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2 22. Have you ever been arrested for drunk driving, driving while intoxicated, or driving under the influence of alcoholic beverages (2 points for each arrest)?

2 23. Have you ever been arrested, or taken into custody for a few hours, because of other drunk behavior (2 points for each arrest)?

Scoring. The scoring is simple. Total your points. There is no sharp cutoff, but a total of 5 points or more places you in the alcoholic—dependent on alcohol—category. Four points suggests that you abuse alcohol. Three points or less suggests no major alcohol problem. This test is conservative, a screening test, so it tends to call more people alcoholic than you would expect. If you score more than 3 points, you should attend very carefully to the sections that follow on recovery from alcoholism.

Is Alcoholism a Disease?

Is alcoholism a disease? There is no question about substance abuse that has produced more passionate controversy than this one. Alcoholics Anonymous insists that alcoholism is a disease and that the alcoholic is “powerless” before it. But for more than a hundred years, others have insisted that “drunkenness is a vice, not a disease,” and that “alcoholism is no more a disease than thieving or lynching.”2

For the scholar, this debate is a matter of truth and the sanctity of language. For the helper, this is a matter of helping tactics. Whatever, this is a subject that inevitably lends itself to give-and-take exchange:

Attack: Alcoholism, unlike a real disease, is not physical. If someone tells you there is a known metabolic deficiency, a known gene, or a known biochemical weakness that alcoholics have, hold on to your wallet. There is no such thing. Alcoholism is a social, economic, and interpersonal problem, not a physical pathology.

Rejoinder: Alcoholism is not a disease like malaria, with a specific germ or chemical abnormality as its cause; it is more like high blood pressure. Hypertension is bound up with social, interpersonal, and economic factors, and most hypertension is essential—it has no known physical cause. But it does have known physical consequences—heart attack and stroke—just as alcoholism brings cirrhosis of the liver and brain damage in its wake. Alcoholism, like many diseases, has strong heritability. Identical twins are more concordant than fraternal twins, and the offspring of biological parents who are alcoholic are several times more likely to become alcoholic, even if they are raised by teetotalers.3

Attack: Heritability does not cut much ice: Stupidity, ugliness, and criminality are inherited, but that does not make them diseases. You either have a real disease, like syphilis or schizophrenia, or you don’t. But with alcoholism there is merely a continuum of alcohol consumed, with heavy drinkers at one extreme. So calling this extreme a disease is like calling very short people (midgets as opposed to dwarfs) diseased.

Rejoinder: Just as there is no clear dividing line with hypertension, there is none with alcoholism. All we can say is the more of it, the worse the problems tend to be.

Attack: This is an egregious instance of victimology, the art of transforming failures into victims. We are a society that does not take kindly to failure. Failures are felt to be vaguely immoral—lazy, stupid, mean, or obnoxious. But we have also become a gentler society in recent years—no longer are our classrooms appointed with dunce caps or our children’s report cards replete with Fs (we now have “Unsatisfactory” and “Incomplete” instead). No longer can our kids go unpunished for taunting a retarded child as the “village idiot.” We now deal with failures in a manner that tries to save them from the humiliations of the past. We relabel them victims, and of victims no ill can be said. Alcoholics are, in truth, failures, and their failure is a simple failure of will. They have made bad choices, and they continue to do so every day. By calling them victims of a disease, we magically shift the burden of the problem from choice and personal control,