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Disease Theory
The seven major components of AA's disease

Disease Theory
Disease Theory

The idea that habitually drinking to excess is a disease originated with a Dr. Benjamin Rush in the early 1800s.71 Rush considered intemperance, as well as lying, murder and political dissent, to all be diseases.72 and being a black person a disease symptom.73 He believed that in habitual drunkards “desire overpowered the will” meaning, in twentieth century terms, that they “lost control.” His cure was temperance, meaning no hard liquor and only beer and wine in moderation.

Rush’s ideas were picked up by the growing Temperance Movement. By the 1840s, hundreds of thousands of members of the Washingtonians, a society of reformed drunkards pledged to abstinence, were preaching about their personal experience of loss of control and religious cure.

Of great significance is that, apparently, through the centuries of colonial America, no one ever reported loss of control until one person did so in 1795. Prior to that date, when people drank too much, it was because they wanted to.

The Washingtonians soon disappeared but Rush’s ideas, enmeshed in strong currents of Protestant Revivalism, were carried through the late 1800s and into the early part of this century. With the collapse of the Washingtonians, secret societies of abstainers were formed such as the “Most Worthy Scribe of the Sons of Temperance” and the “Independent Order of Good Templars.” The Good Templars alone claimed 300,000 members. These groups virtually disappeared in the early 1900s with the development of the movement toward Prohibition. However, the idea that alcoholism is a disease didn’t.

EM Jellinek, Marty Mann and the founding of today's "science" of alcoholism

Central to today’s Alcoholism Movement is Alcoholics Anonymous and the disease theory of alcoholism. Modern disease theory is based on the results of one 1945 survey.74 The survey consisted of 36 questions thought important by AA members. It was distributed to AA members through an AA magazine, The Grapevine. The AA editors of the AA magazine then chose E.M. Jellinek to compile the results. Although Jellinek had some misgivings due to the obvious methodological deficiencies, he felt there was also a great advantage,

“[A]ll subjects were members of Alcoholics Anonymous. …[I]t is difficult to get truthful data on inebriate habits, but there need be no doubt as to the truthfulness of the replies given by an A.A. …”75

It seems that the AA members made an excellent choice in the person to compile their data. Jellinek already held their positions as “truthful” and their members as the only creditable source of information about alcoholics.

Out of the 158 questionnaires received, 60 were thrown out either for being incomplete, from women or for having multiple responses on one questionnaire. Without ever investigating non-AA members and without ever checking the results experimentally, the 98 responses from AA members to an AA survey, compiled by an admirer of AA, were used as the factual basis for a disease of alcoholism. This is the present day “science” of alcoholism which supports the disease of alcoholism as espoused by the alcoholism treatment industry and Alcoholics Anonymous.*1

the seven major elements of the disease theory

The seven major elements of AA’s “disease of alcoholism” and their Big Book origins are:

1) An intense physically based craving is responsible for an alcoholic’s “loss of control” of drinking behavior. From the Big Book comes the slogan, “One drink, one drunk.” Dr. Silkworth’s ideas on alcoholism are covered in the Big Book. Also in the Big Book are dozens of personal stories that stress the loss of control suffered by alcoholics.

2) An alcoholic can not be responsible for his behavior when either drinking or in pursuit of alcohol.The craving takes over normal mental function. The Big Book refers to “the subtle insanity which precedes the first drink”76 and “we were alcoholic and could not manage our own lives.”77 Frequent mention is made of Dr. Jekyll/Mr. Hyde transformations when seized by the obsession to drink or when under the influence.

3) The disease is progressive and incurable, with “jails, institutions, and death,” the only possible fate unless lifetime abstinence is observed. Also from the Big Book, “Over any considerable period we get worse, never better.”78

4) Abstinence is unlikely to be maintained without special assistance. From the Big Book,

“…make clear three pertinent ideas:

(a)That we were alcoholic and could not manage our own lives.

(b)That probably no human power could have relieved our alcoholism.

(c)That God could and would if He were sought.”79

In personal story after personal story in the Big Book, AA members say, no matter how hard they tried, until they “surrendered” they couldn’t maintain abstinence. Also heavily stressed is, “Alcoholics rarely recover on their own.”

5)The underlying disease gets worse even during periods of abstinence, meaning that even if one is abstinent, a return to drinking will be to progressively worse drinking, as if one had been drinking all along. The Big Book tells of the case of a 30-year-old man who was drinking to excess. It was affecting his business so he stopped. Twenty five years later he retired, began drinking again and died within four years.80 The phrases “Once an alcoholic, always an alcoholic”81 and “no real alcoholic ever recovers control”82 are among Big Book references to this.

