoholic will reduce their drinking sensibly, maybe only getting into trouble at big parties, while the AMA alcoholic will regularly find their resolve to be inaccessible while they get worse and worse over time.

The result of this is a society-wide case of equivocation, where group X says something about alcoholism, and then group Y gets to agree with or dispute the statement based on which definition they chose to pick. This is especially true for people's subconscious perception of alcoholics. The recovered common alcoholic can say to himself that he got over his alcoholism, so it must not be as bad as this other alcoholics, the AMA, or someone asking for money makes it out to be. This is a HUGE social problem, and one that I would very much like to take a step towards correcting in this article. Robert Rapplean 01:14, 26 February 2007 (UTC)

I agree with you both that all of the major definitions need to be incorporated into the article. Robert has hit on something with his terminology of AMA alcoholic versus common alcoholic. What he means, I think, is that there are the people who have the disease, as the medical community defines it, and there are people who get in trouble with alcohol, as the overall population defines it. There is obviously overlap between these two groups. Some folks who get into trouble with alcohol and who are seen as alcoholic by a bystander would also be seen as alcoholic by a physician. But some are not. And some alcoholics, diagnosed as such by a physician, do not regularly have trouble with alcohol and might not be recognized as alcoholic by a layperson. I very much agree that when a physician says "alcoholic" and a "person on the street" says "alcoholic," they are likely referring to two different groups of people. It is important that we recognize this within the article and describe the two perspectives. And I think we all agree on this point, yes? Drgitlow 04:31, 1 March 2007 (UTC)

Yay! I think we understand each other now. Now we just have to figure out how to incorporate it into the article. Robert Rapplean 23:01, 1 March 2007 (UTC)

Now that we've come to an agreement, How do we alter the article?

I've been putting some thought to this, and I'm not sure how to handle a word that truly has two definitions, but for which everyone insists that there is really only one definition. We can't do a disambiguation page because people wouldn't know which one to look at, and it would encourage special pages where they define alcoholism as a curse by god upon the unworthy. Maybe we could start off the article "Alcoholism is any of a collection of conditions, all of which are characterized by a continued use of alcohol in spite of negative consequences," and then follow up with the types of things which are considered by alcoholism by various people. If we do this, we would be required to include AA's definition of "the desire to drink that persists long after a person stops drinking". Maybe it would be best to ask Wikipedia specialists and see if there are any similar situations, and how they've handled them. Ideas? --Robert Rapplean 01:22, 3 March 2007 (UTC)

Pretty much agreed on all points. I would really like to find out if this kind of situation has come up on wikipedia before. I think the approach of saying it is a collection of conditions is more or less the right idea, except I think it might be better to say it is one general condition that different groups attribute more specific meanings to. --Elplatt 07:00, 4 March 2007 (UTC)

I'm reposting this from the village pump, and he's the only respondant. Let's go ahead and act on it. --Robert Rapplean 16:22, 5 March 2007 (UTC)

Probably explain which definitions are held by which major groups, which are generally assumed by news media, etc. Be sure to include lots of references and take care to avoid implying that one group's view is the "right" one. --Random832 18:38, 3 March 2007 (UTC)

Here's the JAMA definition again:

Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial. Each of these symptoms may be continuous or periodic.

For reference, here's the AA definition of alcoholism:

Alcoholism is a progressive illness, which can never be cured but which can be arrested. The illness represents the combination of a physical sensitivity to alcohol and a mental obsession with drinking, which, regardless of consequences, cannot be broken by willpower alone.

There's also the DSM definition. DSM-IV does not specifically define alcoholism, referring readers instead to their definition of substance dependence. Here is their definition of substance dependence, where I've inserted the word alcohol for substance where appropriate:

The essential feature of Alcohol Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of alcohol despite significant alcohol-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior.

There is also the American Society of Addiction Medicine definition of addiction, a subset of which would apply to alcoholism:

Addiction is a disease characterized by continuous or periodic impaired control

over the use of drugs or alcohol, preoccupation with drugs or alcohol, continued use of these chemicals despite adverse consequences related to their use, and distortions

in thinking, most notably denial.

