Illustration · A state delegation’s place at a session of the American Medical Association’s House of Delegates in the 1960s, with the delegates’ handbook, a microphone, a water pitcher and a cigarette left burning in the ashtray. Not drawn from a photograph.

The American Medical Association · 1951–1967

A major medical problem

The doctors’ association called alcoholism an illness in 1956 and a disease ten years later, and the story is often told otherwise.

“In 1956 the American Medical Association for the first time designated alcoholism as a major medical problem…”

Justice Abe Fortas, dissenting in the Supreme Court’s drunkenness case · Powell v. Texas, 1968

Illness, syndrome, disease

In 1951 the American Public Health Association gave AA a Lasker Award, praising the fellowship because, “In emphasizing alcoholism as an illness, the social stigma associated with this condition is being blotted out.” That October a committee of the World Health Organization met on alcoholism in Copenhagen. Its report, issued the next year, called alcoholics “excessive drinkers whose dependence upon alcohol has attained such a degree that it shows a noticeable mental disturbance or an interference with their bodily and mental health, their interpersonal relations, and their smooth social and economic functioning,” or those who showed the first signs of it. “They therefore require treatment.”

The American Medical Association moved more slowly. In November 1956, meeting in Seattle, its House of Delegates adopted a statement from its Council on Mental Health on admitting alcoholics to hospitals. In its report, as the Journal of the American Medical Association printed it, the council “recognizes this syndrome of alcoholism as illness which justifiably should have the attention of physicians,” and it urged hospitals “to look upon alcoholism as a medical problem and to admit patients who are alcoholics.” The word “disease” isn’t in it.

Ten years later the House adopted a report from its Council on Medical Service that reaffirmed the 1956 statement. Its conclusions begin, “Alcoholism is a disease that merits the serious concern of all members of the health professions.” The same report asked that insurers be encouraged to drop “unrealistic limitations” on coverage for its treatment, calling alcoholism “a chronic illness.” In 1967 the delegates from Colorado brought a resolution that “identifies alcoholism as a complex disease.” It added that saying so relieved no one of responsibility for what he did drunk. Marty M.’s biographers write that the AMA then stated “formally that alcoholism is a disease.”

The dates have been moved around ever since. In 1968 Justice Abe Fortas put the turn in 1956, and wrote that it “marked the acceptance among the medical profession of the ‘disease concept of alcoholism.’” (A new sign tells that case.)

Listen A major medical problem About 1 minute

In the record

Said, and retold

What the AMA put on record, in its own words, then how others have told it, in the order they wrote it down.

From the Council on Mental Health’s report as JAMA printed it in 1956, the House of Delegates Proceedings for 1966 and the 1967 resolution as introduced, then each retelling as printed. The tag gives the word each one uses.

What the AMA put on record

1956Council on Mental Health, report on hospitals“…recognizes this syndrome of alcoholism as illness which justifiably should have the attention of physicians.”illness
1966Report reaffirming 1956“Alcoholism is a disease that merits the serious concern of all members of the health professions.”disease
1967Resolution 48, as Colorado introduced it“…identifies alcoholism as a complex disease…”complex disease

How it has been told

1958Bill W., in the Grapevine“The American Medical Association has officially declared alcoholism to be a chronic illness…”chronic illness
1968Justice Fortas, in Powell v. Texas“In 1956 the American Medical Association for the first time designated alcoholism as a major medical problem…”major medical problem
2001Marty M.’s biographersOf 1956: “The AMA was not yet ready, however, to state outright that alcoholism was a disease.” Of 1967: “state formally that alcoholism is a disease.”disease, 1967
2019The AMA’s own news pagesThe justices “established that the AMA designated alcoholism as a ‘major medical problem’ in 1956.”major medical problem

Ten years apart

The AMA’s papers said “illness” in 1956 and “disease” in 1966. The retellings put the turn in 1956 or in 1967.

For a closer look

Go deeper

What the 1956 statement asked for, the fine print on responsibility in 1967, and what an AMA doctor told AA in 1955.

