Alcoholism is a complex issue, and these days there is a lot of confusion and debate about its causes.
There are lively debates about how it affects those struggling with it, and how best to tackle it on a societal level.
A lot of people claim addiction is a choice based around the sufferers’ lifestyle and that alcoholics can stop whenever they want to, simply by deciding to and prioritising a different lifestyle.
Other people often argue that addiction is a disease and should be treated as such – meaning that addiction is a healthcare issue instead of a choice.
This group maintain that some people are more prone to addiction, may be unable to quit alone, and that they should be given as much help as possible to get over their problems.
In this article we will go in-depth on some of the thought processes behind both viewpoints in an attempt to answer the question “is addiction really a disease?”
Before that, let’s look into alcoholism and the manner in which it ruins lives and careers, to see which treatment methods have been most successful thus far:
How Does Alcoholism Develop?
Alcoholism usually begins as social or casual drinking, or maybe even having a few drinks alone to relieve stress. Most people engage in this at some stage in their lives, but only some develop the habit into a full-on alcohol dependency.
This is what makes it so hard to judge who is going to develop alcoholism and who will be able to drink with no problems at all.
After all, you don’t start drinking one day and become an alcoholic the next.
We often say people who become addicted or dependent have an ‘addictive personality’, but there is an element of truth that genetic factors seem to play a part, and children of alcoholics have been found to be four times more likely than other children to become alcoholics in later life.
The earliest sign to spot if somebody might be becoming an alcoholic is if the person regularly experiences negative results from their drinking, for example, fighting while drunk, blacking out, or having extreme hangovers on a regular basis.
This is a sign that somebody is drinking beyond the point that they have control of themselves, something most social drinkers and people who enjoy alcohol but have control of the habit would very rarely do.
It can be common for teenagers and young adults to lose control a few times when they are first delving into the world of social drinking, but if this continues into adulthood it becomes a serious and life-changing problem.
These consequences are usually pretty evident, and as the problem moves out of its early stages, we can often see the person’s daily life become more and more chaotic as the negative consequences to drinking continue to mount up.
Drinkers at this stage will often deny they have a problem but will continue to drink more and more as their life potentially descends into chaos.
The end results if somebody doesn’t get help at this stage is usually divorce or broken relationships, unemployment, financial issues, and a swathe of health problems related to their drinking.
When you see this, you know they are now fully alcohol dependent and have very little control over their life. These people need help.
Why This Whole ‘Disease Or Choice’ Debate Anyway?
The main reason this argument gets an emotional response from people and is so prevalent in media debates is that it directly affects the way we approach treating alcoholism and other addiction, as well as the general way we react to addicts in society.
The people who believe alcoholism is a personal choice and can always be overcome by willpower are more likely to be against money and effort being spent on healthcare, rehabilitation, detoxification and other aid for alcoholics, instead believing that they should shoulder the blame for their drinking issues and deal with them alone.
People who believe that alcoholism is a disease are of the belief that, while some people are able to overcome alcoholism alone, for many people it isn’t an option, and as such forms of help have to be available and alcoholics should be treated as patients with genuine health issues, as opposed to being blamed for them.
Let’s delve into both arguments:
What’s The ‘Alcoholism Is A Disease’ Argument?
Is addiction a disease? How is alcoholism a disease? It can seem like a strange idea at first until you look at it in a bit more depth:
The definition of the word ‘disease’ is:
“A disorder of structure or function in a human, animal or plant, especially one that produces specific symptoms or affects a specific location and is not simply a direct result of physical injury”
When faced with this definition, it’s pretty difficult to argue against the idea that alcoholism is a disease – it certainly fills all the prerequisites.
Next time somebody asks you “why is alcoholism a disease?” you could begin the argument pretty strongly just be showing them that definition.
Another huge pointer is that the vast majority of the medical organisations and professionals in the world treat alcoholism as if it’s a disease, including the NHS and American Society of Addiction Medicine (ASAM).
ASAM has gone on record to state:
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Addiction affects neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and addictive behaviours, which may or may not include alcohol and other drug use, supplant healthy, self-care related behaviours”
This quote is pretty unambiguous and helps us to see how certain behaviours in alcoholics that may seem purposeful and a result of a person’s character, are more commonly driven by the alcohol problem itself and the changes it makes to the brain.
Chronic brain diseases cannot be cured by medicine or prevented by a vaccine – they also get worse with time if not treated.
The damage to the brain caused by alcohol addiction also shares this characteristic, requiring ongoing treatment in order to manage symptoms.
It is quite interesting to note that the relapse rate for alcoholics and other addicts that have successfully completed treatment is around 40-60% depending on the severity of the problem.
This is an extremely similar number to other chronic physical disorders, for example, asthma (50-70%) and diabetes (40-60%), once again pointing to alcohol dependency’s status as a disease, or at least behaving in the same way.
