Alcoholism: disease or choice?

CADC<Nursing · Jan 23, 2012

I am a graduate in Addictions counseling and addiction/alcoholism is absolutely a disease, not a choice. Ill tell you why. You absolutely choose to take the first drink second drink third drink. But the changes that occur in your brain from repeated alcohol use actually chemically changes it. There comes a point in the usage that the choice is no longer a choice so much as a compulsion and when that compulsion isnt satisfied, there are direct physical repercussions. Treatment treats the addiction and can encourage people to stay sober but people will always back slide and relapse and anyone working in the addiction field should acknowledge and know that relapse is an integral part of the healing process.

mz.snuggly1 · Jan 24, 2012

Alcoholism is a disease you choose! PERIOD!

Tom RN, NRC · Feb 12, 2012

I think that saying alcoholism is a disease you choose is a bit off. Alcoholism like all addiction is a disease of choice. What I mean when I say this is that addiction is a disease of the very areas of the brain we use to make our choices (specifically the reward pathways running between the mid-brain and cortex) What people have to realize is that it is not the drug use that determines whether or not the disease process of addiction is present, it is craving. Drug use is part of the symptomology, and like many diseases just because one symptom is missing does not mean the disease is not present. It would be like saying because a diabetic does not eat sugar he does not have diabetes. The presence of craving is one of the key factors of addiction being classified as a disease. The addict has no choice about whether to crave or not. Cravings can be triggered by things outside the addicts control. For that reason addiction is not a choice. Of course the idea of choice itself is a lot more complex than most believe. In addiction the the process of choice has been contaminated far before the information ever reaches the cortex. The disease model is very simple 1. Organ 2. Defect 3. Symptoms Diabetes as disease 1. Organ= Pancreas 2. Defect= Death of islet cells/ no insulin 3. Symptoms= elevated blood gluc, blurred vision, coma, ect. Addiction as a disease 1. Organ= Brain 2. Defect=Physical changes in the reward, learning, choice pathways 3. Symptoms= Craving, persistent use despite negative consequences, ect.

jackstem · Feb 12, 2012

Ignorance is bliss. Willful ignorance in a health care "professional" is unprofessional and unethical. Ignorance is the driving force behind the stigma associated with the disease of addiction (and alcoholism is only one form of that disease).

Long Term Care Columnist / Guide · Feb 12, 2012

Ignorance is bliss. Willful ignorance in a health care "professional" is unprofessional and unethical. Ignorance is the driving force behind the stigma associated with the disease of addiction (and alcoholism is only one form of that disease).

Thank you, jackstem. I couldn't have said it better myself.

Fruit Sucker · Feb 12, 2012

The fact that alcohol abuse has physical effects doesn't make it a disease. Alzheimer's is a disease- you can't just stop doing it because you decide to get right with yourself. Personally, I am fed up with people who refuse to take responsibility for their actions because they "can't help it" because "it's a disease." Overconsumption of food and drink is not a disease, it's a problem. Sadly, the physical consequences of both become everyone's problem when people don't take responsibility for themselves and taxpayers are expected to foot the bill for the resulting health problems.

I'm two years divorced from an alcoholic, so I know from personal experience that far too often, alcoholics are people who either don't have coping mechanisms or don't want to face life's problems like the rest of us do, so they decide to bail out and let everyone else deal with it instead while they party. Most recovering alcoholics I've met remain irresponsible and emotionally high maintenance long after the drinking has stopped.

Is spousal abuse a disease? Some people think so. Maybe people who beat their wives should be felt sorry for because it isn't their fault.

Long Term Care Columnist / Guide · Feb 13, 2012

I'm sorry you feel that way, captainmeowbot. It sounds as though your perspective has been colored by your experiences during your marriage to an alcoholic, and that's unfortunate, although certainly understandable given the circumstances.

But you are not getting the whole picture. Maybe you choose not to because it's too painful. If you are in nursing or another health field, however, it would be beneficial to you and your patients to try to understand all sides of addiction, because you'll be dealing with its sufferers throughout your career.

Yes, Alzheimer's is a disease. You can't get rid of it just because you decide you're going to work hard at remembering things. Diabetes is a disease; you can get your blood sugar down to normal levels and keep them there with proper diet, exercise, and medications, but you're still a diabetic. Addiction is a disease too, because you're never "cured", even if you abstain from your drug of choice forever. I've been sober for two decades......I'm still an alcoholic. And I certainly never chose to be one.....thanks to a combination of poor genetics and an addictive personality, that die was cast long before I knew I had a problem.