6)The disease is independent of everything else in a person’s life and has a life of its own. This means people don’t abuse themselves with alcohol because of problems in their lives; they have problems in their lives because alcoholism or alcohol has taken control of them. AA’s first step, “We admitted we were powerless over alcohol — that our lives had become unmanageable” shows the assumed relationship. Because of this force more powerful than themselves, alcoholics’ lives are disordered. Fixing the alcohol problem is assumed to be a prerequisite to fixing any other area of a person’s life.

7)A major symptom of alcoholism and impediment to successful recovery is denial. Persons afflicted with alcoholism, as a result of “disease processes,” deny their problems. Intervention by others, especially those “in recovery,” is often necessary for the alcoholic to understand his situation. This element of the disease of alcoholism is not mentioned in the Big Book, at least not directly. Some present-day writers have suggested that early AA didn’t consider denial an element of alcoholism. Certainly the word as used today wasn’t in the Big Book. It is, however, implied in the first step. The conversion techniques have always called for confession. Without denial of sin, admission (confession) would be unnecessary.

The most important “medical” reason for considering alcoholism a disease is that people do sicken and die from habitual over-consumption of alcohol. When it is pointed out to believers in “the disease” that patterns of alcoholism much more closely resemble habits and compulsions such as nail biting and compulsive gambling, the invariable response is that it is a disease because it is fatal. Of course, car accidents, war and the failure of parachutes to open during free-fall are all fatal too. Are they diseases because they are fatal? Calling something a disease implies a medical remedy. Of course, medicine does have a proper role in all these things. After a car accident, during a war and, in rare instances, after hitting the ground, medical experts are the ones to call upon to take x-rays, give transfusions, set broken bones and carry out other tasks for which they have special training. The same applies to people who have poisoned themselves with alcohol. The results of their behavior may well call for medical assistance. But there is no more medical treatment for the behavior of excessive drinking than there is medical treatment for careless driving, overambitious world leaders or improperly folded parachutes.

The general public accepted the disease theory more out of compassion rather than a concern for the semantic argument of what is a disease and what isn’t. Proponents of the treatment of alcoholism as a disease argued that people with drinking problems should be helped, not jailed. It made sense and still does. The problem and failure has been the nature of the “help.”

medicine’s answer to the disease

Once alcoholism was defined as a disease, the problem was laid on the doorstep of medicine. AA has been shown to be ineffective but can medicine help?

Many studies have tested this. One particularly simple study done in London83 had married male alcoholics assigned to one of two groups. One group received the full gamut of medical treatment; psychiatric care, doctors, hospitalization, whatever seemed appropriate during the one year course of the study. The medical services offered were comparable to those available in America. The other group received one hour of common sense advice on how to deal with everyday problems. They were told they were alcoholic, needed to quit drinking and that it was up to them to do so. Both groups had equal AA involvement.*2 At the end of the year, there was no significant difference between the two groups.

Closer to home, the disease theory has been a tremendous boon to the American treatment industry. Millions of potential clients now have insurance to cover medical treatment. With billions of dollars available, the industry works to convince potential clients of the need for treatment. To capture and maintain market share, individual corporations work to convince their potential clientele of the wisdom of choosing their particular brand of treatment.

Since ads rarely or never mention AA, it is likely that those in charge of marketing know that if the nature of their “therapy” and “aftercare” was known, it would cost market share. Instead, each business concentrates on the need for treatment and boasts of special expertise, an exceptionally understanding, caring environment and, most of all, exceptional treatment success.

The boasted efficiency of for-profit treatment centers is, at best, misleading media hype. When the data these claims are based on is examined, it becomes clear that the question “Who is in treatment?” is more important than “What is the treatment?” These “scientifically proven” treatment programs are “proven” using biased samples. When the demographics of the test subjects are examined it is found that:

1) they are married
2) they are employed
3) they have higher social and economic status
4) they are younger

All of these factors are indicative of a successful outcome without treatment or in any other treatment.

Also misleading is that those who drop out are not included and a short-term follow-up is used. A three-, six- or twelve-month follow-up may look remarkable but, when all factors are accounted for, the amazing 80 or 90 percent becomes equal to every other commonly used treatment and no treatment at all.

Never have the commonly used treatment methods for alcoholism been proven effective. The only evidence for success are the pronouncements of those who have been given the “Keys to the Kingdom”*3 and the promotional sales work of the multi-billion dollar treatment industry.

There is little support for the disease theory among alcoholism researchers. Even people like George Vaillant have major disagreements with many of the elements. It seems that even AA supporters are much less concerned with defending untenable positions than defending the funneling of patients into AA-based treatment programs and on to AA. All of the basic assumptions of the disease theory have been proven untrue.

loss of control

One of the most carefully researched elements of the disease theory is the concept of loss of control. While it may be a common subjective experience, it is not physically based, as a wealth of research has shown.

