The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker. The persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death. (Big Book, Chapter 3) The founders of AA suggest that attempts at moderation provide the best litmus test for alcoholism. In their view, drinkers that are able to cut back without abstaining are not alcoholics because they haven’t become powerless over alcohol. Heavy drinkers that are able to moderate their drinking may be more like people with early-stage heart disease.

The ugly illness of alcoholism and addiction
A couple weeks ago, my wife, kids, and I boarded a plane home from the “happiest place on earth.” We’d gone to Disney World so that my partners and I could attend Mass General’s course on evidence-based treatments for addiction. As the plane taxied to the runway, we became aware of a heated exchange from the row just in front of us. Apparently, a woman had boarded the plane intoxicated, and another passenger had complained about her condition.

Many chronic illnesses involve dysfunction in the systems that keep our bodies in healthy balance. Heart disease involves dysfunction in the cardiovascular system whereby the fine balance between high density lipoproteins and low-density lipoproteins becomes skewed and results in a gradual restriction of the small blood vessels. Diabetes involves an imbalance between the sugars we take in and the insulin we produce to facilitate storage of this important energy source.

Alcoholism was first defined by the American Medical Association as an illness in 1956 and a disease in 1966. Today the disease theory of addiction continues to cause controversy. People with addiction are not permitted to receive Social Security Disability benefits unless they can show that their impairment results from a disease other than addiction. As recently as 1988 the US Supreme court upheld the Veterans’ affairs explanation of “primary alcoholism” as a problem resulting from “willfull misconduct.” Veterans with such primary alcoholism or drug addiction are not entitled to disability benefits due to addiction or to any disability (such as cirrhosis of the liver) that results from addiction. (It is curious to note that this policy applies to diseases resulting from alcohol and illicit drug addiction, but not to diseases that result from the world’s biggest addictive killer—smoking.)