Read This if You Think Alcoholism is a Choice.

Hey, friends!  Happy Easter! I hope you all are spending time with your families and enjoying beautiful weather, wherever you are!  For those of you who read my post about me dreading going to my first family function since I started telling people that I am living a sober lifestyle, it went SO much better than expected.  My cousins even asked me to go see Beauty and The Beast four wheelerwith them on Thursday.  They haven’t asked me to do something with them in years.  Being around the alcohol was slightly annoying, but I let out the stress on the four-wheeler!  And yes, I stayed sober and did not pick up a single drink!

So, I guess its time to put my two degrees to work.  Some people think that alcoholism is not a disease, but I beg to differ.  Everyone is entitled to their own opinion, but I ask that if you choose to comment, that you keep it respectful! 🙂

When I was in school to get my Master’s degree in social work, I had to take a semester-long class about learning the different types of mental illnesses.  At the Master’s degree level, I am licensed to diagnose people with a mental illness (For example: depression, alcoholism, post traumatic stress disorder). The book that I was given is the universal textbook that all mental health providers use: The Diagnostic and Statistical Manual of Mental Disorders- Fifth Edition.  Popularly known as the DSM-5.

In the DSM-5, there are 7 whole pages dedicated to Substance-Related and Addictive Disorders. Specifically, the manual elaborates on Alcohol Use Disorder, Alcohol IntDSM-5oxication, Alcohol Withdrawal, Other Alcohol-Induced Disorders, and Unspecified Alcohol-Related Disorder. According to the text, In the United States, the 12-month prevalence of Alcohol Use disorder is estimated to be 4.6% among 12-to 17-year-olds and 8.5% among adults ages 18 years and older in the United States.  Rates of the disorder are greater among men (16.2%) than among adult women (4.9%). I’m going to focus on Alcohol Use Disorder- how it’s diagnosed, what the symptoms are, and how the severity of the disorder is determined.

In order to meet the criteria for Alcohol Use Disorder, you must meet two of the following:

1.) Alcohol is taken in larger amounts over a longer period that was intended
2.) There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3.) A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4.) Craving, or a strong desire or urge to use alcohol.
5.) Recurrent alcohol use resulting a failure to fulfill major role obligations at work, school, or home.
6.) Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7.) Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8.) Recurrent alcohol use in situations in which it is physically hazardous.
9.) Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10.) Tolerance, as defined by either of the following:
  • A need or markedly increased amounts of alcohol to achieve intoxication or desired effect
  • A markedly diminished effect with continued use to the same amount of alcohol.
11.) Withdrawl, as manifested by either of the following.
  • The characteristic withdrawal syndrome for alcohol.
  • Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

If an individual meets the criteria for Alcohol Use Disorder, it can be specified as:

Mild: Presence of 2-3 symptoms.
Moderate: Presence of 4-5 symptoms.
Severe- Presence of 6 or more symptoms.

Depression isn’t a choice, Post Traumatic Stress Disorder isn’t a choice, and alcoholism is not a choice.

Alcoholism as a Disease

Toward the end of the 19th century and the beginning of the 20th century, addicts/alcoholics were often looked upon as morally corrupt and even labeled as being a bad person or a terrible sinner. This type of thinking led many doctors and mental health professionals to fight to change ordinary.  They wanted to try and help addicts instead of punish them. The founding of AA – Alcoholics Anonymous – in the 1930’s and the publication of noted psychiatrist and Director of the Center of Alcohol Studies at Yale Medical School E. M. Jellinek’s famous book defining the concept of alcoholism as a medical disease facilitated moving alcoholism into a different light.

Jellinek is often called the father of the disease theory or model of alcoholism. His theory listed alcoholism as having stages that drinkers progressively passed through. These stages are:

  • Pre-alcoholic phase, which includes social drinking when drinkers often start to develop a tolerance for alcohol and drink to relieve stress or feel better
  • Prodromal phase, also considered the early-alcoholic stage where blackouts begin to occur, the drinker begins to drink alone and in secret, and thinks about alcohol frequently while their alcohol tolerance continues to grow
  • Crucial phase characterized by a spiral of out-of-control drinking at inappropriate times and problems with daily life and relationships as well as physical changes to the brain and body
  • Chronic phase which includes daily drinking, drinking as the main focus of life, health problems cropping up, cravings and withdrawal symptoms, and physical and mental long-term alcohol abuse issues.

