Lloyd H. Steffen is associate professor of philosophy and religion and chaplain at Northland college in Ashland, Wisconsin.
This article appeared in the Christian Century, July 19-26, 1989, p. 684. Copyright by the Christian Century Foundation and used by permission. Current articles and subscription information can be found at www.christiancentury.org. This material was prepared for Religion Online by Ted & Winnie Brock.
The disease model of understanding alcohol abuse confuses moral thinking with moralizing and jugmentalism.
The memorable discourses on love recorded in Plato’s Symposium were offered at a banquet where much wine flowed. According to the Greek tradition, such banquets always ended with libations of unmixed wines dedicated to the "good genius," Zeus Olympus, the heroes and Zeus Soter. We are told in this dialogue -- -- which has sometimes been called "The Drinking Party" -- that because there had been so much drinking the day before at Agathon’s victory celebration, the revelers are concerned with drinking expectations. They ask whether the host, Agathon, "is set on heavy drinking." Agathon claims not to have the strength for more wine, at which point Eryximachus, offering his wisdom as one trained in the medical arts, comments that given people’s reluctance to drink beyond their limits he will explain the truth about drunkenness. "Drunkenness," he says, "is a difficult thing for human beings; and as far as it is in my power, I should neither be willing to go on drinking nor to advise another to do so, particularly if he still has a headache from yesterday’s debauch." They agree that "each is to drink as much as he wants and there is to be no compulsion about it."
Plato’s Symposium is about love, not drinking; but how interesting it is that the participants at Agathon’s drinking party insist on ground rules for the evening’s drinking. Foreseeing the destructive consequences of heavy drinking, they pause as responsible adults to consider drinking expectations. They do not want to forbid drink; rather, they want permission to moderate their drinking, and they seek to relieve themselves of any pressure to drink excessively which the setting might otherwise impose. They understand drinking as a voluntary activity for which rules are necessary. They desire to establish a noncoercive setting in which the participants agree to accept responsibility for their drinking. These are people who, by their own admission, fulfill expectations to get drunk when coming together in a social situation. Yet they also pause to think about drinking. The revelers in Plato’s Symposium insist on placing their drinking squarely in a moral framework; they regard drinking as a personal decision made with regard for physical, moral and spiritual welfare.
In the culture of The Symposium, morally sensitive and reflective people thought about drinking differently than we do, especially concerning problem or heavy drinking. Athenians in the fifth century B.C. evaluated problem drinking in a clearly defined social and moral context. They traced excessive drinking to a character flaw; they held the drunk morally accountable. To them, drunkenness was unvirtuous conduct that violated the ideal of moderation. In Plato’s day, problem drinking was a behavioral problem to be understood through the resources of moral thought.
Plato’s prize student, Aristotle, likewise saw the problem of drinking as a moral one. In his Nichomachean Ethics Aristotle reiterates that problem drinking is a voluntary activity. When considering the person who has committed a crime under the influence of alcohol, Aristotle does not allow a "diminished capacity" defense. "We punish those who are ignorant of anything in the laws that they ought to know and is not difficult to know . . . we assume that it is in their power not to be ignorant since they have the power of taking care." I read this to mean that the drunken offender is doubly culpable, first for the offense committed while ignorant due to drunkenness, and second for placing himself in a state where such ignorance obtains, that is, for being drunk. Taking a hardheaded view of moral accountability, Aristotle assumes that people can "take care." Losing self-control through drink is itself the result of an exercise of control; the behavior reflects the values and commitments embodied in the problem drinker’s character.
Although we have cracked down on drunken driving and in general want to hold people who commit crimes while under the influence of alcohol culpable, we are not accustomed to holding such persons culpable for their ignorance beyond the particular offense. I suggest that this stems from our refusal to view problem drinking as a moral problem. We think that considering alcohol abuse to be a moral problem invites judgmentalism and moral insensitivity. Furthermore, referring to problem drinking as a moral issue seems to many to fly in the face of scientific thinking. Medical science, they believe, regards heavy drinking as a disease called alcoholism. According to this point of view, the problem drinker’s behavior is quite involuntary; it is caused by conditions over which she or he has no control.
"Why on earth did you put up with him?"
"He’s my brother."
"You could kick him out."
She didn’t answer. When it came to the point, one couldn’t.
I thought of him lying there in his acute self-made misery, a lonely defeated man in a private hell. He’d had girl friends once, but not any more. There was no one except me between him and the gutter, and I knew he relied on me as if I’d been a solid wall.
"Isn’t there any cure?" Sophie said.
"Oh, yes, one certain cure. The only one."
"What is it?"
"Wanting to be cured."
She looked at me dubiously. "Does that make sense?" "He would automatically be cured if his urge to be cured was stronger than his urge to drink."
"I thought it was a disease," she said.
"An addiction. Like football."
"You’ve been at the non-sense again."
"Under the influence of football," I said, "you can tear railway carriages apart and stampede people to death."
