Is Alcoholism A Disease Or A Choice?

Is alcoholism a disease or a choice is a tough question. Ask it and you will get different answers from the same people.

Why does it matter if it is a disease? So what if it’s a mental health issue, moral weakness, disease or anything else. Isn’t a problem a problem?

Yes, it is, but how we treat the problem is very important.
Paying for that problem is pretty important too. (over 35 billion dollars)

At the layman, “everyday walking and talking” level most of us think it is a disease, unless the alcoholic is affecting our lives.

If you think alcoholism is a disease you are going to be much more tolerant with the alcoholic and the complications that they bring with them. No one gets mad at the guy with heart disease for not being able to work as hard as the guy next to him. If, however, you show up to work with a hangover and don’t carry your part of the workload your co-workers can get upset (bosses too). If you are frequently missing from work and your co-workers have to cover for you they can get downright hostile. Again, if you were at a chemotherapy session for your cancer, no one would give you that sort of response.

perceptionSo how we perceive alcoholism (and other addictions) is important.

How we pay for alcoholism is important too. If it is a disease, you get help. If it’s a choice, than your just an a-hole.

Forbes magazine claims that in year 2015 about 35 billion dollars was spent on addiction recovery.

If it is a disease, then insurance should cover it like it does other medical condition. If it is not a disease, why should your premiums go to pay for someone else’s bad choices.

dollar signSome numbers to kick around:
**In 2008 insurers have to pay for rehab by law.
**In 2015 Forbes says that 35 billion dollars   was   spent on addiction recovery
**In 2015 Google says there were 321 million persons living in America
**35 billion dollars divided by 321 million people equals about 110 dollars for each person
(but, not everyone pays for insurance, the young, the old, the people with no insurance at work, etc. so the pool is much smaller and the annual cost much higher than 110 dollars)

So how we are going to treat alcoholism and how we are going to pay for it are important. Then there is the everyday reason for wanting to know.

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 (or get out of paying 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? etc. etc. etc.?

Employers (and co-workers) want to know so they can maintain stable workforces.

Finally, everyone wants to know what to do now to get 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.

What is the right direction?

Most regular people will say yes, but the people asked won’t act like the believe what they said when it comes to their interactions with an alcoholic If you say you are sick because your cancer is back you get compassion, few people care if you are sick because of a hangover.

Asking a doctor and many other professionals about the disease concept of addiction will result in something different than a “yes”. Its as if, professionally they have to say it is a disease but, in their hearts, they don’t believe it.

The only professionals who really get behind the disease theory are the ones who work in the addiction field. Unfortunately, most of these people get a part of the 35 billion dollar pie that Congress forced insurance companies and taxpayers to pay for in 2008.

Anyway, take a look at the “disease or choice” groups below and see for yourself

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.
  • Most Americans

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 MedicineMedical Profession
  • American Medical Association declared it a disease in 1956
  • 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.

Wikipedia – Disease Theory of Alcoholism

Who Says Alcoholism Is Not A Disease

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.

Variety of Differing People

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)

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.

Conflicted About Addiction As A Disease

We know our neighbors and our physicians are not sure, they say one thing and do something different. What about our leadership?

The government uses strict guidelines (HIPPA and several other rules) to protect people’s privacy concerning their health. They do, however, allow employers to drug test before an employment offer and when there is cause, like an employee accident. If drug addicts use drugs and addiction is a disease, doesn’t allowing drug tests that reveal past drug usage sort of defeat the protections provided for all other medical conditions.


If you have a heart attack on the freeway, gets into a crash and hurts someone, it is a tragedy. If you are drunk on the freeway and crash you are going to jail. If someone is hurt, you will likely stay there for several years.

Lets add to the uncertainty.

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 in Alcoholism

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. The studies show that heredity plays a role in alcoholism, so does the environment in which you live and grew up / Damaged DNA

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.

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.

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.

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)

Is Alcoholism A Disease Or A Mental Illness coughing and spreading disease

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.

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?

Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

So, is alcoholism a disease?

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 “a touch of a cold”, but in my experience there is no mild case of breast cancer.

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, disease is a tricky question.  I have a co-occurring disorder (C-PTSD is the primary diagnosis) so I think most, if not all, alcoholics have some sort of mental defect/disorder that they treat with alcohol.

For me alcohol became a crutch. I don’t think mentally healthy persons are willing to drink with the frequency and in the volumes necessary to really work up an alcohol problem the way I did.

That is a lot of going to work sick from hangovers. Or just plain skipping work.  A lot of doing and saying drunken stupid stuff. A lot of people complaining about your irresponsible behavior. A lot of people telling you to watch it before alcohol becomes a problem, that you need to slow down.

I think you kind of need to be running from something in order to pursue alcohol with the gusto required to turn yourself into an alcoholic, but that is me. I am a binge drinker and a certifiably “nuts”.


Betty Ford
Betty Ford

I am pretty sure Betty Ford would tell you a very different story about alcoholism. (although I still think the mental rigors of being First Lady played some part in the problem)


Anyway, you cannot just take my word for it. Alcoholism is a relationship. It is different for everyone and yet ghoulishly similar. Alcoholism is like that, it’s tricky. It cannot be trusted.

In the Bible, Paul says in a few places that drunkards cannot inherit the kingdom of Heaven. It also says we become a slave to whatever master we serve. I did just that, I put alcohol first and it made me a slave.

Anyway, I think neuroplasticity and mental dysfunction does a better job explaining alcoholism than disease.

If you want to believe that alcoholism is a disease, you are in good company. If you want to believe it is not a disease, you are in good company.

Finally, to anyone who needs to believe alcoholism is a disease so they can forgive a “loved one” for past transgression; God Bless And Keep You.
(there are a lot of children, spouses, parents, and others out there who have suffered and deserve some recognition for their long suffering)

What to do after a relapse
Self Help to Stop Drinking

Neuroplasticity and Addiction