Alcoholism: disease or choice?

eriksoln, BSN, RN · Jul 9, 2011

You can have a genetic predisposition to a disease, but not develop it without an inciting event.......this certainly holds true in DM II.....why not Etoh abuse? family hx of either should give someone a hint that this is something they need to be aware of and take appropriate action on.

True. So it is a "moral" disease then? A disease that causes one to act selfish and make bad choices...........it's a hard sale. Not saying it isn't possible, but I'm not sold.

As far as being predisposition goes, I think that has to do with environment than any "gene". Kids who grow up in a home where physical abuse is the norm are more likely to.............physically abuse others as adults. People who grow up in a home where debt is the norm are more likely to...........create uncontrollable debt as adults. If you have parents who are not faithful..........you're practically guaranteed to have a hard time being faithful as an adult. Where is the "disease" or "bad gene" in any of this? Same thing for alcoholism, if you grow up in a home where drinking to excess is the norm...........................

morte, LPN, LVN · Jul 9, 2011

True. So it is a "moral" disease then? A disease that causes one to act selfish and make bad choices...........it's a hard sale. Not saying it isn't possible, but I'm not sold.
As far as being predisposition goes, I think that has to do with environment than any "gene". Kids who grow up in a home where physical abuse is the norm are more likely to.............physically abuse others as adults. People who grow up in a home where debt is the norm are more likely to...........create uncontrollable debt as adults. If you have parents who are not faithful..........you're practically guaranteed to have a hard time being faithful as an adult. Where is the "disease" or "bad gene" in any of this? Same thing for alcoholism, if you grow up in a home where drinking to excess is the norm...........................

If you have a genetic predispostion to any of the above....you had to get it from somewhere! ie parents.....

so if THEY behave this way ..... is it the chicken or the egg?

eriksoln, BSN, RN · Jul 9, 2011

If you have a genetic predispostion to any of the above....you had to get it from somewhere! ie parents.....
so if THEY behave this way ..... is it the chicken or the egg?

Thats my point though. Its not a gene, it's learned behaviors. Of all the examples I gave, alcoholism is the only one I know of that people believe is a "bad gene" or "disease" as opposed to learned behaviors.

rn/writer, RN · Jul 9, 2011

Alcoholism is a condition (I like this term better than disease). Sobriety is a choice.

There are people who have such an affinity for alcohol that it doesn't take much for that appetite to be activated. Once it is, they don't get a choice about whether to crave it or not.

There are others who may not have this strong attraction who, through years of bad choices, get their bodies to develop that craving.

Either way, once the attraction is present at a certain level, it's there, no choice about it. Choice enters the picture when you want to talk about management of the condition. That's where the "morality" comes into it. The alcoholic can choose to keep drinking and damaging his life and the lives of those around him. Or he can choose to do battle with the addiction. He can't choose to not have the addiction. It exists. It's real. It is snaky and sneaky and will present him with all kinds of challenges. But he can become very honest and work very hard at staying away from alcohol one day--sometimes one minute--at a time.

Arguing either side--moral choice vs. physical condition--is to tell only half the story. Looking only at choice without recognizing the powerful pull of drink is to be ill-informed about your enemy and ill-prepared for the battle ahead. Folks who rain condemnation on problem drinkers without understanding the addictive process just heap guilt on someone who already feels lower than low. On the other hand, those who have fought the battle and are winning will be able to encourage sobriety without making the person feel bad that they need so much help.

The flip side is those who look only at the condition. I drink therefore I am. I'm an alcoholic, so I don't have any choice. No, you don't have a choice about wanting to drink. That desire is there. But you do have lots of choices about whether to resist or give in.

The diabetic analogy is really an apt one.

Yes, there are tons of people who become diabetic (Type II) after years of bad diet and insufficient exercise. There are alcoholics who started drinking young. College may have been a blur. Maybe they went without drinking for weeks at a time, but then they'd binge. At some point, their bodies grew accustomed to being somewhat pickled and rebelled when they didn't have at least a low-key buzz going. Just like the midlife Type II diabetics, they brought this nightmare on themselves, one crummy choice at a time.

But there are also lots of Type I kids and older diabetics. Through no fault of their own, they can't make insulin. None of them decided to have their pancreas quit on them, but it did. Now the only choices they have are how they will manage their condition.

