This article is based upon ideas originally presented at the 1985 NASW Professional Symposium: "The People, Yes!" on November 9, 1985.
The morality of alcoholism is a topic seldom on the agenda of workshops concerning alcoholism, or dealt with as a topic by itself in the literature. And yet moral issues regarding alcoholism are often talked about among professionals and is a topic in many counseling sessions. Morality is a difficult subject to deal with in any context. Issues of right and wrong, shame and guilt are brought up in almost every group or individual counseling session. The powerlessness, helplessness and angry feelings the worker experiences doing this work are often related to basic moral issues. The newly detoxed alcoholic is flooded with affect and is supersensitive to how others present themselves. The workers understanding of moral issues and alcoholism is essential to effective helping. If the worker blames the alcoholic, or has an attitude of blame, the worker and alcoholic often dont connect and the work will be stuck.
Much confusion exists about the morality of alcoholism. Alcoholics are often confused when they enter treatment full of shame and remorse then are told they are not responsible for their alcoholism. Family members are confused when the alcoholic enters treatment " the bad guy " and somewhere in treatment becomes " the good guy ". Workers are confused when alcoholics bring feelings out in them unlike no other population. Philosophers are confused when they hear "disease concept" and then think what is being said is the alcoholic is not morally responsible.
The problem is clear - there exits two very opposing moral views of alcoholism. The immoral view has a long, documented history and persists strongly in society to the present day. The immoralists view the alcoholic as not having morals. They also use words such as "sinful" or "moral weaklings" when describing alcoholics. (1) At the other extreme, amoralists divorce morality from alcoholism citing the disease concept as evidence. The amoralist tells a patient/client: "you're not a bad person trying to get good, you're a sick person trying to get well!" (2) Neither view is an accurate perception of reality. Workers and others holding either view are unable to effectively tune in to the alcoholic's struggles regarding moral issues.
Despite what many people observe, many alcoholics must endure a profound and constant internal struggle regarding morality. The morning after a drunken episode can be a horrific time for alcoholics - the feelings of guilt, shame and powerlessness can be overwhelming. Many alcoholics feel these feelings because they are moral beings and their actions from the previous evening do not correspond to their value system. Again, in the midst of guilt and self-loathing, they will make a heartfelt promise to not repeat the actions of the previous evening. However, they are doomed to act immorally until they begin recovery. The immoralists are unable or unwilling to tune into this moral struggle (the alcoholic should simply choose to not drink!). The amoralists are accepting and aware of the struggle, but fail to explain the process.
The alcoholic has a long history of being viewed as morally inferior. Aristotle, while he did not write specifically using the work alcoholic, wrote that a person who drinks to excess is responsible for whatever happens. (3) He used an example of two blind men. One was born blind, the other became blind after a long period of drinking alcohol. Aristotle said the man born blind is in no way responsible for his blindness and should be helped and pitied by others. He said the drunkard should be condemned because he brought it on himself. The drunkards blindness is a logical and deserved consequence of his wrong choice of behavior. It could be safely said that this attitude towards the alcoholic still exists today.
Other philosophers, all of whom have helped to form our system of morals and values, share beliefs similar to Aristotle. Kant's views are the most explicit. He, and many other philosophers, view alcoholics as having a choice over whether or not they drink - the action of becoming drunk is a voluntary one, so the person who gets drunk can be held responsible on a moral level.
Society has ascribed to these views as evidenced by the fact that alcoholics have been jailed just for being alcoholics in the past. (4) At worst, alcoholics have been killed or left to die because of society's views and from a lack of knowledge concerning treatment of alcoholism as well. At best, alcoholics have been laughed at, scorned, pitied and/or run out of town. Heavy Drinking: The Myth of Alcoholism as a Disease (5) illustrates the current day immoralists who arent so much concerned with labeling alcoholics "sinful" as they are in denying the possibility of alcoholism as a disease.