No, the only choice I get is whether or not to pick up that next drink. The disease of alcoholism took away my choice to use alcohol responsibly, no matter how much I might wish I had that option.

I hope this explains a little about how addiction is not a "choice". Violent criminal behavior, such as spousal abuse, isn't even in the same universe, although addicts certainly can and do become abusers. Thank you for reading.

Fruit Sucker · Feb 13, 2012

Nobody is blaming alcoholics for having a craving. Normal people have feelings every single day. And they're expected to make responsible choices when they're faced with feelings, no matter how strong they are. Unless you've been declared mentally incompetent, then yes, it's your fault that you're drinking, getting on the road killing people, ending up in jail, ruining your family and health, etcetera.

If you want people to acknowledge that you're mentally incapable of making choices for yourself, that comes with a price.

If you want people to acknowledge that you have feelings and physical sensations that are really hard to deal with, welcome to being a normal human. What level of empathy you can expect regarding those feelings and sensations is a different matter. Asking for empathy and asking for carte blanche to make bad decisions and hurt others because you have a "disease" is two different things.

sharpeimom · Feb 13, 2012

it's a disease, but as with a disease such as diabetes, the patient has some responsibility for the outcome. my husband's father was a mean,

abusive, alcoholic until he was in his late fifties when my mother-in-law was diagnosed with breast cancer. he quit drinking and never looked back by going to aa and church. he never drank again but it was a battle every day.

my husband is a type-1 diabetic and has been since childhood. it has been pounded into his head since then that much (but not all) of his

good health would be up to him. it's the very same thing with an alcoholic and his disease. you are responsible for not drinking that next drink, but without the presence of the disease, those urges and compulsions wouldn't be there in the first place.

if my husband decides to eat a gallon of oreo ice cream, washed down with non diet cokes, night after night, his health will suffer.

not because he's weak, but because he has a disease and doesn't produce enough insulin.

Long Term Care Columnist / Guide · Feb 13, 2012

I don't recall asking for empathy, so I'm going to presume that the generic "you" was being used in the above post, rather than directed at me personally. :) I can also say in all truthfulness that I never killed anyone, did time in jail, or ruined anyone's life because of my alcoholism---God was that good to me. I didn't deserve it, but He protected me until I was strong enough in sobriety to protect myself.

I am merely stating a case for the disease theory of addiction. Additionally, treatment of it as such---rather than stigmatizing it as a character defect---tends to be more successful in helping alcoholics and addicts achieve long-term sobriety. I know it's helped me a great deal. Heaping scorn and shame on top of the guilt we already feel doesn't make anything better!

As I think my own experience proves, it is entirely possible to take control of our behaviors; what we can't control is the presence of neurochemical imbalances, and/or environmental influences in prenatal life, that gave rise to the disorder in the first place.

I realize, however, that people are going to think what they want, and that I cannot educate those whose minds are already made up. So I will exit gracefully here, and let the conversation continue as it will.

Tom RN, NRC · Feb 17, 2012

The questioned posed is is alcoholism a disease or choice not if alcoholics are responsible for their actions. Alcoholism fits the disease model, is recognized as a disease internationally, and can be treated. captainmeowbot if you have any credibility as a nurse, if indeed you are, you would admit that your objectivity in this matter has to be questioned. It seems more to me that you are using this forum to deal with your personal issues, because rather than engaging the entirety of any one persons response you pick out one or two words and twist them into something you can attack. You have obviously been hurt by someone with a substance use issue. I hope you get to work that out at some point, likely though you will just redirect some of your anger and hurt back at my post which is fine. The burden of proof of fitting addiction to the disease model has been met, now those of us in the profession just have to plug away at till the rest of medicine and society catches up. Heck I hear there are still people who think the world is flat. If you are truly interested in educating yourself I could post some great links on the matter. Cheers Tom RN, BScN, NRC

dirtyhippiegirl, BSN, RN · Feb 17, 2012

Unless you've been declared mentally incompetent, then yes, it's your fault that you're drinking, getting on the road killing people, ending up in jail, ruining your family and health, etcetera.

You have a very odd idea about what alcoholism actually entails.