Is Alcoholism a Disease?

First let’s define disease: deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown. Also: A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms. A condition or tendency, as of society, regarded as abnormal and harmful. Obsolete Lack of ease; trouble. It is very clear to see how alcoholism fits into these definitions. Still, the debate is heated and the jury is still out.

Here’s some facts that support the disease model of Alcoholism:

1. There is a gene that seems to be linked with one’s sensitivity to alcohol. It’s called CYP2E1. The manipulation of this gene may be very helpful in the field of alcohol treatment. You can read about it here.

2. The role of alcohol on brain neurotransmitters is well known and proven. Neurotransmitters are crucial to brain processes and for our purposes here, our mood and behavior patterns. One of them in particular seems to be directly related to happiness: Serotonin. Neurotransmitters are closely linked to mental health and should be considered in addiction treatment and alcohol treatment. You can read more about the effects of alcohol on Serotonin here.

3. Researchers have been focusing on a particular area of the brain that seems to be involved in alcohol relapse. This area is called the nucleus accumbens (NAcb) core which drives motivated, goal-directed behaviors. Researchers studying a new drug that could help in preventing alcohol relapse, Chlorzoxazone, found that decreased calcium-activated potassium channels (SK) and increased excitability in the NAcb core represents a critical mechanism that facilitates motivation to seek alcohol after abstinence. Read more about it here.

There is overwhelming evidence from neuroscience that supports the short-term and long-term effects of alcohol on the brain.

Yet, we are skeptical. We tend to say things like “why can’t you just put it down?!” “why can’t you just quit?” “what’s wrong with you?”

The disease model of addiction and alcoholism does not imply that we are powerless robots incapable of recovery. Information is out there to help us outsmart the disease, help us understand it and inform treatment alternatives. Information should be able to make us less judgmental and more accepting. Somehow it doesn’t. This is another blog topic all together. Also the disease model implies that there are biological, psychological and social factors that determine the course of the disease and recovery. Just like other well-known diseases such as obesity and diabetes. Our biological predisposition, our psychological make-up and our societal influences COMBINED lead to alcoholism.

Which means, if you are a family member, a friend, a primary care doctor, you too affect the course of the disease of addiction as much as the person’s choice to pick up a drink and a drug. The disease model does not intend to strip the individual from any power or responsibility over the disease, it is meant to create a SHARED responsibility and power between the individual and his/her environment.

Ultimately, it is not as important to determine who’s fault it is that one drinks, as it is to collectively help each other live healthier, happier lives.


2 Comments on “Is Alcoholism a Disease?”

  1. I take it you are not pro-Stanton Peele, M.D. or pro-CBT?

    For me, I’ve wasted so many years debating this disease model in my head (and the powerless assertion) and have spoken to so, so many addicts – homeless ones at the center where I volunteer and on the bus, to a father of two who is a daily blackout addict – and so many have refused to enter the twelve steps. The 12-steppers of course say that it is because of the denial of/that is a part of their disease. But it seems that their is another dynamic here at work: With so much vested in the achievement of quitting, the admission of powerlessness is the zeroing out of their self-esteem and so it is not denial at work – but the preservation of what little self-esteem they have left.

    It seems to me that America is fraught with addictions because America is being provided with a dominant recovery approach that doesn’t work in concert with the side them that feels there is no logical rationale to the 12-step approach.

    With no alternative approach in their sight – this subsequent continual bottoming-out strengthens the emotional and intellectual relationship they have with their behavior. Being focused on it for years without an approach that works in concert with their gut feeling that something direly significant in the 12-step approach is wrong reinforces the focus, until the behavior with the substance or activity becomes, in essence, like a lover. It’s all kind of Romeo and Juliet, really – the more you tell me you’re right, when you’re not – the more I will stand where I am. Even if it’s in a place of addiction.

    Personally, I believe that the disease is life itself, that’s all. But that’s saying much. Especially in the increasing complexity of life and the world in which we live….

    And when you say that the “the disease model implies that there are biological, psychological and social factors” – is that really true of disease? That there are *social* factors that determine the course of the disease and recovery of breast cancer or diabetes? Social?

    It seems the disease model, which is fraught with language like “drugs that *could* help” or phrases like “seem to be”. Indeed it is. It seems more like evidence is being found to *make* things true.

    As for the 12-steps, which seem to be based on the disease model – regardless of whether or not it is a disease anyway (which indeed does imply at least *some* unchangeable powerlessness in its identification of addiction as unchangeable – ever-recovering and never in remission) – telling someone they are powerless is something I would never do to a breast cancer patient, a child, or even another human being. That’s what some addicts, I believe, are fighting against. Fiercely. Possibly foolishly as well, like myself – but also fiercely.

    And of the twelve steps themselves, if one examines the philosophical underpinnings that lie underneath them, at least seven of them are actually *dis-*empowering, if anything at all.

    And the concept of *shared* responsibility does little to define the role of the addict himself in his own life. Where does his or her responsibility and the friends’ families’ responsibilities end and begin? It it good to teach people, who are already often in weakened and destroyed relationships, a blurred and unclear line of demarcation in regards to responsibility? Every twelve stepper I’ve come in contact with, especially those who have been steeped in it for years, tend to become hostile or immature all too soon enough, when things have not gone their way. So I wonder if this concept of shared responsibility, while helping them during initial phases of recovery, shoot them in their future feet….

  2. Thank for your well-thought response. When I talk about the disease model of alcoholism I am not thinking about AA. I think AA downplays the role of biology and overplays the role of character defects in a way that can be detrimental to someone’s recovery. Many of my clients have found AA helpful and as many have found it ineffective. There is very little scientific evidence that AA is effective. It’s more of an epmirical, word of mouth, evidece, so to speak. There is more best practice evidence that supports medication assisted therapies in addiction and alcoholism treatment (which AA doesn’t particularly support). I’m an evidence-based therapist and I do use CBT and Motivational Interviewing in trying to help clients. But that’s not enough.
    Also, the biopsychosocial model is specific to the disease model of alcoholism not of disease in general. I am not a medical doctor, but I would argue that there are psychological and environmental factors that are related to cancer, HBP, diabetes such as lifestyle choices, environmental cancerogens (even in the food we eat everyday)etc. There are well-known lifestyle choices that are associated with diabetes, HBP and cancer (i.e smoking). Certanly we have to be careful not to confuse correlation with causality. I would though argue that the environment and one’s psychological make-up, can be responsible for one’s ability to recover and/or manage disease. Same with alcoholism.
    I agree with you about the issue of responsability. That is a much larger issue that involves political, economical and larger cultural issues related to alcoholism.
    The whole point of this post was to highlight the biological/medical basis of alcoholism which is unique to the disease model. Obviously, there is valid criticism to the model especially around the implied lifelong/chronic nature of the disease. But this is an important model in helping people understand the nature of their problem in all it’s complexity without feeling like there is something wrong with their character or willpower for craving alcohol or struggling with staying sober or chronically relapsing and so on.

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