Many people say that you won’t 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. Yet skin cancer and AIDS are accepted as preventable diseases.
Alcoholism is also a disease that can sometimes be avoided through prevention strategies and educational initiatives. Like other health problems, some people take risks and develop alcoholism despite preventative measures.
“Alcoholism is a disease in the sense that over time there are neurological or functional changes that happen as a result of heavy continuous drinking,” Dr. Kenneth Leonard, director of the Research Institute on Addictions, told DrugRehab.com.
“Those changes create a condition that make alcohol a more salient, pleasurable experience for people,” Leonard said. “And it leads to brain changes that weaken control over drinking.”
The terms alcoholism, alcohol addiction and alcohol use disorder are often used interchangeably. Alcohol use disorder, which includes alcohol abuse, alcohol dependence and alcoholism, is the official medical term for recurring alcohol consumption that causes clinically significant impairment and an inability to meet responsibilities, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.
More simply, alcoholism can be defined as a disease that causes a compulsive desire for alcohol, loss of self-control and diminished judgement.
“Someone who struggles with alcoholism will likely have issues surrounding work, relationships, physical health, or mental health caused by the consumption of alcohol. They will likely be seen by others as having difficulty controlling their use.”
The term alcoholic is often used loosely and indiscriminately. An alcoholic may be someone who is addicted to or physically dependent on alcohol. It’s also used to describe drinkers who are not addicted or dependent but tend to experience problems involving alcohol.
The differences between causal drinking and problem drinking include how responsibly a person drinks and the effects that alcohol has on them. It’s possible to be a problem drinker and not an alcoholic. Problem drinkers get too drunk and make poor decisions, but they aren’t always addicted to alcohol.
The American Psychiatric Association classifies alcohol use disorders as mild, moderate or severe depending on how many diagnostic criteria a person meets. Each of the 11 diagnostic criteria the association uses is a problem related to alcohol use.
Someone with a mild disorder meets two to three criteria. Someone who meets four to five criteria has a moderate disorder, and anyone who meets six or more criteria has a severe disorder.
Researchers have also classified five types of alcoholics. The types are characterized by age, drinking behavior and preferred treatments.
The types of alcoholics include:
Alcoholics may be characterized by how much they drink or how long they’ve been drinking. But the criteria for alcoholism have nothing to do with those factors.
People develop alcoholism when they lose the ability to control their drinking. They feel an uncontrollable urge to drink, and they have incredible difficulty stopping themselves from drinking. All alcoholics share those traits.
The stages of alcoholism aren’t scientifically defined like the severities of alcohol use disorders. But they do provide an easy-to-understand view of how someone becomes addicted to alcohol.
As a person progresses through the stages, he or she becomes more severely addicted. Many of the stages are defined by the signs of alcoholism a person is displaying.
Signs and symptoms of alcoholism by stage:
Some people remain in the early stage their entire life. Others rapidly progress to end-stage alcoholism. The way that alcohol affects each person is determined by a combination of genetic, environmental and social factors. The stages of alcoholism can indicate the intensity of treatment that a person needs.
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Alcoholism is considered disease because it affects the way the brain operates. It causes symptoms such as compulsive behavior and intense cravings. It disrupts a person’s ability to think critically, make rational decisions and function normally.
Today, most authoritative medical organizations consider addiction to alcohol and other substances a disease.
The following organizations recognize alcoholism as a brain disease:
In the past, addiction was misunderstood because it’s a disease that many people who drink never develop. People assumed that those with alcoholism chose to keep drinking.
Drinking excessively affects the brain’s reward system. Alcohol causes a dopamine release in the brain, making us feel pleasure. When people drink too often, the brain adapts. It releases less dopamine, and it changes other parts of the reward system.
These changes make it more difficult for alcoholics to feel happiness. They also make people with alcoholism crave the substance.
Brain scans 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.
The resulting changes to how people feel pleasure, make decisions and control behaviors cause alcoholism.
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 symptoms.
The terms chronic disease and 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 alcoholism medications, such as disulfiram or acamprosate, may aid recovery from alcoholism. But no medication can cure it.
The primary treatment for alcoholism is behavioral therapy. Therapy teaches alcoholics to control emotions, cope with stress, make healthy decisions and avoid relapse.
People with severe alcohol use disorders often require long-term residential rehab and years of aftercare support. After months or years of abstinence, most people who have completed all the alcoholic recovery stages 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.
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 alcoholism is a chronic disease that’s associated with relapse.