Heavy Drinking: The Myth of Alcoholism as a Disease

This book is brilliant in its simplicity. It shows very clearly how well intentioned half truths can take on a life of their own. And it is done in a very orderly fashion. It can be argued that many people cannot handle the truth and that lying to them is an act of kindness, but someone needs to tell the truth to the rest of us who can handle it. That is this book in a nutshell. The author takes apart the doctrine of Alcoholism bit by bit. The progression of the chapters is done very well. The examples are not excessive and even though there are a lot of scientific references in the text, the book is written for easy access to the layperson. And for anyone who has had the Doctrine of Alcoholism forced upon them, this book is not only a page turner, it is delightful revenge. There is very little truth in the modern American view of excessive drinking, and this book exposes the anti-drinking fanatics for what they are. I was very pleasantly surprised to see the lack of negative reviews of this book. It does indeed hint that there are many people out there who would rather handle an inconvenient reality than to cling to a comfortable lie.

Fingarette's book assults basically all of the central tenets of the alcoholism-as-disease industry, including the causes of alcoholism, the lack of self-control of an alcoholic, the efficacy of treatments, and the chances of recovery. The idea that somehow a person can't help but be an alcoholic, can't control his own behavior as one, and can't get better without specialized treatment administered by self-appointed experts, is simply demolished by the evidence, presented in hard numbers quoting study after study. It becomes clear that alcoholism or what we call alcoholism is in fact not one 'disease' that can be 'treated', certainly not in the way they have been over the last few decades. The book skewers the logical inconsistences regarding the treatment of people supposedly unable to control their drinking in any way by insisting that prior to beginning treatment they voluntarily stop drinking. It analyses the success/failure ratios of various in- and out-patient treatment and arrives at the conclusion that no treatment does anything much more for the patient than would an hour in front of a competant shrink. He refutes the argument that alcoholics not in some kind of program are doomed by showing that fully 30% seem to recover completely on their own, regardless of circumstances of treatment or cause. The problem is that people have made decisions over a period of time in which for them drinking has become the 'central activity' in their lives, around which almost all revolves. This can be replaced with another less destructive choice but it takes time and effort. And here is the frustratingly sad part because while it is doable many choose not to do it. Much as society would like to help, and Fingarette has some suggestions (unfortunately most of them involving Big Brother state-imposed solutions), in the end the choice is that of the problem drinker. There is as yet no pill or injection or psychological treatment available to make imprudent and self-destructive people prudent and self-affirming. Bucking the vast industry that benefits from the current dominant approach taken to deal with alcoholics is not easy. Fingarette's classic of scholarship and common sense was a brave and fundamentally positive contribution to helping people with serious problems.

In the fourteen years since the debut of this remarkable work, Professor Fingarette's book continues to be vilified by the current Alcoholism-as-Disease paradigm as a sham, harmful to its readers, and that it should be banned from all major book stores. It is simply amazing how this book struck the paradigm at its core, and how they haven't gotten over the hangover.This book is truth at its simplistic best. It is cumbersome to admit one's own culpability, and even harder for an alcoholic to admit that he is his own worst enemy. I know. I was one. After years of living in fear of the next drink, which surely would lead me to a single, inexorable destructive conclusion, works like Dr. Fingarette's "Heavy Drinking" had shown me that I was creating my own self-fulfilling prophecy, and that I indeed had the power to change, not just one day at a time, but forever.Of course, this idea flies in the face of those who promote the disease concept of alcoholism. Naturally, the multi-billion dollar institution will not tell you that they have done nothing to help the addiction situation since the AMA self-servingly declared alcoholism to be an illness in 1956. They continue to tell the public that the alcohol problem continues to skyrocket.The harshest attack on Dr. Fingarette's book is his assertion that alcoholics can learn to control their drinking. It has been proven time and again by several major studies since the 1960s. And yet, the disease camp, founded by the old unfounded addage "Once an alcoholic, always an alcoholic" spends countless millions in government-funded dollars promoting the idea that this is impossible. They have to. If they admitted that it was possible, their very essence would be threatened, and the industry would collapse.Bravo to Dr. Fingarette for having the guts to stand firm in the face of such pressure and present the truth. It is only by the presence of more secure individuals like the good doctor when a real answer can be offered to those who abuse alcohol and drugs. The keys to success are motivation, values, morality (yes, what's wrong with living a morally decent life?), and maturity. Life is worth living, and the same joy that was once found in a bottle can be found inside the joys of parenthood, work, and success.

