Is Alcoholism A Disease?

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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].

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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:

  • Understanding and processing the outside world
  • Forming memories
  • Using and understanding speech
  • Reasoning, problem solving and decision making
  • Motor responses involving the muscles [3]
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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:

  • Cravings;
  • Attempts to satisfy them;
  • Experiencing the after effects;
  • ...and then beginning the cycle again.

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].

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How Diagnosis Works

Diagnosis of alcoholism depends on fulfilling these criteria:

  • A high alcohol tolerance that requires someone to consume alcohol at greater volumes to experience intoxication
  • Impaired control making a person unable to stop drinking [13]
  • Signs of withdrawal such as hand tremors, sweating, nausea and vomiting [14]

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:

  • Challenging life events, death of a family member, financial issues, divorce
  • Stress
  • Insomnia
  • Social anxiety
  • Trauma/PTSD symptoms [25]

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].

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Other Factors Contributing To Alcohol Addiction

  • Alcohol laws in the area, although restrictions on the production and sale of alcohol have reduced alcoholism, there then is a demand for illegal forms of alcohol, which does not have any regulations on the type, strength and amount that can be bought, leading to alcoholism [27].
  • Advertising, a study in 2006 on the effects of alcohol advertising exposure on drinking among youth found that those who were exposed to alcohol advertisements were more likely to drink alcohol than those who were not [28]
  • Religious involvement, with religions such as Islam prohibiting alcohol, others such as Catholicism and Protestantism are twice as likely to say drinking is morally wrong than those who are not religious [29].
  • Friends attitudes towards alcohol, a survey by Drinkaware found that 35% of drinkers have found themselves drinking more alcohol than they intended to when around friends, with 57% saying they would like there to be less pressure to drink alcohol [30].
  • Poverty, the WHO expert committee in 2007 highlighted the overlap between marginalised members of society, who struggle to access housing, jobs and education, and alcohol use disorders [31].
  • Parental alcoholism, an alcoholic parent means the child will experience a lack of setting boundaries or rules and verbal or physical abuse causing them to be unable to distinguish between healthy and unhealthy choices and normalise the parent's behaviour and develop alcoholism themselves [32].

Social and economic effects also increase the likelihood of alcoholism:

  • Influence from others, especially at a young age [33]
  • Coping with trauma or PTSD symptoms [34]
  • Poverty, lack of housing jobs and education [35]

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].

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Last Updated: January 18, 2023

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health issues, and is a member of the Burney Society. Content reviewed by Peter Szczepanski (Clinical Lead).