Similarly, there are alcoholics who develop an almost instant addiction. Early on, sometimes from the first drink, they have a strong attraction toward alcohol that even they may not understand for years and years. Think of people like Drew Barrymore who did her first stint in rehab at the age of 13. Her father was a notorious drunk who passed the baton to her genetically because he wasn't around enough to be a direct influence.

These folks, like the Type I diabetics, need help, and lots of it, if they are to survive.

When you have someone who is 40 years old and a heavy drinker, it can be pointless to try to determine whether he's a Type I or Type II alcoholic because whether it's a dastardly genetic legacy or a prison made of bad choices, the condition functions the same. And the remedy is the same. Sobriety--one day, one hour, one minute, at a time.

Choices early in the game? Maybe. Maybe not. But there are plenty of choices down the road. In fact, a recovering alcoholic will have all kinds of opportunities to choose life and health over drinking and destruction every day for a long, long time. For some, the craving settles down to a dull roar that only occasionally rears its head. For others, they have to do battle every day for a long time before achieving peace.

I commend anyone who has faced their demons, whether they came with the house (the body) or were invited in. Those critters don't leave without a fight.

eriksoln, BSN, RN · Jul 9, 2011

Arguing either side--moral choice vs. physical condition--is to tell only half the story. Looking only at choice without recognizing the powerful pull of drink is to be ill-informed about your enemy and ill-prepared for the battle ahead. Folks who rain condemnation on problem drinkers without understanding the addictive process just heap guilt on someone who already feels lower than low. On the other hand, those who have fought the battle and are winning will be able to encourage sobriety without making the person feel bad that they need so much help.

Kinda like telling an overweight person they need to lose weight and calling them fat I guess.

I still feel like the whole "gene" theory is cruel. It's like telling someone they are a mutant or biologically less than. That's what it sounds like to me anyway. Would you say that to a diabetic?

"You body is all ****** **, you're going to spend the rest of your life having to do stuff to make up for it."

Hmmm. Food for thought I guess. Maybe taking the disease process into account doesn't necessarily mean "condemning" the person like some Morlock. People with cancer aren't simply hooked up to morphine and told "Sorry, your genes were different so you got the CA when others didn't." But then again, with CA, there are concrete medical/surgical practices that improve the quality of life. With alcoholism...........isn't recovery primarily focused on changing one's thinking/values?

Long Term Care Columnist / Guide · Jul 9, 2011

Being a drunk and a drug addict is a choice. I don't think anyone who has these issues should be in nursing at all. I have been exposed to working with nurses who claim to have "addiction" issues and I personally can't trust working with them. I think they BON in every state should revoke their licenses if they are caught drinking or stealing narcs on the job. Nursing already has a bad name with some of the nurses who go into it just for the money. Get rid of the nurses who choose to put everyone at risk. There is no such thing as "addiction" being a disease.

OK, you've had your say. Now you get to listen to mine.

Try as I might, I just can't wrap my mind around this blanket generalization, because according to you, I don't deserve to be a nurse.

I haven't touched a drop of ETOH in 19 1/2 years. I have never had a problem with cross-addiction, never diverted narcotics, never even been tempted to do so. Heck, I have fired subordinates who endangered patients by being under the influence at work or out-and-out stole narcotics from them, and I'm in full agreement that the BON should revoke licenses in the case of nurses who drink or use drugs on the job. Yet, you think I can't be trusted.

I was born to a pair of upper-middle-class lushes who felt they were better than other alcoholics because they did all their boozing out of town where no one they knew could see them. Like it or not, the genetic component does exist, and addictive personalities can be found in the branches of every family tree. In my family's case, not a single relative EVER quit drinking.......I was the only one who succeeded in getting sober and staying that way. But that apparently counts for nothing in your estimation---nurses like me should just hang up our stethoscopes because we "choose to put everyone at risk".

If you took the time to get to know an alcoholic nurse instead of judging her/him, you might be surprised at the fact that we DON'T have horns or forked tails. We are just people who happen to have a disease that we have to manage, much like diabetes or CHF, and we work everywhere, in all sorts of occupations. There might even be someone working right beside you at this very moment---a nurse who you admire or respect because s/he has a great attitude and mad skills---who you don't know is quietly battling an addiction with as much grace and dignity as possible. Will you change your tune and condemn this colleague if s/he confides in you that s/he has a drinking problem?

