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February 3, 1993

The Definition of Alcoholism-Reply

Author Affiliations

Mayo Clinic Rochester, Minn
National Council on Alcoholism and Drug Dependence New York, NY

JAMA. 1993;269(5):586-587. doi:10.1001/jama.1993.03500050064014

In Reply.  —The thoughtful letter from Drs Howard and Donovan serves to highlight some of the difficulties in communicating the concept of a revised definition of alcoholism to a widely varied audience of scientists, clinicians, and laypersons. We welcome the opportunity to respond to their critique and hope to clarify some of the confusion about denial.We disagree with their judgment that our definition is "vague." To the contrary, we have been quite specific, given the length of our article, about the nature of this defense mechanism, its clinical ubiquity, and its roots in biopsychosocial phenomena.Further, we do not think there is "inadequate empirical justification" for including this construct. In fact, the lion's share of justification is just that—empirical. The difficulties have arisen more in scientific attempts to define, delineate, describe, and measure the denial process. Virtually all experienced clinicians point to the denial mechanism as a key construct