Alcoholism: Sin or Sickness?

The disease concept may help avoid condemning the patient, but it may also delay dealing with real causes.

Mention alcoholism and alcohol abuse and thoughts may turn to skid row and the unshaven, poorly dressed men who shuffle in and out of rescue missions, the homeless wanderers who probably left their families years ago.

But a different kind of alcoholic has emerged in American society in recent years. He or she is the person apparently uncontrollably addicted to liquor, yet still managing to hold a job, stay with a family, and avoid the skid row route.

The CHRISTIANITY TODAY-Gallup Poll documented the sharp increase in this form of alcohol abuse. One in four persons reported that an alcohol-related problem affected family life. Only one in eight, or 17 percent, gave a similar response in 1974.

The personal testimonies of prominent public figures have brought more attention to the problem of middle-and upper-class alcohol abuse. Joan Kennedy and Betty Ford have talked publicly about their problem and how they recovered through hospitalization. Other public figures, such as former U.S. Senator Harold Hughes of Iowa, have described how conversion to Christ, coupled in some cases with the support of Alcoholics Anonymous, has helped them recover from addiction to liquor.

Christian conversion, however, is not the only remedy offered these days for alcoholism and alcohol abuse. It may be the most effective remedy, but the government, the mental health profession, hospitals, and alcoholism counselors offer a variety of other routes to recovery.

Sheer willpower and rigorous self-discipline do not seem to be effective remedies—at least when alcoholism is defined as uncontrollable addiction to liquor. Alcoholism is not necessarily the same as drunkenness, though at times the two overlap. Some people get drunk without getting addicted to liquor. Some Christians can recall drunken weekends from preconversion days, but they were never alcoholics in the sense of their repeatedly drinking uncontrollably.

What seems to be needed for any recovery is outside support of some kind. Evangelicals are quick to point to conversion and the indwelling Holy Spirit and church fellowship as a kind of support. But the twentieth-century secular mind has been looking for other routes to recovery, and Christians ought to be familiar with these.

The Disease Theory In Treatment

The dominant theory in the field of alcoholism is the disease concept. It emerged in various forms before World War II, when in 1933 the repeal of Prohibition made social drinking legal and socially respectable. The disease concept borrows from various disciplines.

To some, the theory that alcoholism is a disease points to the fact that there are people who seem able to drink liquor moderately over a lifetime, whereas there are others who drink and become uncontrollably addicted. To others, the theory provides a ray of hope that medical science will discover some cure for alcoholism, perhaps a medicine or pill, that will allow the alcoholic to drink moderately without continually craving more. To still others, this concept merely points out the damaging results physically of heavy drinking. In short, the disease theory is not well defined, but it must be reckoned with because it dominates the field of alcoholism treatment and research in the U.S.

The American Association for the Cure of Inebriates declared drunkenness a disease in the nineteenth century. The American Medical Association voted approval of the disease concept of alcoholism in the 1950s. One of the primary goals of many alcoholism groups, including the federal government’s National Institute for Alcoholism and Alcohol Abuse, is to advance the concept that alcoholism is a disease.

In this case, applying the term disease is somewhat arbitrary, because the definition of disease has widened in recent years. According to the American Medical Association, it is “a deviation from a state of health.” E. M. Jellinek, in his influential book, The Disease Concept of Alcoholism, says of the disease label: “A disease is what the medical profession recognizes as such.”

The major weakness of the disease theory is obvious: someone may say, “Don’t blame me if I catch it. Furthermore, don’t blame me if I pull out a gun and shoot you; I’m just drunk and it’s not my fault.”

Some experts respond to this by saying that alcoholism is a bit like heart disease: you are not necessarily responsible for getting the problem, but you are responsible for recovering and taking steps to avoid it in the future.

In that sense, the disease concept reflects the widened meaning of disease: it is no longer just something caught, like the flu or a cold, but it is any deviation from a state of health. In the latter sense, alcoholism is a disease. However, widening the definition of disease tends to make it less meaningful for ordinary discussion of alcoholism.

But the disease concept may have a few pragmatic advantages. It points to the possibility that physiologically some people may be more prone than others to alcoholism, even after one drink. If science ever develops a means of detecting who has that predisposition—whether it is based in genetics, for example—then it would be helpful to issue no-drink warnings to certain people. The disease concept may also serve some purpose in relieving the guilt that some alcoholics feel. But such guilt seems only to drive them to more and more drunkenness.

