Talk:Alcoholism/Archive 3

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Starting our work

The article starts with:

Alcoholism is a condition within the Substance Use Disorders category that describes a multifactorial condition widely believed to be based upon both genetic (Lowinson JH, Ruiz P, Millman RB, Langrod JG. Substance Abuse, A Comprehensive Textbook, 4th Ed. 2005) and environmental factors.

This sentence has been edited so much as to no longer make grammatical sense. From a medical perspective, alcoholism is but one of the substance use disorders. While it is only one, it is also the most prevalent and most costly to our society when compared with the others. Alcoholism is 20x or so more prevalent than opioid addiction, for example. Perhaps that information should be in the leading paragraph? The citation here is one of the two major textbooks in the field of addictive disease and the content of this sentence is more or less the first line of nearly all the major texts in the area. But interestingly, we haven't said what the condition is, and that could be a much better introduction.

It's easier to say what alcoholism is NOT. It's not heavy drinking. It's not illegal use of alcohol (e.g. a 15 year old drinking). What I'd like to do is start off this way, and I've tried to temper wording in a manner I hope will be acceptable to all:

Alcoholism is a primary and progressive condition in which alcohol is used in an ongoing or intermittent manner despite one's best interest as measured via psychosocial function. In a 1992 JAMA article, the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine published this definition for alcoholism: "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, mostly denial. Each of these symptoms may be continuous or periodic."

I assume that some of you have another definition of alcoholism that you'd like to see in the lead-off paragraph, so perhaps the lead-off should also have an alternative definition for readers to consider? Drgitlow 20:42, 3 July 2006 (UTC)

I don't know if alcoholism is officially classified as a disease under medical definitions, but the current introduction is horrible, in defining it specifically in terms of a medical condition under categories and then filling up with a bunch of references from medical societies. This is a general-purpose encyclopedia, not the DSM. Even a medical encyclopedia would never start off an entry this way. For comparison, here is the first paragraph of the Britannica introduction, s.v. "Alcoholism":

excessive and repetitive drinking of alcoholic beverages to the extent that the drinker repeatedly is harmed or harms others. The harm may be physical or mental; it may also be social, legal, or economic. Because such use is usually considered to be compulsive and under markedly diminished voluntary control, alcoholism is considered by a majority of, but not all, clinicians as an addiction and a disease.

Here is the first sentence of the article at Medline Plus[1]:

Alcoholism is an illness marked by drinking alcoholic beverages at a level that interferes with physical health, mental health, and social, family, or occupational responsibilities.

—Centrx?talk • 20:55, 3 July 2006 (UTC)

Drgitlow, I agree the intro needs some work and is fuzzy at best. Due to the lack of editorial consensus and the current demonstrated mistrust amongst most of us alcoholism editors here, I would suggest we put this one on one ice for the time being and instead let's get our feet wet on something slightly less caustic before we tackle the definition of alcoholism. I think we need some baby steps so to speak.

I am currently writing something to add to the Pro/Con section that I think will give us a good opportunity to learn how to establish editorial consensus and it's on a topic that is slightly less volatile. Realistically I think we are weeks (or longer) away from having an article that everyone feels does a good job of articulating the subject of alcoholism, so I think we can address some of the more explosive subjects best if we wait until we've got a little editorial consensus under our belts. That's my take on it. If you agree then by all means go ahead and write what you think would be appropriate but I would suggest you not present for comments on the talk page until we ("we" meaning all the editors who are either active or wish to be active when things cool down) have established an ability to work constructively together. Mr Christopher 21:03, 3 July 2006 (UTC)

Centrx, you make excellent points. You didn't suggest alternative wording, but taking your thoughts into account, perhaps an approach like this would be better:

Alcoholism is an illness in which individuals intermittently or continuously use alcohol despite such use causing them objectively determinable harm in areas of personal, social, educational, and occupational function or in terms of increasing medical complications. Alcoholism is diagnosed not by the quantity or frequency of alcohol used but rather by the degree to which alcohol's use has caused harm to the individual.

The textbook definition of alcoholism (the JAMA reference) can be incorporated into some of the following text. Since we have had ongoing discussion regarding different opinions on the subject, it might be useful to have sidebars of boxed text to the entry that include the DSM-IV definition, the JAMA article definition, as well as any other pertinent definitions.

All that being said, I agree with Chris's point above as well and don't mind just coming back to this once we're done working elsewhere in the article. I don't even know if Chris and others feel the same way about the word "illness" as they do about "disease." The two words have different meanings to me: a broken bone is a disease, but not an illness; but I don't know if there's a standard there or not. Drgitlow 21:12, 3 July 2006 (UTC)

I think you both make very good points, I simply think this specific subject is ripe for a nuclear reaction, at least at the present. For me, this one merits waiting for a cool down as well as some consensus building experience. Mr Christopher 21:19, 3 July 2006 (UTC)

Hmmm...should we take the 4th off and agree not to even visit the page? :) Drgitlow 21:29, 3 July 2006 (UTC)

