Illustration · A claims desk at a Veterans Administration office in the 1980s, the terminal showing a request to extend a GI Bill deadline turned down for “willful misconduct.” Not drawn from a photograph; the screen’s words are written for the picture.

Willful misconduct

The psychiatrists renamed it, the Veterans Administration called it misconduct, and the Supreme Court said it didn’t have to decide whether it was a disease.

“It is not our role to resolve this medical issue on which the authorities remain sharply divided.”

Justice Byron White, for the Supreme Court, upholding the Veterans Administration · Traynor v. Turnage, 1988

A new name, an old rule

In 1980 the American Psychiatric Association published the third edition of its diagnostic manual, DSM-III. In it, as the National Institute on Alcohol Abuse and Alcoholism later put it, “for the first time, the term ‘alcoholism’ was dropped in favor of two distinct categories labeled ‘alcohol abuse’ and ‘alcohol dependence.’” They now sat among the “substance use disorders,” no longer with the personality disorders.

The Veterans Administration still worked from an older rule. A veteran had ten years after his discharge to use his GI Bill education benefits, and more if he had been kept from them by “a physical or mental disability which was not the result of such veteran’s own willful misconduct.” The VA counted “primary” alcoholism, alcoholism not caused by a mental illness, as willful misconduct. Eugene Traynor, discharged in 1969 after service that included Vietnam, and James P. McKelvey, discharged from the Army in 1966, had both stopped drinking by 1975. Both asked for more time, and both were turned down.

On April 20, 1988, the Supreme Court ruled that it could hear their claim, then upheld the VA, four votes to three; Justices Scalia and Kennedy took no part. “This litigation does not require the Court to decide whether alcoholism is a disease whose course its victims cannot control,” Justice Byron White wrote for the Court. Among the work he cited on the medical debate was a 1970 article by Herbert Fingarette, a philosopher whose book Heavy Drinking: The Myth of Alcoholism as a Disease came out that same year.

The answer from Congress became law that November. For the deadlines on education and rehabilitation benefits, “the disabling effects of chronic alcoholism shall not be considered to be the result of willful misconduct.” Two years later it went the other way on disability pay, barring compensation for a disability that resulted from a veteran’s “abuse of alcohol or drugs.” The Americans with Disabilities Act, also passed in 1990, let an employer “hold an employee who … is an alcoholic to the same qualification standards for employment or job performance and behavior” as other employees.

In 1992 a committee of the National Council on Alcoholism and Drug Dependence, the council Marty M. founded, under the name it took in 1990, and the American Society of Addiction Medicine published a definition in JAMA. Alcoholism, it said, is “a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.”

Listen Willful misconduct About 1 minute

In the manuals

The manuals

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, edition by edition: where each filed alcoholism, and what it called it.

From the National Institute on Alcohol Abuse and Alcoholism’s Alcohol Alert No. 30 (1995) and reviews of the manuals by Robinson and Adinoff (2016), Nathan, Conrad and Skinstad (2016) and Schuckit and others (1994). The spine is plain where alcoholism sat with the personality disorders, and in the accent where it sat with the substance use disorders.

DSM-I 1952

Filed underThe personality disorders
Called it
- alcoholism
Usually as a sign of something else; on its own only for “a well-established addiction to alcohol without recognizable underlying disorder.”
DSM-II 1968

Filed underThe personality disorders
Called it
- alcoholism
In three kinds: episodic excessive drinking, habitual excessive drinking and alcohol addiction.
DSM-III 1980

Filed underSubstance use disorders
Called it
- alcohol abuse
- alcohol dependence
The word alcoholism dropped. Dependence needed tolerance or withdrawal.
DSM-III-R 1987

Filed underPsychoactive substance use disorders
Called it
- alcohol dependence
- alcohol abuse
Dependence by any three of nine items; abuse left for those who never met them.

A new shelf

For its first two editions the manual filed alcoholism with the personality disorders. From 1980 it filed drinking with the substance use disorders and stopped calling it alcoholism at all.

For a closer look

Go deeper

The two men in the Court’s case, two critics of the disease idea, and the definition a committee settled on in 1992.

