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The Debate Continues - Is Alcoholism a Choice or a Disease?

The most hotly debated topic in the recovery community at the moment is whether addiction is a disease or a choice. The consensus right now (especially in the US) is that it is a disease, and there is even some evidence to support this idea. There are also critics of the disease model who suggest that this is a disempowering way of looking at things and it is actually making the problem worse. There are a growing number of vocal experts insisting that alcoholism is a choice and that it is up to the individual to decide when to stop.

Alcoholism Not a Moral Failing

Up until the nineteenth century, the popular view of alcoholism was that it was just a moral failing. People were seen as choosing to get drunk all the time because they were bad or just lazy. The type of treatment options available at the time involved keep alcoholics away from the rest of society and teaching them how to be good (these facilities were usually called 'inebriate homes').

Around the 1930s, there was a move away from seeing alcoholism as just a moral failing (although some people still look at the problem this way). Many started to recognise that individuals were often drinking despite the fact that they desperately wanted to stop. This idea of alcohol being a disease was further supported due to the work of neurological scientists who discovered that addiction actually caused physical changes in the brain.

The recovery fellowship Alcoholics Anonymous originated from the time when alcoholism was starting to be recognised as a disease, and this organisation has played a significant role in spreading this view of addiction. In the case of this recovery group, alcoholism is seen as a physical, mental, and spiritual disease.

Arguments against the Disease Model of Addiction

Alcoholism does not really fit the normal idea of what many think of as disease. For example, a minority of alcoholics just make the decision to stop and may do this without the need of much support. In the past, there was a tendency to just dismiss such individuals as not 'real alcoholics', but this can lead to a dangerous type of circular logic that makes the disease theory unfalsifiable (i.e. unscientific). It is also the case that many of these individuals met the criteria for alcoholism, but may have struggled for years before finally being able to stop. It is hard to think of many other diseases where the person can just decide they do not have it anymore and get better.

The other argument against the disease model of alcoholism is it could be viewed as extremely disempowering; in fact, the first step in the 12-step programme is for the person to admit that he or she is powerless. Telling somebody that one has a disease can make him or her feel helpless and it can also be used as an excuse for further substance abuse; "of course I'm drinking, I've got a disease."

The Future of the Disease Model of Addiction

The disease model of addiction is an attempt to explain what happens when falling into addiction. It is only a model, and it may become less popular in the future. The reality is that thinking this way has helped many break free of addiction and it still has a great deal of support. The fact that the healthcare reforms in the US have made addiction one of the compulsory medical conditions that need to be covered by insurance means that the disease model is probably going to get even further support.

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