I respect Stanton Peele, if for no other reason than simply because he is well informed and doesn’t mind telling us all about the way he sees things. However, even the mighty sometime misstep, and this article is about what I see as one of Dr. Peele’s errors.
Why Stanton Peele thinks addiction isn’t a disease
In his recent post about why the disease concept of alcoholism, or addiction, is bull$&%# (his words), Dr. Peele decides to quote a piece from the NIAAA’s website that states that approximately 75% of people who’ve met the definition of alcohol dependence (read: alcoholism) in their lifetime quit by themselves without any outside intervention. That’s great, but what he forgot to also quote is another passage that states that while “70 percent of [alcoholics] have a single episode of less than 4 years, the remainder experience an average of five episodes. Thus, it appears that there are two forms of alcohol dependence: time-limited, and recurrent or chronic.”
Why Stanton Peele is a little right and a lot wrong
Maybe Stanton missed this sentence since it was a few lines above the one he was focusing on, but what it’s telling us is that the vast majority of people who meet alcohol dependence criteria do so for a very limited amount of time (seemingly their 4 years of college) while another 30% or so (or 25% according to the line Dr. Peele decided to use) have the chronic-relapsing version of alcoholism we’ve all come to know. I guess the question of what is substance abuse doesn’t have the simplest of answers.
So yes, most people quit without help, and as we’ve pointed out on this site before, most people who experiment with drugs never develop a problem with them. But the reality is that the remaining group has a hell of a time quitting and most of them need help and even then don’t necessarily respond to addiction treatment. I don’t know that this is very different from the percentage of people that eat too much and gain weight – some stop and return to a normal BMI, the rest become obese. The same story holds for the pre-diabetics who never quite cross that line but once they do, will need insulin and a strictly managed diet. In both cases I don’t think we need to discount the latter because the former exists.
I agree that this sort of nuanced observation is missing from the public discourse, and I think that it’s important to bring it in since it does something important – it lessens the stigma of alcoholism and addiction by showing us what is really happening without distortion. However, showing only the other side does little to improve the situation.
So in closing – most of those who meet the definition of alcohol-dependence should probably not be called alcoholics. Instead, they can be referred to a “Frat boys,” “Sorority girls,” or really “late teens to early adults.” However, there is a large enough group of people out there who really suffer with a condition that doesn’t go away when their first 4 year-long episode of hard alcohol use ends. They need addiction treatment and they’re the focus of most research on addiction and alcoholism, as they likely should be when it comes to treatment. That other group, they just need to be careful not to get in a car accident or get pregnant too early.
That’s my take anyway.
When people ask “what is substance abuse?”, they are probably referring to the former group most of the time, although based on our present definition, substance abuse per se is a diagnosis that is pretty easy to meet, which likely means both groups actually meet abuse criteria.