Personally, for now, I don't plan on changing anything in the article (other than a typo or broken link) without some sort of editorial consensus, no matter how nutty the article might get. And your suggestion for taking off the 4th sounds like a plan. I'll not add the ideas I previously spoke about to the talk page until after the 4th. Mr Christopher 21:49, 3 July 2006 (UTC)

I think, though, that we can agree that it's a "health condition", which is to say a condition that effects a person's health. Does anyone have a problem with that? Robert Rapplean 21:34, 3 July 2006 (UTC)

I have used "diseased condition", meaning that the body is not functioning normally or properly. I made it so that excessive drinking causes the diseased condition, which is absolutely true, not that excessive drinking is a disease caused by biological factors, which seems to be what is the contention. —Centrx?talk • 22:07, 3 July 2006 (UTC)

Alcohol intake itself can cause disease. It can cause hepatic difficulties, dementia, and so forth if taken in sufficient quantity. What it can't do is CAUSE alcoholism, although the condition can't be identified and diagnosed in the absence of alcohol use. Push comes to shove, there will probably come a day when we can identify individuals who are predisposed to develop the condition prior to their ever using alcohol. But that day isn't here yet. And then you get into the whole "What's a disease?" issue. Let me give an example: Imagine I have a patient with Huntington's. He has the gene but no signs or symptoms of the disease yet. We know that between age 35 and 50, he will begin showing the onset. Would you say he has the disease at age 20? Or must it wait for symptoms?

Similarly with alcoholism, if I take an alcoholic and move him to an alcohol-free environment, is he still alcoholic? What if he hasn't started drinking yet, but my crystal ball shows the future and sees that he will? Is he alcoholic now? That difficulty is part of why docs don't typically relate the disease to alcohol use itself.

So I agree that excessive drinking is not a disease. But excessive drinking does not cause the condition of alcoholism either, though SOME drinking is necessary for the condition to be present. If you want my opinion, what I tell patients is that alcohol use is simply a marker for the presence of the disease, which typically is more an issue of a failure for them to have learned how to relate on an emotional and intimate basis with other people combined with some genetic issue that causes them to have an unusual response to alcohol that on a short-lived basis helps them to feel better. That's in my textbook and is educated opinion, but I acknowledge that it's my opinion and not a belief that is necessarily shared by all addiction treatment professionals. Does it have a place in this article? Up to you all...it's in the book so I suppose it could be cited. :) Drgitlow 00:49, 4 July 2006 (UTC)

Disease arguing moved to a more appropriate spot

In short, Centrx I like the introduction and think it's the closest thing we've had to NPOV yet. I have two intitiall thoughts. One is the ethanol article does not describe ethanol as a drug, there they define it as

Ethanol, also known as ethyl alcohol or grain alcohol, is a flammable, tasteless, colorless, mildly toxic chemical compound with a distinctive odor, one of the alcohols that is most often found in alcoholic beverages. In common usage, it is often referred to simply as alcohol. Its molecular formula is C₂H₆O, variously represented as EtOH, C₂H₅OH or as its empirical formula C₂H₆O.

We'd be wise to not call ethanol a drug. Otherwise I this is a good place to reach a consensus. I think it does a pretty good job of tipping it hat to the medical community's take on the issue without assuming their POV. I'm sure some of the finer points could be expanded upon or even debated but we're better off with something brief and agreed upon. It is because the opening entry is no longer claiming alcoholism is a disease (what I have been calling the "AMA POV") that I think referencing the debate introduced by Medical Man in the opening section might be misplaced. To me those viewpoints should be heard but in a more logical section. You and I share some similar concerns so if you think I'm bonkers let me know. But the opening section does not glamorize the disease concept so I'm thinking this is a good compromise. I think the overall article will read better if we correctly categorize where conflicts in opinion are strategically best placed keeping in mind we don't want to silence any voices (verifiable, reliable, etc) on the subject. Anyhow, we gotta start somewhere, might as well be at the top of the article in the opening definition. Mr Christopher 05:40, 4 July 2006 (UTC)

The reason I included the ethanol mention is so that the introduction explicitly states the mechanism by which alcoholic beverages could ever cause any harm or why they would be used despite detrimental effects. It seems obvious to us, but a child would not know and perhaps others, and it should anyway be written for the ages. Most introductions to common subjects seem rather obvious to the average intelligent reader, but it is to introduce the unfamiliar reader and to exactly define the subject. Ethanol (an unusual name too) may not be the best to link to, because that article is primarily about its chemical properties. An alternative is Effects of alcohol on the body.

