Is Alcoholism a Disease?
Organizations such as the National Institute of Health (NIH) support the idea that alcoholism is a disease. Further, alcoholism is diagnosable by credentialed professionals.1 Yet, some struggle with this concept. Why does the question, “is alcoholism a disease?” create such a debate for some, while others agree that it is? This article addresses both views by utilizing research and evidence-based perspectives.1
What is Alcoholism?
Alcoholism is also known as alcohol use disorder (AUD) in the professional community. It is a chronic condition characterized by an uncontrollable pattern of compulsive drinking even though it may be responsible for negative consequences in your life.1
Alcoholism describes a dependence on alcohol, the body’s physical inability to stop drinking, and the presence of alcohol cravings. Some people consider it a disease, and it is starting to be widely understood as a brain disorder.1
How is Alcoholism Diagnosed?
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the taxonomic and diagnostic tool published and maintained by the American Psychiatric Association (APA). It is used by credentialed professionals during alcohol assessments and intakes to provide a clinically and medically-based diagnosis.2
To be diagnosed with alcohol use disorder, you must meet certain chronic criteria. The verbatim DSM-5 criteria for alcohol use disorder are as follows:2
In the past year, have you:
- Had times when you ended up drinking more, or longer, than you intended?
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
- Spent a lot of time drinking? Or being sick or getting over other aftereffects?
- Wanted a drink so badly you couldn’t think of anything else?
- Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
- Continued to drink even though it was causing trouble with your family or friends?
- Given up or cut back on activities that were important or interesting to you, or gave you pleasure, to drink?
- More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
- Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
- Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
- Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?
The presence of at least two of these symptoms indicates alcohol use disorder.
The severity of the AUD is defined as:
- Mild: The presence of 2 to 3 symptoms
- Moderate: The presence of 4 to 5 symptoms
- Severe: The presence of 6 or more symptoms
You may have just informally answered those questions for yourself. If they resonate with you and you can answer yes to a few, or many, it indicates that you may benefit from alcohol treatment. Answering these questions on your own doesn’t suffice as a proper assessment by a credentialed and trained professional. Please reach out to a provider or your PCP if you feel you need an intake assessment or could benefit from treatment.2
Why is Alcoholism a Disease?
You may be asking yourself, “why is alcoholism considered a chronic disease?” The term “disease” can be a loaded term for some people. The view that alcoholism is a disease can be difficult or controversial for some to grasp. However, authorities in the field have agreed it is a chronic disease of the brain. The National Institute on Drug Abuse (NIDA), The National Institutes of Health (NIH), and the Substance Abuse and Mental Health Services Administration (SAMSHA) all support that alcohol use disorder is a disease.3,4
The controversy or challenge lies in the fact that disease is defined as:5
“A condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.”
Examples of conventional diseases include infectious diseases, genetic diseases, and diseases such as heart disease and cancer.5 Alcoholism is self-acquired, meaning you wouldn’t catch it from someone like the flu or an STD.6
Subject matter experts in the field and organizations such as NIDA, NIH, and SAMSHA support the disease model of addiction for the following reasons:1,7
- Alcoholism changes the physiology of the human brain.
- How the brain responds to rewards, pleasure, and stress is altered once alcohol use disorder sets in.
- The alterations in the brain are long-lasting and can continue despite the discontinuation of alcohol intake.
Furthermore, having a “drinking problem” is different from having alcoholism because of the inability to quit or discontinue alcohol intake and the presence of alcohol cravings.1,7,8
There is a behavioral component to alcohol use disorder in that someone may go to extreme behaviors to keep drinking: 1,7,8
- Hiding alcohol
- Minimizing how much is being consumed
- Drinking household cleaners and items containing alcohol
These behaviors are underlying contributing factors that must be considered. If you are partaking in such behaviors, there is the presence of an inability to stop, and there is typically the presence of cravings. These are, therefore, symptoms of alcoholism and indicators you may benefit from treatment at a rehab facility or participating in a program like Alcoholics Anonymous (AA).
