Alcohol Addiction: Disease? Choice? Other?


Is Alcohol Addiction A Disease?

If you have a drink problem and you sign up to the idea that alcoholism is a disease, then you are a member for life! Even when you stop drinking you are still in the club and you cannot leave. It’s a sort of shitty Hotel California. The disease model enriches a booming rehab industry, keeps millions of people enslaved to alcohol and distracts us all from blaming the most obvious source of alcohol addiction – alcohol!

In 1956 the American Medical Association (AMA) categorised alcoholism as a disease and from that point forward most treatment centres around the world have operated from this model. Treatment centres that charge somewhere between £4,000 and £40,000 a month for their services, many of whom have very high relapse rates. Not their fault – it’s the disease!

The American website states,

“Though there may be no easy ‘cure’ for alcoholism, or alcohol use disorder, the condition is treatable. Ongoing treatment and continued recovery efforts can be helpful in successfully managing alcoholism and preventing relapse in the long term.”

The key word there is ‘managing’. They cannot offer freedom from alcoholism because it’s a lifelong condition according to the disease model. You must live with the label ‘alcoholic’. Once an addict, always an addict. You are different from the lucky people who can happily drink alcohol, with no risk of addiction. They are free and you are shackled to disease!

What Does Alcoholics Anonymous Say?

Bill Wilson set up Alcoholics Anonymous in 1935 with a distinctly religious fervour.  The organisation was then very much as it is now: a Christian fellowship with no professional leadership. It encourages daily member-led meetings all over the world whose purpose is to help people quit alcohol for good. At the heart of AA is the belief that alcohol is a disease.

Here are the 12 steps of AA.

  1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
  2. Came to believe that a power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

A Medical Model With A Spiritual Charter

The 12 steps are focused on confession, morality and awakening – they are spiritual and personal. There’s no mention of physiology or psychology in the 12 steps because they are not a treatment plan. So, it’s really surprising to know that most treatment centres across the world base their rehabilitation on the 12 steps. Clinics which offer interventions such as medical detoxes and drug therapy in distinctly medical settings, place AA’s spiritual charter at their core.

Priory, the UK’s best-known rehab centre, explains it’s addiction treatment thus,

“Addiction treatment at Priory is based on the world-renowned 12-Step approach, which is an abstinence-based addiction treatment model that was first pioneered by the organisation Alcoholics Anonymous (AA).”

That’s the same AA that call alcohol addiction an ‘allergy’ and depression a ‘spiritual malady.’

I have to say that the wonderful people I met at AA were universally kind and generous and I really believe that we all need to find the best path for us. Remove the disease theory from AA, turn down the God focus and I still think it’s very special in many ways.

The Alcohol Industry Loves The Disease Model

In 2020 the rehab industry in the US is worth $42 billion and that figure is rising at a rate of about 5% annually. That includes alcohol, drugs and other addictions such as sex and gambling. In the eyes of most treatment centres, addiction is a disease. The rehab industry loves the disease model because they can stand behind its incurable nature. The only other industry who loves the disease model more than the rehab industry is the alcohol industry!

The alcohol industry was worth $1.47 trillion in 2018, rising to around $1.74 trillion in 2024. Failing legislation on sales, marketing, advertising and labelling means it is going from strength to strength with the disease model bogie man sweeping up the bad press. It’s a lucrative status quo.

But if alcohol addiction is not a disease then it must be, what? A choice? This uncharitable opinion of addicts is another reason that people cling so tightly to the disease model. Which would you rather? Have the power of choice but by god do you make shitty choices. Or be a victim to a disease that you’ll forever be fighting? In my opinion, it’s neither.

Alcohol And The Brain

The brain logs the stuff that feels good: chocolate, sex, drugs, alcohol, dancing, laughing. It stores memories of good feelings and when the opportunity arises for those good feelings to be experienced again, it sends you a little nudge of desire so you don’t miss out. Like a little excited puppy that wants a treat. It’s very persuasive.

In his excellent book, The Biology of Desire, Marc Lewis explains how we are wrong to identify so closely with our urges and desires.

“Brains just do what hundreds of millions of years of evolution have determined to be useful, and that includes identifying things that taste good or feel good to us.”

But what stops us from becoming sex mad, chocaholic drunks? If the brain is so focused on feeling great, how do we control ourselves at all? The conscious mind: the part of the brain that controls our behaviour, considers consequences and weighs up all the rational information it has stored from previous experiences in this situation. It reasons that if we give in to every urge we’ll be in a world of trouble.

For the most part, our conscious minds stop us from imploding in a state of animalistic self-obsession.  But anyone who has ever experienced addiction will know that the brain’s desire for reward is strong and can override all reason. If you really, really want a drink, you’ll have it, even though you know you may be risking your relationship, your children or your home. What started as a gentle lick is now a barking, shitting Great Dane of desire that will have what it wants, or else. The chronic addict will go with immediate good feeling and ignore all consequences.

So How Come Some People Can Take It Or Leave It?

How come one person can take or leave alcohol while others are fixated on it and get to a point where it’s abstinence or death? The more you give in to the brain’s desire for instant gratification, the more easily you access that route to satisfaction next time. Eventually your sensible self stops saying no. When I discuss addiction with people who have been through severe alcohol and drug addiction the word ‘inevitable’ comes up a lot. One guy told me,

“I’d tell myself that I’m not drinking today but as the day went on I knew that it was inevitable and some days I would just head out to get beer first thing in the morning, just so I could stop having that conversation with myself over and over again.”

This is how addiction works. Your desire grinds you down. Sensible you, the conscious part that identifies as a decent person with self-esteem and self-respect, gives in to the animal part that wants to feel good.

All sorts of factors will influence how strong your sensible self is…. Whether, in childhood, you had a good family example which you can now follow as an adult. How your parents treated alcohol. What stressors are at play in your work or relationship. If you struggle with anxiety or depression. All these things have a hand in your ability to override the animal demand for pleasure and relief. So, it’s no wonder that around 107 million people globally are addicted to alcohol – and that’s just the reported cases.

Will You Quit Alcohol?

First off, if you are a dependent drinker then you should not stop drinking alcohol without getting medical advice.

Second off, get on with it! I spoke to a lady today who said she thinks about giving up alcohol everyday but just doesn’t want to deal with the monotony of life. LOL! What’s more monotonous than wondering if you should quit alcohol, EVERY DAY? Just do it already.

I am making light of a major decision, I know but really, I wish I had quit alcohol years before I did. For me, it’s been an upward spiral of self discovery and happiness. Why wouldn’t you do it as soon as possible?

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