Alcohol is a drug. Specifically, it has a direct, substantial effect on the physiologic function of the body. There may have been some popular mutation of the term in the last 30 years, but the fact remains that aspirin and cocaine are both drugs, and that ethanol is a psychoactive drug. Both Effects of alcohol on the body and Alcoholic beverages agree. This is not to imply any Drug War hysteria or any sinister will-circumventing influence. —Centrx?talk • 06:31, 4 July 2006 (UTC)

Medical Man Citations

Medical Man has made several citations in the last sentence of the opening paragraph, but the citations are simply a list of names rather than references. We need the actual references for (U.S. Supreme court, Fingarette, Peele, Schaler, Hobbs, Meyer, Kolata, Korhonen, Nackerud, Kelly, Doweiko, Levy, Maltzman). Drgitlow 01:28, 4 July 2006 (UTC)

Apparently, they are listed at the bottom under section References. Still, the introduction should not be cluttered with this many sources. If there is a controversy, it belongs in its own referenced section, with a statement about it in the introduction that is in reference to that section but without so many sources, many of which are rather tangential to the matter. —Centrx?talk • 03:34, 4 July 2006 (UTC)

—Reposted 07:15, 4 July 2006 (UTC)

I think part of the trouble we're having is based on terminology issues. When one of us uses a term like moderation, addiction, disease, etc., I suspect we're all thinking of different things. You're describing behavioral modification, I think. Can you post (repost?) the citation as to the efficacy of that approach for treating alcoholics?

The reason so many alcoholism treatment professionals reject the idea that alcoholics can drink in moderation is that it is completely inconsistent with the disease model. For many decades, all evidence that some alcoholics could learn to drink in moderation was dismissed as a fluke, as erroneous, or as impossible. It was rejected because it was a threat to their firm belief that alcoholics can never drink in moderation. When faced with increasingly strong evidence that some alcoholics can drink in moderation, they fell back on the lame argument that those successful people couldn't have been alcoholics or they couldn't have drunk in moderation! After all, they argued , and still do that , "an alcoholic is someone who must abstain because he or she can't ever learn to drink in moderation."

Reminds one of Freud's assertion that men could not suffer hysteria because it was defined as a disese of women. Or Jellinek's assertion that "a disease is anything the AMA says is a disease"! Or some of the arguments we've been getting trying to rebut evidence that there is no consensus about the disease concept of alcoholism in the alcoholism field.

However the NIAAA reports that about 18% of US alcoholics are now recovered (its term) and drinking in moderation (its term). [2]Medical Man 00:31, 5 July 2006 (UTC)

Problem with "intermittent or continual"

Textually, this means that any drinking at all, whether it be often or only intermittently every now and then, is alcoholism. The "excessive" is important, and something like "habitual" or "repetitive" is also. —Centrx?talk • 07:14, 4 July 2006 (UTC)

Hmmm, no, that's not the intent. I'll try to reword it. The problem is that an individual can have alcoholism but drink only rarely. A heavy drinker, on the other hand, might not have alcoholism. The disease is independent of the quantity of alcohol intake. Imagine, if you will, a binge drinker who doesn't drink for long periods of time, but then drinks to the point of oblivion, losing his job in the process and ending up in the hospital with DT's. His total alcohol intake might not be very much compared to your average college student, but he's alcoholic and the college student probably isn't. Drgitlow 13:56, 4 July 2006 (UTC)

I think the article would be incomplete without the APA's stance that lighter drinking can also be a sign of alcoholism as well as their definition of alcoholism. By introducing this in the opening paragraphs we're inviting more contention. I think there is a more logical place to put the APA's stance. To me the entry needs to be as contention proof as we can make it. Mr Christopher 15:16, 4 July 2006 (UTC)

I don't think that's the APA's position necessarily. The DSM diagnostic criteria don't address intake levels at all. I just looked through the DSM section and didn't see anything on light drinking versus heavy drinking. It's not that lighter drinking is a sign of alcoholism -- I'd never try to argue that light drinkers are, in general, alcoholics. I think in general (vast majority of the time) they are not. (We all agree on that, right?) The criteria are saying only that one need not be a heavy drinker to suffer from alcoholism. In my last edit, I tried to remove any indication of light versus heavy from the opening paragraph so that the condition is noted to be present solely based upon the effects of alcohol. I think that's consistent with the DSM definition, with the JAMA definition, and with your perspective as well, is it not? Happy 4th, by the way! Drgitlow 15:53, 4 July 2006 (UTC)

Well rain ended the fireworks display too soon but other than that things are swell this holiday weekend. Yes your latest edits to the entry are good and advance the cause of consensus building as well. Nice. I think we have made some significant recent strides. Mr Christopher 17:03, 4 July 2006 (UTC)

Definition of Alcoholism

Robert Rapplean, I hope you won't be angry that I copied this quote of yours from outside WP. I have been following the discussions and I think that you have a very valuable insight with this definition; I'd like to share it here for the sake of us who don't have doctorates but do have an interest in improving Wikipedia:

• Alcoholism is a health condition characterized by impaired control over drinking habits, preoccupation with the drug alcohol and events surrounding the drinking of alcohol, and use of alcohol despite adverse consequences. It does not refer to heavy drinking, although that is one of the primary symptoms of it.

I think that this is an excellent definition, or at least represents the beginning of one, because it is readily understandable to a layman who is looking for basic information on the topic. I think it's very important that the introductory paragraph of an encyclopedic article should:

1. be as clear and concise as possible.
2. be intellectually accessible to the majority of readers.
3. be free from controversial issues which can reasonably be dealt with later in the article.