What is Alcoholics Anonymous’s (AA’s) Role in Perpetuating That Alcoholism is a Disease?
AA’s role and history in impacting the disease model of alcoholism are that the basic text of AA, refers to alcoholism as “an allergy of the body” and “obsession of the mind.”9
This can be found in the chapter, “The Doctor’s Opinion.” While the text was attributed to Bill Wilson, “The Doctor’s Opinion” was written by Dr. Silkworth, a prominent medical doctor who worked at the prestigious Towns Hospital. Dr. Silkworth was a well-known doctor and chief physician at the nationally prominent Towns Hospital.9
In his writing, Dr. Silkworth stated that a person who drinks alcoholically cannot stop because of this so-called allergy. The allergy works such that once a person with alcoholism puts alcohol in the body, they cannot stop like a ‘normal’ drinker.9
If there is a period of abstinence, the phenomenon of craving ensues. The person afflicted with alcoholism then experiences physical cravings to drink alcohol. Therefore, just remaining abstinent is not enough to treat alcoholism.9 This is in line with modern treatment beliefs that simply going through detoxification is not a substitute for treatment for alcoholism.10
Finally, Dr. Silkworth discusses the obsession of the mind that occurs after a period of abstinence. Unless there is some type of approach to address this obsession, then you are most likely going to return to drinking.9
As stated, multiple times in this article, alcoholism has been defined by modern APA and medical societies as the inability to stop drinking, in the presence of cravings. This is very much in line with the Chapter Dr. Silkworth contributed to the AA literature.9
Research has shown that cognitive-behavioral therapy is an effective way to treat your thought processes if you have been diagnosed with alcohol use disorder. It helps to adjust thoughts (in Dr. Silkworth’s terms, obsession of the mind) which in turn impacts your ability to make healthier behavioral choices.8,10
How is Alcoholism Similar to Other Diseases?
While relapse doesn’t have to be part of your recovery story, research shows it often is.11
It is important to note that there are similar relapse rates of other chronic conditions such as high blood pressure and asthma. For example, when asthma symptoms are relieved temporarily, it doesn’t necessarily mean that asthma can’t be triggered again. Similarly, alcohol use disorder needs to be treated as a lifelong disease.
The following is a comparison between asthma and alcohol use disorder:11,12
- Both asthma and alcoholism disturb the regular functioning and physiology of an organ in the body.
- In asthma, the lungs are primarily affected, and in alcoholism, it is the brain that is affected.
- Neither are communicable.
- Asthma and alcoholism can both create a lowered quality of life.
- Both contribute to the risk of premature death.
An asthma attack or ‘relapse,’ so to speak, can be prevented by lifestyle behavioral choices such as proper breathing and staying away from over-tasking the lungs. However, if you have asthma and have an athletic or movement-based lifestyle, you may trigger a relapse and need a bronchodilator inhaler to assist the lungs to recover from a sporting event or situation where the lungs have been challenged.11,12
Similarly, if you find yourself in a triggering environment, you may experience a physical relapse and drink alcohol. In this case, you and your loved ones can assess if you need to re-enter treatment, bolster your existing recovery program, or alter the situations that lead to your relapse.11
Both asthma attacks and relapse are largely preventable through positive lifestyle choices. Both have specific actionable behaviors that can be taken to directly address and treat a relapse.11,12
They can both be treated to prevent further damage—to the lungs in asthma and to the brain in alcoholism, respectively.11,12
Alcohol Use Disorder is Not a Choice
Is alcoholism a disease or a choice? Regardless of if alcoholism is a disease or not, it’s important to understand that alcoholism is not a choice or a moral failure. It is caused by a myriad of spanning genetic and environmental risk factors.13
For example, while alcoholism may begin from your choice to start drinking, alcoholism use disorder is a diagnosable disease versus a continued choice.1,13
Alcoholism is best described through a biopsychosocial lens.