'Nuff said........I don't think I really want to know the answers anyway. :coollook:

rn/writer, RN · Jul 9, 2011

Kinda like telling an overweight person they need to lose weight and calling them fat I guess.
I still feel like the whole "gene" theory is cruel. It's like telling someone they are a mutant or biologically less than. That's what it sounds like to me anyway. Would you say that to a diabetic?
"You body is all "****** up, you're going to spend the rest of your life having to do stuff to make up for it."
Hmmm. Food for thought I guess. Maybe taking the disease process into account doesn't necessarily mean "condemning" the person like some Morlock. People with cancer aren't simply hooked up to morphine and told "Sorry, your genes were different so you got the CA when others didn't." But then again, with CA, there are concrete medical/surgical practices that improve the quality of life. With alcoholism...........isn't recovery primarily focused on changing one's thinking/values?

There are indeed genes that predispose some people to cancer. And, yes, that really bites. The same is true for alcoholism and that also bites.

Think of little kids who need surgery and chemo and radiation and meds for genetic conditions. How fair is that? The answer is that it isn't fair at all, but we play the hands we're dealt.

One of my nursing school instructors lost her mother, aunt, and a couple of sisters and cousins to breast cancer. With this obvious and perilous genetic sword hanging over her head, she elected to have a bilateral mastectomy in her thirties. Her reasoning was that she couldn't change her heredity, but she could choose to take herself out of harm's way.

Most of us are under some kind of genetic sentence, whether it be for alcoholism, cancer, diabetes, Huntington's disease, or hemophilia. Or milder things like color-blindness, excessive freckling, big ears, or hay fever. I would wager that just about everyone has some family history that makes them less than biologically perfect. So, while I can appreciate your compassion and concern for alcoholics feeling "less than" others, the reality is that we all fall short of being the perfect human specimen.

The good news is that we may at some point be able to access this genetic information so that people could find out in their youth that they are biologically susceptible to alcoholism. We might see support groups and medications and other types of help given before there is a visible problem to keep them from falling down the rabbit hole in the first place. Or having gotten in trouble, they might save themselves years--even decades--of not knowing what's happening and realize much earlier in the game what they need to do to get themselves righted again. Forewarned, they might recognize the reality and be more open to help than if they were just floundering around unaware.

With alcoholism...........isn't recovery primarily focused on changing one's thinking/values?

With alcoholism, as with any other chronic and debilitating condition, recovery is based on finding out what you need to do (staying sober), believing it to be true (resisting denial), making changes where needed (making new friends and developing new habits) and practicing healthy choices every day. Diabetics need to change their thinking about what good food really is. Cancer patients need to accept that medicine that makes them horribly sick can eventually make them well. The list goes on.

When confronted with any kind of health challenge, a person needs to change their thinking and adapt their life accordingly. Playing the hand you're dealt requires humility and determination. And the loving support of others who understand what you're up against.

Alcoholism is a condition that comes with a lot of choices.

Rob72, ASN, RN · Jul 12, 2011

"You body is all ****** **, you're going to spend the rest of your life having to do stuff to make up for it."
Hmmm. Food for thought I guess. Maybe taking the disease process into account doesn't necessarily mean "condemning" the person like some Morlock. People with cancer aren't simply hooked up to morphine and told "Sorry, your genes were different so you got the CA when others didn't." But then again, with CA, there are concrete medical/surgical practices that improve the quality of life. With alcoholism...........isn't recovery primarily focused on changing one's thinking/values?

Hehheh. Type I x38.6 years here. I see no problem with the above statement. Is it couched in "theraputic communcation"? No. Do some people need more empathetic direction? Yes. I believe we've gone a bit too far down that road, tho'. You haven't been condemned, you have work to do.

Here's the problem, and it applies to most of the "new" diagnoses in the DSM-IV- there is abusive/addictive behavior that is choice, and therefore falls under moral paradigm; there is also abusive/addictive behavior that is pre-disposed by genetic pathway, and there are (in most cases) pharmacologic and surgical interventions available.