The fact that your definition avoids "alcoholism-as-disease" would seem to be a net benefit. That 'discussion' should probably have its own section with pros and cons presented there, rather than in the introduction. Obviously I lack the academic background to contribute to this article, but I hope that what I've brought up here will help give more of a "reader's-eye view". BTW - I appreciate the fact that everyone working on this article has done so well maintaining civilty and good faith; it's a nice contrast to certain politacal and religous articles that I wouldn't touch with a 3 meter keyboard :) --Doc Tropics ^{Message in a bottle} 17:45, 5 July 2006 (UTC)

Doc Tropics ^{Message in a bottle} Welcome to alcoholism! I appreciate your contribution and hope you plan to dig in and help us improve this article. I do have a concern, though. My concern is if we are not careful we will be redefining alcoholism every other week. Before we consider yet another definition I'd like to hear who objects to the existing definition and why. I could be wrong but I think we are close to getting editorial consensus on the existing definition, though there seems to be a lingering disagreement as to whether indroducing the debate over the disease called alcoholism belongs in the opening definition or not.

But again, we can write a new definition but is there a reason to do so? I'd like to first hear the comments of any editors (including yourself, Doc Tropics) who object to the existing definition and why before we consider replacing it with something else? Does that seem fair? Mr Christopher 17:58, 5 July 2006 (UTC)

Oh gosh, I certainly wasn't suggesting a rush to undo the hard work you've put into building consensus there! It's just that from a layman's standpoint the intro seems both dense and unwieldy; from an editor's standpoint it seems that some of that info could be used to best effect elsewhere. I didn't mean to muddy the waters here, but when I found that Robert Rapplean had produced such a clear and simple definition I found it very appealing. I certainly understand your concern about "...redefining alcoholism every other week". Stability is important to an article like this, and lack of stability on an important topic is potentially damaging to WP's credibility. I have no intention of 'interfering' with the good work you've all done on this article, I was just offering up something that I had hoped would be useful. --Doc Tropics ^{Message in a bottle} 18:20, 5 July 2006 (UTC)

Doc, your suggestion was an excellent one and I explained (and you heard and understood) my reasons for not taking your suggestion, at least not yet. And please do not back peddle too far, I have read some of your Wiki contributions and we can use experienced editors like you here. And I might be smoking crack, the other editors have yet to clearly chime in on the existing definition so it's possible I am the only one who finds it acceptable. Mr Christopher 18:32, 5 July 2006 (UTC)

Don't mind your using my words at all. The reason for making this kind of change (although not specifically this change) is a matter of linguistics. Precision, conciseness, and information density are all important when creating a written work. Let me give you a few examples. Here's the current entry:

Alcoholism is the use of alcoholic beverages—which contain the drug ethanol—to the extent that such use causes physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life.[1][2] Such chronic use causes a diseased condition marked by psychological and physiological disorders. Most medical clinicians consider alcoholism an addiction and a disease influenced by genetic, psychological, and social factors and characterized by compulsive drinking with impaired control, and preoccupation with and use of alcohol despite adverse consequences. However, the disease theory is still controversial and there is disagreement on the issue after 200 years of debate. U.S. Supreme Court decisions, books and scientific journal articles demonstrate this lack of consensus.

"the use of alcoholic beverages" is imprecise on one side and too precise on the other. Use could mean rubbing it on one's skin, for instance, thus I would replace it with the word "consumption". Also, alcoholic beverages is too precise. You don't need to specify beverages when you're consuming them, and alcoholics will drink straight grain alcohol. Everclear COULD be considered a beverage, but mostly it's an ingredient to be added to beverages, kind of like sour mix but with a kick. Thus "consumption of alcohol" would be better, and save us a couple of words. When a reader has to read too many words their attention drifts and their eyes cross.

DrGitlow: I agree that "use" is vague because it doesn't necessarily mean "imbibe." I'd be all for changing "use" to "drink," "imbibe," "consume," or some equivalent. It was a quick fix a few days ago.

Also, alcoholism ISN'T the consumption of alcohol. It's the DESIRE to consume alcohol. That's the whole "dry drunk" issue. If you're an alcoholic you can't even have one drink because it leads to binge drinking. An alcoholic who doesn't drink is still an alcoholic because any amount of drinking can result in drinking until he/she's unemployed and hospitalized. The cessation of drinking does not cure a person of alcoholism.

Also, we keep stating that the use of the word disease is controversial, and yet it appears three times in the introduction. If something is controversial, you don't use the opening paragraph to drill it into people's head. The heavy debate over whether or not alcoholism is a disease is taking over this page, and it's totally useless to those who are suffering from it instead of legislating about it. Can we please get a vote about whether or not we can move it to its own page?

Also, you're trying to pack too much information into the first paragraph, meandering over various points which are in heavy contention. The purpose of the first paragraph of a wiki article is to give the reader an operational explanation of what the topic is, not gloss over what everybody thinks about it. All of the arguments about alcoholism involve categorization, and we can get into the debates about alcohol later in the article. For the first paragraph we should provide a description of its functional impact on an alcoholic.

