Whether or not alcoholism is curable is a frequent argument on social media these days. Some argue it’s a “choice” and others argue it’s a disease. While there is a difference between a social or recreational drinker and someone with a severe alcohol use disorder, one certainly has a harder time stopping without help, and drinks without choice.
Alcohol use exists on a spectrum and it starts with experimentation, often beginning in adolescence. There is research that indicates experimentation with alcohol prior to the age of 15 greatly increases the risk of a more serious problem in adulthood (Grant and Dawson, 1997; Hingson et. al, 2006; Poudel and Guatam, 2017). Experimentation can expire on its own, or transition into recreational use.
In recreational drinkers, alcohol consumption is more frequent and in higher amounts, typically because tolerance increases. Tolerance is evidence that higher amounts of alcohol are required to achieve the same effect. During this phase, the brain adjusts to higher levels of dopamine, released as the person drinks. The increased exposure to dopamine over time, coupled with increasing tolerance, can lead to cravings, withdrawal symptoms, and worsening consequences for the individual. This transition marks the beginning of physical dependence, when use becomes involuntary as the individual drinks to ward off withdrawal symptoms, or drinks to “feel normal.” This process physically changes the brain’s natural response to dopamine and is visible on brain scans.
The word “disease” conjures up images of cancer, diabetes, or asthma. To be defined as a disease, a condition must deviate from the normal function of an organism and be associated with clear symptoms. In 1784, physician and signer of the Declaration of Independence, Benjamin Rush, described alcoholism as an “overwhelming and irresistible desire to consume alcohol.” In today’s terms, this would be a “compulsion.” Research involving functional magnetic resonance imaging (FMRI) in the late 20th century made observations of the brain regions most affected by chronic alcohol use, providing the basis for a neurobiological theory or “disease model” of alcoholism, more commonly called “alcohol use disorder.” In other words, substance use disorders are diseases just like cancer, diabetes, or asthma and are diagnosable just like other disorders.
Consider diabetes, a chronic and complex disease with distinct types. It is given the descriptor “chronic” because it can last a lifetime, and can be managed often with diet, proper medication, and physical activity. Diabetes can also cause secondary medical conditions like kidney disease or blindness. It is also considered “progressive” in that it can get worse, even with proper care. Diabetes is also incurable, but it may go into remission, whether partially (symptoms are better, but not gone totally) or fully (no symptoms). Diabetes can be managed and monitored and one may have no symptoms once in remission. This does not mean it is gone, and can return with a fury.
The same is true for alcohol use disorder. Alcoholism is a chronic, progressive, incurable, and often fatal disease. It lasts a lifetime, can get worse if not treated or a relapse occurs, cannot be cured (but can go into remission, or ”recovery”) and can be fatal through overdose or secondary disease of another bodily organ (i.e. liver disease, throat or esophageal cancer).
In general, reading about diseases can cause panic and paranoia, especially if you self-diagnose using WebMD or other online resources. The good news about the disease of addiction is that it has a name, and it is treatable. Millions of Americans live in recovery (approximately 23 million). Individuals can go years without drinking, living meaningful and productive lives, often helping others along the way.
Evidence-based approaches have decades of solid research behind them and are considered the most effective treatments for alcoholism. For alcohol use disorder, there are several evidence-based medical treatments that are effective and include pharmacotherapy, group and individual interventions, such as:
These are just three examples of treatments with research efficacy. Many more anecdotal or in their infancy, but work for some. More research is needed, but we’re far from where we used to be when alcohol and other drug use was considered a moral failing.
The reality today is that alcohol use disorder is as much a disease as cancer, diabetes, and others. Individuals with alcohol use disorder deserve our compassion, patience, and treatment. Call ICFR today to benefit from the therapies listed above, a community of support, and staff that treat everyone like family.