Is alcoholism a disease?

A critical review of a controversy
  • Irving Maltzman


Commentators have repeatedly attacked the traditional view that alcoholism is a disease. Their arguments that alcoholism is a central aspect of life, a deviant life style, or a form of learned behavior are examined in the light of the history and philosophy of medicine as well as current bio-behavioral research. Our conclusion is that alcoholism, as a lawful pattern of observable signs and symptoms that deviate significantly from a norm of health, is a bio-psychosocial disease.


Frontal Lobe Dorsolateral Prefrontal Cortex Abstinence Rate Wisconsin Card Sort Test Moderate Drinking 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Ader, R. (Ed.). (1981)Psychoneuroimmunology. New York: Academic Press.Google Scholar
  2. Armor, D.J., Polich, J.M., & Stambul, H.B. (1976).Alcoholism and treatment. Report R-1739-NIAAA. Santa Monica, CA: Rand Corporation.Google Scholar
  3. Berg, G., Laberg, J.C., Skutle, A., & Ohman, A. (1981). Instructed versus pharmacological effects of alcohol in alcoholics and social drinkers.Behaviour Research & Therapy, 19, 55–66.CrossRefGoogle Scholar
  4. Berman, K.F., Illowsky, B.P., & Weinberger, D.R. (1988). Physiological dysfunction of dorsolateral prefrontal cortex in schizophrenia. IV. Further evidence for regional and behavioral specificity.Archives of General Psychiatry, 45, 616–622.PubMedGoogle Scholar
  5. Blakiston’s Gould Medical Dictionary. (1979). (Fourth Edition). New York: McGraw-Hill.Google Scholar
  6. Cala, L.A. (1987). Is CT scan a valid indicator of brain atrophy in alcoholism?Acta Medica Scandinavica, 717, 27–32.PubMedGoogle Scholar
  7. Cohen, H. (1961). The evolution of the concept of disease. In B. Lush (Ed.).Concepts of Medicine. (pp. 159–169). New York: Pergamon Press.Google Scholar
  8. Davies, D.L. (1962). Normal drinking in recovered alcohol addicts.Quarterly Journal of Studies on Alcohol, 23, 94–104.PubMedGoogle Scholar
  9. Dubos, R. (1968).Man, medicine, and environment. London: Pall Mall Press.Google Scholar
  10. Edwards, G. (1985). A later follow-up of a classic case series: D.L. Davies’s 1962 report and its significance for the present.Journal of Studies on Alcohol, 46, 181–190.PubMedGoogle Scholar
  11. Engel, G.L. (1977). The need for a new medical model: A Challenge for biomedicine.Science, 196, 129–136.PubMedCrossRefGoogle Scholar
  12. Fingarette, H. (1988).Heavy Drinking. Berkeley: University of California Press.Google Scholar
  13. Foy, D.W., Nunn, L.B., & Rychtarik, F.G. (1984). Broad-spectrum behavioral treatment for chronic alcoholics: Effects of training controlled drinking skills.Journal of Consulting and Clinical Psychology, 52, 218–230.PubMedCrossRefGoogle Scholar
  14. Graber, R.A., & Miller, W.R. (1988). Abstinence or controlled drinking goals for problem drinkers: A randomized clinical trial.Psychology of Addictive Behaviors, 2, 20–33.CrossRefGoogle Scholar
  15. Harper, C., Kril, J., & Daly, J. (1987). Are we drinking our neurones away?British Medical Journal, 294, 534–536.PubMedCrossRefGoogle Scholar
  16. Heather, N., & Robertson, I. (1983).Controlled Drinking. (Revised Edition). London: Methuen.Google Scholar
  17. Hodgson, R., Rankin, H., & Stockwell, T. (1979). Alcohol dependence and the priming effect.Behaviour Research and Therapy, 17, 379–387.PubMedCrossRefGoogle Scholar