After reading Fingarette's essay "Alcoholism and Self-Deception" in _Self-Deception and Self-Understanding_, I was eager for more of his unique and interesting perspective on problem drinking. In this short and very readable book, Fingarette steadily and easily demolishes the prevailing opinion that alcoholism is a disease in which the alcoholic loses control over his drinking. (The scientific community long ago abandoned this view, but it lives on as dogma through the recovery movement.) Fingarette instead explains problem drinking as the result of choices that elevate drinking into a "central activity" in the drinker's life. He argues that the motivations for the choices that make drinking a core value are as many and varied as are the individuals making them. My only serious objection to the book comes in the final chapter on social policy; Fingarette would seem to be happy to turn this country into a totalitarian state to prevent some people from making stupid choices about alcohol. Despite that flaw, _Heavy Drinking_ presents an impressive and well-reasoned case against the disease model of problem drinking.

In 7 chapters, Herbert Fingarette, formerly a professor of philosophy at UC Santa Barbara, dispels the myth that alcoholism is a disease, while taking very seriously the social problem of alcoholic behavior. In 1960 E. M. Jellinek published a book titled THE DISEASE CONCEPT OF ALCOHOLISM (p. 20). Alcoholics Anonymous members adopted this book as their scientific basis for asserting that alcoholism is a disease. But Jellinek's data was compiled by interviewing A.A. members. Thus, his conclusions were based on the reasoning of the very people who came to endorse his book. Furthermore, his research was based on only 98 interviews.Today, the politics of alcoholism is big business (pp. 22 ff.). Conceiving of it as a disease enables treatment centers to receive payments from health insurance companies.If somebody has cancer, you don't say, "You foolish person! You have cancer!" But when it comes to alcoholism, it is not unusual to find the relapsing drinker to be accused of having done something wrong. Many think the alcoholic, unlike the "canceric," has control. This, Fingarette argues, is in an important sense true, and shows the disanalogy between the disease of cancer and the PROBLEM of alcoholism. (Have you ever noticed that "alcoholic" is the dominant "-ic" in the U.S.? If you examine the word "alcohol," what is added to it is only "-ic." But when a person has a fancy for, say, chocolate, we don't say, "chocolatic," but rather "chocoholic." "Holic" always makes its way in, so obsessed are we as a society with alcohol.)Heavy drinkers -- as Fingarette refers to what others call "alcoholics" -- do not become heavy drinkers for just one reason. Therefore, it is unclear that treatment should consist of just one variety. Twelve-step programs, in our society, play a role like that of various forms of fundamentalism both here and abroad, reducing problems to a formulaic response that is often insulting at best, and deadly at worst. The person is by-passed because the program directors "know" what the right thing is for the "patient" to do.Controlled drinking programs are available in many countries (p. 128). In Europe, attitudes toward drinking are remarkably different from attitudes in the U.S., and these differences often make a difference in the way people actually drink. Stigmatizing behavior often reinforces the very negative behavior it seeks to prevent, especially in a country like the U.S. where rebellion is schizophrenically considered a virtue.Fingarette discusses the GENETIC HYPOTHESIS on pp. 51-55. This is very important: IT HAS NOT BEEN PROVED. I have spoken with several substance abuse counselors who very nonchalantly remark, as though possessing conclusive scientific authority to do so, "It's genetic." We don't know that. We don't know that 12 steps to recovery is the gospel. Agents of recovery should consider adopting a more epistemically modest stance. But although this book would help them make a move in that dir