"I thought there was a drug that could cure it," she said.
"You mean antabuse?"
"Some stuff that makes alcohol taste disgusting. Sure, it works. But you’ve got to want to stop drinking in the first place; otherwise you don’t take it."
"How about Alcoholics Anonymous?" she asked.
"Same thing," I said. "If you want to stop drinking,
they’re marvelous. If you don’t, you keep away from
"I never thought about it like that."
The protagonist understands alcohol abuse as a moral problem, having to do with desires and wants, rather than a scientific one, having to do with disease and cures. Locating problem drinking in the moral universe neither legitimates simplistic judgmentalism nor authorizes a lack of compassion; rather, it asks that a sober look be taken at a self-destructive behavior so that the desires giving rise to it can be squarely and honestly addressed.
Herbert Fingarette, in his book Heavy Drinking: The Myth of Alcoholism as a Disease (University of California Press, 1988) , does not make the particular case I do here, but I believe he would support it. Having carefully examined medical and social science research, he argues that "heavy drinking" is not a disease. The idea that alcoholism is a disease -- first proposed in the 1930s -- is a myth, Fingarette says. The disease concept, according to Fingarette, has usually been thought to mean -- that those afflicted with the disease of alcoholism inevitably progress to uncontrolled drinking because of the distinctive disability produced -- loss of control, loss of choice in the matter of drinking. Says Fingarette: "No leading research authorities accept the classic disease concept." He is concerned that believing one is unable to control one’s drinking may in fact discourage a heavy drinker from trying to stop. Heavy drinkers may deceive themselves into thinking they are powerless to deal with their problem, as if they lacked that "power of taking care" to which Aristotle refers.
Fingarette cites statistics that suggest that 20 percent of people in the U.S. drink enough to qualify as heavy drinkers. Yet their consumption of alcohol does not affect their families, jobs, finances, health and public behavior as it does in traditional diagnoses of alcoholics. As a college chaplain, I have known college students who were, heavy drinkers but who matured into adults who drink only moderately -- because, I believe, they avoided the stigma of being diagnosed as "alcoholics." Fingarette presents convincing evidence that heavy drinkers can moderate their behavior and resume drinking even after it is clearly established that they are, in fact, problem drinkers.
That some people may be biologically vulnerable to alcohol addiction has not been proven; in fact, there is no evidence that heredity places a person at greater risk of becoming a heavy drinker than family environment, character, beliefs and conduct. Fingarette says that "even if genetic factors play a role in some social drinking, it does not necessarily follow that they play a role in generating the problem behaviors associated with heavy drinking."
No one causal formula explains why people become heavy drinkers, Fingarette says, and he pleads for a new approach to treating problem drinking. He believes Americans have devoted enormous financial and social resources to explaining a disease that does not exist. Fingarette argues that some people drink excessively to blunt anxieties or to attempt to meet certain personal needs in certain circumstances. Such behavior needs responses tailored to individual cases. Indeed, Fingarette goes on to point out that although treatment centers use medical terminology to describe what they do, their approaches are not medically based but consist of "practical advice and personal support." He isolated the treatment paradox: "If the alcoholic’s ailment is a disease that causes an inability to abstain from drinking how can a program insist on voluntary abstention as a condition for treatment?" This approach invokes the moral cure before treatment begins and challenges the whole notion that heavy drinkers are out of control or lose control because of a disease.
Moral issues are at stake. Young people today are under great stress, and a social environment has been created to deal with that stress. Because excessive drinking has become a social expectation, our social environment has, in my opinion, become increasingly coercive. The Symposium agreement that "each is to drink as much as he wants and there is to be no compulsion about it" does not emerge when students, feeling the compulsion of peer pressure, surrender their freedom to moderate their drinking or abstain. The nature of the problem in such situations is essentially moral. It does not cry out for a solution from science, no matter how attractive we find impersonal, objective assessment. Rather, the problem lies in behavioral practices and social expectations that demand ethical elucidation and moral clarity.
Moral maturity, as I understand it, requires people to assume responsibility not only for Wow they behave but for how they think. Mature thinking about drinking requires that people assume responsibility for how they think about drinking.
Because the scientific paradigm directs and alters understanding, the issue at stake is freedom of thought itself. And when freedom is the issue, the spiritual is at stake. When excess and abstention dominate our thinking, we eliminate the possibility of moderation and not only deny certain pleasures of life but surrender our freedom of thought to what seem to be the impersonal and uncontrollable forces of nature that cause disease. By ignoring the very personal issues of character, desire and decision, all of which create the individual life histories in which problems like alcohol abuse arise, we abuse the concept of freedom and become spiritually misdirected.
That some people suffer from problem drinking is a fact; but medical science does not explain all its implications. The meaning of problem drinking must, in the end, be decided in the moral and finally the spiritual realm of individual anxieties, hopes, attitudes and beliefs.