Wednesday, 17 August 2011

America redefines alcohol addiction, Ireland redefines denial

Ireland has a lot to teach the world about alcohol, but perhaps not in the way it thinks. Having consulted 80 experts over four years The American Society of Addiction Medicine has published a new definition of addiction.  It confirms what, as the Los Angeles Times puts it, 'neuroscientists have been saying for years- that addiction is a chronic disease of the brain. There are stacks of studies to back up the chronic-disease theory – changes in brain circuitry, changes in the way that genes in the brain are turned on or turned off ...even after a person has given up a habit'. The new definition acknowledges the behavioral aspects of addiction, but concludes that “addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry”.  In other words addiction is not a matter of predisposition but is a condition caused by the consumption of addictive substances.

Professor Patricia Casey disagrees

 'But just because something’s widely accepted professionally doesn’t mean it’s widely accepted out there in the world', the Los Angeles Times continues. Sure enough in Ireland, the new home of alcoholism, Professor Patricia Casey is reported in the The Irish Examiner proving just that.  She tells us that the new definition is an "over-simplification" of the problem'. "By speaking of addiction as simply a brain illness we are in danger of being over-simplistic and of removing choice from our understanding," said Prof. Casey.  "It is important that those who are addicted accept that they have a choice and realise that, unlike certain mental illnesses, such as schizophrenia, their behaviour is not in the first instance determined by the neurochemistry," she said.

The personal choice argument suits Prof Casey's views but doesn't answer the facts.  Prof. Casey was criticised for over-extrapolating facts before, but in this instance she seems to be ignoring the research in favour of a message also spun widely by the alcohol industry.  As David Poley of the Portman Trust puts it, 'it is only through education, coupled with targeted interventions against misusers, that we shall ultimately change the drinking culture'. Or as drinkaware advise 'a predisposition towards alcohol can be inherited, or shaped by family attitudes ... occupations, such as high pressure sales jobs or ...people living through stressful events... may find they start to drink more heavily'.  In other words,  the industry want us to believe that the problem with addiction lies not in the substance but in the user.  Alcohol, they imply,  is not really an addictive substance at all, and the 'misusers' who let the side down for the safe-drinking majority are weak minded, emotionally damaged or just having a hard time. 


So are people cured of addiction, as Professor Casey is arguing, because they can choose to be unaddicted?  Or are they, as the new American Society definition says, struggling with an 'addiction characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response'?  Science, when not sponsored by the alcohol industry itself, supports the latter view.  Alcohol addiction 'at its core' says leading expert Professsor Nutt, is a 'state of altered brain function that leads to fundamental changes in behavior that are manifest by repeated use of alcohol'. Over time cravings and behaviours over-ride common sense until 'the situation is compounded by the occurrence of withdrawal reactions which motivate desperate attempts to find more of the addictive agent'.

Ireland itself now offers proof that it is wide availability coupled with a general acceptance of the over-consumption of alcohol that primarily drives addiction in society.  The government took the advice of the alcohol industry to heart in 1992 when it began a process of deregulation of sales and marketing restrictions and fell for the charms of 'self-regulation' lobbied for by a strong alcohol producing and publican's sector.  Since then alcohol consumption and alcoholism have rocketed.  In 2007 a European report found that while 19% of Germans, for example, drank too much 36% of Irish people binge every week and 72 % abuse alcohol on a regular basis.  And this year a European police study found that while on average one in fifty drivers across Europe are drunk, Ireland boasts on in eight. Or to take other figures from Europa, abstainers represented 39% of the Irish population in 1992, 17% in 1998 and 16% in 2002, and by 2007 only 11% had not actually binged during the last year.

So does Professor Casey think that this is explained by a collective 'choice' to drink more alcohol by more of the population?  During this time many socal changes have taken place, but nothing in Ireland's history seems to explain our unique and rampant alcoholism more than this deregulation which mirrors Ireland's other world class disaster, the deregulation of the banking sector over the same period.  It looks very much as if  the long term result of unregulated advertising, marketing and availability of alcohol has resulted in widespreaad addiction.  As the new definition puts it 'early exposure to substance use is another significant factor in the development of addiction'. Yes, Ireland has certainly managed that.

4 comments:

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