There may always be a huge debate about alcoholism and whether or not it is a real disease.
This seems to be a very polarizing topic. People always seem to have a strong opinion about the issue, one way or the other.
They are either absolutely sure that alcoholism is a disease, or they are absolutely sure that it is NOT a disease. There is very little middle ground on the issue, apparently.
And of course I have my own opinions as well. But perhaps more important than our opinions on this topic is the question: “Regardless of how we label alcoholism, what can we do to help people?” That question cuts to the heart of the matter and gets down to what is really important.
And ultimately I believe it is an important topic because it might help you to deal with your addiction and eventually overcome it, depending on your understanding. So it is worth discussing in my opinion.
My story and why I thought addiction was an issue of low willpower
Let me tell you my story so that you know where I stand on the issue.
When I was growing up I was fairly sheltered. No one in my immediate family had addiction problems of any kind.
Eventually I saw some alcoholics in the media and I asked questions about them. “Why don’t they just stop drinking alcohol if it is screwing up their life?” I was told that they can’t stop.
At that moment I was young and I had never taken any drugs or alcohol and I formed an opinion. My opinion was that these “alcoholics” must be weak willed people who were simply lazy or irresponsible. Because I had control over my own body I believed that everyone else must have that same level of control. I did not believe the idea that someone could be powerless over a glass of liquid. It did not make any sense to me and I did not believe it. My opinion was basically “alcoholics are lazy, or stupid.”
Now you can guess what happens at this point in my story. Fast forward. I grow up a bit. And I take my first drink. Bam! I find myself hopelessly addicted to alcohol. At first I just loved the stuff and I did not consider myself to be addicted; I just loved the stuff and I drank it all the time.
Later on I realized what had happened. I had become an alcoholic, without even giving my permission. It had completely blindsided me. And I thought that I was so smart! It obviously didn’t matter. Addiction had chosen me, I had not chose it.
How wrong I had been when I was growing up. Here I blamed the alcoholics for being lazy and stupid for being addicted. Suddenly I became addicted myself through no fault of my own.
I was convinced that it was a real disease. Or maybe the “disease” label is wrong, but I certainly did not choose addiction. I looked down on the addict or the alcoholic and I thought they were lazy. That certainly wasn’t me. And yet I could not deny that this is what I turned into.
TL;DR = I thought addiction was a choice. Then I became addicted myself, through no fault of my own.
How is this possible if addiction is not a disease?
The problem with people who are not addicted to anything
Some of the most vocal people arguing that addiction is a choice are NOT addicted to anything.
This is a problem based on my story above. Obviously if you are not addicted then you can argue from the standpoint of telling other people that they must be weak or stupid. I made this mistake myself once and then later on I learned differently. Addiction chooses you, not the other way around.
People who are not addicted to drugs or alcohol have a very limited experience from which to speak on addiction. They can talk about what it is like to not be addicted, and that is pretty much it. Once they start pointing the finger at others and making judgments they are making a mistake in my opinion. They don’t have a foundation of knowledge when it comes to addiction. They don’t have real world experience.
The word “disease” is a label that may not be very helpful any more
In the end I think the whole disease debate might actually do more harm than good in some cases. The real question should be: “How can we help people to recover?”
For example, what happens when you try to tell alcoholics that they are simply making poor choices and that they don’t really have a disease? What happens when you tell alcoholics that they can learn to moderate their drinking and that they do, in fact, have power over alcohol? Does that produce a better outcome than if you tell them that they are forever powerless over their disease and that they have a lifelong disease? Which approach leads to better outcomes?
From what I have been told, the disease model works better than anything that ever came before it, but on the other hand our success rates are not all that great either. But in the past before AA existed they simply locked up alcoholics who could not control themselves rather than trying to rehabilitate them. Surely some form of rehabilitation is better than simply incarcerating people, no?
