The Idea of Alcoholism as a Disease

After the initial views of the colonial physician Benjamin Rush on alcoholism as a disease, little was done to advance this idea, and the average person viewed the alcohol-dependent person as evil and depraved or weak. Then in 1870, according to author Sarah W. Tracy, a group of clergy, physicians, and businessmen in New York City, Philadelphia, Boston, and Chicago formed the American Association for the Cure of Inebriates. They declared that "intemperance" was a disease that was either inherited or acquired, and that it could be cured. They recommended the establishment of asylums for alcoholics and recommended that every large city have a local home for inebriates (chronic alcoholics) and that each state should have at least one asylum.

They further recommended that law enforcement officials should view intemperance as a disease that should be managed by other than fines and jails.
According to Stolberg, in 1922, about 13 percent of all psychiatric hospital admissions were for alcoholism.

In the 1940s, Elvin Morton Jellinek, a professor at Yale, described his theories on the cause of alcoholism. Jellinek's views are no longer accepted and are offered as historical information only. Jellinek said there were five different types of alcoholics, including alpha alcoholics, beta alcoholics, gamma alcoholics, delta alcoholics, and epsilon alcoholics.

An alpha alcoholic was someone who used alcohol to loosen up or to cope with stress. He or she need not have a physical tolerance for alcohol, although one could develop. Jellinek said that beta drinkers were alcoholics who developed health problems because of their excessive drinking. As with alpha alcoholics, betas did not physically depend on alcohol and drank for social reasons and despite the health problems that drinking caused them. Jellinek said that the most common alcoholic was the gamma alcoholic, who had increasing health and social problems because of his or her heavy alcohol consumption. An alpha drinker could become a gamma alcoholic. The delta alcoholic, according to Jellinek, was a person who drank all day long, had a physical dependence on alcohol, and also had a tolerance such that he or she needed to consume increasing amounts of alcohol to achieve the same level of intoxication.

The epsilon alcoholic was a person who went on binges of drinking but who abstained from alcohol between those binges.

Although Jellinek's typologies were not adopted by medical organizations, such organizations did begin to formally accept the idea that alcoholism was a disease; for example, in the mid-1950s, the American Medical Association with the American Hospital Association issued joint policy statements that alcoholism was a disease.

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Mark S. Gold, M.D. and Christine Adamec

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