Thus, I would edit the first paragraph to read:

Alcoholism is a craving for alcohol that encourages the drinker to consume it beyond the point where it causes physical harm or interferes with the drinker's family, social, or work life. It is characterized by heavy drinking, but persists indefinitely even after an alcoholic maintains abstinence.

You'll notice that I completely skipped over trying to categorize it as a disease, addiction, or even a health condition because that's not nearly as important as describing it functionally. Also, I didn't specify what kind of alcohol because craving rather strictly implies consumption, and there's only one kind of alcohol we consume. In fact, ethyl alcohol is though of as the "default" alcohol, all other forms of alcohol requiring specification. We can link it to the ethyl alcohol page if people need further specification.

In the pre-Gitlow article the next section explained the terms used to describe alcoholism so that the rest of the article made more sense. The addiction article is useful, but it's necessary to break out the various forms of addiction within this specific article because alcoholism is the result of a collection of them, all of which must be treated individually. A casual reader is very likely to just gloss over a link to addiction and assume that they understand what it means.

Following that, I had it arranged (yes, that was my work) so that it progressed through the details of alcoholism in the order that they tend to impact an alcoholic and/or his family. I believe that the order was health problems, social problems, treatment options, societal impact, and political issues. Various ways to identify if you're an alcoholic would have been the first section of treatment options, but theoretically the descriptions under health and social problems would provide the reader with enough background to decide if it's worth it going off site to take a test.

When continuing the editing of this article, please keep in mind that we should be creating an article with content that is of value to the reader, not what you personally want the reader to know. Robert Rapplean 19:14, 5 July 2006 (UTC)

Here is my take on the existing paragraph sans the debate piece (which I think is not in the correct location):

Alcoholism is the use of alcoholic beverages—which contain the drug ethanol—to the extent that such use causes physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life.
Mr Christopher: This is acceptable to me, and I suppose we could change the "use" to consumption, but I really think anyone reading it will know we're talking about drinking alcohol and not rubbing it on our arms. This seems NPOV to me and there is nothing subjective about it.

Robert: Can anyone point me to a text that states that a drinker needs to be actively drinking in order to be an alcoholic? To my knowledge, there is no dividing line for abstinance at which a person suddenly stops being an alcoholic. The "which contain the drug ethanol" is entirely superfluous and breaks the flow of the statement.

Such chronic use causes a diseased condition marked by psychological and physiological disorders.
Mr Christopher: This is acceptable to me. Alcohol can cause all sorts of verifiable medical conditions. This seems NPOV to me and there is nothing subjective about it.

Robert: I disagree with this because it states that chronic consumption of alcohol automatically results in "a diseased condition". This is equivalent to stating that alcholism is a disease, which violates NPOV. We could replace this with "Such chronic use can result in many physical and mental health conditions." Be sure when you write this statement that you maintain cause and effect "alcoholism" causes "overuse" causes "health conditions". Short term alcoholism among the young and otherwise healthy mostly just causes gastritis and sleeping problems.

Most medical clinicians consider alcoholism an addiction and a disease influenced by genetic, psychological, and social factors and characterized by compulsive drinking with impaired control, and preoccupation with and use of alcohol despite adverse consequences.
Mr Christopher: Again, I think this is a reasonable sentence. This seems NPOV to me and there is nothing subjective about it.

Robert: I'm ok with the content, but feel that the very fact that you have to include "most" as the first word suggests that it should be de-emphisized to a later paragraph.

Mr Christopher: Some points you made which I do not wish to debate with you or anyone else but I feel they are highly subjective and invite debate/contention:

Alcoholism is a craving for alcohol that encourages the drinker to consume it beyond the point where it causes physical harm or interferes with the drinker's family, social, or work life.
Mr Christopher: "Craving" is a subjective term in this context and we'll be debating a definition for it as well. In this context one does not have to even drink alcohol to be an alcoholics, they just need to "crave". This seems highly subjective to me.

DrGitlow: The use of the term "craving" doesn't work though because alcoholics don't generally have craving the way opioid addicts do. In fact, one of the reasons the World Health Organization didn't recognize alcoholism as a disease back in the 50s was because craving was one of the defining points of addictive disease (and alcoholics don't have that). Ask an alcoholic who has relapsed why he relapsed and he will generally say it was an impulsive action based on availability or proximity. That differs from opioid dependent folks who acknowledge craving. (Since the '50s, the WHO changed the requirement for craving for addictive diseaes and added alcoholism to the category).

Robert: Ok, let's roll with the idea that "craving" is subjective. I've also used "desire", and you've used "preoccupation". Any of these would work for me.

What's the difference between window cleaner and alcohol? An alcoholic can forget that window cleaner exists. Personally, I have about fifty bottles of alcohol in my basement, but I forget they exist unless something reminds me of them. Alcoholics can't do this. It's part of any recovery program to dig out all of the bottles that an alcoholic has hidden away and get them out of his reach.