A very real and potentially fatal consequence of holding an immoralist view of alcoholism concerns the difficulty of getting help for the alcoholic. The alcoholic may have been socialized in a home where alcoholism was viewed as a moral failing and the alcoholic viewed as a "sinner" or moral weakling. Being raised with such a set of beliefs will strongly inhibit that alcoholic from admitting their alcoholism and from seeking help. Family members will not seek help for themselves or the alcoholic, except in extreme cases, to avoid the shame and disgrace. This scenario has been played out many, many times over many years. It is particularly difficult for a family member to reconcile their view of alcoholism with the fact that their family member, whom they love and respect, could be an alcoholic and thus a moral weakling. Alcoholics with this view would logically hold onto their system of denial more strongly than an alcoholic who was raised to view alcoholism as a treatable disease. Although the alcoholic who believes in the immoral view towards alcoholism will be less likely to seek or be involved in treatment for alcoholism, he or she will seek medical attention for secondary physical problems. However, alcoholism cannot usually be arrested without being treated directly.
The newest form of the immoralists also can result in the alcoholic not seeking services as well because they often espouse the view of moderation to the person with the problem with alcohol. While there are many people who drink excessively and then moderate their drinking, this discussion revolves around those people who have been unsuccessful in moderating their drinking despite attempts to do so.
Two proponents of the amoralist view of alcoholism are James Milam and Katherine Ketcham. Milam and Ketchem are quoted below:
The alcoholic must also understand that he is not responsible for the things he said or did when he was drinking. The physical addiction controlled his behavior, and because he is powerless over the addiction, he cannot be held responsible for it. When the alcoholic looks back at his life as a drinking alcoholic, he should learn to say, "That's what alcoholism did to me", not "That's what I did." Saying the words "I am an alcoholic" should convey the same moral overtones as the words, "I am allergic to pollen". (6)
Milam and Ketcham are correct when they state that the alcoholic should not be held morally responsible for actions during active alcoholism. However, they and most authors in the field fail to give any justification for the lack of moral responsibility beyond the disease concept. It is felt that a blanket statement such as "The alcoholic... is not responsible for the things he said or did when he was drinking" is inappropriate. If the alcoholic is not physically responsible for actions while drinking, several questions immediately come to mind. Who is responsible for the bad checks the alcoholic wrote while on a spree? Who is responsible for repairing the next door neighbors' car he ran into while drunk? Who ought to apologize to his son for not going to the son's graduation as promised and instead goes to the bar? Why should the alcoholics feel guilty if they are not at least physically responsible? How can alcoholics be motivated towards recovery if they are not responsible? These are questions that the amoralists do not answer.
The problem with amoral point of view usually becomes evident on an individual basis during treatment. Often alcoholics enter treatment at least partially aware of their inappropriate behaviors during active alcoholism. As alcoholics are detoxed and progress in treatment, much of the time they become more aware of their inappropriate behaviors from the past, and are often filled with shame and remorse. At this point, alcoholics hear something like this from the worker: "you're not a bad person trying to get good, you're a sick person trying to get well!" or "it's a disease, it is not a moral issue!" Alcoholics understandably become confused. If I have not done "bad" things, why do I feel so guilty about the things I have done? How can what they are saying be true when I know I have done "bad" things while drinking? They may think the disease concept too convenient or just something made up to help him or her with guilt. To abruptly dismiss the moral issues of alcoholism can place additional pressures or stress on the alcoholic and does not provide enough information for alcoholics to be able to successfully resolve their guilt and shame.
