ALCOHOLalcoholism as a disease is the officially stated posi-
tion of the federal agency most responsible for
alcohol research and treatment, the National Insti-
tute of Alcoholism and Alcohol Abuse (National
Institute on Alcohol Abuse and Alcoholism 1987).
Nonetheless, many sociologists and behavior-
al scientists remain highly skeptical and critical of
the disease concept of alcoholism (Trice 1966;
Cahalan and Room 1974; Conrad and Schneider
1980; Rudy 1986; Fingarette 1988, 1991; Peele
1989). The concept may do more harm than good
by discouraging many heavy drinkers who are
having problems with alcohol, but who do not
identify themselves as alcoholics or do not want
others to view them as sick alcoholics, from seek-
ing help. The disease concept is a tautological (and
therefore untestable) explanation for the behavior
of people diagnosed as alcoholic. That is, the
diagnosis of the disease is made on the basis of
excessive, problematic alcohol behavior that seems
to be out of control, and then this diagnosed
disease entity is, in turn, used to explain the exces-
sive, problematic, out-of-control behavior.
In so far as claims about alcoholism as a dis-
ease can be tested, ‘‘Almost everything that the
American public believes to be the scientific truth
about alcoholism is false’’ (Fingarette 1988, p.1;
see also Peele 1989; Conrad and Schneider 1980;
Fingarette 1991; Akers 1992). The concept pre-
ferred by these authors and by other sociologists is
one that refers only to observable behavior and
drinking problems. The term alcoholism then is
nothing more than a label attached to a pattern of
drinking that is characterized by personal and
social dsyfunctions (Mulford and Miller 1960; Con-
rad and Schneider 1980; Rudy 1986: Goode 1993).
That is, the drinking is so frequent, heavy, and
abusive that it produces or exacerbates problems
for the drinker and those around him or her
including financial, family, occupational, physical,
and interpersonal problems. The heavy drinking
behavior and its attendant problems are them-
selves the focus of explanation and treatment.
They are not seen as merely symptoms of some
underlying disease pathology. When drinking stops
or moderate drinking is resumed and drinking
does not cause social and personal problems, one
is no longer alcoholic. Behavior we label as alco-
holic is problem drinking that lies at one extreme
end of a continuum of drinking behavior with
abstinence at the other end and various other
drinking patterns in between (Cahalan et al. 1969).
From this point of view, alcoholism is a disease
only because it has been socially defined as a
disease (Conrad and Schneider 1980; Goode 1993).Genetic Factors in Alcoholism. Contrary to
what is regularly asserted, evidence that there may
be genetic, biological factors in alcohol abuse is
evidence neither in favor of nor against the disease
concept, any more than evidence that there may
be genetic variables in criminal behavior demon-
strates that crime is a disease. Few serious re-
searchers claim to have found evidence that a
specific disease entity is inherited or that there is a
genetically programmed and unalterable craving
or desire for alcohol. It is genetic susceptibility to
alcoholism that interacts with the social environ-
ment and the person’s drinking experiences, rath-
er than genetic determinism, that is the predomi-
nant perspective.The major evidence for the existence of he-
reditary factors in alcoholism comes from studies
that have found greater ‘‘concordance’’ between
the alcoholism of identical twins than between
siblings and from studies of adoptees in which
offspring of alcoholic fathers were found to have
an increased risk of alcoholism even though raised
by nonalcoholic adoptive parents (Goodwin 1976;
National Institute on Alcohol Abuse and Alcohol-
ism 1982; U.S. Department of Health and Human
Services 1987; for a review and critique of physio-
logical and genetic theories of alcoholism see Riv-
ers 1994). Some have pointed to serious methodo-
logical problems in these studies that limit their
support for inherited alcoholism (Lester 1987).
Even the studies finding evidence for an inherited
alcoholism report that only a small minority of
those judged to have the inherited traits become
alcoholic and an even smaller portion of all alco-
holics have indications of hereditary tendencies.
Whatever genetic variables there are in alcoholism
apparently come into play in a small portion of
cases. Depending upon the definition of alcohol-
ism used, the research shows that biological inher-
itance either makes no difference at all or makes a
difference for only about one out of ten alcoholics.
Social and social psychological factors are the
principal variables in alcohol behavior, including
that which is socially labeled and diagnosed as
alcoholism (Fingarette 1988; Peele 1989).