In early 2001, a global encyclopedia went online under the Wikipedia banner. Now available at Wikipedia.org, the site contains millions of entries on an enormous array of topics. Each page consists of a single article on one topic and may be edited by any interested individual. As a result, some articles have been written and posted by one person while others are modified and updated regularly by multiple editors. Article editors can come together to discuss or argue their points on a discussion page that is associated with each article. Some articles are quite controversial; Wikipedia provides for internal mediation for articles where editors are unable or unwilling to arrive at consensus. Editing wars can quickly arise as the occasional article repeatedly gets modified by individuals on two sides of an issue.

Wikipedia professes to have a neutral point of view, striving to have articles that do not advocate for a certain perspective. Rather, editors are to cite verifiable and authoritative sources while describing each perspective. While editors are encouraged to be bold in editing, in truth, some editors become possessive of what they see as their work; open hostility on the discussion pages can result when new editors arrive to work on articles in which others have already invested their time. Fortunately, the site tracks all changes on a History page for each entry. This allows individuals to deconstruct who modified what and when.

The importance of Wikipedia in terms of article accuracy has grown as it gradually becomes the de facto online encyclopedia rather than simply one potential reference site. It has been of great interest to me to observe the rapidity with which some groups have been attracted to the editing while other groups have stayed away. For instance, a quick review of the entry for "American Medical Association" (AMA) makes it seem that no physician (and certainly none at the AMA) has paid any attention to the site. The AMA's history seems to have stopped in 2001 and a significant portion of the article focuses on past political positions and criticisms that appear to be the result of those who have something other than a neutral point of view.

Closer to our area of interest, let's look at the entry for "alcoholism." As of April 30, 2006, the opening sentences read:

Alcoholism is the compulsive consumption of alcohol. Some believe it to be a biological disease. The etiology and nature of alcoholism are both currently being debated within the medical and scientific communities and the very definition of alcoholism is a part of that debate. Alcoholism is often a controversial subject and the disease hypothesis represents a focus of the debate.

A rather bitter feud among editors ensued, with almost every word of the opening paragraph debated. Several editors felt that the entire disease approach was simply the unsupported opinion of relatively few, that the controversy about "disease" or "not disease" was still actively raging, and that it remains entirely unclear as to what alcoholism is. Proponents of the disease theory cited medical research and organizational policies, while dissenters cited outspoken sociologists and a Supreme Court finding. By May 30, the opening sentences had been modified further:

Alcoholism is a powerful craving for alcohol which often results in the compulsive consumption of alcohol otherwise known as an addiction. The cause of this craving is heavily debated, but the most popular beliefs are that it is (1) a chemical or nutritional imbalance, (2) a genetic predisposition, (3) a neurological effect caused by runaway learning mechanisms, or (4) an inability to curb one's own desire for enjoyment. As a result, the etiology and nature of alcoholism are both currently being debated within the medical and scientific communities and the very definition of alcoholism is a part of that debate. Alcoholism is often a controversial subject. Some believe it to be a biological disease, but the inability to tie it to a specific biological cause leads to much political debate.

By the end of July, consensus had not been reached, but the editors were working together and had reworded the opening paragraph extensively:

Alcoholism is the consumption of, or preoccupation with, alcoholic beverages to the extent that this behavior interferes with the drinker's normal personal, family, social, or work life, and may lead to physical or mental harm. The resulting chronic use can result in many psychological and physiological disorders. Alcoholism is one of the world's most costly drug use problems; with the exception of nicotine addiction, alcoholism is more costly to most countries than all other drug use problems combined.

The biological mechanism of alcoholism is unknown. While alcohol use is a required component of alcoholism, it remains a scientific uncertainty as to whether early alcohol use causes a higher risk of alcoholism. Those with alcoholism tend to start drinking alcohol at an earlier age than those without alcoholism. There are many factors which put a person at risk of developing alcoholism, including a person's social environment, emotional health and genetic predisposition. An alcoholic can develop several forms of addiction to alcohol simultaneously - psychological, metabolic, and neurochemical - and they all must be treated in order to effectively treat the condition.

Is this a reasonable middle ground? Are you interested in contributing? Entries at Wikipedia exist for numerous related areas, such as "addiction," "recreational drug use," and "opiate dependency." Entries are also present for related organizations such as MADD, NCADD, and NIAAA. Many of these entries are currently being maintained primarily by individuals who are critical of the organizations or whose beliefs differ from those of the scientific community. Perhaps we should all go there to help out. Drop me a note at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to let me know if you think we should chip in. And if you have feelings about the alcoholism entry, please don't hesitate to post your thoughts on the discussion page for that article.

This article is published in Counselor,The Magazine for Addiction Professionals, October 2006, v.7, n.5, pp.62-63.

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