However, even though the disease concept may have some practical value, it is not necessarily verified by medical and scientific studies. Harold Mulford, director since 1956 of alcohol studies at the University of Iowa, notes: “I think it’s important to recognize that the alcohol disease concept is a propaganda and political achievement and not a scientific achievement. Science has not demonstrated that alcoholism is a disease by defining it, nor has science or technology demonstrated it’s a disease by coming up with an effective treatment or preventive.”

The pragmatic approach also suffers from lack of biblical insights. Psychiatrist John White explains:

“For too many years we have paid too much attention to what works and too little to what is right. What is right may or may not work. If we were laboratory animals or computers, the right would be determined by what works and morality would bow to function. But we live in a moral universe, a universe made by a righteous God and inhabited by creatures who have often failed to respond to the way he has handled them, who have instead chosen the opposite of what he wished (Parents in Pain, InterVarsity, 1979, p. 163).

The weaknesses of the disease theory far outweigh its benefits. It tends to relieve the alcoholic of personal responsibility for recovery. Harold Mulford believes it actually encourages nondrinkers to assume: “I don’t have the disease, so I don’t need to watch my drinking. I only hope I don’t catch it. But even if I do, I can always get treatment at the center. So why should I worry about it?”

The disease theory also seemingly encourages an almost totally materialistic approach to the problem. It assumes that our problems in life are essentially physical and material, not moral and metaphysical, and that they can best be resolved by science and its research. The impressive advances of science and medicine in the twentieth century lend extra weight to this world view.

“The disease concept of alcoholism [is] out of tune with the facts and a serious obstacle to rational solutions,” says Dr. R. E. Kendell, a Scottish psychiatrist, in a British Medical Journal article.

Timothy Johnson and Stephen Goldfinger, editors of the Harvard Medical School Health Letter Book, claim “there is still no good evidence that persons with a drinking problem consistently demonstrate biological differences that separate them from others.”

Kendell asserts that despite stories of people getting hooked on alcohol after just one or two drinks, most alcoholics who enter treatment centers admit to a previous daily intake of at least a half bottle of liquor. “In other words, what determines whether a person becomes dependent on alcohol is how much he drinks and for how long, rather than his personality, psychodynamics, or biochemistry.”

One study from London, based on 100 married male alcoholics, showed that sophisticated medical treatment, assuming alcoholism is a disease, was no better than telling the alcoholic to stop drinking, go back to work, and improve his marriage. Both methods produced the same results at the end of a year: about one-third of each group had improved.

The disease concept encourages some counselors to describe alcoholism as a physiological, emotional, and spiritual problem. Usually they are more well versed in the physiological, and sometimes the emotional, aspects of the problem

I asked one counselor at an alcoholism hospital about the personal responsibility of the recovering alcoholic. Was he morally responsible for becoming an alcoholic in the first place? To what extent was it his responsibility to quit drinking after being told he had this disease and should never touch liquor again? What if he fell back into the problem even after he had been hospitalized several times? Was he responsible at that point?

The counselor’s answer has helped me understand the tragic deficiency in the disease concept of alcoholism and in secular treatment of the problem. He said he would leave those questions in the hands of a loving God and get on with the business of counseling and treatment as best he knew how. The failure to have at least a foundation for exploring questions of personal responsibility is the key weakness in such alcoholism treatment.

The answers to these questions lie in Christian theology. There is a critical need to apply the doctrine of man to questions about personal responsibility for destructive behavior.

Christian And Other Remedies

There are Christians who work with the disease concept of alcoholism, developing answers to the theological questions. To what extent is a person responsible for behavior that seems to have a physiological basis, at least in part? To what extent is alcohol addiction similar to greed, lust, smoking, temper, and overeating? Some people have more of a struggle with these things than others do. Failure to control them is sin.

How can a Christian condemn the sin of drunkenness, but not the alcoholic? The disease concept, in part, is an effort to avoid condemnation of the alcoholic. It is a means of trying to restore the person’s self-image. The alcoholic, the same as everyone else, is created in God’s image. He deserves dignity and respect, no matter what his addiction leads to. But we have a hard time holding on to these two truths at the same time. Some Christians fall short in terms of seeing God’s image in the alcoholic.

There are other Christians who have not adopted the disease concept of alcoholism, but who have made enormous contributions in the treatment and prevention of alcohol abuse. These contributions are not a cause for pride, but they show what God has done and can yet do.