I'm going to include a couple definitions from people who are more attempting to characterize how we use the word than attempting to solve alcoholism as a problem. This should provide us with a basis for the "common" definition.

n. A disorder characterized by the excessive consumption of and dependence on alcoholic beverages, leading to physical and psychological harm and impaired social and vocational functioning.

— alcoholism. (n.d.). The American Heritage® Dictionary of the English Language, Fourth Edition

1. habitual intoxication; prolonged and excessive intake of alcoholic drinks leading to a breakdown in health and an addiction to alcohol such that abrupt deprivation leads to severe withdrawal symptoms
2. an intense persistent desire to drink alcoholic beverages to excess [syn: dipsomania]

— alcoholism. (n.d.). WordNet® 2.1

I think we have enough to get a start. If other essential definitions crop up, we can see how much of them needs incorporating. The bottom two seem to match well with Elplatt's (A) case of definition, don't you think? I'm tempted to say that alcoholism is a collection of disorders, all of which are characterized by either habitual intoxication or an intense, persistent desire to drink alcoholic beverages. I don't think that "collection" is the proper word, though. --Robert Rapplean 18:46, 10 March 2007 (UTC)

More thoughts. How about "Alcoholism refers to any condition which results in habitual intoxication or causes an intense, persistent desire to drink alcoholic beverages despite adverse consequences related to their use."? --Robert Rapplean 22:41, 10 March 2007 (UTC)

Pretty good, how about: "Alcoholism generally refers to any condition which results in the consumption of, or desire to consume, alcoholic beverages despite adverse consequences."? --Elplatt 02:48, 16 March 2007 (UTC)

The two of you have just provided your own definitions of alcoholism, which I don't think is the point of an encyclopedic article. Our job, if you will, isn't to define the term, but to report upon how the term is defined. The term is defined in multiple ways, as we see above, and we should refer to each of these. But we still need to open the article with a statement.

We might therefore do one of the following: 1) Pick the definition from the boxes above that we feel merits prominence based upon its being attributable to a reliable source. 2) State that alcoholism is described and defined differently by different groups.

Robert, your statement that alcoholism is a collection of disorders would not be accepted by the medical community, which clearly feels that alcoholism is a single entity. Elplatt, your statement that alcoholism refers to any condition resulting in the consumption of or desire to consume alcoholic beverages despite adverse consequences also is problematic. Let's say that a patient has a sudden head injury after which he develops an intense desire to drink alcohol heavily. Is this alcoholism? Or is this an organic brain disorder, a behavior which results from traumatic brain injury? Most docs, I suspect, would say the latter, particularly if the patient drank without difficulty prior to the incident. So alcoholism does not refer to "any condition" which results in the given behavior.

Again, I don't think our job is to redefine the term, but rather to summarize knowledge already gathered and studied by others. Drgitlow 05:49, 19 March 2007 (UTC)

I don't believe it's the case that we gave our own definition for it. What we've done is created a "least common denominator" definition, which is a starting point from which we can differentiate the varying definitions of alcoholism. You are right, though, that head trauma resulting in alcoholic cravings probably wouldn't be called alcoholism by anyone who understands it. No, the medical community wouldn't accept "collection of conditions" as they only recognize the one true medical alcoholism. We've been through that, and we've already established that alcoholism is more than what medical science thinks of as alcoholism. So maybe we can call it "any naturally occuring condition"? Besides that, I do like Elplatt's wording. Robert Rapplean 06:45, 19 March 2007 (UTC)

Dr. Gitlow's statment brings up an important distinction. We are not creating a new definition of alcoholism, but making a neutral statement about the usage of the word alcoholism. I agree that saying "any condition" is too strong a statement, but "naturally occuring" could be confusing. Maybe we can just make a weaker statement and say something like "a condition" and elaborate on specific (such as JAMA) and general definitions in the following sentences. --Elplatt 19:15, 20 March 2007 (UTC)

We're really getting into semantics here. Unless we take someone else's definition word for word, we are technically coming up with our own definition. Our charge as responsible Wikipedizens is to make the Wikipedia definition reflect all known usages that aren't covered on a different page, and there are no other alcoholism pages. Therefore the definition that we produce has to cover all the bases.

