Is alcoholism a disease or a choice is a good question. It is something many people are interested in. Alcoholics want to know if alcoholism is a disease because they want to explain what is happening, or what happened, to them. Insurance companies want to know so they can determine how to pay for it. Families and spouses want to know about the disease model of addiction for the same reasons drunks do. They want to know what happened to them. How did things get so out of control? More importantly, they want to know what to do now to this drinking problem under control.
Asking “is alcoholism a disease” to most people we bump into on the street will get you an answer of yes. Asking a doctor and many other professionals about the disease concept of addiction will result in something quite different.
Who Says It Is A Disease?
Most members of 12 step programs (based on AA) follow the disease model of alcoholism
Television, the movies and the news generally agree that alcoholism is a disease.
Where TV goes, the American public follows.
This makes it look like no one with credentials follows the disease model. Below are some heavy hitters who do:
The American Society of Addiction Medicine
American Medical Association both maintain extensive policy regarding alcoholism.
The American Psychiatric Association recognizes the existence of “alcoholism” as the equivalent of alcohol dependence.
The American Hospital Association
American Public Health Association
National Association of Social Workers
American College of Physicians classify “alcoholism” as a disease
National Institute on Alcohol Abuse and Alcoholism (NIAAA) It funds approximately 90 percent of all alcoholism related research in the United States.
A national study of doctors in the United States reported in The Road to Recovery asked them what proportion of alcoholism is a disease and what proportion is a personal weakness. The average proportion thought to be personal weakness was 31 percent. Significantly, only 12 percent of doctors considered alcoholism to be 100 percent a disease.
Another study found that only 25 percent of physicians believed that alcoholism is a disease. The majority believed alcoholism to be a social or psychological problem instead of a disease. (S.I. Mignon. Physicians’ Perceptions of Alcoholics: The Disease Concept Reconsidered. Alcoholism Treatment Quarterly, 1996, v. 14, no. 4, pp. 33–45) Wikipedia
A survey of over 88,000 physicians in the U.S. found that “Only 49% of the physicians characterized alcoholism as a disease.” Over 75% believed that the major causes of alcoholism are “personality and emotional problems. Potsdam.edu
Look at the findings of a 1991–1992 National Longitudinal Alcohol Epidemiologic by the National Institute for Alcohol Abuse and Alcoholism (NIAAA):
Most persons who develop alcohol dependence have mild to moderate disorder, in which they primarily experience impaired control. For example, they set limits and go over them or find it difficult to quit or cut down. In general, these people do not have severe alcohol-related relationship, health, vocational or legal problems.
About 70 percent of affected persons have a single episode of less than 4 years. The remainder experience an average of five episodes. Thus, it appears that there are two forms of alcohol dependence: time-limited, and recurrent or chronic.
Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence.
About 75 percent of persons who recover from alcohol dependence do so without seeking any kind of help, including specialty alcohol (rehab) programs and AA. Only 13 percent of people with alcohol dependence ever receive specialty alcohol treatment. National Institute for Alcohol Abuse and Alcoholism (NIAAA)
Do Genetics Play A Role
We know that forty percent of the children of alcoholics have alcohol problems themselves. This happens whether they are raised by the alcoholic parent or not. Most people who say they have a drinking problem also report that they have relatives who have drinking problems.
Multiple genes play a role in a person’s risk for developing alcoholism. There are genes that increase a person’s risk, as well as those that may decrease that risk, directly or indirectly. NIAA
The genes involved in susceptibility to alcoholism include both alcohol-specific genes and those that affect neuronal pathways to do with reward, behavioral control and resilience to stress. PyschCentral
Research shows that genes are responsible for about half of the risk for alcoholism. Therefore, genes alone do not determine whether someone will become an alcoholic. Environmental factors, as well as gene and environment interactions account for the remainder of the risk. NIAAA
30 of the teens had the genetic variant that increased their risk of an alcohol use disorder. “The key finding of this study is that while genetics appear to play a role in the development of alcohol problems among teenagers, environmental factors can considerably reduce this risk National Council on Alcoholism and Drug Dependence (NCADD)
Alcoholism A Disease Or A Mental Illness
The DSM V handles the problem like this:
Problem drinking that becomes severe is given the medical diagnosis of “alcohol use disorder” or AUD. Approximately 7.2 percent or 17 million adults in the United States ages 18 and older had an AUD in 2012. This includes 11.2 million men and 5.7 million women. Adolescents can be diagnosed with an AUD as well, and in 2012, an estimated 855,000 adolescents ages 12–17 had an AUD.
To be diagnosed with an AUD, individuals must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Under DSM–5, the current version of the DSM, anyone meeting any two of the 11 criteria during the same 12-month period receives a diagnosis of AUD. The severity of an AUD—mild, moderate, or severe—is based on the number of criteria met. NIAAA
To assess whether you or loved one may have an AUD, here are some questions to ask.
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 the aftereffects?
Experienced craving — a strong need, or urge, to drink?
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, in order 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?
Problem drinking sounds like a mental illness to me. Like a behavioral problem, especially since they gave it a spectrum (mild, moderate, or severe).
A person may have a mild case of a virus, like “a touch of a cold”, but in my experience they do not have a mild case of Hepatitis C.
Disorder sounds an awful lot like disease and that should keep lay and professional people from all schools of thought happy. We can call it anything we like and still be right. Just like before.
Is alcohol dependence a disease is a tricky question. I have a co-occurring disorder so I think most, if not all, alcoholics have some sort of mental defect/disorder that they treat with alcohol. The alcohol then becomes a crutch. I don’t think mentally healthy persons are willing to drink the amounts and with the frequency necessary to really work up an alcohol problem. I think neuroplasticity and mental dysfunction does a better job explaining alcoholism than disease.