Is Alcoholism A Disease?

For generations, alcoholism was considered to be a weakness of character and a moral failing by the 12-step group, Alcoholics Anonymous (AA). Contemporary science and research have changed that thinking, and we now understand that alcoholism or alcohol addiction is a complex disease or condition of both body and mind. It is similar to other chronic conditions like diabetes, heart disease, and asthma.

This means that it is preventable, and for people who experience alcohol use disorder, it is treatable.

Why Is Alcoholism Considered a Disease?

Alcoholism is considered a disease because of a great body of research showing that unhealthy consumption of alcohol causes severe changes in the body and brain.[1]

The National Institute on Alcohol Abuse and Alcoholism says alcohol can impact parts of the brain that control balance, memory, speech, and judgment. Long-term drinking can alter the brain cell’s ability to communicate. Those changes can make it difficult for people to control their behavior and their ability to quit drinking.[26]

Researchers say that alcohol causes brain cells to release dopamine, and the more you drink, the more is released. Dopamine is critical in the brain’s ability to connect cues (like people and places) with the rewarding effects of alcohol. Over time, people experience intense cravings for alcohol when they’re exposed to routine cues.[28]

These changes affect many biological mechanisms, including those related to how the brain communicates with the body and with itself, and how the brain interprets risks and rewards. These changes are behind the medical understanding that alcoholism is a treatable, but not curable, disease.

Alcoholism needs long-term (and potentially lifelong) management and treatment, much like other chronic diseases such as hypertension and diabetes. Without appropriate treatment, the symptoms and effects of alcoholism will get worse, which is again similar to other recognized diseases.

Alcohol use disorder also shares other traits with chronic disorders, like these:

• Heritability and genetic influences
• Affected by the environment and behaviors
• The ability to respond to appropriate care

Like other diseases, alcoholism has damaging physical and mental health consequences, including neurological damage, psychiatric disorders, liver disease, and cardiovascular complications.

Is Alcoholism a Disease? A Historical Perspective

People have been drinking alcohol for hundreds of years, but we haven’t defined excessive drinking issues with terms like disease until relatively recently.

In 2020, researchers published a history of alcoholism in the 20^th century. The following time frames were specifically mentioned within the article:[25]

• 1784: Experts begin to describe people who have an overwhelming, irresistible desire to consume alcohol.
• 1813: Doctors describe people who experience medical problems when they quit drinking abruptly.
• 1919-1933: Prohibition reduces legal alcohol intake, but illegal alcohol consumption slowly increases
• Late 1930s: Alcoholics Anonymous is founded, and organizers discuss how drinking can be hard for some people to control
• 1942: Experts agree with Alcoholics Anonymous that alcoholism is a disease and not a moral failing
• 1954: The World Health Organization states that alcoholism is a progressive disease and not a moral failing
• 1960s: Insurance companies begin to pay for treatments for alcoholism
• 1987: The American Psychiatric Association considers alcoholism a mental disorder

As this time frame makes clear, people once considered alcoholism a moral failing. People who drank too much had a lack of willpower and just needed to be stronger to quit. Over time, experts dug into the biology of alcohol, including how withdrawal can make people keep drinking, and they determined that some people have a disease process that’s triggered by alcohol use.

In 2021, the American Society of Addiction Medicine defined addiction in this way: “Addiction is a primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social, and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”[27]

This definition clearly places alcoholism within the disease spectrum, and this is the understanding most experts use today.

Damage to the Body

Alcoholism is a medical condition because it can harm your body in many ways. Alcohol addiction can lead to the following:[1,2]

• Heart disease
• Stroke
• Hypertension
• Liver disease
• Cirrhosis
• Cancer of the colon, rectum, liver, voice box, esophagus, throat, mouth, and breasts
• Weakened immune system

Damage to the Brain

Alcoholism is also considered a brain disorder or psychiatric condition because of the ways in which it harms your brain and mental health. Alcohol use disorder can cause the following:[1,2]

• Poor academic performance
• Dementia
• Impaired learning
• Severe memory loss
• Anxiety
• Depression
• Dependence on alcohol, which results in brain changes and withdrawal symptoms
• Brain damage
• Increased risk of suicide

Risk Factors for Alcoholism: What Causes AUD?