  18. Jellinek, E.M. (1952). Phases of alcohol addiction.Quarterly Journal of Studies on Alchol, 13, 673–684.Google Scholar
  19. Jellinek, E.M. (1960).The disease concept of alcoholism. New Brunswick, N.J.: Hillhouse Press.Google Scholar
  20. King, L.S. (1954). What is disease?Philosophy of Science, 21, 193–203.CrossRefGoogle Scholar
  21. Knight, L.J., Barbaree, H.E., & Boland, F.J. (1986). Alcohol and the balanced-placebo design: The role of experimenter demands in expectancy.Journal of Abnormal Psychology, 95, 335–340.PubMedCrossRefGoogle Scholar
  22. Korytnyk, N.X. & Perkins, D.V. (1983). Effects of alcohol versus expectancy for alcohol on the incidence of graffiti following an experimental task.Journal of Abnormal Psychology, 92, 382–385.PubMedCrossRefGoogle Scholar
  23. Lemere, F. (1956). The nature and significance of brain damage from alcoholism.The American Journal of Psychiatry, 113, 361–362.PubMedGoogle Scholar
  24. Lhermitte, F. (1986). Human autonomy and the frontal lobes. Part II: Patient behavior in complex and social situations: The “environmental dependency syndrome.”Annals of Neurology, 19, 335–343.PubMedCrossRefGoogle Scholar
  25. Luria, A.R. (1980).Higher cortical functions in man. (Second Edition) New York: Basic Books.Google Scholar
  26. Lyvers, M.F. & Maltzman, I. (1991). Selective effects of alcohol on Wisconsin Card Sorting Test Performance.British Journal of Addiction, 86, 399–407.PubMedCrossRefGoogle Scholar
  27. Maltzman, I. (1987). Controlled drinking and the treatment of alcoholism.Journal of the American Medical Association.257, 927, 3229.PubMedCrossRefGoogle Scholar
  28. Margolis, J. (1976). The concept of disease.The Journal of Medicine and Philosophy, 1, 238–255.Google Scholar
  29. Marlatt, G.A. (1979). Alcohol use and problem drinking & cognitive-behavioral analysis. In P.C. Kendall, and S.D. Hollon (Eds.).Cognitive-behavioral interventions: Theory, research, and procedures. (pp. 319–355). New York: Academic Press.Google Scholar
  30. Marlatt, G.A. (1983). The controlled-drinking controversy: A Commentary.American Psychologist, 38, 1097–1110.PubMedCrossRefGoogle Scholar
  31. Marlett, G.A., Demming, B., & Reid, J.B. (1973). Loss of control drinking in alcoholics: An experimental analogue.Journal of Abnormal Psychology, 81, 233–241.CrossRefGoogle Scholar
  32. McQueen, D.V., & Siegrist, J. (1982). Social factors in the etiology of chronic disease: An overview.Social Science and Medicine, 16, 353–367.PubMedCrossRefGoogle Scholar
  33. Miller, W.R., Leckman, A.L., & Tinkcom, M. (1987). Controlled drinking and the treatment of alcoholism.Journal of the American Medical Association, 257, 3228–3229.PubMedCrossRefGoogle Scholar
  34. Orne, M.T. (1962). On the social psychology of the psychological experiment: With particular reference to demand characteristics and their implications.American Psychologist, 17, 776–783.CrossRefGoogle Scholar
  35. Peele, S. (1988). Can alcoholism and other drug addiction problems be treated away or is the current treatment binge doing more harm than good?Journal of Psychoactive Drugs, 20, 375–383.PubMedGoogle Scholar
  36. Pendery, M.L., Maltzman, I.M., & West, L.J. (1982). Controlled drinking by alcoholics? New findings and a reevaluation of a major affirmative study.Science, 217, 169–175.PubMedCrossRefGoogle Scholar
