Mason Delacroix
Alcoholism, or alcohol use disorder (AUD), is a common medical condition that is often considered a disease. The American Medical Association (AMA) defines alcoholism as a major medical problem and has played a key role in changing how the court system views and treats individuals who cannot control their alcohol consumption. The AMA considers alcohol a drug and defines alcoholism as a chronic, relapsing brain disease characterized by compulsive alcohol seeking and consumption despite negative consequences. This definition has influenced the legal system's understanding of alcoholism and its treatment of individuals struggling with alcohol dependence.
| Characteristics | Values |
|---|---|
| Alcoholism Definition | Alcoholism is a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. |
| Prevalence | Approximately 6 million Americans suffer from alcoholism, with an estimated 1.5 million arrests for drunkenness each year. |
| Health Effects | Alcoholism can reduce life expectancy by about 10 years and increase the risk of traffic accidents, violent and non-violent crimes, and various health issues. |
| Risk Factors | Genetic predisposition, mental health conditions, environmental influences, social and cultural factors, stress, and alcohol accessibility are all risk factors for developing alcoholism. |
| Treatment | Treatment options include medication and behavioral therapy, with most people able to reduce alcohol consumption or achieve abstinence. |
| Gender Differences | Alcoholism is more prevalent in men, but the proportion of female alcoholics has been increasing in recent decades. |
| Diagnosis | Alcoholism is classified as Alcohol Use Disorder in the DSM-5 or Alcohol Dependence in the ICD-11. |
| Court Recognition | The U.S. court system has recognized the AMA's definition of alcoholism as a disease, influencing how those with alcohol dependence are viewed and treated. |
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What You'll Learn
Alcoholism as a disease
Alcoholism, or alcohol use disorder, is a common disease that affects millions of Americans. It is characterised by a loss of control over alcohol consumption, leading to excessive drinking that interferes with bodily and mental health, interpersonal relationships, and social and economic functioning. The American Medical Association (AMA) defines alcoholism as a "major medical problem", urging hospitals to admit and care for alcoholic patients.
The AMA, along with other prominent organisations like the American Psychiatric Association, recognises alcoholism as a disease. This classification is supported by research highlighting the genetic and environmental factors contributing to alcoholism. Studies show that individuals with a family history of alcohol use disorder are at a higher risk of developing the condition themselves. Additionally, factors such as stress, anxiety, and the easy availability of alcohol can increase the risk of alcoholism.
The disease theory of alcoholism has evolved over time, with historical figures like Scottish physician Thomas Trotter and American physician Benjamin Rush recognising excessive drinking as a mental disease or medical defect. The AMA's influence on the court system has been significant, with the U.S. Supreme Court referencing its policies as early as 1926. In 1966, Justice Abe Fortas cited the AMA's stance on alcoholism in a dissenting opinion, acknowledging that alcoholism warrants medical treatment rather than criminal punishment.
While the medical community has not reached a unanimous consensus on the definition of alcoholism, the disease model is widely accepted. Alcoholism is now understood as a chronic relapsing brain disease, with biological, environmental, and developmental factors influencing its development. Treatment options include medication and behavioural therapy, with studies showing that most individuals can reduce their alcohol consumption or achieve abstinence with appropriate support.
The impact of alcoholism extends beyond the individual, as it is associated with an increased risk of violent and non-violent crime, traffic accidents, and social problems. Additionally, drinking during pregnancy can harm the child's health. Alcoholism also carries a significant impact on life expectancy, reducing it by approximately ten years on average. Recognising alcoholism as a disease enables a shift from criminalisation to treatment and support, helping individuals manage their condition and mitigate its negative consequences.
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Alcoholism as a mental illness
Alcoholism, or alcohol addiction, is a complex disease with psychological, biological, and social components. It is a chronic illness that involves cycles of relapse and remission, and it affects the brain's reward centre. The American Medical Association (AMA) defines alcoholics as "those excessive drinkers whose dependence on alcohol has attained such a degree that it shows a noticeable disturbance or interference with their bodily or mental health, their interpersonal relations, and their satisfactory social and economic functioning".
The AMA's disease theory of alcoholism is biological in nature, viewing alcoholism as a disease with a known pathology and an established biomolecular signal transduction pathway. The American Society of Addiction Medicine (ASAM) defines addiction as "a primary, chronic disease of brain reward, motivation, memory and related circuitry". The American Psychiatric Association (APA) recognises alcoholism as equivalent to alcohol dependence and identifies substance use disorder as a primary mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
The National Alliance on Mental Illness reports that among adults in the US who experienced a substance use disorder, about 50% had a co-occurring mental illness. Mental illnesses can contribute to substance use disorders, and vice versa. For example, individuals might drink to alleviate symptoms of mental health disorders, but excessive drinking can also stimulate symptoms of depression or anxiety. Co-occurring disorders can make treatment more complicated, but recovery is possible, especially when mental health and behavioural health conditions are treated simultaneously by professional, licensed providers.
Alcoholism was not always viewed as a disease requiring treatment. The debate over whether alcoholism is a disease or a choice remains ongoing. However, the AMA has been at the forefront of changing how the court system views and treats those who cannot control their alcohol consumption. The US Supreme Court has referred to the AMA's policies in establishing that alcoholism is a disease.
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Alcoholism as a physical illness
Alcoholism, or alcohol use disorder (AUD), is a physical illness characterised by a pattern of drinking that results in significant negative consequences and interference with daily functioning. It is defined by a loss of control over alcohol consumption, increased alcohol tolerance, and physical and psychological dependence on alcohol. The American Medical Association (AMA) has played a pivotal role in shaping the understanding of alcoholism as a disease, advocating for its recognition as a "major medical problem" since 1956.