Acceptance of the disease concept is placed in jeopardy by the amoralists. Immoralists tend to feel angry when the amoralists state the alcoholic is not responsible because of the disease. This anger probably prompted one person to write: "the disease concept gives reprieve to the odious alcohol sinner." The divorce of moral issues from alcoholism also reinforces the immoralists in their view of alcoholism. When a worker in a family service agency sees children emotionally scarred because of an alcoholic parent, they will say "there is something wrong or bad going on." When a physician has to wrestle with a drunk in an ER, they will say "there is something wrong here". When a family hears their daughter has been killed by a drunken driver, they know something is wrong. It is wrong for innocent lives to be taken. The reality is this rightness and wrongness (Morality) needs to be talked about in the context of alcoholism - to not do so is being unrealistic. If moral issues in the context of alcoholism are not talked about, the immoralists and amoralist will continue to exist in their absolutes.
Another side to the amoral view is the alcoholic who is actively drinking and telling friends and family "I can't help it, I've got a disease". This person is correct in that he has a disease, but like the above examples, he does not possess all of the appropriate information concerning morality and alcoholism. And the reality is that society will hold this person legally responsible, at the very least, for his actions.
The immoralists are right in the fact that alcoholics commit wrong or harmful acts while actively alcoholic. This piece of information can be verified by almost anyone with personal or professional experience with alcoholics. But the immoralists are misinformed in their belief that drinking by the alcoholic is voluntary (a matter of choice), or that drinking or not drinking is a question of lack of moral development or "willpower".
The amoralists are correct when they infer that the alcoholic is not morally responsible for actions in active alcoholism, but they fail to explain to colleagues and clients why this should be so, beyond stating it is a disease. But the amoralists are incorrect when they infer that the alcoholic is not physically responsible. All members of society, whatever their impairment, are held responsible to at least some degree of their action.
WHAT HOLDS THIS PROBLEM IN PLACE
The problem concerning the two opposing views of morality and alcoholism is held in place by several factors. The immoralist view, which states the alcoholic is morally deficient, is firmly entrenched in the hearts and minds of many, and has been for centuries. Such a firmly entrenched view has been and will be very difficult to change. Social workers will readily attest to the difficulty in changing views developed over a very small part of a lifespan. The view that alcoholics are immoral is also held by some helping professionals. All the techniques and skills developed by professionals over the years had been inadequate to treat alcoholism (7) until the advent of Alcoholics Anonymous and the knowledge base and skills concerning alcoholism as a primary disease. And yet the disease concept is clearly not universally accepted by members of the helping professions.
Another factor that holds this problem in place concerns a common characteristic of many human beings - a characteristic that social workers are trained to overcome. That characteristic is that many of us have a tendency to think that everyone is on the same psychological wavelength as we are. (8) Another way to state this phenomenon is to say we believe that people are able to do the things that we are able to do. A person who doesn't have a problem with alcohol may drink too much on an occasion. That person wakes up, feels uncomfortable or embarrassed and makes a decision not to drink that much anymore and doesn't. He has a friend who is alcoholic (diagnosed or undiagnosed) and tells that friend to "just drink a couple, and you'll be OK". It worked for the first man, but didn't for the second, because the second man has a disease. The first man notices a big difference between the two and uses the following logic: A. I'm a good, moral man who stopped drinking when I saw it as a problem. B. Good, moral men can stop drinking when it's a problem. C. You must not be a good, moral man because you can't stop drinking after two like me.
The alcoholic drinks more than two because of an irresistible inner compulsion. It is very difficult for most people to understand compulsion unless it has been personally experienced. Compulsion doesn't make sense because it bypasses logic and rationality. However, when compulsion is understood, the unpredictable actions of the alcoholic begin to make more sense. When the worker understands compulsion, he or she is able to connect with the alcoholic.
A NEW PERSPECTIVE
Morality in the context of alcoholism can be viewed as a moral/physical dualism where alcoholics are not morally responsible for their behavior during the active alcoholism, but they are always physically responsible for their behavior. Each piece of the moral/physical dualism will be explained below.
That alcoholics are not morally responsible for their actions can be expressed in other ways: not blameworthy on a moral level; not morally culpable; or morally excusable. Each of these ideas will be discussed in more detail later in this article.
