Monday, May 3, 2010

Origins of the Disease Model of Addiction

Roger Williams and “deranged cellular metabolism.”

                                                  (with Linus Pauling, 1974-------------->)

The idea of addiction as a disease first began to gain a tentative foothold in scientific and government circles in the early 1960s, after the publication of E.M. Jellinek’s The Disease Concept of Alcoholism. Jellinek may not have invented the “alcohol science movement,” as he called it, and he may not have been much of a scientist himself (the evidence suggests that he faked his doctorate), but he was the first to describe the “disease syndrome” of alcoholism—chronic relapse leading to death by liver failure. A salesman by nature, Jellinek ardently presented the disease model of alcoholism to the world of the social sciences just as zealously as he had previously done banana research in Honduras for United Fruit, and biostatistics work for Worcester State Hospital in Massachusetts. The trouble was that the “science” part of alcohol science was murky at best. No real progress was made in loosening the grip that traditional psychology exerted upon the prevailing public view of addiction.

A few years earlier, in 1959, a colorfully maverick dissenter named Roger J. Williams, professor of chemistry at the University of Texas, had proposed a specific disease model of his own; one that went all but unnoticed at the time. The late Roger Williams was best known as the biochemist who discovered vitamin B-5, commonly known as pantothenic acid, one of the so-called “anti-stress” vitamins. This discovery produced a nice revenue stream for Williams’ home university through the patents he took out on various processes for synthesizing B-5.

 One of the problems with traditional theories of alcoholism, Williams believed, was that it was very difficult to identify the specific psychosocial pathologies psychiatrists insisted were behind alcoholism—such things as infantile regression and oral fixation. Those few researchers who did pay attention to alcoholism, he asserted, “have been so diverted by the rather vague and ill-defined personality disorders that alcoholics allegedly have that they have failed to concentrate upon the one thing that all alcoholics have—whether they are rich or poor... introverts or extroverts, dominant or submissive, repulsive or charming—namely, an excessive appetite for alcohol.”  The idea of appetite was, for Williams, the essential semantic shift. As Williams insisted in his book, Alcoholism: The Nutritional Approach:

“Alcohol is a physiological agent and the urge which the initial drink produces, in my opinion, arises because of deranged cellular metabolism. Except for the fact that derangement is involved, the urge is fundamentally similar to the urge we have for water when our tissues become dehydrated, for salt when our tissues become salt-hungry... or the unfortunate craving some diabetics have for sugar....”

Dr. Williams was saying that after a certain point, the burning urge for alcohol, or the insatiable craving for heroin became, for “addiction-prone” people, indistinguishable from the primal drives of food, thirst, or sex. “This is something that it is impossible to understand unless we take into account the tremendous biochemical individuality that exists.” If alcohol and addictive drugs didn’t effect you that way, well then, they just didn’t, and you thanked your lucky stars for it, the way you would be thankful for not having allergies or diabetes. Blood composition, enzyme levels, endocrine activities, excretion patterns, and nutritional needs all vary from person to person, argued Williams, and the effect of any given addictive drug was going to vary widely from person to person. This neglect of biochemical individuality, Williams was convinced, was the reason physicians had no medical treatment to offer. They had the wrong paradigm—they were focusing on the drugs themselves, and not on the bodies and brains of the users.

There were, Williams insisted, periodic references in the literature to what he called the “X” factor—some particular defect, or excess, or absence, that was present in alcoholics, but absent in moderate drinkers and abstainers. The hunt for the X Factor, for Substance H, was fast becoming the Holy Grail of addiction research.

Williams thought the X factor was genetic.

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