I'm not sure I agree with "a condition" because it's really multiple conditions. The "lapse in judgement" condition is entirely differentiable from the "genetic endorphin release induced neurochemical addiction" condition. I've taken a survey of about a dozen people at random, and nine of them say that they would consider excessive drinking to be alcoholism even if it were induced by brain trauma, so once again we can't stand on ceremony on the AMA definition. One person gave me the reasoning "if it looks like a duck and quacks like a duck, I'm gonna call it a duck." It's really an uphill battle getting past people's insistence on stuffing it all into a single mold. I actually do now thing that "any condition" works, or maybe "a set of conditions"? Group? Also, could we strike "generally" from the beginning? I don't think it's necessary, and encourages people to think "what does it refer to the rest of the time?".

I can accept either "any condition" or "a set of conditions" and you can strike "generally" if you'd like. I don't think it's ideal, but it's an improvement. My concern is with differentiating between two cases: 1) alcoholism means the same thing to everyone and encompasses many conditions, and 2) alcoholism means different specific conditions to different people. I think it's clear from our discussion that 2) reflects reality, but I think it's possible to misunderstand our working description to mean 1). --Elplatt 02:46, 2 April 2007 (UTC)

Sorry, got hung up with other projects for a bit. Elplatt definitely identified an important point. With that in mind, I'd like to propose this as a straw man. I don't like "segment of population", and hope that someone can come up with something better. After this opening paragraph, I'd like to see a separate paragraph for each identifiably distinct definition that we can find. Robert Rapplean 18:51, 8 April 2007 (UTC)

A new beginning

I've broken this section off because the above section was getting too long, and I think we have a decent break point. Here is the current best effort at a starting paragraph. Robert Rapplean 00:58, 14 April 2007 (UTC)

The definition of alcoholism varies depending on the segment of population that is using the word. For common usage, it refers to any condition that results in continued consumption of alcohol despite negative consequenses. Medical definitions specify those conditions in the above group which developed from the consumption of alcohol and which involve a loss of control over usage. The medical definitions invariably describe alcoholism as a disease. Definitions of alcoholism commonly refer to a loss of control over one's alcohol consumption, a preoccupation or obsession with alcohol and drinking, and an impaired ability to recognize the effects of alcohol consumption. Some definitions specify a current use of alcohol and include the effects of long-term heavy alcohol use, including dependence and withdrawl.

Is good! --Elplatt 22:17, 8 April 2007 (UTC)

Continuing on to a second paragraph.

The variation in definitions is caused by an inability to identify clinical alcoholism except through tertiary effects on the sufferer. Clinical alcholism is an unusually strong craving for alcohol. The craving results in drinking, and the drinking results in a negative impact on the person's life that exceeds the positive benefits of alcohol drinking.

For common usage, a person is considered an alcoholic any time the person using the word percieves serious negative consequences in the drinker's life. This consideration may not take into account positive effects, and may not consider craving or the lack thereof.

How's that? This brings us to a description of the medical version of alcoholism. We can use the AMA definition, but really should accumulate definitions from international sources.Robert Rapplean 00:58, 14 April 2007 (UTC)

I've done some editing of the extant paragraphs, as you can see, rather than embarking on a solo wholesale revision. I think you will find that we are all moving in a similar direction. My sense is that the current intention to be more precise in the opening paragraph is a good one.

Cheers! Empacher 10:54, 14 April 2007 (UTC)

Commentary on The Alcoholism Revolution by Dr. James R. Milam

Also, are you familiar with the Dr. James R Milam? What is your opinion of articles such as this? --Elplatt 18:33, 21 February 2007 (UTC)