Biologically, it is considered a brain-based disorder. After drinking continues for a length of time and excessive alcohol is drank, the brain physiology is altered. The pleasure reward circuit in the brain changes. The chemicals in alcohol change the brain’s pleasure-reward circuit such that it becomes likely you will intake alcohol again, whether you want to or not, because of physiological cravings.8
Research shows genetics can play a part in whether you drink alcohol excessively or not. If someone else in your family has the disease of alcoholism, it increases your risk of being diagnosed with alcohol use disorder.13
Psychologically, the mindset of someone with alcoholism is different than someone without it. The mentality and thought process has changed so that you think alcohol is a solution to your problems. This is where treatments such as cognitive-behavioral therapy can help you adjust your thoughts to make different, healthier choices.8,10
Socially, several environmental factors play into alcohol use disorder. These factors could be whether you had friends or family who misused drugs or alcohol growing up. Since you would have seen this behavior and experienced it during your formative years, your likelihood of repeating such behaviors ins increased.13
Additionally, the following is a list of risk factors for alcoholism:8,10,13
- Genetics (parent or grandparent with alcoholism)
- Early exposure to drinking from family, friends, community
- Access to alcohol
- A co-occurring mental health problem (anxiety, depression)
- Frequent drinking
- History of trauma
- Underlying medical condition(s)
- Social factors (social group drinks frequently)
How to Find Alcoholism Treatment
It takes much courage to admit you need help. When you ask for help, you take the first step to no longer fighting alone. It is no small feat to reach out and ask for help.
To find treatment, you can search for the following key terms in an internet search engine or browser:14
• Alcohol rehab(s) near me
Alternatively, you can receive a substance use assessment through your primary care physician (PCP) or a treatment program. If you choose to have an assessment by your PCP, make sure that your doctor has some background in substance misuse treatment or alcohol misuse treatment, preferably some specific credentials or training in the field.
Otherwise, you can schedule an intake with alcohol rehab, and they can conduct an assessment at that time.
If you or a loved one feels treatment is the right fit, or you are unsure of where to start, contact a treatment specialist at 800-598-5053 (Who Answers?) .
- National Institute of Health, National Institute on Drug Abuse. (n.d.). Understanding Alcohol Use Disorder.
- National Institute of Health, National Institute on Drug Abuse. (n.d.). Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5.
- National Institute of Health, National Institute on Drug Abuse. (n.d.) Alcohol.
- Substance Abuse and Mental Health Services Administration (SAMSHA). (2017) Alcohol Use Facts and Resources.
- Merriam-Webster. (n.d.). Disease.
- Volkow, N.D., & Koob, G. (2015). Brain Disease Model of Addiction: Why is it So Controversial? Lancet Psychiatry, 2(8), 677-679.
- Substance Abuse and Mental Health Services Administration (SAMSHA). (2022, April 27). Behavioral Health Treatments and Services.
- Blum, K., Thompson, B., Demotrovics, Z., Femino, J., Giordano, J., Oscar-Berman, M., Teitelbaum, S., Smith, D. E., Roy, K. A., Again, G., Fratantonio, J., Badgaiyan, R. D., & Gold, M. S. (2015). The Molecular Neurobiology of Twelve Step Program & Fellowship: Connecting the Dots for Recovery. Journal of Reward Deficiency Syndrome, 1(1), 46-64.
- Wilson, B. (2001). Alcoholics Anonymous. Alcoholics Anonymous (Fourth Edition). Alcoholics Anonymous World Services, Inc.
- Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. Treatment Improvement Protocol (TIP) Series, No. 47. Center for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016.
- Melemis S.M. (2015). Relapse Prevention and the Five Rules of Recovery. Yale Journal Biological Medicine, 88(3), 325-32.
- World Health Organization (WHO). (n.d.) Asthma.
- Office on Women’s Health. (2021, Feb 17). Alcohol Use Disorder, Substance Use Disorder, and Addiction.
- FindTreatment.gov. (n.d.). Find a Treatment Facility Near You.