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Is Alcoholism a Disease or a Choice?

Written By
Chris Elkins, M.A.
This page features
9 Cited Research Articles

Alcoholism, also known as alcohol addiction, is a chronic disease of the brain that’s characterized by compulsive decision-making, impulsive behavior and relapse. It’s triggered by genetic and environmental factors, and it causes biological changes in the brain that make abstaining from alcohol nearly impossible without medical treatment.

Many people say that you can never become an alcoholic if you choose to never drink alcohol. However, that logic doesn’t mean that alcoholism isn’t a disease.

You may never develop skin cancer if you always protect your skin from the sun. You may never develop AIDS if you always have protected sex. But skin cancer and AIDS are preventable diseases.

Likewise, alcoholism is a disease that can sometimes be avoided through prevention strategies and educational initiatives. Like other health problems, some people take risks and develop an alcohol use disorder despite prevention measures.

Today, most authoritative medical organizations consider addiction to alcohol and other substances a disease.

In the past, addiction was misunderstood because it’s a disease that many people exposed to alcohol never develop. People assumed that those with alcohol use disorders chose to keep drinking.

Today, we know that alcohol causes serious changes in the brain that prevent a person from making rational decisions regarding alcohol use. We know that it’s a chronic disease that’s associated with relapse.

Why Alcohol Addiction Is Called a Chronic Disease

The terms chronic disease or chronic condition have multiple definitions. Major medical agencies and organizations disagree about which diseases are considered chronic, according to a 2016 article published in the journal Frontiers in Public Health.

Many organizations use the following criteria to identify chronic diseases:

Using those criteria, alcoholism is a chronic condition. It often lasts for multiple months or years. Many experts say a person never recovers from alcoholism. They may always experience cravings associated with the disease.

Alcoholism is caused by multiple environmental and hereditary factors. It can’t be prevented by vaccine. Some medications, such as disulfiram or acamprosate, may aid recovery from alcoholism. But no medication can cure it. People with severe alcohol use disorders often require long-term residential rehab and years of aftercare support.

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Why Alcoholism Is a Brain Disease

Alcoholism is considered a brain disease because it affects the way the brain operates, causing symptoms such as compulsive behavior and intense cravings. It disrupts a person’s ability to think critically, make rational decisions and function normally.

We know this through observational studies and self-reports from alcoholics. We see people with the disease make decisions that negatively impact their careers, relationships and health. People addicted to alcohol say that they want to stop drinking but are unable to.

Brain scans also show the biological impact of chronic alcohol use, according to the National Institute on Alcohol Abuse and Alcoholism. CT scans have revealed that atrophy, or wasting away of cells, commonly occurs in the brains of alcoholics. The earliest damage occurs in the frontal lobe of the brain, which is responsible for memory, decision making, behavior and executive function.

Other types of brain scans have revealed that alcohol damages parts of the nervous system and the brain stem, causing issues with problem-solving and emotional regulation. The scans have also shown differences in electrical activity in the brains of people dependent on alcohol and people going through alcohol withdrawal.

The primary treatment for alcoholism is behavioral therapy. Therapy teaches alcoholics to control emotions, cope with stress, make healthy decisions and avoid relapse. After months or years of abstinence, most people who have completed all the stages of recovery from alcoholism exhibit improved functioning and decision-making.

Like diabetics who learn to eat healthy foods to cope with their disease, alcoholics can learn skills to cope with alcoholism and maintain long-term sobriety.

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