There are environmental and genetic factors that contribute to the likelihood of the development of alcoholism.[2]

Some people may have a genetic predisposition to alcoholism. Others may experience exposure to alcohol at a young age or be surrounded by threatening conditions that lead to alcohol use as a coping mechanism. These factors have led to the modern understanding of alcoholism as a complex condition that requires medical intervention.[2,3]

Generally, alcoholism develops due to many interacting influences, such as these:[2,3]

• Drinking at a young age
• Family history of alcohol use disorder
• Co-occurring mental health conditions
• A history of trauma
• Peer pressure
• Ease of alcohol availability
• Impulsiveness
• Low self-esteem
• Need for approval from peers

Recognized medical guidelines, like the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies alcoholism as a disease. The criteria of the identification are based on the severity of symptoms from the consumption and effects of alcohol as well as withdrawal from alcohol once dependence has formed.[4]

How & When Does Drinking Turn Into a Disease?

While many people can enjoy alcohol consumption without it becoming a problem, drinking turns into a disease when the consumption and effects of drinking meet the DSM-5’s diagnostic criteria for alcohol use disorder. The criteria include the following:[5]

• A strong, persistent desire for more alcohol
• A physical tolerance for alcohol (needing more alcohol to achieve the desired effect) and experiencing withdrawal symptoms when alcohol use is reduced or discontinued
• An inability to cut oneself off (drinking more and for longer than intended) and changing patterns, behavior, and lifestyle to accommodate drinking
• Continuing to drink despite physical or mental health problems caused by drinking, such as loss of employment, relationship issues, and legal problems directly related to drinking
• Reducing or giving up participation in recreational or social activities because of persistent intoxication or a desire for more alcohol
• Continuing to drink despite being aware that alcohol use is causing physical and psychological problems

A clinician will consider a person to be an alcoholic (that is, to meet the criteria for alcohol use disorder) if a patient meets at least two of these criteria within a 12-month period. If six or more criteria are met, the diagnosis would be “severe” alcohol use disorder.[6]

How to Recognize the Signs of Alcoholism

Some of the typical signs of alcoholism include the following:[7]

• Regularly drinking more than intended
• Having to drink more and more to achieve the desired effect
• Experiencing withdrawal symptoms when you stop drinking
• Constantly looking forward to drinking again
• Continuing to drink, even as problems related to drinking arise and accumulate
• Lying to others about drinking and hiding evidence of drinking 
• Losing interest in hobbies
• Struggling at work or school
• Other unexpected and unhealthy changes in behavior

If someone you know is displaying any combination of these symptoms, they may be struggling with alcoholism. 

Alcoholism is a serious medical condition, but it is treatable. With early intervention, professional help, and lifelong support, people experiencing alcoholism can learn to manage the condition and live happy and healthy lives. 

What Can You Do if Someone You Know Is Showing These Signs of Alcoholism? 

To get through to someone you know that their drinking has become problematic, it is important to encourage supportive and honest communication. 

If they feel like they are being judged or condemned, they may retreat further into their drinking habits. Instead, create a safe and non-judgmental space where they can talk about their drinking and what might be compelling them to drink excessively. Without criticism or admonishment, express your concern for them and make it clear that you want to help them. 

It is also important that you learn about how alcoholism works, what it is and what it is not, and how best to help someone in your life who may be an alcoholic. Alcoholism is a difficult disease to treat, and you should prepare yourself for the ways it will try to escape treatment. 

Professional Treatment

Encourage your loved one to get professional help. While it is good for you to reach out to them, they need a trained healthcare provider or addiction specialist with whom they can do the hard and long-term work of treatment and recovery. [9]

Look at treatment options. Depending on the severity of the problem, certain options may be more appropriate, such as:

• Inpatient rehab
• Partial hospitalization
• Intensive outpatient
• Outpatient rehab
• Counseling
• Support groups
• Group and family therapy
• Medication-assisted treatment (MAT)

Even once formalized alcohol addiction treatment begins, it is very important to continue to offer emotional support for the duration of treatment and beyond. People in recovery go through many complicated feelings, and they need to know that their loved ones want them to succeed. Some ways to do that might be to drive your loved one to therapy or support group meetings, celebrate recovery milestones with them, change your own habits (for example, not drinking around them), and accompany them to meetings and other sober events. 

Boundaries & Self-Care

A big part of emotionally supporting a loved one in alcoholism recovery is establishing boundaries. You have to be careful to avoid any enabling behaviors that might precipitate a relapse and to give your loved one space, so they can take ownership of their growth and recovery.

You also need to look after yourself. Helping someone with alcoholism can be emotionally draining. The best way to help a loved one is to be in your own place of good health and stability. Prioritize your own self-care. For many people, it’s helpful to begin personal therapy to work through individual issues related to your loved one’s addiction.