There are a few programs out there that attempt to teach moderation. There are a few programs out there that attempt to deny the disease theory and empower people with choices instead. Some of these programs are abstinence based (they recommend that you never drink again) while others are open to the idea of moderation. Of course if you teach an abstinence based model of recovery then in my opinion you are agreeing with the disease theory. Even if you do not call alcoholism a disease, teaching lifelong abstinence is basically treating it as such.
If you want to buck the disease trend then you would need to teach moderation and empowerment. While this sounds like a nice idea I have not seen any numbers that back it up as being superior to an abstinence based approach. First of all you have to ask yourself what value you are really getting by being able to drink alcohol in the future. For example, my life is amazing today even after 12 plus years of total abstinence from alcohol, and I don’t think anyone would argue that I am “missing out” due to my abstinence. Those who attempt to learn to moderate their drinking are hanging on tight to something that is probably not worth the risk. What benefit do you get from social drinking that you cannot get through other means? Do people who abstain at a party really miss out on all of the fun? I have learned that this is not true, the alcohol is not necessary to have a good time. As an alcoholic we will of course argue that it is essential though.
In the end you are arguing about labels and words. My bottom line is that if someone is losing control of their life due to alcohol then that person needs to abstain entirely from alcohol on a permanent basis. We can call that “a disease” and a “recovery program” if you like but ultimately it is still the best course of action for that person. Drinking creates chaos in their life so they should avoid it on a permanent basis. Does it really matter what the root causes of the obsessive drinking are? Does it really matter if there is a chemical imbalance in the brain that allows us to label this as a disease, or not a disease? What do the words really matter? It is outcomes we are interested in. If someone needs help to live a better life then we need a way to help them.
The current state of recovery in the world is that we label this pattern of destructive drinking as a “disease” and then we use a recovery program to try to fix it. In the end I don’t think the labels matter so much, what matters is that people are still going to get addicted to alcohol. They are still going to struggle. We can try to help them to overcome this struggle and the best way to do that is by teaching an abstinence based model of recovery. Don’t drink, period.
The real question is: What can we do to help the alcoholic or drug addict?
So what you have to do in your own situation is figure out how to get the results that you want in life.
Maybe you are an alcoholic or a drug addict that is struggling with addiction. What can you do in order to get the help that you need?
If you need to label it as a disease then go ahead and do that. If you are convinced that this label is somehow wrong then simply go do what you need to do in order to get help.
Recovery programs are based on abstinence because that is the foundation for recovery. Stop drinking, stop using drugs, and start living a “normal” life again. At least get the chemicals out of your system so that you can think clearly again.
Then you start to rebuild your life from there. In traditional recovery this starts with a spiritual transformation. But realize too that it is also a physical transformation in the form of physical detox. You stop putting alcohol and drugs into your body. You start to live healthier on a number of different levels.
In my experience this is the whole key to recovery. It is a movement towards greater health. This is also why I believe that the solution is “holistic.” Holistic just means that we are treating the “whole” person, not just their spirituality. So we need to look at emotional health, mental health, physical, and so on. It is all important.
When a person drinks too much alcohol for a long time everything starts to break down. They get physically sicker in different ways. They stop thinking as clearly. Emotionally they become a wreck because they have consequences in their life and they rely on the alcohol to medicate all of their emotions. Their relationships suffer. They find themselves hanging out with the wrong crowd and falling into toxic relationships. They are spiritually ill. They think only about themselves and getting drunk or high. They resent the world and they are not grateful for anything.
How do you fix this? And is it really a disease?
My answer so far is that it doesn’t matter if we label it as a disease–that is up to you to decide based on how it helps you to treat it. If you can motivate yourself without the “disease” label then by all means do so. Call your drinking a poor choice and simply change your choices. If that fails for you then you might try thinking of it as a disease.
So how do you fix it?
You take action and you establish a baseline. The foundation of recovery can be realized by going to detox. This is the physical part. You flush the drugs and the alcohol out of your system and get your body back to “normal.” I say that because even though you can get through acute detox in a very time period (5 days or so usually) it will take months or even years before your body, mind, and spirit have really fully detoxed from the addiction. It takes time.