The test most often cited due to its methodological soundness, was reported in 1973.84 The experiment involved 32 alcoholics and 32 social drinkers as controls. Both groups were treated identically. The 32 alcoholics were divided into two groups. Under the guise of a taste test, both groups were told they would be rating a new product that had not yet reached the market. One group was told they were taste-testing Brand X vodka; the other, Brand X tonic water. In the group told they were taste-testing alcohol, the drinks were mixed in front of them. The catch, however, was that only half actually received alcohol. The other half were poured drinks from vodka bottles which had been filled with decarbonated tonic water. Half the group that thought they were testing plain tonic water was actually given vodka. For those given vodka in both groups, the concentration was one part vodka to five parts water. It was an amount that would evade detection after use of a mouthwash.

All participants were given two ounces of each of the three different brands as an “introductory sample.” This was the priming dose that, according to the disease theory, would cause loss of control. Twenty minutes later, the actual “taste testing” began. Each participant was given three twenty-four ounce decanters, each decanter labeled for a different brand. They were told to drink as much as they needed to in order to rate it.

No one lost control. No one drank all the liquid. The most important result of the experiment was that the amount drunk was determined, not by whether there was alcohol in the drink, but whether the subjects thought there was alcohol in the drink. The ones who thought they were drinking plain tonic, whether they were really drinking alcohol or not, drank about ten ounces. Those who thought they were drinking alcohol drank more than twice as much, whether or not they were in fact drinking alcohol. It made no difference whether they were really drinking alcohol or not. What made the difference was what they believed and what they expected based on that belief.

The loss of control hypothesis has been tested many times. In another type of experiment, alcoholics who had to have suffered the DT’s*4 in order to participate were allowed to drink all they wanted until a certain cut-off date.85 Before the cut-off date, they tapered off on their own in order to avoid severe withdrawal. They gave them boring and tedious tasks to perform in order to earn “credits” for drinks. Even when the subjects were going through withdrawal from prior earned drinking bouts, drink credits were saved up for later use.

Loss of control has never been proven and, time and again, has been shown to not exist.

AA oriented people like to point out that all experimentation has been done under hospital and laboratory conditions. It has not been done “in the real world.” Somehow the point is missed. The point, as far as the loss of control is concerned, is that belief and environmental effects are more important than the chemical effects of alcohol.

“Bad behavior,” like fighting with the wife, missing work, getting in fights, skipping school and committing crimes, is considered a symptom of the disease. The possibility that those who, for whatever reasons, are inclined to break society’s rules would be less likely to obey rules regarding drinking customs is completely discounted. The use of unacceptable behavior as a diagnostic factor in alcoholism has expanded to such an extreme that self-destructive consumption is no longer necessary for diagnosis. Now, as little as one drink a day, never more, may qualify.

progressive and incurable

The belief that alcoholism is progressive and incurable also has a firm hold on our consciousness even though it has been successfully challenged time and again. One of the first studies to report a return to social drinking by alcoholics was published in 1961.87 The researcher used extremely stringent requirements in order to avoid error and criticism. The 93 alcoholics in the study had to meet the World Health Organization’s criteria for alcoholism. To qualify as having become a moderate drinker, the subject must have never been drunk in the years after hospital release. The shortest time period allowed was seven years. He found that seven of the 93 who qualified as alcoholics had returned to moderate drinking.

The announcement created a storm. Everyone knew that alcoholics couldn’t return to social drinking. There was something wrong with his study. Two of the criticisms were particularly amusing in the light of the careful restriction used in the categories. One was that the test subjects were never really alcoholics, they drank too much, meaning they drank too much to have ever been alcoholics.88 The other was that the moderation in drinking didn’t count because it was too moderate.89

Other studies have been done since. The largest was by the prestigious Rand Corporation.90 In a follow-up of 548 alcoholics at eight different AA-based treatment centers, they found that 18 percent had moderated their drinking and become non-problem drinkers after treatment. Only 7 percent managed to abstain for the four year period. Those who had some or complete success remaining abstinent, as a group, had twice as many drinking-related problems as those who had moderated their consumption. Overall, they did almost as poorly as those who were still problem drinkers at the four-year point. The Rand Reports also pointed out that those who came to believe the “traditional alcoholism ideology” and had successfully adopted the AA self-mage of “alcoholic” were the ones most likely to continue heavy, problematic drinking.

