Alcoholism: disease or choice?

nola1202 · Jun 13, 2011

I can see why the debate rages on. A family member hurt by the addicts disease, feels they chose the addiction over them. Addicts will maintain they did not have a choice.

An addict well into recovery will say they are humbled by the knowledge that relapse is just one decision away.

I think most chronic illnesses or conditions are characterized by a genetic predisposition and behavioral changes that keep it in check.

floridanurse1983 · Jun 21, 2011

I believe it is a choice. You don't choose Parkinson's, MS, or mental illness. It happens to you. Everyone makes life choices everyday and I feel that by saying it is a disease, you are not accepting responsibility.

I may have a biased opinion, but had a horrible experience with an alcoholic. I used to believe it was a disease until I was on the inside of the problem. Completely changed my entire opinion.

Long Term Care Columnist / Guide · Jun 21, 2011

I used to believe it was a disease until I was on the inside of the problem. Completely changed my entire opinion.

I am on the inside of the problem.......I'm a recovering alcoholic myself, and I most certainly did not choose to have this condition, any more than I chose to have diabetes or asthma or arthritis.

What I DID choose was not to give in to my disease. Instead, I chose to manage it by abstaining from alcohol. I have not touched a drop in 19 1/2 years, and God willing, I never shall again. THAT, I can and do take responsibility for; one always has a choice as to whether to continue the dysfunctional use of alcohol. But I didn't pick my parents (both of whom were your basic upper-middle-class lushes who drank "cocktails" at home from noon till bedtime and looked down on people who were so uncouth as to do their drinking at the local tavern), didn't select "addictive" from the menu of personality choices I was given (NOT), and wasn't taught appropriate coping mechanisms during my formative years.

Nobody who knows me now would ever guess I'm an ex-drunk, but I am, and no, I didn't choose that. I wish I could be a normal, "social" drinker, but I never have been and never will be because I am incapable of controlling my drinking once I get started. The only "choice" open to me is to never, EVER pick up that first drink, for "one drink is too much, and a thousand aren't enough".

Peace out!

sissiesmama, ASN, RN · Jun 22, 2011

I am on the inside of the problem.......I'm a recovering alcoholic myself, and I most certainly did not choose to have this condition, any more than I chose to have diabetes or asthma or arthritis.
What I DID choose was not to give in to my disease. Instead, I chose to manage it by abstaining from alcohol. I have not touched a drop in 19 1/2 years, and God willing, I never shall again. THAT, I can and do take responsibility for; one always has a choice as to whether to continue the dysfunctional use of alcohol. But I didn't pick my parents (both of whom were your basic upper-middle-class lushes who drank "cocktails" at home from noon till bedtime and looked down on people who were so uncouth as to do their drinking at the local tavern), didn't select "addictive" from the menu of personality choices I was given (NOT), and wasn't taught appropriate coping mechanisms during my formative years.
Nobody who knows me now would ever guess I'm an ex-drunk, but I am, and no, I didn't choose that. I wish I could be a normal, "social" drinker, but I never have been and never will be because I am incapable of controlling my drinking once I get started. The only "choice" open to me is to never, EVER pick up that first drink, for "one drink is too much, and a thousand aren't enough".
Peace out!

Love it!! I am glad to see some other posters in my line of thought. I don't drink, but I am a recovering addict, and I didn't choose using, as you said, I didn't pick HTN or a PFO.

I have had people ask me why I am "proud to be an addict". I tell them in no uncertain terms that I am not proud of it - I am proud that I was able to get the help I needed and am definetly proud that I am almost 11 years clean and sober.

Anne, RNC

jackstem · Jun 22, 2011

I believe it is a choice. You don't choose Parkinson's, MS, or mental illness. It happens to you. Everyone makes life choices everyday and I feel that by saying it is a disease, you are not accepting responsibility.
I may have a biased opinion, but had a horrible experience with an alcoholic. I used to believe it was a disease until I was on the inside of the problem. Completely changed my entire opinion.

It's difficult to wrap our heads around something that seems to be voluntary. I assure you, I didn't choose thise disease anymore than I chose a pilonidal cyst or the spondylolisthesis which caused the chronic pain that led to my addiction to opioids. I had a spinal fusion which has relieved the chronic pain, but it took quite awhile for me to realize that what I had (addiction) was a disease and that I didn't "ask for it". While I'm not responsible for the disease, I am responsible for my recovery. It takes a conscious effort to design a recovery plan and actually "work" it.

Try reading the research on the pathophysiology of the disease, including the genetics involved. Fascinating stuff.

Bruin's Mom · Jun 28, 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.