The physical aspect of alcoholism is evident in the body's physiological response to alcohol and the withdrawal symptoms that occur upon cessation of drinking. Alcoholism can lead to a range of physical health problems, including liver cirrhosis, irregular heartbeat, impaired immune function, increased cancer risk, and severe cognitive issues such as dementia and brain damage. The brain adapts to the presence of alcohol, undergoing persistent changes, and when alcohol consumption suddenly stops, the body experiences significant withdrawal symptoms due to the abrupt absence of alcohol.
The risk factors for developing alcoholism include genetics, family history, mental health conditions, and environmental influences. Individuals with a family history of alcoholism are at an increased risk due to the genetic predisposition and potential exposure to alcohol at an early age. Mental health disorders, such as depression, anxiety, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD), are also associated with a higher risk of developing alcoholism, as individuals may turn to alcohol to cope with their symptoms. Additionally, environmental factors, such as social groups or family influences that normalise heavy drinking, can contribute to the development of alcoholism.
The diagnosis of alcoholism is based on established criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Healthcare providers conduct physical examinations and assess symptoms to determine the severity of the disorder, which can range from mild to severe. Treatment options include behavioural therapy, inpatient medical treatment, residential rehabilitation, psychotherapy, and participation in support groups such as Alcoholics Anonymous (AA).
It is important to recognise that alcoholism is a disease that requires treatment and support. The stigmatisation associated with terms like "alcoholism" and "alcoholic" can create barriers to individuals seeking help. Therefore, terms such as "alcohol use disorder" and "alcohol dependence" are often used in clinical settings to encourage individuals to seek the necessary treatment without fear of judgement.
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Alcoholism and genetics
Alcoholism, or alcohol dependence, is recognised as a disease by the American Medical Association (AMA). The association has played a key role in changing how the court system views and treats those who cannot control their alcohol consumption. The AMA defined alcoholics as:
> [...] those excessive drinkers whose dependence on alcohol has attained such a degree that it shows a noticeable disturbance or interference with their bodily or mental health, their interpersonal relations, and their satisfactory social and economic functioning.
Alcoholism has long been observed to run in families, but this alone does not prove that genetic factors are responsible. However, multiple lines of evidence, including adoption studies, twin studies, animal studies, and research into specific genes, all point to genetic contributions.
Adoption studies have shown that alcoholism in adoptees correlates more strongly with their biological parents than their adoptive parents. Twin studies in the US and Europe suggest that 45-65% of the liability is due to genetic factors. Animal studies also demonstrate genetic liability; for example, mice and rats have been selectively bred for traits associated with alcohol dependence, such as alcohol preference and sensitivity.
Research has identified numerous genes that are candidates for being inheritable addiction genes. The genes with the clearest contribution to the risk for alcoholism and alcohol consumption are alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2), which are central to the metabolism of alcohol. Other candidate genes include CHNR5, GCKR, and DRD2. These genes are involved in how the central nervous system responds to alcohol and how the body metabolises it.
While genetic differences do affect the risk of developing an alcohol use disorder (AUD), there is no single "alcohol gene". Both environmental and social factors also play a significant role. The risk of developing an AUD is influenced by the interaction of genetics and environment, with genetics accounting for approximately half of a person's overall risk. For example, living with parents who drink alcohol and encourage or pressure their children to drink increases the chances of those children developing alcohol-related issues.
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Alcoholism treatment
Alcoholism, or alcohol dependence, has long been considered a disease by the American Medical Association (AMA). The AMA defines alcoholics as:
> [...] excessive drinkers whose dependence on alcohol has attained such a degree that it shows a noticeable disturbance or interference with their bodily or mental health, their interpersonal relations, and their satisfactory social and economic functioning.
The AMA's work has been at the forefront of changing how the court system views and treats those who cannot control their alcohol consumption. The AMA has been instrumental in shaping policies and briefs that helped establish alcoholism as a disease, rather than a choice or character flaw, and advocated for the hospitalization and treatment of patients with alcoholism.
For those seeking treatment, a good first step is to talk to a primary care provider, who can provide referrals to treatment facilities, support groups, and community-based organizations. SAMHSA's National Helpline is a free, confidential referral and information service for individuals and families facing substance use disorders, providing referrals to local treatment options via phone or text message.
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Frequently asked questions
The American Medical Association (AMA) defines alcoholism as a "major medical problem" and a disease. The AMA considers alcohol a drug and states that "drug addiction is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite often devastating consequences."
The AMA designated alcoholism as a "major medical problem" in 1956 and urged hospitals to admit alcoholics for care. The high court's first reference to this policy came in a 1966 case, Budd v. California, which posed the question of whether it is constitutional for California to punish someone who suffers from alcoholism.
Alcoholism is now classified as Alcohol Use Disorder in the DSM-5 or alcohol dependence in the ICD-11. The World Health Organization (WHO) discourages the use of the term "alcoholism" due to its inexact meaning.
People with Alcohol Use Disorder (AUD) experience impaired control over drinking, preoccupation with alcohol, drinking despite adverse consequences, and distortions in thinking, most notably denial. They may also experience physical issues like craving alcohol or having alcohol withdrawal symptoms. AUD can be mild, moderate, or severe and is often progressive and fatal if untreated.
Treatments for AUD include medication and behavioral therapy. Studies show that most people are able to reduce their alcohol consumption or stop drinking entirely with treatment.
