Alcoholism defined as a disease Define alcoholism as a disease Definition of alcoholism as a disease Ama definition of alcoholism as a disease Defining alcoholism as a disease is associated with Who defined alcoholism as a disease. HIGH COURT FACES ALCOHOLISM ISSUE -

Nearly 200 years after a Philadelphia physician first advanced the theory of alcoholism as a disease rather than merely a character weakness, the issue may be faced squarely by the Supreme Court. Define alcoholism as a disease.

The Court has agreed to hear a challenge against the Veterans Administration for excluding alcoholism, which it considers the result of ''willful misconduct,'' from the illnesses and disabilities that allow veterans more time to claim education benefits.

The case could portend serious consequences for Government agencies, employers, insurance companies, alcoholism-care providers and the estimated one million alcoholics expected to seek treatment in the next year.

''Over the last two decades, the disease concept of alcoholism has become the premise for social policy,'' said Ronald Roizen, a scientist at the Medical Research Institute of San Francisco. ''But the legal basis has never been clear.''

The case, to be argued Dec. 7, has enlivened debate about the view that alcoholism is a disease. Proponents point to research implicating genetic factors in drinking problems, while critics are becoming increasingly vocal.

''The entire notion of alcoholism as a disease is at stake here,'' said Michael Ford, executive director of the National Association of Addiction Treatment Providers. ''It's taken years for the public to come to understand alcoholism as a disease. And here's the Federal Government saying it's just a temper tantrum.''

While about 87 percent of Americans now view alcoholism as a disease, according to a Gallup Poll last April, treatment based on that concept is relatively new. Through the 1940's, alcoholics were often jailed as criminals, ostracized as irresponsible or committed to sanitariums as psychological deviants. And it was not until 1956 that the American Medical Association concurred in the disease concept.

Treatment today overwhelmingly rests on the notion that alcoholism is a disease of unknown origin, without a cure, and that the only way to arrest its development is abstinence.

In recent years, however, a growing minority of alcoholism experts contend that the pendulum has swung too far. 'Moral Responsibility'

They contend that alcoholism is a behavioral, not a medical, problem. They reject the idea that genetics play a primary role and contend that the disease concept ''blurs the issue of moral responsibility.''

''People are using alcoholism as an excuse for wife abuse, vehicular homicide, embezzlement, every crime you can think of,'' said Stanton Peele, a New Jersey psychologist whose book, ''The Meaning of Addiction,'' disputes the notion of alcoholism as a disease.

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''The more and more we allow alcoholism to be used as an excuse for misbehavior, the more misbehavior we get,'' he said. ''Ten years from now, we'll have spent another $10 billion in treatment and found out we've got more alcoholics than we had before. In five or ten years, there's going to be a rush back to a value-oriented consideration of alcoholism. The best way to treat alcoholism is not to treat it as a disease, but to concentrate on values.''

Treatment of alcoholics, who Mr. Peele contends are ''deficient in certain values,'' should stress that drinking is a ''moral choice,'' not a disease. These experts argue that alcoholism treatment would achieve better results as part of psychological therapy. Broader Problems Seen

Alcoholism is ''just the tip of the iceberg'' of broader psychological problems, contends Herbert Fingarette, a professor of philosophy at the University of California at Santa Barbara and an author of the forthcoming book, ''The Myth of Alcoholism as a Disease.''

The case before the Supreme Court, which joins two separate lawsuits filed in 1984, was brought by veterans who contend that alcoholism, as a disabling illness, prevented them from taking advantage of education benefits in the 10 years after their military discharge. In denying them an extension of benefits, they contend, the Veterans Administration violated the Federal Rehabilitation Act of 1973, which prohibits discrimination on the basis of handicaps. The law was amended in 1978 to include alcoholism.

Extensions can be granted to veterans hindered by physical or mental problems ''not the result of their own willful misconduct.'' The V.A. accepts ''secondary alcoholism,'' in which drinking is a symptom of an underlying psychiatric problem, as an involuntary illness eligible for extension of benefits, but not the more common ''primary alcoholism,'' in which drinking itself as the root disorder. Plaintiffs in Two Cases

The plaintiffs, Eugene Traynor, a 46-year-old New Yorker who works as a supervisor in a photography laboratory, and James P. McKelvey, 42, an alcoholism counselor who lives in Washington, received honorable discharges from the Army in the late 1960's. Both men said they had abstained from drinking alcohol since the early 1970's, when they were hospitalized and treated for alcoholism.