The 1956 statement

The statement, “Hospitalization of Patients with Alcoholism,” came from the AMA’s Council on Mental Health. The Journal of the American Medical Association printed it among the reports of officers on October 20, 1956, and the House of Delegates adopted it at Seattle that November. Its point was beds. The council’s introduction said alcoholism “must be regarded as within the purview of medical practice,” and asked hospital administrators and staffs to admit alcoholics for treatment. (Something useful, in People Like You, tells how hospitals had been turning them away.) Looking back in 1966, the AMA gave the statement its House had adopted as five numbered points, the first of them that “Alcoholic symptomatology and complications which occur in many personality disorders come within the scope of medical practice.”

Fortas’s “major medical problem” is close to its words. The council asked hospitals “to look upon alcoholism as a medical problem”; “major” isn’t in it.

Responsibility

Resolution 48, as Colorado’s delegates introduced it in 1967, said the recognition of alcoholism as a disease “is not intended to relieve the alcoholic of moral responsibility, as provided by law, for any acts committed when inebriated; nor does this recognition preclude civil arrest and imprisonment, as provided by law, for antisocial acts committed when inebriated.”

Marty M.’s biographers quote it from the Proceedings of that year’s convention with one more word: “moral and legal responsibility.” The copy of the resolution consulted here shows only that it was introduced and sent to a reference committee, not the vote, so the extra word may be an amendment or a slip. A chronology by William White, Ernest Kurtz and Caroline Acker also says the resolution passed in 1967.

Bill W. had made the same point to a room of priests in 1960 (A far safer term): AA used the fact of illness to put more responsibility on the drinker, not less.

The AMA’s man in St. Louis

The year before the vote, at AA’s twentieth-anniversary convention in St. Louis in July 1955, Dr. W. W. Bauer of the American Medical Association spoke on its medical panel. “We know of course that the alcoholic is a sick person,” he said; not long before, the alcoholic had been seen as “a nuisance, a pest, a person who could snap out of it if he really wanted to.” He placed the sickness in “illness of the emotions.”

Bill W. printed the talk in Alcoholics Anonymous Comes of Age (1957), among the addresses of AA’s friends.

Sources

AMA Council on Mental Health, “Hospitalization of Patients with Alcoholism,” Reports of Officers, Journal of the American Medical Association, October 20, 1956, from the copy at chestnut.org.
AMA, House of Delegates Proceedings, Clinical Convention, 1966: Council on Medical Service Report G, “Recommendation for the Admission of Alcoholics to General Hospitals – Reaffirmation of the 1956 Statement,” from the copy at chestnut.org.
AMA, House of Delegates Proceedings, Clinical Convention, 1967: Resolution No. 48, “Alcoholism,” from the copy at chestnut.org.
Alcoholics Anonymous, fourth edition. AA World Services, 2001. Appendix IV, “The Lasker Award.”
AA Grapevine, November 1954, “Voice of the Expert” (aagrapevine.org), quoting the World Health Organization’s Expert Committee on Mental Health, Alcoholism Subcommittee, second report, Technical Report Series 48 (1952; who.int).
Alcoholics Anonymous Comes of Age. Alcoholics Anonymous Publishing, 1957. Dr. W. W. Bauer’s talk at St. Louis, 1955.
The Language of the Heart. AA Grapevine, 1988. Bill W., “On the Alcoholism Front” (March 1958).
Powell v. Texas, 392 U.S. 514 (1968), Fortas, J., dissenting (law.cornell.edu).
Sally Brown and David R. Brown, A Biography of Mrs. Marty Mann. Hazelden, 2001. Chapter 24 and its notes.
Tanya Albert Henry, “Court listened to AMA on defining alcoholism as a disease, not a crime,” ama-assn.org, August 16, 2019.
American Society of Addiction Medicine, “Our History.”
William White, Ernest Kurtz and Caroline Acker, “The Combined Addiction Disease Chronologies,” 1956–1965 (silkworth.net).