Two veterans

As Justice Harry Blackmun told it in his partial dissent, Eugene Traynor “began drinking when he was eight or nine years old” and was having alcohol-related seizures by the time he served in Vietnam. After his discharge he was in and out of hospitals for four years; by the end of 1974 he had stopped. He started college part-time in 1977, and his ten years ran out in 1979. James P. McKelvey “also started drinking as a child” and was 13 when his dependence began; he “took his last drink in 1975, only a year and a half before his 10-year delimiting period expired.”

The VA’s rule, Blackmun wrote, “presumes, irrebuttably, that primary alcoholism always is the result of the veteran’s ‘own willful misconduct.’” The regulation itself said that “The simple drinking of alcoholic beverage is not of itself willful misconduct,” and that illnesses caused by years of drinking, “whether out of compulsion or otherwise,” were not misconduct either.

The critics

Herbert Fingarette taught philosophy at the University of California at Santa Barbara for forty years. His 1970 article in the Harvard Law Review, “The Perils of Powell,” questioned the factual footing of the disease idea that A new sign follows into the courts. His 1988 book argued, as its publisher put it, that research had discredited “the very concept of alcoholism as a single disease with a unique cause.” What troubled him about the label he told the Christian Science Monitor that July: “It says that you are helpless - you can’t control yourself. You are never cured.”

The psychologist Stanton Peele went further in Diseasing of America (1989). “Alcoholism and drug-taking may be addictions, but they are not diseases,” Publishers Weekly summed up his case.

A definition by committee

The definition came from a committee of 23 that worked on it for two years. Beyond calling alcoholism a disease, it named what marks it: “impaired control over drinking, preoccupation with the drug alcohol, use of alcohol despite adverse consequences, and distortions in thinking, most notably denial.” Each, it added, “may be continuous or periodic.”

The National Council on Alcoholism had added “and Drug Dependence” to its name in 1990. People Like You tells how Marty M. built it.

Sources

National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert No. 30, October 1995 (pubs.niaaa.nih.gov).
Sean M. Robinson and Bryon Adinoff, “The Classification of Substance Use Disorders: Historical, Contextual, and Conceptual Considerations,” Behavioral Sciences 6, no. 3 (2016), 18 (mdpi.com).
Peter E. Nathan, Mandy Conrad and Anne Helene Skinstad, “History of the Concept of Addiction,” Annual Review of Clinical Psychology 12 (2016), pp. 29–51, abstract (annualreviews.org).
Marc A. Schuckit and others, comparing DSM-III-R, DSM-IV and ICD-10 diagnoses, Addiction 89 (1994), pp. 1629–1638 (downstate.edu).
Traynor v. Turnage, 485 U.S. 535 (1988), with the regulation, 38 C.F.R. § 3.301(c)(2), quoted in its notes (law.cornell.edu; justia.com; U.S. Reports, loc.gov).
The GI Bill’s ten-year limit, 38 U.S.C. § 1662(a)(1), as quoted in the Solicitor General’s brief in opposition, February 1987 (justice.gov).
Veterans’ Benefits and Programs Improvement Act of 1988, Pub. L. 100-689, § 109 (govinfo.gov).
38 U.S.C. § 1110, and its note on the Omnibus Budget Reconciliation Act of 1990, Pub. L. 101-508, § 8052 (law.cornell.edu; govinfo.gov).
Allen v. Principi, 237 F.3d 1368 (Fed. Cir. 2001) (law.resource.org).
Americans with Disabilities Act of 1990, 42 U.S.C. § 12114 (law.cornell.edu).
Herbert Fingarette, Heavy Drinking: The Myth of Alcoholism as a Disease. University of California Press, 1988 (the publisher’s page, ucpress.edu); “In Memoriam: Herbert Fingarette,” UCSB Department of Philosophy (philosophy.ucsb.edu); Curtis J. Sitomer, “Alcoholism as a disease: a bad call?” Christian Science Monitor, July 18, 1988 (csmonitor.com).
Review of Stanton Peele, Diseasing of America (Lexington Books, 1989), Publishers Weekly (publishersweekly.com).
Robert M. Morse and Daniel K. Flavin, for the Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine, “The Definition of Alcoholism,” JAMA 268, no. 8 (August 26, 1992), pp. 1012–1014, abstract (jamanetwork.com).
William L. White, “National Council on Alcoholism and Drug Dependence,” in Alcohol and Temperance in Modern History (2003) (chestnut.org).