The drinker or the drink? The concept of alcoholism in the 19th and 20th century

About 1800 the concept of addiction is introduced in the medical world. Medical doctors renounce the idea that misuse of alcohol is the result of a free choice of the drinker. The drinker is no longer seen as a responsible agent, but is declared to be under the influence of a disease. Yet the moral approach, with its accentuation of the responsibility of the drinker, does not vanish. Although a disease-approach seems to exclude moral concepts, both appear to go together well in practice. Psychiatrists in the second half of the 19th century combine the disease-concept with the so-called 'Moral Treatment'. The disease-concept is adopted by social groups with a moral background, such as the Temperance Movement in the last century and Alcoholics Anonymous in this century. These developments show that a disease-approach and a moral approach are not mutually exclusive. In this article we argue that both approaches presuppose one another and call for one another. This throws new light, not only on the history of alcoholism, but also on the status of recent positions in the alcoholism-debate, which reject both the disease-model and the moral approach and stress social aspects of alcohol-use and alcoholism.