What has happened is that the "choice" group has co-opted the "disease" process/group to enable their predillictions, and it is true of everything from homosexuality to crack. I'm not trying to kick the hornets' nest, but simply, objectively, there are behaviors that may be "pleasurable" that do not make evolutionary or "moral" sense, but, because pleasure-seekers do not wish to evaluate behaviors objectively(and because there is less $$ in resolving ills than in "therapy" or enabling the behavior), the discussion has become an emotional, and therefore unresolvable, morass.

But, to the original topic, with F-MRI, it is possible to locate, with reasonable accuracy, paths of stimulation. While I don't think a lobectomy is a reasonable answer, it is not unreasonable to think that a DBS could activate those pleasure pathways, on a decreasing scale, to create pleasurable stimulus without the negative behavior. In conjunction with behavioral modification, this could have some fairly significant potential. Of course, that would mean that for a significant portion of alochol abusers, they would have to learn effective coping mechanisms, and many people simply do not have the desire to do that work without some extreme experience that can (IME) only be termed spiritual. The paradigm shift is generally in terms of no longer looking at "me/my/I", and getting to a model of "what can I give".

Thomas RN · Jul 14, 2011

i personally believe that alcoholism is and is not a choice. individuals choose to drink alcohol at some point in time. they choose how much and how often they drink alcoholic beverages. individuals choose to use alcohol to often produce pleasurable feelings and to diminish inhibitions in social situations. they experience euphoria and return to a normal state after drinking. they choose occasional drinking, perhaps a few times monthly; weekends. individuals can also choose to increase their use to several times a week and may choose to drink during the day. they might choose to drink alone rather than with friends. they may choose to drink alcohol in quantities and at a frequency that is not consistent with maintaining good health. at some pint a "switch" is turned on and what were choices are no more. when this "switch"" is turned on it is at this time alcoholism is not a choice any longer. the individual begins to drink compulsively and his or her control over drinking is impaired and now there is a preoccupation with obtaining and using alcohol and continues to drink despite adverse consequences such as health problems, legal problems, job loss etc. the experts talk about individuals that possess certain vulnerabilities and are biologically susceptible to becoming addicted to alcohol and through molecular adaptions in the brain that are important for the alcohol reward and cravings have now taken away the choice of drinking or not drinking. this is at the point the "switch" has been turned on. regardless of how much the individual wants to choose not to drink alcohol they cannot stop drinking.

also i personally believe that certain individuals that are given the tools and skills through rehabilitation and treatment often choose not to use the tools or do the necessary things to be completely abstinent (this being their first priority) and going on to become sober in life long recovery. in a round about way this is choosing alcoholism. i understand that if individuals do not have the skills or tools and information they need to stay completely abstinent and then sober the return to drinking is gong to happen sooner or later. if the tools, skills and information have been given to them and they choose not to use them or do as they have been taught; that results in choosing to remain in the state of being "alcoholic" addiction is a disease that is chronic and life-long, but remission is totally possible. individuals can choose to be in remission or choose to be in the active disease state.

ashley16 · Jan 8, 2012

I have to do a report on if alcoholism is a choice or a disease. I strongly believe its a choice, only because you choose to pick up the drink and you choose to drink. No one forces you to drink, addiction is a choice not a disease. My main point is, did a person with cancer choose to have cancer? Did they wake up saying "Oh i want to have cancer." no . they did not choose that its a disease. But does someone choose to drink? Yes. But what do i know? I'm still a kid in high school.

Long Term Care Columnist / Guide · Jan 8, 2012

And you have a lot to learn. :)

We alcoholics/substance abusers CAN choose to engage in our addictions---or not---but we do not choose to have the disease of addiction, any more than one chooses to have cancer, or diabetes, or Parkinson's disease. Believe me, nobody wakes up and decides they're going to be a drunk, or a junkie, or a gambler who can't stop betting, even when they're about to lose their home, family, and everything they've worked for. Who ever would CHOOSE that?

Makes a difference when you look at alcoholism/addictions in that light, doesn't it?

Good luck in your future studies. :specs:

dirtyhippiegirl, BSN, RN · Jan 9, 2012

Plenty of people live lifestyles and make choices that pre-dispose them to get certain forms of cancer.