KEY TAKEAWAYS
Alcoholism was first considered a disease by Dr Benjamin Rush in 1784, who identified alcohol's addictive qualities [1].
Since then, the alcoholism as a disease model has received mixed acceptance, with critics claiming it removes the personal responsibility from the alcoholic, leading to higher rates of alcoholism [2].
What Classes Alcoholism As A Disease?
What makes alcohol use disorder a disease, is (i) the effects on the brain; (ii) alcohol's addictive qualities; leading to (iii) physical and psychological dependence.
Effects On The Brain - Impaired Cognitive Function
Regular heavy consumption of alcohol causes changes in the brain leading to impaired cognitive function.
Drinking alcohol causes cognitive difficulty in:
Physically Addictive Properties
In both alcoholism and drug dependence, the brain progressively craves increasing amounts of the substance, and needs greater amounts to achieve the same positive feelings, as brain receptors become habituated [4].
This leads to a cycle of:
At this point, alcohol dependence has developed.
Much like drug dependency, those suffering with alcohol use disorder find that they need more alcohol to satisfy their cravings, and prevent withdrawal symptoms [5].
These changes in the brain, resulting in physical and psychological addiction, lend weight to the alcoholism as a disease argument.
What Is The Disease Theory Of Alcoholism?
The disease theory of alcoholism was first presented by Dr Benjamin Rush in 1784 who discussed alcohol as being addictive and causing a loss of control in the drinker [7].
It has been developed since then, leading to the American Medical Association classifying alcoholism as a disease in 1956, and in 1991 classifying it as a dual mental health disorder and medical disease [8].
Today, disease theory categorises alcohol abuse as a brain disease that alters a persons thought process, decision making and feelings, created by the physiological differences between drinkers and non-drinkers, through genetics or the effects of alcohol [9].
Genetic and environmental factors are both at play.
Alcohol use disorder is considered to have a genetic link, with studies from the National Institute Of Health stating that alcohol addiction is 50% genetic, with the other half being due to environmental factors [10].
Alcohol use disorder is also considered a disease in addiction medicine, due to the presence of alcohol withdrawal symptoms such as hand tremors, nausea and vomiting [11].
Disease theory recommends treating alcoholism as any other medical disease, through diagnosis, observation and treatment [12].
How Diagnosis Works
Diagnosis of alcoholism depends on fulfilling these criteria:
Criticism Of Alcoholism As A Disease
Alcohol abuse and alcohol dependency has often been looked down on by society.
Throughout history, it has been seen as a moral failure or a sin, especially in religious societies [15].
Some in the addiction medicine community have opposed the idea of classifying alcoholism as a disease, believing that by calling alcoholism a disease, it removes the stigma and personal responsibility, leading to a higher rate of alcoholism [16].
Disease theory has been considered discredited in some parts of the world, with it being practised predominantly in the United States [17].
Research has found that only 25% of medical practitioners believe that alcoholism is a disease, with most believing it to be a social or psychological issue [18].
Healthcare providers have also suggested that labelling alcoholism as disease ignores other drivers of alcohol use disorder, such as socio-economic, environmental, and psychological motivations for addiction [19].
It has been suggested by other qualified healthcare providers that if there is a continued stigma towards alcohol use disorder, sufferers are less likely to seek help.
This means that they are more likely to develop serious health concerns before they gain access to treatment [20].
Alternative Theories Of The Cause Of Alcoholism
In opposition to disease theory, other theories have been created to understand why people drink and then become addicted to alcohol.
Social Learning Theory
Humans learn from observation, and as we grow we take on the behaviours of those around us.
This can include parents, other family members, teachers and neighbours and can influence attitudes towards alcohol from an early age [21].
Social learning theory continues through later development as in order to feel more confident socially, those in the social environment will imitate or model themselves on other's behaviour, including their alcohol misuse [22].
A study by Patock- Peckham et al in 2001 states that the risk of alcoholism is higher in those who have low self-esteem or self regulation [23].
Where someone with higher self-esteem would be able to change their behaviour or realise that their environment is destructive, someone without this would be unable to.
Drinking To Cope
A study by Cooper and Russell in 1988 found that 93% of participants drank to escape their problems [24].
Drinkers may use alcohol to cope with issues such as:
Alcohol gives drinkers short term positive and relaxed feelings when stressed.
In the long term, heavy drinking alters the brain chemistry and what it believes is normal, meaning that a heavy drinker is more likely to become more stressed over a situation than a non-drinker [26].
Other Factors Contributing To Alcohol Addiction
Social and economic effects also increase the likelihood of alcoholism:
Although alcohol use disorder is the widely accepted model today, some believe that considering it as a disease takes too much responsibility away from the alcoholic to not be held accountable for their own actions [36].