ARGUMENTS FOR THE DUALISTIC CONCEPT
This article has four specific arguments for workers and others to adopt the dualistic concept or moral/physical responsibility in their work with the alcoholic. These are explained below:
Argument # 1: Biochemistry. "To behave morally is to have internalized control over behavior that inhibits harmful act and facilitates beneficent acts". (9) One of the first effects of drinking alcohol is disinhibition. Disinhibition is an effect noticed in all drinkers; it is not confined to alcoholics. As the blood alcohol level rises in the drinker, reason and judgment are progressively more affected until the drinker is physically unable to be rational or to use his or her judgment. The drinker at this point is unable to act morally.
Mention should be made at this point of two studies done to determine if there exist significant differences in Kohlberg's moral reasoning levels between alcoholics/addicts and socioeconomically matched controls. Both studies discovered there is no significant difference. (10) Also, both studies pointed to the problem being located in what Kohlberg called "ego controls"(11) rather than in the ability to reason morally at a socially acceptable level. It is these ego controls which are sedated by the drug alcohol. Rationality and judgment are what separates human beings from other animals. Indeed, systems of thought regarding morality are based upon the premise that the agent is rational and can use judgment (choose between alternatives). It is easy to understand why Kant states: "....when a man is drunk, he is simply like a beast, not to be treated as a human being..." (12) The lack of ability to be moral (to be reasonable, to use judgment and make a right choice of action) is easily observable in an intoxicated person. Kant and other philosophers (and mankind in general) have made this observation. Kant's anger seems to be caused by his belief that the drunkard chooses to place himself in such a state. However, research is showing that the alcoholic does not choose to drink; in fact be definition, the alcoholic is powerless over drinking alcohol. In treatment and Alcoholics Anonymous, alcoholics learn skills for dealing with their powerlessness over alcohol and so can arrest the disease. The concept of choice in alcoholism will be further examined under the next argument.
When drunk, a person is experiencing a drug induced organic brain syndrome, which is reversible after the alcohol has been metabolized, and is similar in its effects on behavior to Organic Brain Syndrome (OBS). As a society, we do not hold persons with OBS morally responsible for their behavior. But because of society's lack of understanding of the biochemistry of alcohol on the CNS and because of their long held belief that the alcoholic chooses to put himself in such a state, society holds the alcoholic morally responsible for his actions.
The reader at this point may say, "Okay, I know enough to realize that when a person drinks enough they are physically unable to act morally. But I've seen plenty of social drinkers who get drunk and don't beat up their kids or other people, or they aren't obnoxious like most of the alcoholics I've run into. Why the difference?" This point is well taken. A specific reason exits for the difference - the amount of emotional pain in the drinker. As with all drugs, set and setting affects how alcohol affects the drinker. While the social drinker may be in emotional pain before drinking, that is not usually the case by definition. The social drinker drinks to be "social", to have a good time with others. The social drinker does not drink to relieve emotional pain. However, the alcoholic almost always is in emotional pain. The alcoholic has a realization of previous inappropriate behaviors while drinking (and the guilt associated with that). The broken promises and dreams in the alcoholic's life is a source of ongoing emotional pain. The huge gulf between the ideal self and the actual self in the alcoholic is a source of tremendous emotional pain. If one assumes the inescapable link between pain and anger, and one tunes into the sources of emotional pain cited above (to say nothing of the shame/stigma and the physical pain brought on by the medical consequences of alcoholism), it is easy to understand why the alcoholic acts out in an angry manner. The social drinker does not have this pain, so does not act out in the same manner.
Society must hold the alcoholic physically responsible for his or her behavior, much in the same way it holds the criminally insane responsible for their actions (not to imply that alcoholics are criminally insane). When a criminally insane person (one who is unable to distinguish right from wrong) performs an act which society considers harmful, that person is isolated from society (to protect society and the person) and treated until such a time when professionals can make a judgment that this person will be able to conform to the rules of society.
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