Bruin's Mom · Jun 28, 2011

It's difficult to wrap our heads around something that seems to be voluntary. I assure you, I didn't choose thise disease anymore than I chose a pilonidal cyst or the spondylolisthesis which caused the chronic pain that led to my addiction to opioids. I had a spinal fusion which has relieved the chronic pain, but it took quite awhile for me to realize that what I had (addiction) was a disease and that I didn't "ask for it". While I'm not responsible for the disease, I am responsible for my recovery. It takes a conscious effort to design a recovery plan and actually "work" it.
Try reading the research on the pathophysiology of the disease, including the genetics involved. Fascinating stuff.

Well if you are not responsible for it who is? You took the meds and now you are claiming that addiction is a "disease?" As a nurse you should have known the risk when taking opioids and the fact they could cause you to become "addicted" to them. Drug use and drinking is a choice and you take responsibility your actions when you take drugs and alcohol.

eriksoln, BSN, RN · Jul 8, 2011

My attitude towards those that abuse drugs has been put out there before. It was in a thread that was mostly focused on drug diversion and giving nurses second chances though. My reactions to a nurse doing this are profoundly different than my reactions to, IDK, a friend who is drinking too much or a relative who is headed down the path of alcoholism. Heck, my article, "Talked into a career in nursing by Stephen King" describes my excessive drinking I went through during my earlier years as a landscaper.

With that said, I have to say, I still insist on holding onto the idea that it is a matter of choice. A lot of people tend to disagree, and I often get the "You are going by primitive thinking" answers for having that attitude, but I can't shake it. Here is why:

My attitude that taking a drink and drinking to excess is a matter of choice, in a round-about way, stems from compassion for the alcoholic. What I see when I look at the behavioral patterns of an alcoholic, I see a long period of poor decision making that tends to wreck havoc on their lives and the lives of those around them. Their decision making often is driven by a sense of selfishness and a sort of moral bankruptcy that makes decisions like drinking before you work or using money that should go to your children's school lunches for booze.......OK.

Then I see many of these people, as the natural consequences of their living catches up to them, wake up and change their ways. They realize being alone, not being able to hold down a job, having to schedule EVERYTHING around drinking isn't what they want. The people who come to this conclusion are the people we see in recovery. Recovery is hard because it is more than a matter of putting down the alcohol. It is also a matter of changing one's thinking so that the "decision making often driven by a sense of selfishness and moral bankruptcy" no longer is what guides their attitudes/approach to life. To me, recovery must include changing the flaws that lead to the excessive drinking. I'll point out, the number of ETOH cases at my facility has gone up significantly during the two years I have been there. I predicted this would happen. I foresaw a lot of people, with the bad economy, throwing their hands up in the air and saying "To hell with it, it's easier to just spend the day buzzed than to deal with this."

Now, my views show I consider alcoholism a "moral dilemma". I prefer that view over the "alcoholism is a disease" theory because I consider that theory cruel. With it, we are saying, people who drink to excess are biologically different, hence they react to alcohol differently. No matter what attitudes they change, no matter what they use as a moral compass..........the DNA will be there and they are an alcoholic more likely to love their booze of choice than themselves or their fellow humans.

That, to me, is cruel. It sounds too much like saying alcoholics are Morlocks with no chance of changing who they are. I think people can recover from alcoholism, and the treatment plan is not changing ones genes. It is changing ones thinking and values. I rather prefer giving alcoholics (addicts) the benefit of the doubt with regards to believing they do have a chance to recover. The "it is a disease" argument seems to slam the door shut on there being any way of changing................sort of makes you think they should be locked underground, like the Morlocks (unless you have a pill that can target the ETOH gene and change it without harming everything else).

IDK. Maybe I'm a victim of "the road to hell is paved with good intentions" or maybe I'm just plain old vanilla ignorant. Either way............the whole "alcoholism is a disease process" seems so final and segregating to me.

shrinkyrn · Jul 8, 2011

I would like to recommend Dr. Kevin T. McCauley's DVD Pleasure Unwoven....It gives hypothesis for both Disease and Choice and goes on to scientifically prove that indeed Addiction is a Disease......It is not a boring presentation, in fact it is one of the most well put together DVD's on brain function/dysfunction that I have ever seen....I use it with my clients...who are able to understand it and therefore the concepts.

