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February 3, 1993

The Definition of Alcoholism

JAMA. 1993;269(5):586. doi:10.1001/jama.1993.03500050064013

To the Editor.  —The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine1 purport to offer a definition of alcoholism that is scientifically valid and clinically useful. Alcoholism is described as a "primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by... distortions in thinking, most notably denial." Denial is construed as "a range of psychologic maneuvers that decrease awareness of the fact that alcohol use is the cause of a person's problems rather than a solution to those problems" that "becomes an integral part of the disease and is nearly always a major obstacle to recovery."While the committee has done much to elucidate important aspects of alcoholism and to encourage consistent application of the term, its identification of denial as a cardinal feature