  37. Piazza, N.J. & Wise, S.L. (1988). An order-theoretic analysis of Jellinek’s disease model of alcoholism.The International Journal of the Addictions, 23, 387–397.PubMedGoogle Scholar
  38. Pokorny, A.D., & Kanas, T.E. (1980). Stages in the development of alcoholism. In W.E. Fann, I. Karacan, A.D. Pokorny, and R.L. Williams, (Eds.).Phenomenology and treatment of alcoholism. (pp. 45–68). New York: Spectrum Publications.Google Scholar
  39. Polich, J.M., Armor, D.J., & Braiker, H.B. (1980).The course of alcoholism: Four years after treatment. Report R-2433-NIAAA. Santa Monica, CA.: Rand Corporation.Google Scholar
  40. Rychtarik, R.G., Foy, D.W., Scott, T., Lokey, L., & Prue, D.D. (1987). Five-six-year follow-up of broad-spectrum behavioral treatment for alcoholism: Effects of training controlled drinking skills.Journal of Consulting and Clinical Psychology, 55, 106–108.PubMedCrossRefGoogle Scholar
  41. Selye, H. (1956).The stress of life. New York: McGraw-Hill.Google Scholar
  42. Smith, J.W. & Frawley, P.J. (1990). Long-term abstinence from alcohol in patients receiving aversion therapy as part of a multimodal inpatient program.Journal of Substance Abuse Treatment, 7, 77–82.PubMedCrossRefGoogle Scholar
  43. Sobell, M.B. & Sobell, L.C. (1978).Behavioral treatment of alcohol problems: Individualized therapy and controlled drinking. New York: Plenum Press.Google Scholar
  44. Sobell, M.B. & Sobell, L.C. (1987a). Conceptual issues regarding goals in the treatment of alcohol problems. In M.B. Sobell and L.C. Sobell (Eds.),Moderation as a goal or outcome of treatment for alcohol problems: A Dialogue. (pp. 1–37). New York: The Haworth Press.Google Scholar
  45. Sobell, M.B. & Sobell, L.C. (1987b). Stalking white elephants.British Journal of Addiction, 82, 245–247.CrossRefGoogle Scholar
  46. Stockwell, T.R., Hodgson, R.J., Rankin, H.J., & Taylor, C. (1982). Alcohol dependence, beliefs and the priming effect.Behaviour Research and Therapy, 20, 513–522.PubMedCrossRefGoogle Scholar
  47. Stuss, D.T. & Benson, D.F. (1984). Neuropsychological studies of the frontal lobes.Psychological Bulletin, 95, 3–28.PubMedCrossRefGoogle Scholar
  48. Taylor, J.R., Helzer, J.E., & Robins, L.N. (1986). Moderate drinking in ex-alcoholics: Recent studies.Journal of Studies on Alcohol, 47, 116–121.Google Scholar
  49. Walker, N.D. (1987). Long term outcome for alcoholic patients treated in a hospital based unit.New Zealand Medical Journal, 100, 554–556.PubMedGoogle Scholar
  50. Wallace, J. (1989). Can Stanton Peele’s opinions be taken seriously? A reply to Peele.Journal of Psychoactive Drugs, 21, 259–271.PubMedGoogle Scholar
  51. Wallace, J. (1990). Controlled drinking, treatment effectiveness, and the disease model of addiction: A commentary on the ideological wishes of Stanton Peele.Journal of Psychoactive Drugs, 22, 261–284.PubMedGoogle Scholar
  52. Wallace, J., McNeill, D., Gilfillan, D., MacLean, K., & Fanella, F. (1988). I. Six-month treatment outcomes in socially stable alcoholics: Abstinence rates.Journal of Substance Abuse Treatment, 5, 247–252.PubMedCrossRefGoogle Scholar
  53. Weinberger, D.R., Berman, K.F., & Zec, R.F. (1986). Physiologic dysfunction of dorsolateral prefrontal cortex in schizophrenia.Archives of General Psychiatry, 43, 114–124.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • Irving Maltzman
    • 1
  1. 1.Dept. of PsychologyUCLALos Angeles

Personalised recommendations