morte, LPN, LVN · Jul 8, 2011

My attitude towards those that abuse drugs has been put out there before. It was in a thread that was mostly focused on drug diversion and giving nurses second chances though. My reactions to a nurse doing this are profoundly different than my reactions to, IDK, a friend who is drinking too much or a relative who is headed down the path of alcoholism. Heck, my article, "Talked into a career in nursing by Stephen King" describes my excessive drinking I went through during my earlier years as a landscaper.
With that said, I have to say, I still insist on holding onto the idea that it is a matter of choice. A lot of people tend to disagree, and I often get the "You are going by primitive thinking" answers for having that attitude, but I can't shake it. Here is why:
My attitude that taking a drink and drinking to excess is a matter of choice, in a round-about way, stems from compassion for the alcoholic. What I see when I look at the behavioral patterns of an alcoholic, I see a long period of poor decision making that tends to wreck havoc on their lives and the lives of those around them. Their decision making often is driven by a sense of selfishness and a sort of moral bankruptcy that makes decisions like drinking before you work or using money that should go to your children's school lunches for booze.......OK.
Then I see many of these people, as the natural consequences of their living catches up to them, wake up and change their ways. They realize being alone, not being able to hold down a job, having to schedule EVERYTHING around drinking isn't what they want. The people who come to this conclusion are the people we see in recovery. Recovery is hard because it is more than a matter of putting down the alcohol. It is also a matter of changing one's thinking so that the "decision making often driven by a sense of selfishness and moral bankruptcy" no longer is what guides their attitudes/approach to life. To me, recovery must include changing the flaws that lead to the excessive drinking. I'll point out, the number of ETOH cases at my facility has gone up significantly during the two years I have been there. I predicted this would happen. I foresaw a lot of people, with the bad economy, throwing their hands up in the air and saying "To hell with it, it's easier to just spend the day buzzed than to deal with this."
Now, my views show I consider alcoholism a "moral dilemma". I prefer that view over the "alcoholism is a disease" theory because I consider that theory cruel. With it, we are saying, people who drink to excess are biologically different, hence they react to alcohol differently. No matter what attitudes they change, no matter what they use as a moral compass..........the DNA will be there and they are an alcoholic more likely to love their booze of choice than themselves or their fellow humans.
That, to me, is cruel. It sounds too much like saying alcoholics are Morlocks with no chance of changing who they are. I think people can recover from alcoholism, and the treatment plan is not changing ones genes. It is changing ones thinking and values. I rather prefer giving alcoholics (addicts) the benefit of the doubt with regards to believing they do have a chance to recover. The "it is a disease" argument seems to slam the door shut on there being any way of changing................sort of makes you think they should be locked underground, like the Morlocks (unless you have a pill that can target the ETOH gene and change it without harming everything else).
IDK. Maybe I'm a victim of "the road to hell is paved with good intentions" or maybe I'm just plain old vanilla ignorant. Either way............the whole "alcoholism is a disease process" seems so final and segregating to me.

I can see your point of wanting it to be a choice, so that it would "go away"....but diabetes doesn't do that...and I don't think etoh abuse will either......they are both long term, chronic diseases. Amenable to long term management, but requiring much self discipline and acknowlegement of need of support.

eriksoln, BSN, RN · Jul 8, 2011

I can see your point of wanting it to be a choice, so that it would "go away"....but diabetes doesn't do that...and I don't think etoh abuse will either......they are both long term, chronic diseases. Amenable to long term management, but requiring much self discipline and acknowlegement of need of support.

Mmmmmm, I don't think with it being a choice it "goes away" at all. As I said, I think the choice to change, or "recover" is a very difficult one and its not an easily traveled path. There are such severe changes in morality and attitude that must happen, most people aren't really capable of doing it.

The diabetic must go through some of the same. They must watch their diet, avoid snacking.........these are things that are not easy for the "emotional eater". How many diabetics you know of that are compliant?

The diabetic must watch their diet and do meal time blood glucose monitoring/coverage. The alcoholic must change their thinking, their values and moral compass. Different tx plans, but both involve a matter of choice.

I mean, really. If the "gene theory" and "alcoholism is a disease" stuff is true, what is the next step then? Create new leprosy camps and throw them in? Isn't that what we do with Morlocks?

morte, LPN, LVN · Jul 8, 2011

Mmmmmm, I don't think with it being a choice it "goes away" at all. As I said, I think the choice to change, or "recover" is a very difficult one and its not an easily traveled path. There are such severe changes in morality and attitude that must happen, most people aren't really capable of doing it.
The diabetic must go through some of the same. They must watch their diet, avoid snacking.........these are things that are not easy for the "emotional eater". How many diabetics you know of that are compliant?
The diabetic must watch their diet and do meal time blood glucose monitoring/coverage. The alcoholic must change their thinking, their values and moral compass. Different tx plans, but both involve a matter of choice.
I mean, really. If the "gene theory" and "alcoholism is a disease" stuff is true, what is the next step then? Create new leprosy camps and throw them in? Isn't that what we do with Morlocks?

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.