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Beyond the disease model

What are the benefits of treating alcoholism as a disease?

A broad survey in the U.S. showed that 90 per cent of those polled believed alcoholism was a disease. However, a survey of medical doctors indicated that 80 per cent of them thought of alcoholism as simply bad behaviour.

The American Medical Association regards it as a disease, but the American Psychiatric Association classifies alcoholism as a mental disorder (DSM-IV).

AA and the 12-step movement are the biggest promoters of the disease model, but the cofounders of AA disagreed: “We have never called alcoholism a disease because, technically speaking, it’s not a disease entity” (Bill Wilson).

We “have to use disease.[It is the] only way to get across hopelessness” (Dr. Bob Smith).

Alcohol affects the brain. Research shows that the pleasure centers in the brain become desensitized to alcohol with excessive drinking, thereby requiring more and more alcohol to get the original pleasurable effects. However, it works exactly the same way with sugary drinks (pop).

Ongoing excessive drinking interferes with storing events in memory (the alcoholic blackout), but without alcohol, the ability to store events in memory recovers.

Nicotine is far more addictive than alcohol. One inhalation of cigarette smoke affects the brain within seven seconds, yet we don’t call smoking a disease.

What are the benefits of treating alcohol as a disease?

Aside from serving the huge vested interests of the multi-billion dollar treatment industry, some former excessive drinkers depend on the notion of a chronic, progressive, incurable disease to remind them of the choices they must make every day. It helps them stay sober and this is good.

What are the disadvantages of treating alcoholism as a disease?

Huge numbers of people who drink excessively use their “disease” as an excuse to keep on abusing alcohol. Some of them really believe they have no choice and therefore are not responsible.

Furthermore, if alcoholics are treated as having a disease, it carries the stigma of an abnormality. It becomes part of their identities, further limiting choice.

The paradox is that every recovery program out there involves making choices, yet accepting alcoholism as a disease may strip away responsibility for those choices.

What if there were a way of maintaining the benefits of the disease concept while avoiding the traps inherent in treating alcoholism as a disease?

I believe there is. I start with the view that each of us is ultimately responsible for the choices we make in life.

If treating their alcoholism or any other addiction as a disease has helped you make better decisions about your life, including your choices around drinking, then don’t change anything as long as it serves you.

On the other hand, if other people have said you have a drinking problem, or if you find yourself making some poor choices around drinking, I would encourage you to reflect on what is going on. Might your life be more manageable and fulfilling (work, marriage, physical health, emotional health) if you drank less or not at all?

If your answer is yes or maybe, then choose to do something about it. If you need help choose wisely. Accept help, but choose never to relinquish your responsibility for your own life.




You can reach Registered Psychologist Dr. Neill Neill at 250-752-8684 or through his website



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