Answer me this: If there's no craving, why can't he ignore a bottle of alcohol the way he can ignore a bottle of window cleaner? The level of effort an alcoholic has to go to to get his hands on alcohol is certainly a factor in relapse, but if an alcoholic doesn't crave alcohol, why does he ever drink it again?

Go to an AA meeting and ask 100 people to tell you about their last relapse. The story you'll hear repetitively will be one like these...I was in my apartment and I found an old bottle of bourbon that I'd hidden in the back of the closet; I was walking down the street and suddenly found that I was in front of a bar where I used to hang out; I went out with some new colleagues from work and they all ordered wine with dinner. Those are different stories than the ones you'll hear if you went through the same exercise at NA where the people who relapsed did so because they actively sought out the drug even after a period of abstinence. I'm not saying this is true 100% of the time, but I think it's reasonably accurate. The alcoholic drinks again for many reasons: he/she wants to be "normal," and everyone "normal" seems to drink alcohol from time to time; he/she is uncomfortable, unhappy, stressed out, irritable, and realizes that alcohol will help all those feelings go away if only for a little while; it's a recognition that alcohol will help you feel better as opposed to the type of craving one might have for food if you haven't eaten in 1-2 days. Drgitlow 01:40, 7 July 2006 (UTC)

It is characterized by heavy drinking, but persists indefinitely even after an alcoholic maintains abstinence.
Mr Christopher: No offense, Robert, but this sounds very AAish to me ("persists indefinetly"). Again, I find it highly subjective and think it invites debate/contention.

Robert: I only know people for whom the desire to drink has persisted for about five years. I'll have to see if I can dig up a few abstinant alcoholics who can give me a better long-term view of the experience. I do know, however, that the inability to drink even small amounts without danger of overdrinking persists indefinitely.

Mr Christopher: And we'll also have to define "heavy drinking" and who's definition shall we use for that? Fingarette's? And fellow editor Drgitlow has suggested "heavy drinking" is not a sign of alcoholism (at least I think so, correct me if I am wrong Stuart).

DrGitlow: And thanks, Chris, yes, heavy drinking isn't required for the diagnosis, nor does heavy drinking mean that one has the diagnosis. And the definition of "heavy" of course varies depending on gender, weight, age, and overall medical status, so it's not a useful term either diagnostically or educationally.

Robert: Ok, I'll retract the "heavy drinking". That was a spur of the moment characterization based on various studies, which generally define it something like "five or more drinks on one sitting, or drinking on five or more occassions in one week", but again that's subjective. We could use "chronic consumption of unhealthy amounts of alcohol", and possibly point to the section somewhere below which lists the side-effects of overconsumption of alcohol.

Mr Christopher:So, to me, the existing definition (without the debate piece) is less subjective and less prone for debate and having to define additional terms. You have made some very good contributions to this article and although I have not responded to all your comments, I have read them all. I am only one editor here but I think the existing definition is far less subjective and therefore will best serve our readership.

Robert: I've broken it down into individual points of contention, with point and counter point. I'm looking for additional input.

FOLLOW UP: I can see where some might object to this piece in the existing definition:

• Most medical clinicians consider alcoholism an addiction and a disease influenced by genetic, psychological, and social factors and characterized by compulsive drinking with impaired control, and preoccupation with and use of alcohol despite adverse consequences.

Unless we cite a poll that indicates most clinicians think alcoholism is a disease we're not presenting a NPOV. To me this is the only sentence that has some subjectivity to it and I would therefore suggest we work on that single sentence. Again, this my take on it. Mr Christopher 20:46, 5 July 2006 (UTC)

We do have that 2001 article that Medical Man brought up in which 82% of docs said alcoholism is a disease, so we could use that as a citation to meet Chris' point above if we decide that's the direction we all want to go.

It's nice to see some new names here. I think we've made some wonderful progress lately but the more input the better. I think we can end up with an article that really addresses the key features of alcoholism while creating some sections within which all perspectives can be explained.

Drgitlow 23:02, 5 July 2006 (UTC)

Request For Editorial Consensus

For now, can we agree or disagree on the following two initial sentences of of the existing definition:

Alcoholism is the use of alcoholic beverages—which contain the drug ethanol—to the extent that such use causes physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life.[1][2] Such chronic use causes a diseased condition marked by psychological and physiological disorders.

Please show your approval or disaproval with your signature thusly:

• Approve <signature>
• Disaprove <signatue>

Indicate your position below this line

---

• approve Mr Christopher 23:15, 5 July 2006 (UTC)

I am not changing my "vote" but ethanol seems to be the hot topic so I thought it's worth mentioning I have already expressed my concern about ethanol and I'd be in favor of seeing it go. It could prove to be relevant elsewhere else but not in the definition. Mr Christopher 04:29, 6 July 2006 (UTC)

• Approve - relatively clear and concise, but hits the most important points. Well done :) --Doc Tropics ^{Message in a bottle} 23:55, 5 July 2006 (UTC)

Comment: after reading later contributions I agree that the hyphenated ethanol statement could be deleted or moved to help maintain continuity. --Doc Tropics ^{Message in a bottle} 03:58, 6 July 2006 (UTC)

• Approve Medical Man 01:44, 6 July 2006 (UTC)
• Approve (am OK with either "use" or "consumption")(am also OK either keeping or removing the hyphenated statement about ethanol) Drgitlow 03:52, 6 July 2006 (UTC)
• Disapprove Robert Rapplean 07:05, 6 July 2006 (UTC) I believe that the current first sentence fails to differentiate between a person who hasn't figured out that alcohol is harming them and a person who knows that it's harming them but can't quit on their own.

