The disease model for alcoholism is practically a secular religion in this country, embraced by psychiatry, most treatment clinics, and (perhaps most important) by AA. What this means is that those seeking help for excessive drinking are told they have a disease (though the exact nature of the disease is unknown), that it’s a probably genetic condition, and that the only treatment is abstinence.
But the evidence is not strong enough to support these claims. There are several theories of how genes might lead to excessive drinking. A genetic insensitivity to alcohol, for example, might cause certain people to drink more; or alcoholics might metabolize alcohol differently, or they may have inherited a certain personality type that’s prone to risk-taking or stimulus seeking. While studies of family pedigrees and adoptees have on occasion indicated a familial pattern for a particular form of alcoholism (early onset disorder in men, for example), just as often they reveal no pattern. This shouldn’t be all that surprising, given the difficulty of defining alcoholism. Some researchers identify alcoholics by their drunk driving record, while others focus on withdrawal symptoms or daily consumption. This is what geneticists call a “dirty phenotype“; people drink too much in so many different ways that the trait itself is hard to define, so family patterns are all over the place, and often contradictory.
Given these methodological problems, researchers have been trying to locate an actual gene (or genes) that might be involved in alcoholism. A 1990 study reported that a severe form of the disorder (most of the subjects in the study had cirrhosis of the liver) was linked to a gene that codes for a chemical receptor for the neurotransmitter dopamine. The researchers even developed and patented a test for the genetic mutation, but subsequent attempts to confirm the dopamine connection have failed.
The issues of choice and responsibility come up again and again in discussions of alcoholism and other addictive disorders. Even if scientists were to identify a gene (or genes) that create a susceptibility to alcoholism, it’s hard to know what this genetic “loading” would mean. It certainly wouldn’t lead to alcoholism in a culture that didn’t condone drinking – among the Amish for example – so it’s not deterministic in the strictest sense. Even in a culture where drinking is common, there are clearly a lot of complicated choices involved in living an alcoholic life; it’s difficult to make the leap from DNA to those choices. While few would want to return to the time when heavy drinking was condemned as strictly a moral failing or character flaw, many are concerned that the widely accepted disease model of alcoholism actually provides people with an excuse for their destructive behavior.