Fundamental Questions About Alcoholism in Society

Perhaps no medical topic arouses more confusion, dismay, and passion in both the public and the medical profession than alcoholism. Although alcohol is often associated with joy and celebration, ritual, and reverence, alcoholism is associated with sorrow and moral failing, disease, and death. No other disease entity can be conceived as having such extreme attributes.

Society’s decision to ban certain substances while allowing others to be freely available has little to do with the dangers inherent in any particular substance, and it has more to do with the emotional outcry that a particular substance engenders. For example, consider the seemingly benign over-thecounter medication acetaminophen, or Tylenol. Tylenol was first introduced in 1956. About 150 acetaminophen-related deaths are reported every year in the United States alone. Add to that the associated morbidity and mortality from those requiring liver transplants from Tylenol overdoses, and the numbers become even greater. Contrast that with Ephedra, a once hugely popular drug for weight loss and bodybuilding that has been linked to a grand total of 155 deaths. The deaths from Vioxx are more difficult to calculate because these deaths are primarily from patients already suffering from cardiovascular disease and not from the direct effects of the drug itself.

The estimates suggest up to 27,000 deaths since its introduction in 1999. The outrage leading to its removal had more to do with the company’s refusal to acknowledge the risks than the risks themselves. Alcohol, however, is responsible for approximately 85,000 deaths annually from injuries or diseases directly related to the use or abuse of alcohol. Thus, people often judge the risks and benefits of a particular substance based more on cultural, religious, and moral beliefs than on scientific fact. Alcohol is a prime example

Alcohol is the single most unique intoxicant because it is a legal, non-prescription, and culturally sanctioned substance that causes more devastating effects to human lives than any other known drug, whether available by prescription or over the counter or on the street. Prohibition, the one attempt in American history to prohibit alcohol use, was a miserable failure, with the cure being worse than the illness. Although it successfully cut the deaths from cirrhosis in half, it came at the cost of increased crime and social unrest.

Ingesting anything-medicine, an illegal drug, or even food-is an act that entails a degree of risk. Therefore, people should understand the risks and the alternatives before ingesting anything. Informed consent is both a legal and an ethical responsibility of healthcare providers to ensure that their patients are knowledgeable about the drugs they are ingesting, including over-the-counter medications, herbal remedies, street drugs, food, and alcohol.

Although the institution of medicine has accepted the concept of alcoholism as a disease, the larger culture with its personal values and beliefs, which includes healthcare providers themselves, continues to debate the issue, with many still viewing alcoholism as a moral failing.