Oops, Robert. I earlier missed your comment about the "--which contains the drug ethanol--" being unnecessary and breaking the continuity of thought, to which I totally agree. Therefore, I don't think the current first two sentences are completely acceptable. I apologize.Medical Man 03:12, 6 July 2006 (UTC)

Medical Man, are you changing your previous "agree" to "disagree"? It's not clear to me in your comments, I'm cool either way, no need to apologize, I just want to make sure we're on the same page. And if that is the case I'd be hip to you changing your approval above and adding a comment like "previously agreed" or something for clarity.

Chris- Thanks for your understanding. I don't want to slow up the good progress that's recently been made and I think drgitlow's suggestion below neatly solves the problem.Medical Man 15:49, 6 July 2006 (UTC)

Robert, I read your latest comments and agree with you on much of it. I do not believe this will be the final word on the definition but to me it will give us a "beta" version, one that isn't exactly the way I would personally write it but it does not offend the senses. I view it as a editorial compromise that does not compromise the integrity of the article. I think the average reader would find it sensible. I agree it is imperfect and if we fail (in this round) to get consensus on the first two sentences we'll simply try again. Mr Christopher 04:08, 6 July 2006 (UTC)

I want to be clear, I was mainly taking about the first two sentences in my comments to you above, Robert Rapplean. Since that is what I am currently proposing we agree or disagree on. I too have some issues with some of the rest of it that I'll view and seek comments on after we decide about the first two sentences. Sorry if I seem anal, just wanting to be clear. Mr Christopher 04:12, 6 July 2006 (UTC)

I agree the "which contains the drug ethanol" breaks up the sentence badly, but something in reference to "drug" or "ethanol" or "Effects of alcohol on human body", or whatever that article is called, should remain. —Centrx?talk • 07:23, 6 July 2006 (UTC)

Centrx, I agree in that that ethanol belongs at least somewhere in the article. Since this seems to be an editorial sticking point, at least as it is currently written and in the opening sentence/definition, would you feel comfortable if we either put it elsewhere in the article or put it on ice for the time being where we can revisit the merits of it being in the opening definition later? And by the way, you're being an exception sport about us all sitting here nitpicking your handy work. I appreciate it. Mr Christopher 15:05, 6 July 2006 (UTC)

FYI there is some good stuff on ethanol in the Alcoholic Beverage article! Mr Christopher 15:17, 6 July 2006 (UTC)

It's unfortunate that alcohol is a generic term that refers to a variety of chemical substances that include ethanol, when really the only one we're concerned with here is ethanol. I suppose a more precise term would be Ethanolism. I don't suppose we could be single-handedly responsible for changing the terminology (though we could certainly try). Given that alcoholism is really talking only about ethanol use (consumption), it seems that we could change the first line to read "Alcoholism is the consumption of ethanol-containing beverages to the extent that such use...." Drgitlow 15:22, 6 July 2006 (UTC)

I agree with drgitlow's suggestion, which is both accurate and solves the problem.Medical Man 15:49, 6 July 2006 (UTC)

I don't want to be a stick in the mud but it still seems odd to me. In view of what FloNight added below, and as a compromise, how would you folks feel about us not putting the ethanol portion in the definition section, but instead make it the subject of the section following the definition where we could elaborate on the subject? So in effect we'd have

• Alcoholism - here is our handy definition of alcoholism - yadda yadda
• Alcohol - this is what constitutes alcohol, the key term here would be ethanol (yadda yadda).

Does that seem reasonable? Mr Christopher 16:55, 6 July 2006 (UTC)

To address my most recent comments, there is good stuff about ethanol on the alcoholic beverages article, but sadly it is not well cited. Stuart, on the ethanol topic I'd lean towards us handling it in a similar fashion on the alcoholic beverages article. Obviously I want to cite it better than what we see there but I think giving ethanol it's own section (within the article, not a spin off) makes sense to me. Mr Christopher 15:28, 6 July 2006 (UTC)

As for specialized terminology, we can still use the word "alcohol" rather than "ethanol", and either link it to Ethanol or to Effects of alcohol on the body. To clarify though, don't let this argument hold up the process of streamlining the introduction by removing this clause, at least temporarily. —Centrx?talk • 21:32, 6 July 2006 (UTC)

Regarding the nature of alcoholism

Question for Robert: You're right, it doesn't address that issue at all. I know that the distinction is important, but do you think it's absolutely necessary to address it in the very first sentence? I'm a fanatic about preserving useful information and I don't think anyone is suggesting that this point be excised, just shuffled around a bit. Could we, for the sake of our Hypothetical Reader, simply clarify that point later in the article? I'm hoping that if we can achieve even a general consensus on the intro it will give us a fresh start on collaborative editing and help the article move forward :) --Doc Tropics ^{Message in a bottle} 16:12, 6 July 2006 (UTC)

I'm afraid this is a bit of a sticking point with me. This definition states that drinking=alcoholism. If that were the case, there would be no studies which measure time until relapse. Once you stop drinking, you'd be cured. Because of this, I think that the first sentence dangerously mischaracterizes the problem.

