Earlier in this series I wrote about the notion that the desire for intoxication may be universal, and how that connects with the “disease model” of addiction. The disease model, as far as I can tell, first gained traction as an idea in the 1930s with the formation of Alcoholics Anonymous. Groups similar to AA, such as the Washingtonian Movement and the Oxford fellowship (which AA cofounder Bill Wilson attended before forming his own voluntary fellowship) had existed prior to AA’s formation, but AA took off in a way they never did, for a variety of reasons. Alcoholism wasn’t recognized as a disease by medical and psychiatric associations until the 1950s—but the disease model is now pretty firmly entrenched in our understanding of chemical dependency.
Personally, I don’t think it’s an accident that AA was formed just a few years after Prohibition ended. Its formation represented a fundamental cultural shift—one that recognized prohibiting the sale of alcohol had not solved any of the problems that concerned Temperance leaders, including the way problem drinking affected families. It still prescribed total abstinence from alcohol, just not for the entire population. And while Temperance leaders placed more of the blame for problem drinking on alcohol itself—and the people who sold it—than on the drinkers, heavy drinking was still viewed as a moral failure rather than a medical problem. In the decades after the advent of AA, many cities’ laws against public drunkenness were thrown out or softened, and instead of being thrown into drunk tanks, people found stumbling around or sleeping it off in public spaces were taken to detox and rehab facilities—a problematic policy shift in itself since people who aren’t ready for rehab won’t benefit from it but still, arguably, a change for the better.
All of that resulted from a movement that has attempted to make addiction a morally neutral, medical issue and has argued for treating people with addiction issues with compassion rather than dismissive contempt. But our understanding of addiction, through the disease model lens, has evolved in odd ways. (It occurs to me, for instance, that if 12-step recovery programs don’t necessarily view addiction as a moral problem, they promote a faith-based—and therefore “moral,” in some sense—solution.) In the 1980s, researchers began investigating a potential link between addiction and genetics—and almost immediately started talking about whether genetics would explain why some races or nationalities had higher incidences of problem drinking than others.
Again, it was offered as a morally neutral alternative to existing stereotypes about weak-willed, shiftless, or mean drunks, particularly those in certain minority groups (Native Americans, and to a much, much, lesser extent, Irish-Americans). Brown University epidemiologist Stephen Buka, in a paper discussing health disparities as they relate to substance abuse, notes that there is greater genetic variability within major racial groups than between them and that racial disparities in health status. Research on ethnicity and race as they relate to heavy drinking is intrinsically problematic, if not impossible to conduct, because these are plastic concepts that change with society; discussions about the ethnic connection to drinking invariably group all Native Americans (on both continents) into one single ethnic category; in the same discussions, the Irish are presented as genetically distinct from all other European ethnicities.
The same way that evolutionary psychology (or at least, bad reporting on evolutionary research) often conveniently reinforces sexist stereotypes about the role of men and women in the 21st society, genetic explanations for alcoholism tend to reinforce preexisting stereotypes about certain ethnic groups and races; in the case of both Native Americans and (now fully assimilated, but still cheekily stereotyped) Irish-Americans, these are stereotypes that date back centuries before the discovery of DNA; stories about the purported “out-of-control” drinking habits of Native Americans date back to the first interactions between white explorers and natives, with the former presenting their own drinking norms as refined and in control.
Socioogist and social worker Richard Thatcher, author of the 2004 book Fighting Firewater Fictions: Moving Beyond the Disease Model of Alcoholism, argues that both the disease model and the “firewater myth” not only cast Native American people in the most essentialist terms, but considers problem drinking from the social, cultural and economic realities with which many indigenous people cope—perpetuating a racist status quo and leading many young people to believe they will eventually, inevitably become alcoholics themselves. That becomes a self-fulfilling prophecy, particularly in cultures (Thatcher’s work focuses on indigenous people in Canada) where no effort is made to address the other societal factors that lead to problem drinking.
People drink for a lot of reasons: to celebrate, to grieve, to relax and, I would argue, we sometimes drink, too much, too heavily, to bear the unbearable, including systematic racism (not just on the part of indigenous peoples, but other racial minorities as well). While removing moral judgment from that coping mechanism is a step in the right direction, treating alcoholism as a disease separate from the social and historic factors that brought it about in the first place gives societies license to continue not addressing those factors. It gives dominant groups a pass to perpetuate the racist status quo, rather than helping to improve the living conditions and economic prospects of Native people. Where alcohol dependence and ongoing marginalizing intersect is where the discourse—and the treatment—should be centered.