After you have this baseline, this foundation of recovery, you have to build on it. If you just quit the alcohol and change nothing else then will you stay sober forever? This is actually a good test of how much sense your label makes. Call your drinking a choice, and all you have to do is quit drinking to recover. Simply choose not to drink. If that doesn’t work for you, then maybe there is something deeper going on there? In Narcotics Anonymous they acknowledge the fact that the drinking and the drug use is not the disease, but it is only a symptom of the disease. This makes a lot of sense, especially if you have ever watched a recovering alcoholic suddenly get addicted to gambling, or sex, or whatever. The addiction is not the intake itself, it is the need for that consumption. Something inside is driving the disease and the actual drug of choice (be it alcohol or something else) is merely an outward manifestation of that addiction. When viewed like this the disease model starts to make a lot more sense. But again, only use a label if it is helping you to reach your goals.
Physical disease with a moral solution?
One of the arguments against the disease model of alcoholism goes like this:
1) Alcoholism is a disease because the body is allergic to it. The allergy causes the body to react badly and to crave alcohol.
2) The solution for this is to work the 12 steps of AA, which include taking a moral inventory in order to help overcome this physical allergy and this disease.
When taken together these two ideas do not seem very compatible!
The first idea is that alcoholism is a physical disease of the body. That alcohol reacts differently in some people based on their physiology.
The second idea is that the solution for this physical allergy is a moral prescription. That we need to look our lives through a moral lens, figure out what is right and wrong, and then try to become better people.
They say that alcoholics are not bad people, but that they are sick people with a physical disease. But if this is the case then why is the solution moral?
I have heard many people in AA try to answer that and they seem to have no problem talking a lot about it and waving their hands around and so on. But none of those explanations have really given me a clear understanding of what is going on. The best that they can do is to separate it out: “Yes, alcoholism is a disease of the body. Yes, taking a moral inventory and trying to improve our moral lives helps us to overcome this physical addiction.” That is the best that they can connect these two dots.
And I still do not have my own answer for this, other than to point out that my own philosophy of addiction and alcoholism tries to steer around the issue somewhat by arguing that:
1) Addiction and alcoholism are holistic diseases, not spiritual diseases. Therefore they impact the whole person, including physically, emotionally, mentally, spiritually, and socially.
2) The best solution for addiction is holistic. That means a baseline of physical abstinence followed by personal growth in every area of a person’s life. Spirituality alone is not the solution, it is only part of the solution.
In fact, this philosophy of addiction and recovery sort of dodges the whole morality issue entirely. It is about health, not morality. But your health can be in terms of physical, emotional, social, and so on.
Whether you consider alcoholism to be a disease or not is somewhat beside the point. You have to ask yourself:
1) Have I been able to acknowledge that I have a serious problem that I need to address?
2) Have I been able to overcome my problem and build a new life for myself in recovery?
It is a little bit like the debate between “recovered” and “recovering.” Some people say that they are “recovered” in an AA meeting and other people jump all over them because they say that this language is dangerous and it can lead you to become cocky and relapse if you call yourself “permanently recovered.” In the end such people should probably relax a bit. Sure, the language we use to talk about recovery is important, because the language that we use can mold and shape our ideas and our thoughts. But you can also go a bit overboard in some cases and get too technical. Plus there are people out there in recovery who simply disagree with you. They call it “a choice” while you call it “a disease.” You have to be tolerant of other ideas because some day you might rely on those ideas yourself. It is possible to evolve and change our minds, after all.
I learned this the hard way when I realized that I had become alcoholic, even though I never asked for it or gave my permission. If life can deal you a card like that then you had better stay open to the possibilities so that you can find a solution that might help you.
Whether or not you call alcoholism a “disease” is beside the point. The point is that we realize it is a real destructive force and that we can take action and correct it. And that doing so is a difficult path to walk but the rewards are amazing. The journey is well worth it.
What do you think? Does it help for you to label alcoholism and addiction as a disease? Or do you find it helpful to call it a choice instead? Let us know in the discussion forums. It only takes a second to register!