The essential problem with alcoholism isn't that the alcoholic drinks. The problem is that they can't stop drinking. It's the urge to drink regardless of obvious consequences that identifies an alcoholic, not the actual consumption. This is an essential fact about alcoholism that must be understood for a person to understand alcoholism. I'll go even further to say that this is one of the biggest misunderstandings in the public regarding alcoholism, and results in the greatest amount of mistakes in its treatment outside of the medical field. I'm afraid I can't accept any description that doesn't address this. Robert Rapplean 17:11, 6 July 2006 (UTC)

Thanks for taking the time to make such a thorough reply; I understand and respect your postion on this. Flonight has given us an excellent guideline in a new section just below this. Let's try to find an intro that will satisfy everyone, but still be accessable to an "average" reader. To help get started can you give us an example of what you think would be a better wording for the intro? Since it seems that the rest of it is (mostly) acceptable to everyone, can we still use that as a framework and just add the necessary distinction? --Doc Tropics ^{Message in a bottle} 17:38, 6 July 2006 (UTC)

I think this can be achieved with a very minor change, thus:

Alcoholism is the urge to consume alcoholic beverages to an extent that results in physical or mental harm, or interferes with the drinker's normal personal, family, social, or work life. The resulting chronic use can result in many psychological and physiological disorders.

Opinions? Robert Rapplean 18:27, 6 July 2006 (UTC)

• Approve - This version seems to incorporate the suggestions made in discussions of the previous version and it seems very readable to me. I tried to bluelink "chronic", "psychological" and "physiological", but the results were non-useful and I didn't save that copy. --Doc Tropics ^{Message in a bottle} 18:58, 6 July 2006 (UTC) Addendum - I tried to bluelink from this page but didn't get the tags right. The bluelinks from the article page are good. --Doc Tropics ^{Message in a bottle} 19:07, 6 July 2006 (UTC)

Comment - I have temporarily stricken my Approval pending resolution of Mr Christopher's concerns (see below).

The opening sentence has two cites for reliable sources, those sources are other online encyclopedias. It's worth noting neither of them use the term "craving" or "urge" in their definition of alcoholism. Those references are well worth reading and are pretty NPOV in my opinion (at least the definition, they get a bit goofier as they go deeper in the subject). Robert, what reliable sources do you have to support this sentence you are suggesting? And as far as my own opinion goes, I am not in favor of using terms like "urge" or "craving" in the opening definition and feel things like urges and cravings (and things like the idea of time abstinence) belong elsewhere in the article. If you have not already, I really suggest folks read the two existing references and see exactly how other online encyclopedias handle this subject. My $.02. Mr Christopher 18:50, 6 July 2006 (UTC)

Ok, let's do some citing. NIAAA attempts to explain craving mechanisms, American Academy of Family Physicians describes craving as a symptom, Alcohol Craving in Problem and Occasional Alcohol Drinkers from the Oxford Journal of Medicine, What Is Craving? Models and Implications for Treatment from Alcohol Research & Health, Fall, 1999. I have to admit that this entire argument has caught me rather flatfooted. It's almost like trying to explain to people that pain is a symptom of a broken leg. Where would you go to cite articles about that? If alcoholics don't crave alcohol, why is it so hard for them to stop drinking? Robert Rapplean 20:09, 6 July 2006 (UTC)

Now we come to the heart of the matter...Robert made a wonderful comment above: alcoholism is NOT about the fact that the alcoholic drinks. Here's the best part, though: it's not about the alcohol at all. What I'm about to say isn't what I'm looking for the article to say; it's mostly opinion. Alcoholism is a condition in which the disease is all about the individual's discomfort when they're NOT drinking, discomfort that is so omnipresent and harsh that when the individual discovers that alcohol helps them feel better, albeit briefly, they continue to drink despite the hardship that such use brings. That's what leads to what I always tell alcoholics at their intake visit: once you stop drinking, then we'll start treating your alcoholism. That's when we'll be able to work on getting you to feel better.

Done with opinion now. I'm really sincere about our need to stay away from the term "craving." Although you WILL be able to find plenty of citations in which educated scientists speak of craving and alcohol in the alcoholic, for the most part such studies come from people who were originally trained in opioid dependence, or who don't distinguish among the various addictive conditions. Those of us who focus in the sedative/alcohol dependence world recognize that the sedative/alcohol dependent patients don't have "craving," at least not in the way that most people would define the term. Alcoholics use impulsively or chronically but not out of a craving. Drgitlow 23:30, 6 July 2006 (UTC)