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IT WAS NICE TO SEE A piece on alcohol that treated the substance for what it is—a drug (“Booze N the Hood,” 9/3). Unfortunately, while Bill Gifford was dismantling the misconception that booze is safe, he was fortifying a more pervasive and dangerous lie: to wit, that “long-term abuse” of alcohol can “lead to psychological and physiological dependence.”

This is horseshit. Ironically, Gifford’s article appears as a battle is raging about the very definition of alcoholism, one in which the old model of the illness, which holds that addiction to alcohol is the result of psychological and cultural problems or excessive use, is being uprooted to make way for an entirely new model that will render old concepts—and with them, absurd terms such as “alcohol abuse”—obsolete.

The champion of the paradigm is Dr. Jim Milam, author of Under the Influence: A Guide to the Myths and Realities of Alcoholism. In a powerful position paper that ran last year in Professional Counselor magazine, Milam spelled out his “new gestalt” for the disease. It should be recommended reading for every medical student, member of the media, and bartender in the country.

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“When controlled for heredity,” Milam wrote, referring to alcohol studies conducted over the last 30 years, “no pre-drinking psychological or social variable of any kind can be found to correlate with later alcoholism—not child abuse, depression, antisocial attitude, poor self-image, or any other.” He then broke the two schools of thought on alcoholism into separate categories: the erroneous “psychogenic,” which holds that alcoholism is a “character defect” or a “destructive response to psychological and social problems,” and the “biogenic,” which “recognizes that alcoholism is a primary addictive response to alcohol in a biologically susceptible drinker, regardless of character and personality.” In other words, the idea that someone with personal problems drinks excessively and therefore becomes a drunk is false.

Here’s where the skeptics chime in: If someone imbibes heavily for 20 years, they reason, surely that person could become a drunk. And it is here that Milam’s arguments begin to make tight and uncanny sense. In the early stages, alcoholism causes the victim’s tolerance to skyrocket, triggering the heavier drinking. The popular perception that heavy drinking leads to alcoholism is exactly wrong—in fact, the opposite it true: Alcoholism causes drunkenness. The only difference between the drunk Gifford saw stumbling across the street in the beginning of his piece and the robust and healthy-looking jock who drinks all his buddies under the table in Georgetown is that one is suffering the final, deteriorating stages of the illness (it’s useful to remember that the chemistry of alcoholism makes the brain sick as well as the body), and the other enjoys what is alcoholism’s initial and temporary first-stage benefit—high tolerance. Both are alcoholics. Conversely, there are people who can drink every night of their lives and never become addicted. Without the right biological makeup, it’s simply impossible to create an alcoholic. To hold otherwise is like saying that diabetes is caused by eating candy bars.

If our culture could step off the pulpit, take a deep breath, and look at the biogenic model, more alcoholics might start getting better and thus emerge from the revolving door of police, shrinks, emergency rooms, and other secondary problems resulting from addictive diseases. Doctors would stop treating addicts with drugs (one joke holds that most mainstream doctors believe alcoholism results from a Valium deficiency), and the entire format for treating the illness would be revolutionized.

Bethesda, Md.