The temperance and abstinence movements have saved thousands of persons from alcohol abuse and alcoholism. As Mark Noll pointed out in an earlier article (CT, Jan. 19, 1979, “America’s Battle Against the Bottle”), evangelical support for temperance is nothing to be ashamed of. Even Prohibition is getting a second look from those who are concerned about the increasingly tragic impact of alcohol abuse.”

Robert Sherrill, writing for the widely distributed Field Newspaper Syndicate, has written:

“Prohibition is usually marked down as a great failure. In fact, it was a smashing success at first—and even though the law was widely disregarded in later years, the era of Prohibition significantly changed America’s drinking habits. Total alcohol consumption during Prohibition was lower than it had ever been before during a comparable span of years … lower than it would ever be again. Despite the proliferation of bootleg, rot-gut whiskey during Prohibition, total hospital admissions from alcoholism dropped sharply during those years.”

After describing in detail the tragic costs of alcohol abuse in terms of drunk-driving deaths, productivity losses, and with other statistics, Sherrill suggests a new kind of liquor prohibition: raising the price. He favors massive tax increases on alcoholic beverages to cut consumption.

Revivals have also made a significant dent in the problem of alcohol abuse. The first Great Awakening came during the “Gin Age” of English history. Statistics tell why. Gin consumption ran 527,000 gallons in 1684, 2 million gallons in 1714, 5.3 million gallons in 1735, and 11 million gallons in 1750. The cure, according to some historians, was revival. Historian John Wesley Bready sums up the impact of the revivals:

“Not till the challenge of the evangelical revival had touched the hearts and directed the lives of great numbers of people in all parts of the country, did any semblance of redemption appear.

“Liquor control legislation, challenging perforce deeply rooted personal appetites, before it could effect any real reform, had to be backed and vitalized by strong moral and spiritual convictions; and of such convictions, prior to the great revival, England was almost bankrupt.”

Christian social and gospel ministries have also made significant contributions in response to alcohol abuse. Many rescue mission workers have accomplished what proponents of the disease theory only aimed at—loving the alcoholic but still hating his drunkenness. At the same time, they have saved the taxpayers millions of dollars.

An Indianapolis attorney, Jack Brown, board member of Lighthouse Mission and a former U.S. attorney, once made an informal calculation of the savings that mission, one of several in Indianapolis, provided for the city. “I figured up that the Lighthouse Mission saved the city of Indianapolis over $1 million in a year,” he said. An accountant figured various public costs, assuming that 30 percent of the transients who came to the mission would be arrested and jailed. He included court costs, but not social welfare payments to families and some other items. “This was over 10 years ago when I did this,” he adds. “Naturally all these prices are higher today.”

Another major factor in defeating alcoholism has been the work of Alcoholics Anonymous. Widely acknowledged as the most effective popular means of recovery, AA includes biblical principles. A quick reading of AA’s 12 steps reveals the biblical roots, though they were written so as to avoid doctrinal controversy. (AA’s debt to biblical Christianity is clearly spelled out in Not God, by Ernest Kurtz.)

Throughout American history, evangelicals have made significant contributions in response to the tragedy of alcohol abuse. Now we must enter the debate about the exact nature of alcoholism, its cause, to what extent it is a sin that requires repentance, to what extent it is also harmful behavior with which some because of physiological differences must grapple more than others. The treatment of alcoholics must not be left to those who disregard biblical truths.

In medical and counseling circles, evangelicals can counteract the weaknesses of the theory that alcoholism is a disease. The popular idea that society need not accept any limitations on drinking, simply because comparatively few people are “sick,” must be attacked with vigor. The whole of society suffers a dreadful toll because of alcoholism. Besides offering hope of deliverance and therapy for alcoholics, Christians can demand rigorous enforcement of drunk driving laws, stiff penalties for offenders, and higher taxes on beer and liquor.

While Christians respond with loving care for those whose lives have been broken by alcohol abuse, they can also be sensitive to the millions of closet alcoholics (many of them lonely women at home). Responsible action and teaching are demanded in churches and schools as well, to head off the growing spiral of teen-age alcohol abuse. But beyond studying the explanations for the alcoholic’s condition and behavior, Christians can get involved at many stages on the local level. Doing so will help curb what many believe to be this country’s most destructive social problem.

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