Asserting that alcoholism is a dysfunction beyond the control of the individual, the plaintiffs were joined in friend-of-the-court briefs by the American Medical Association, the Vietnam Veterans of America and the National Association of Addiction Treatment Providers. These groups are hoping the Court, for the first time, will explicitly define alcoholism as a disease.

But it is possible that the Court could decide the case on other matters. Indeed, in 1985 the Federal courts, in siding with Mr. Traynor and Mr. McKelvey, held the V.A. policy discriminatory, but did not address the disease issue.

But last year the United States Court of Appeals in New York reversed the Traynor decision on the ground that benefits policies are exempt from judicial review. In the McKelvey case, the Court of Appeals in Washington agreed to review the policy but upheld the V.A. policy on the ground that medical experts were divided over the question of alcoholism as a disease.

The Washington appellate panel included Antonin Scalia, now a Supreme Court Justice. Justice Scalia has recused himself from the case. Disease Issue Raised in 1968

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The question of whether alcoholism is a disease initially reached the Supreme Court in 1968, in a challenge to a Texas law against public drunkenness. In that case, Powell v. Texas, the Court rejected the argument that public drunkenness should not be considered criminal on the ground that it is alcoholism sickness. In its decision, the Court noted that there were differences of opinion among medical authorities on whether alcoholism is a disease.

In the case now before the Court, the Government has argued that alcoholism, unlike most orthodox diseases, results from years of behavior chosen freely.

''Even those medical authorities who label alcoholism a 'disease' concede that it is a disease that can and does involve significant elements of volition,'' the Government brief argues.

Critics of the Government's position dispute that alcoholism is purely a matter of free will. And they note that other diseases, such as heart problems, can result from freely chosen behavior, such as diet and smoking. Proponents of Disease Concept

They also note that scientific findings in recent years make a strong case for the theory that alcoholism can be inherited. In several studies of twins adopted at birth, for example, the sons of alcoholic fathers were found to be four times as likely as others to develop alcoholism themselves, despite being reared in a home with non-alcoholics.

A New York researcher, Henri Begleiter, has found abnormalities in brain wave patterns among sons of alcoholics identical to abnormalities found in their fathers. The sons, some of them as young as 7 years old, had never consumed alcohol.

''There are all kinds of biological abnormalities in alcoholics and their offspring which point to the existence of one thing: a bona fide disease,'' said Mr. Begleiter, a professor of psychiatry at State University of New York's Downstate Medical Center in Brooklyn. ''We're not saying environment doesn't play some role. And not all alcoholism is the same, just as there are different kinds of diabetes and hypertensions.''

Providers of alcoholism treatment fear that a victory by the Veterans Administration would encourage insurers to curtail coverage. In addition, they worry that employee assistance programs, which in recent years have provided treatment for hundreds of thousands of alcoholic workers who once might simply have been dismissed, could similarly face retrenchment. Outlook on Court Decision

Perhaps most important, they warn, a ruling that alcoholism is not a disease could thwart society's compassion toward the suffering of alcoholics.

But critics of the disease concept of alcoholism argue that treatment programs, now a billion-dollar-a-year industry, have been largely unsuccessful. Moreover, they contend that a ruling against the Veterans Administration would result in enormous extra cost and complication for the Government. And they believe that employers have already been unduly stripped of options in dealing with workers who drink inappropriately.

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They contend that dealing with alcoholism as just another disease opens a Pandora's box of legal difficulties. In a case now pending before an Appeals Court in Philadelphia, a veteran has filed suit to collect disability payments because his alcoholism makes it impossible for him to work.

''Where does it all end?'' asked Professor Fingarette.

The continuing dispute over the causes of alcoholism, both sides agree, reflects the frustrations in grappling with the problems of an estimated 10 million alcoholics in the United States. And it perhaps illustrates society's ambivalent attitude toward its drinking problem.

''As a society,'' said Harold A. Swift, president of the Hazelden alcoholism treatment center in Minnesota, ''we still don't know whether to laugh or to cry when we see someone who is drunk.''

Photo of Eugene Traynor (NYT/Jim Wilson) (Page 34)

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