Also in contradiction to the idea of the inevitable progression and incurability of alcoholism are studies of the drinking habits of young people. A twenty-year follow-up of college students found it rare for a student who drank until blackout to be doing so twenty years later.91 Another study followed high school sophomores for 13 years.92 The data showed that levels of alcohol consumption in the teen years were only mildly predictive of later consumption. Teenage abstinence was also found to be mildly predictive of later heavy drinking. In other words, in this study and others, abstinence has been found to “progress” to alcoholism almost as well as being a teenage drunkard.

The concepts of inevitable progression and incurability have great value, great dollar value to the multi-billion dollar treatment industry and, as Dr. Silkworth taught Bill Wilson, great indoctrination value.


Another characteristic of the disease of alcoholism, one which is increasingly being stressed by the treatment industry in their struggle to fill beds, is the symptom of denial. Obviously, those who engage in self-destructive behavior of any type usually have a strong tendency to discount the damage they inflict upon themselves. Denial as used in the disease of alcoholism, however, has a much broader and sinister meaning.

Refusing to turn oneself over to the treatment authorities is denial. One cannot abstain on one’s own, they say, so anyone who believes they can is suffering the symptom of denial. Anyone caught in the webs of the treatment/AA system who believes they can moderate their drinking is guilty of denial. Failure to take the full first step of Alcoholics Anonymous, admitting that one is “powerless” and can’t manage one’s own life, is denial. Either you begin accepting their doctrine or you are suffering a symptom of alcoholism. Stopping drinking is insufficient. One still must accept having the disease and submit to the treatment authorities.

Prior to alcoholism as defined by AA, the only other “social ill” for which denial was considered a symptom was in the Middle Ages. In the “diagnosis” of witches, a sure sign of a woman being a witch was that she denied it. It was based on common sense. A real witch would deny it.

It must have been as difficult for someone accused of witchcraft to argue their way out of it as someone today who, once accused, can’t help but “prove” their alcoholism by denying it.

It is important to point out that AA members really believe that alcoholism is a disease with the specific characteristics mentioned here. Much of the reason for this is entirely semantic.

self-proving definition: the disease of alcoholism

By defining alcoholism as a disease and attaching each of the elements of the disease theory to that definition, it proves itself. Just like the basic assumptions about witchcraft proved to almost everyone’s satisfaction the existence of witchcraft in the Middle Ages.93

Imagine, for instance, the flu redefined as an always fatal disease. If it isn’t fatal, it isn’t the flu. Now imagine a doctor with a patient who is running a fever, coughing and headachy. If the patient should die, he can be held up as an example of the inevitable fatality of the flu. But what if the patient lives, as is to be expected? He didn’t have the flu. How could he have? The flu, by definition, is always fatal. Using such a definition makes it impossible to prove that the flu isn’t always fatal. The presence of the same virus and symptoms in those who live and those who die is irrelevant. If it isn’t fatal, it isn’t the flu.

The definition of alcoholism as believed by AA members and presented to the public operates in the same way. It doesn’t matter how many alcoholics have moderated drinking behavior. Using the disease definition, it can’t be proved that alcoholism isn’t irreversible and progressive. If it is reversed and doesn’t progress, it isn’t alcoholism.

AA has a semantic method of dealing with the many people who don’t fit their model. They aren’t “true alcoholics.” Whenever anyone returns to “social drinking,” the first response of the groupers is that sooner or later “the disease” will get them. They will either return to AA with proper penitence or they will die. Of course this doesn’t always happen. When it does, it proves the nature of the disease and wisdom of AA. When it doesn’t, it is obvious they never were “true alcoholics.”

As with all of life’s problems, people with drinking problems sometimes feel as if their lives are out of control. At vulnerable times, it is always helpful to find support until one’s bearings are regained. The support can be from friends, family, one’s minister, a psychologist or any of innumerable other sources.

Unfortunately, due to the dominance of the AA-and-treatment-industry-serving disease theory, when someone with drinking problems looks for help, all that is found are expensive treatment centers and AA indoctrination.

The heart of the disease theory is the idea that people are helpless to change themselves; to manage their own lives. It denies, in the face of all available evidence, the God-given human potential for growth and change we are all endowed with. It has never been shown that convincing someone they are incompetent to change an unwanted habit or dependence helps them change it.

However, the AA/disease theory of powerlessness through physical/genetic/allergic susceptibility to alcohol does serve to create an additional dependency, a dependency on AA and expensive treatment centers. One walks in with what is usually a transitory problem and, if treatment is “successful,” the rest of one’s life is spent with the belief that, as a defective person, one must faithfully follow most of the Oxford Group precepts or die.*5

Much has been said in this chapter about what alcoholism isn’t. If it isn’t a disease…