A
useful analysis of terminology:
“This comprehensive
definition, published by the Journal of the American Medical
Association in 1992, was developed by a group of the nation's
most esteemed physicians working in the addictions field.
1."Alcoholism
is a primary, chronic disease with genetic, psychosocial, and
environmental factors influencing its development and manifestations.
The disease is often progressive and fatal. It is characterized by
continuous or periodic: impaired control over drinking, preoccupation
with the drug alcohol, use of alcohol despite adverse consequences,
and distortions in thinking, most notably denial."
2."Primary"
refers to the nature of alcoholism as a disease entity in addition to
and separate from other pathophysiologic states which may be
associated with it. "Primary" suggests that alcoholism, as
an addiction, is not a symptom of an underlying disease state.
3."Disease"
means an involuntary disability. It represents the sum of the
abnormal phenomena displayed by a group of individuals. These
phenomena are associated with a specified common set of
characteristics by which these individuals differ from the norm, and
which places them at a disadvantage.
4."Often
progressive and fatal" means that the disease persists over
time and that physical, emotional, and social changes are often
cumulative and may progress as drinking continues. Alcoholism causes
premature death through overdose, organic complications involving the
brain, liver, heart and many other organs, and by contributing to
suicide, homicide, motor vehicle crashes, and other traumatic events.
5."Impaired
control" means the inability to limit alcohol use or to
consistently limit on any drinking occasion the duration of the
episode, the quantity consumed, and/or the behavioral consequences of
drinking.
6. "Preoccupation"
in association with alcohol use indicates excessive, focused
attention given to the drug alcohol, its effects, and/or its use. The
relative value thus assigned to alcohol by the individual often leads
to a diversion of energies away from important life concerns.
7. "Adverse
consequences" are alcohol-related problems or impairments in
such areas as: physical health (e.g., alcohol withdrawal syndromes,
liver disease, gastritis, anemia, neurological disorders);
psychological functioning (e.g., impairments in cognition, changes in
mood and behavior); interpersonal functioning (e.g., marital problems
and child abuse, impaired social relationships); occupational
functioning (e.g., scholastic or job problems); and legal, financial,
or spiritual problems.
8. "Denial"
is used here not only in the psychoanalytic sense of a single
psychological defense mechanism disavowing the significance of
events, but more broadly to include a range of psychological
manoeuvres designed to reduce awareness of the fact that alcohol use
is the cause of an individual's problems rather than a solution to
those problems. Denial becomes an integral part of the disease and
a major obstacle to recovery.”
Approved by the Boards of Directors of the
National Council on Alcoholism and Drug Dependence, Inc. (February 3,
1990) and the American Society of Addiction Medicine (February
25, 1990).
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