Elplatt, the Milam article is interesting. Give me a little while to digest it and I'll get back to you. At first glance, Dr. Milam uses some terminology that isn't often used in the field, but he defines his terms well. It's interesting that he says, "Psychiatrists have always been regarded as the ultimate authorities on alcoholism." That's not at all the case, and in fact the majority of those who treat alcoholism are not psychiatrists (I'm a psychiatrist, by the way). The American Society of Addiction Medicine's membership is about 1/3 psychiatrists. Psychiatrists through the 1950s and 60s ignored addictive disease entirely, and for the most part those who specialized in the field were internists. Milam also suggests that the disease concept is equivalent to the thought that alcoholism is caused by excessive 'relief drinking.' That's not the case at all. Those nitpicks (and some others) aside, I agree with his approach with respect to alcoholism being of biologic origin. But that's not a new approach at all...that's something that's been general knowledge within the field for 50 years. But I think this article was written around 1990, and it may well be that within the context of the field two decades ago, some of his arguments are more pertinent. Take a look at Milam's follow up at http://www.lakesidemilam.com/drmdcc.htm. Here he certainly echos many of my own concerns about how easily the general public has been duped by misguided pundits who have absolutely no research skill or scientific background yet are quite skilled at garnering publicity for themselves because they're saying exactly what the public wants to hear. Drgitlow 02:41, 22 February 2007 (UTC)

Addiction Medicine specialists

There has been some editing recently which removed a reference to Addiction Medicine specialists. I've noted that most of the disease entries on Wikipedia include a reference to the physician specialty "responsible" for treatment of that illness. Schizophrenia refers to psychiatrists; cancer refers to oncologists; etc. There are a number of specialties responsible for treatment of alcoholism, as with other illnesses, but the primary one is addiction medicine. Is there a specific reason we should not include such a reference with alcoholism as we do for other illnesses? Drgitlow 02:05, 24 February 2007 (UTC)

I'm all for putting the info back in. --Elplatt 21:28, 25 February 2007 (UTC)

I didn't remove it, I moved it to its own paragraph. That paragraph is a stub, feel free to expand on it. In your original edit you stated that Addiction Medicine Specialists have tools for identifying alcoholism. This is somewhat misleading, suggesting that Addiction Medicine Specialists are the ONLY ones who have these tools. Considering that later in the article we list numerous online resources, I felt that we were contradicting ourselves. Nonetheless, I agree that the specialists should be mentioned as a way of letting people know the specific words they should look for when trying to find a medical professional to help them with the problem. I think you two will do an excellent job at explaining why such specialists have the best qualifications for treating alcoholism. --Robert Rapplean 01:31, 26 February 2007 (UTC)

OK...I'll take another look at that. By the way, what you say is often true, at least in the medical field. For example, a patient with diabetes can be treated by an endocrinologist, a family practice specialist, an internist, or a pediatrician (if a younger patient). The medical literature generally supports the concept that the best outcomes exist when patients are seen by clinicians who specialize in the field of interest. My usual recommendation is that a patient with a chronic illness be seen at least once by the specialist, then followed by the clinician of their choosing. Drgitlow 04:35, 1 March 2007 (UTC)

I love what you've done with this place!

Every so often I swing back by this article, and it seems better and better each time. I recall a time period when for a months or so it would be AA based, then some odd chelation/dietary/astro-healing based, then some unsightly abomination attempting to preserve all the original text... and now it seems to be encyclopedic, non-biased, and pretty much backed up by verifiable citations! Kudos, Folks! Ronabop 05:07, 28 February 2007 (UTC)

Funny Pair of Phrases

It is common for a person suffering from alcoholism to drink well after physical health effects start to manifest. The physical health effects associated with alcohol consumption are described in Alcohol consumption and health, but may include cirrhosis of the liver, pancreatitis, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies, sexual dysfunction, and death from many sources.

How often to people continue to drink after the physical health effect of, uhm, death? :D Ronabop 05:45, 28 February 2007 (UTC)

Hi, Ronabop, and thanks for the props! This comment gave me a good chuckle, but I'd have to say that when death occurs, the physical health effects of drinking alcohol have stopped manifesting. Robert Rapplean 18:36, 28 February 2007 (UTC)

Wish to contribute

I'd like to contribute to this article, at the very least at the level of general editing for flow and readability. If I am a registered user, why can't I edit under the semi-protection policy. Empacher 21:14, 9 April 2007 (UTC)

Welcome! Semi-protection limits users with accounts less than four days old from making changes. There's currently an ongoing discussion about the article in this section. You should at least read through that section before making any changes, but the more of the discussion you can read the better. --Elplatt 21:39, 9 April 2007 (UTC)

