The book, Heavy Drinking: The Myth of Alcoholism as a Disease (amazon link or free at archive.org) is the third book in a sort of trilogy I’ve read recently that gives an alternative perspective on addiction. The other books I’ve reviewed are: Addiction is a Choice and The Useful Lie. They present a picture of addiction that places responsibility for behavior in the hands of the so-called addict.
The author of Heavy Drinking was Herbert Fingarette. He was a philosopher at UC Berkley. He wrote on a variety of topics such as self-deception, psychoanalysis, and death. You can take a look at his free books on archive.org. His son Andrew Hasse, made a short film about his dealings with death when Fingarette was 97 years old. It was featured in the Atlantic and you can view it below.
When Fingarette turned his philosophical gaze toward addiction, he was surprised by how much the scientific literature was at odds with the unscientific social narratives. Scientific studies showed that people labeled alcoholics could regulate their drinking when given incentives to do so. It showed that the loss of control theory — one drink leads to many — was wrong. It also showed that recovery programs like Alcoholics Anonymous have a horrible track record – fewer than 10% who graduate go on to stop drinking.
Why Don’t We Hear More Truthfulness About Addiction?
Early in his book Fingaretter wonders why we don’t hear more about how the disease model of addiction is incorrect.
The classic concept remains the cornerstone of traditional treatment on public opinion, the central premise of media coverage and social debate, such that anyone who publicly doubts or challenges the disease concept is likely to be ignored, dismissed, or ostracized. In this version of the emperors new clothes, truthfulness can threaten, block, or run the truth tellers career… Another important influence on the public conduct of scientists is the concern that revealing the bankruptcy of the classic disease concept might discourage heavy drinkers from seeking help. The essence of this rationale is that if chronic drinkers are told that there is no disease of alcoholism, they will see their drinking as a personal failing; out of guilt and shame they will tend to hide or deny their problem.
After discarding the disease concept of alcoholism Fingarette writes a message of hope that comes with a true understanding of alcoholism:
Instead of looking at heavy drinkers as victims of some wayward gene or physical abnormality, we can now see them in a truer light: as a diverse group of people who for diverse reasons are caught up in a particularly destructive way of life although this depiction is messier than any single factor theory it has the advantage of being true to the observations of clinicians, and to those of many heavy drinkers and their families and friends. Moreover, once alcohol abusers themselves realize that they are not stricken by some by some unidentifiable physical or psychiatric condition they may find new cause for hope and for a more realistic self-understanding.
Recovery Programs Have a Horrible Track Record
Fingarette was surprised when he looked at the data about recovery programs. Many studies find that they are worse than not going at all. This is because they tell their attendees a defeating message: they have no control over their problems — they are victims of a disease.
In one study, a group of alcoholics was assigned to consistent treatment with AA, and the other group was given a single session with a psychiatrist. After a year, there was no difference between the two groups drinking behavior.
There are multiple studies cited by Fingarette that show this same finding. These findings underscore the fact that people are not statistical entities. The motivation of the person is the central factor for quitting or moderating drinking.
In a further essay entitled, “Alcoholism and Self-Deception”, Fingarette writes:
Instead of encouraging those concerned to see the drinking in the context of the person’s way of life, and thus to discern what role or roles it may play for that person in coping with life, the logic of the disease concept does the contrary. It leads all concerned, including the drinker, to deny, to ignore, to discount what meaning that way of life may have. Seen as an involuntary symptom of a disease, the drinking is isolated from the rest of life, and viewed as the meaningless but destructive effect of a noxious condition, a “disease.”
I disagree with Fingarette’s solution to the problem – more spending on “scientific” recovery programs, and heavy taxes on alcohol. He ignores the unseen consequences of these. If one taxes alcohol too heavily, a black market for these products will emerge of dubious quality and even worse safety issues. More spending on (un)scientific recovery programs won’t help. This is because choosing bad habits has nothing to do with science, it has to do with free will, diligent living, and choice. This is the domain of ethics, morality, and religion.
I think a better way forward is, to be honest about the problem of addiction. It is not a life sentence nor a medical condition. One can pull oneself out of addiction, or seek help in as many ways as there are people suffering from the bad habits they choose. There are endless ways to change oneself. Some will seek religious help, AA, a book, help from friends or mentors, new-age spiritualism, a drug-induced psychedelic trip (as the founder of AA Bill W. did), or find some other way to replace a bad habit with a good one.
For those unfamiliar with alternative models of addiction, Heavy Drinking is essential reading. The short book summarizes the problems with the disease model of addiction and sheds light on the hollowness of the addiction recovery industry. For those dealing with addiction, it is a message of empowerment to know that one is not governed by a mysterious disease known as addiction.