Addiction is caused by a combination of biological or genetic factors and environmental and behavioural ones, something it shares with heart disease, cancer, asthma, diabetes and many other physical conditions that are universally accepted as diseases with no debate.
The medical strategy of treating alcoholism as a disease is known simply as “the disease model” and is largely driven by the fact alcohol dependency typically comes with physical withdrawal symptoms, such as nausea, tremors, dizziness etc.
While the disease model is difficult to argue with and has led to countless lives of alcoholics being turned around or even saved, it may fail to take into account the reasons certain people become addicted and others don’t, even when the regularity and volume of drinking are comparable.
This has led to arguments being made that alcoholism, or at least the addictive personality that can lead to it, is a psychological condition as opposed to a physical disease.
Despite this, most medical experts continue to treat alcohol addiction as a disease, and the more recent interventions using the disease model as a basis have been more likely to yield positive results.
So, you can see why experts tend to believe alcoholism is a disease and should be treated as such.
Where is the other side getting their thought process?
Let’s take a look:
What’s the ‘alcoholism is a choice’ argument?
The sticking point for many of those who argue that alcohol or drug addiction isn’t a disease is that they believe the original habit is “self-inflicted” – after all, they drank a lot in their younger years and never developed a problem!
This can make it hard to swallow for some people that alcoholics have no or little control over their problems.
As mentioned above, however solid the disease model’s results may be and however sound its scientific explanations may be, it does tend to ignore what causes a person to become susceptible to alcohol dependency in the first place.
The lines get crossed because a person’s initial choice to drink is certainly a free choice that they have complete control over.
However, the people arguing that continued alcoholism is not a disease and is rather their own free choice and responsibility tend to ignore the fact that prolonged use of alcohol does directly affect the brain’s processes and impairs their ability for self-control.
Another thing they may have missed is the fact that a condition originating from somebody’s personal choices, does not in any way mean it can’t be a disease.
Heart disease, lung cancer and diabetes can develop from a person’s choice to smoke, eat unhealthily, or neglect to exercise for example.
We’ve never come across anybody arguing that those aren’t diseases!
It is also commonly brought up that alcoholism can’t be a disease because many people are able to overcome it themselves with strong willpower and no requirement for medical help.
While this is wonderful for increasing confidence of those with a drinking problem, and willpower is the most important aspect in somebody’s recovery, it is only true for milder forms of alcohol addiction that quitting without help is manageable.
Serious, long term drinkers pretty much always require professional help in order to regain control of their lives.
Is Drug Addiction a Disease or a Choice?
While we are mostly talking about alcoholism here, the question applies to addiction as a whole.
Is addiction a choice that leads into or causes a disease?
Each addictive substance has its own way of getting into people’s heads and becoming a crucial part of their lives, but as a whole addiction tends to work the same way.
Some drugs such as cannabis, LSD and certain legal highs can have a much less powerful withdrawal effect than others, meaning overcoming them yourself with strict willpower is much more of an achievable goal.
It can be difficult to call an addiction to these substances a disease, but others such as cocaine or amphetamines are arguably even more so than alcohol.
Despite this discrepancy, the question of whether or not drug addiction is a choice comes down to the same basic talking points as it does when we talk about alcohol.
What if Neither is True?
A small but growing amount of experts say this whole argument is entirely unhelpful and that addiction should be treated as a separate issue, being studied and treated along those lines and held to its own standards.
Their argument tends to be that it can’t be a disease if it can be overcome without medical intervention, but it also can’t be a choice when the sufferers’ rationality and decision-making skills are seriously impaired.
Even lifelong professional psychologists who have debated and studied this issue for years can still be unsure exactly which belief to follow.
Doesn’t that suggest that while both have useful aspects, neither is 100% true?
The one thing we all know is that alcoholism is an incredibly damaging condition, and can ruin or end your life without proper treatment.
In that sense, we must continue to treat it as a disease and do what we can to help those in the deepest darkest depths of alcohol dependency to return to the surface and regain control of their lives.
Meanwhile, for those patients in the earlier stages of alcoholism or approaching it, maybe it is more beneficial to treat alcoholism as a choice, focusing on encouraging and inspiring them to avoid going down that path.
One thing is for sure, this discussion is likely to continue for a long, long time.
With that in mind, if you know anybody with an alcohol dependency, please do everything you can to get them to call us now on 03334 440 315 – we offer friendly expert guidance on treatment options in your area, both NHS and private, local support groups, and how best you can tackle your addiction – no matter which stage of alcoholism you’re at.
We also offer a proven and powerful new alcohol home detox programme, meaning we can help you overcome your addiction and get back control of your life by receiving professional treatment for alcohol withdrawal at home, even if you are unable to attend a rehab clinic for 24/7 supervised treatment.