WITCH BURNING

Why do we need the label ‘alcoholic’? Yes, there are people whose consumption of alcohol is on balance detrimental to their well being, but there are people whose consumption of carbonated drinks (soda) or cholesterol is detrimental to their well being too. Do we feel the need to define who is, and who isn’t a ‘cholesterolic'? The reason we have trouble defining who is an alcoholic in rigorous scientific terms is because 'alcoholic' is a social construct and not a scientific one. This desire to mark people out with labels is as old as humanity. In earlier times I suspect the participants in this debate would have spent much time defining who is, and who isn't a 'witch' or a 'heretic' (choose your period in history).

Because biochemistry is unique to the individual it is impossible to say what the overall effects of alcohol consumption will be on any individuals 'balance sheet' of well-being.

When the word 'alcoholic' is used the instinctive tendency is to conjure up images of a shambolic unhealthy individual, maybe a social outcast, these images have been taught to us by years of movie making and literature. We too may have come across extreme alcohol users who confirm this stereotype. It is said that Winston Churchill spent the entire second world war drunk, I wonder if the sober reader of this article has lived a life as full as Britain's former Prime Minister.

I think we need to have a new debate, who in our society is a 'label-olic'.

I think what is happening is that the mental health profession profit more from having more people labled as 'alcoholics' (Just as they do for ADHD etc). I have taken several of the on line tests as an experiment. I tried different levels of alchohol comsumption. It seemed to me that no matter how low your consumption is the test will say you have a problem and should seek help. Excessive coffee drinking can make one drive badly yet no one is tested for that after an accident. Many small cities get a lot of income from DWI arrests and fines. I am not saying there are not some real problem drinkers but it seems now that there no level of alcohol consumption which the mental health community will feel is acceptable. Then on the other side there is evidence that say 1 or 2 drinks a day is beneficial. But if you drank that much you would be considered an alcoholic. The 'alcoholic' in many ways (as the smoker) has been a bit of a scapegoat for society's ills. I would like to hear from the mental health community what amount of alcohol a person could consume and not be labeled a 'problem drinker' or 'alcoholic'. Maybe this whole side of the issue could be brought up in the article. 69.211.150.60 13:09, 27 April 2007 (UTC)

( THINKER 26.04.95) —The preceding unsigned comment was added by 86.9.138.200 (talk) 06:56, 26 April 2007 (UTC).

The topic you suggest, again, is not appropriate for an informational article. It is a topic for a forum of debate.

As to your request, the consumption of alcohol to the point where that alcohol consumption does not impair the individual by virtue of the medically defined standard used by law enforcement to determine intoxication leaves one outside the diagnostic category.

Any individual who engages in the consumption of alcohol to the point of impairment on a regular basis (i.e., daily and/or several times a week), binge drinks, maintenance drinks, or uses alcohol to self-medicate, can be classified as having a drinking problem, being a problem drinker (they are different) or being an alcoholic. That's it. Empacher 17:29, 27 April 2007 (UTC) aka a member of the mental health community.

But how do we define or measure an 'impairment'? Is there anything wrong with self-medicdiation? I would like to see in the article some mention of the benefits of alcohol and how some feel that many in the mental health community are over diagnosing. 68.109.234.155 18:20, 27 April 2007 (UTC)

Alcoholic is not a label. It is an acknowledged part of the medical nomenclature. Empacher 20:02, 26 April 2007 (UTC)

Do I really need to explain that one description doesn't preclude the other? A giraffe does not stop being an animal because it is also a mammal.

(THINKER 27.4.07)

Kindly read the disclaimer at the top of this page regarding conversational etiquette.

It is easy to snipe when you are not a registered user. Further, you have been making contributions only since April 4th, and those you have made have no relevence to this topic, or those topics related.

Finally, this is a discussion page intended for discussion of the article, not a forum to debate one's personal POV on nomenclature and its applicability. This article is controversial, and those contributing are working hard to help it along. That said, any useful contributions are welcome. Otherwise, you may wish to find a bullentin board or chat room more suited to your needs. Empacher 12:54, 27 April 2007 (UTC)