Is Alcoholism A Disease?

Much of the scientific thinking these days leans toward alcoholism being a brain disease. In the chronic disease model of alcoholism or addiction, the belief is that continued alcohol abuse changes the brain’s functioning as well as its structure. It can never truly be cured, only kept at bay.

Substance Use Changes the Brain

Substance use disorders (alcoholism qualifies as one) occur after repeated consumption alters the brain, affecting it in three ways:

• It fosters a craving
• It leads to loss of control over use
• It contributes to an urge to use that continues despite adverse effects

Any potentially addictive substance — heroin, cocaine, alcohol, and so on — causes the neurotransmitter dopamine to surge. Feelings of pleasure follow, and the reward circuitry of the brain lights up. The gray matter quickly adapts, however, and soon more of the substance is needed to achieve those first-time feelings.

The result is the brain’s functioning changes. The user no longer feels pleasure, learns information, copes with stress, makes decisions, or practices self-control the way he or she once did.

They not only like the effect of the substance, but also want it. The result is a powerful desire to seek out alcohol (or whatever drug it may be) and replicate the feelings. In time a user may consume more and more, or supplement and/or replace the substance with other substances, because a tolerance has developed.

This also tends to make stopping all the harder, due to the pangs of withdrawal.

There are dissenters, however, on the disease theory. Some naysayers insist it’s not a brain disease but a bad habit, or “deep learning” that can be reversed by adopting better activities to replace bad practices.

Some people believe that these habits are a reaction to feelings of loneliness or depression, a way to self-medicate and (temporarily) soar above those psychological lows.

In the 1930s, scientists studying the roots of addiction thought that it was due to lack of willpower. The “cure” either was punishing the individual (in particular when a law was broken) or pushing them to step up to the plate and break the habit already.

That’s some of the reasoning why some people say addiction is not a disease.

That a dependency is purely biological troubles some researchers, which is understandable. After all, there are far more people who drink or use other drugs and never become addicted. Some must relearn the way to feel pleasure.

Some studies have found that one in eight, or 12.7% of the U.S. adult population has an alcohol use disorder.

The Centers for Disease Control and Prevention says that six out of every 10 U.S. adults have a chronic disease. Four in 10 have two or more chronic conditions.

But evidence is out there that alcohol (and many other drugs) rewires the brain. Normally, exercise or hanging out with friends generates pleasure (and dopamine), but the addicted brain roadblocks such normal processes of cause and effect.

Studies have analyzed brains of the addicted and the nonaddicted. Changes have been noted in the synapses and circuits where repeat drug use is a factor.

Not only that, these findings have led to the development of effective medications such as naloxone and acamprosate for treating alcoholism along with buprenorphine and naloxone for opioid dependencies.

Managing Alcoholism Symptoms

Alcoholism, or alcohol use disorder, is the result of drinking enough — and often enough — that one’s body grows dependent on alcohol.

Symptoms of alcoholism include:

• Drinking at unusual times, such as early in the morning or on the job
• Drinking alone
• Avoiding longtime friends and making new friendships with fellow drinkers
• Withdrawing from loved ones
• Hiding alcohol or hiding drinking
• Needing alcohol to get through the day
• Getting into trouble with the law or losing work due to drinking
• Experiencing withdrawal when not drinking
• Trying to quit or wanting to quit but not being able to
• Neglecting hygiene
• Eating poorly or rarely eating

If a person experiences tremors or vomiting or nausea after not drinking for a few hours, or experiences blackouts, those are more warning signs that there is a problem.

In time alcoholism can cause many health problems, including ulcers, sexual problems, vision problems, increased likelihood of many cancers, liver disease, and heart problems.

Alcohol addiction’s causes are not exactly clear. There is the point where alcohol is consumed often enough that the brain’s chemistry changes, but genetics, environment, and any underlying mental conditions such as depression can contribute to — but not guarantee — addiction.

Are People with Addiction Responsible for Their Actions?

Whether the addicted person is responsible for their actions is hard to answer. Some people will blame them for that first drink, insisting they had the choice to say no.

Perceived responsibility in part may hinge on whether someone believes alcoholism is a disease or moral failing. Ultimately, it may not matter.

Alcoholism and addiction affect more than the person with an alcohol use disorder (AUD). Family and friends suffer. Lives are altered and put at risk.

No matter if it’s seen as disease or weakness, what’s more important is to find help. Rehabilitation can help people work through emotional problems and ensure safe withdrawal.

Outpatient care lets a person stay at home while focusing on getting better. Twelve-step programs such as Alcoholics Anonymous or non 12-step programs such as SMART Recovery help a person work through living sober while offering relatable experiences and support. Drug therapies and counseling can help with physical cravings and instill better coping mechanisms.

Like any other chronic health condition (defined as lasting a year or longer, requiring continued medical care and/or limiting day-to-day life), alcoholism as a disease affects a person just as much as many ongoing illnesses such as diabetes or depression, or liver or heart problems.

It can also cause those kinds of ongoing health issues.

Sources

• surgeongeneral.gov – The Neurobiology of Substance Use, Misuse, and Addiction
• unsw.edu.au – Why Addiction Isn’t a Disease but Instead the Result of ‘Deep Learning’
• health.harvard.edu – How Addiction Hijacks the Brain
• washingtonpost.com – One in Eight American Adults is an Alcoholic, Study Says
• cdc.gov – About Chronic Diseases
• nbi.nlm.nih.gov – Brain Disease Model of Addiction: Why Is It So Controversial?
• healthline.com – Alcohol Addiction
• healthline.com – Alcoholism
• cdc.gov – About Chronic Diseases
• cdc.gov – Excessive Alcohol Use