Alcohol works largely as a depressant on the central nervous system and due to the relatively small size of alcohol molecules, it can affect many parts of the brain and body simultaneously.

Alcohol changes brain chemistry, initially increasing neurotransmitters that drive the brain’s pleasure centers, but over time and with chronic abuse, depleting them. As the tolerance to alcohol increases, the abuser must take in more in order to feel the effects, which further damages both the body and brain.
Disease Model

The National Council on Alcoholism and Drug Dependence likens alcohol dependence – alcoholism – to a medical illness through the disease model. The disease model of alcoholism depends on it being a physical addiction that cannot be controlled, distinguishable by specific symptoms and requiring specialized medical treatment. Cycles of physical cravings and withdrawal symptoms, including shaking, sweating, nausea and dizziness, are part of the reason alcoholism has been classified as a phHow alcohol attacks the brainysical disease. As alcoholism is an addiction, it is considered a disease of the brain. The brain has been physically altered by extended exposure to alcohol, causing it to function differently and therefore creating addictive behavior.
This disease model may not take into account the reasons some people become addicted and others d
o not. Cultural and environmental factors need to be considered, as do traumatic events. Compounding on this disease model, the theory of addiction being genetic or hereditary was born. This theory states that addicts may have certain predispositions to addiction, or genes that may help determine whether or not a person becomes an alcoholic. Many believe that it is a combination of genes and environmental stimuli that actually lead to addiction. Still, others argue that addiction is a psychological symptom and not necessarily a physical disease.

Personal Reflection

When I met both of my biological parents, I found out that my biological father and his father both suffer from alcoholism.  Unfortunately, that gene was passed on to me.  I was raised in a very stable household, neither of my parents drank to excess- but I still wound up being an alcoholic.  For those of you who think that alcoholism is a choice, I would encourage you to read what I have to say next.  Sure, my first drink ever was my choice, but the literal insanity that alcohol did to me is certainly not my choice.  I did not choose to worry my parents half to death, I didn’t choose to constantly crave alcohol during the work day, I didn’t choose to shake in the mornings, I didn’t choose to have an addiction– alcohol messed up the chemicals in my brain.

When I was in the heat of my alcoholism, nobody could stop me from drinking.  Whatever you had to say about my alcoholism went in one ear and out the other, and probably a lot of less-than-nice words out of my mouth. I didn’t even know who I was at the time. Sober Sara is hell of a lot different than intoxicated Sara, thats for sure.  I had to hit rock bottom before I realized that I had to make some major lifestyle changes.

When I look back on it, I’m actually glad that I hit rock bottom at such a young age, because if I kept going on the path that I was on, it could have been so much worse. Unfortunately, some alcoholics/addicts never truly hit rock bottom and addiction takes over their lives (either leading them to an early grave, various medical issues, suicidal ideations, homeless, etc.) I’m very humbled and lucky to be sober today and to have broken the insanity. They say in AA that “the first drink gets you drunk”, and thats totally, completely, 100% correct. Because if I pick up that drink, I lose absolute control over myself- and I can’t help it. It was not my choice to spiral out of control, but it is my choice to live a sober lifestyle.


one day at a time



Sources: Diagnostic and Statical Manual of Mental Disorders, 5th Edition

11 thoughts on “Read This if You Think Alcoholism is a Choice.

  1. Wonderfully written. My father met every criteria. As a young child, what I remember most was number three. A Sunday afternoon activity for my father meant packing us three kids in the car and driving from friends house to friends house looking for that “social drink”. Most of the time we were just left in the car. Yes, daddy of the year.

    Liked by 1 person

  2. I didn’t have a mental defense against the first drink. Once I was in the grip of getting a drink, I was in trouble. The mental obsession was irresistible. I got drunk to get sober, to get drunk to get… forgetting all the bad stuff that happened between the cycle. I don’t believe an alcoholic has a choice. I don’t have a choice today. The difference between me today and me from 1988 when I stopped is I am not battling the mental obsession and craving caused by my last drunk, and I have some old trusty rusty tools that help me along the way. Ups and downs are normal. It’s my experience that it is truly a spiritual battle today. I choose the spiritual path vs the path of least resistance. Let up and I may drink. Let up and I may not. Push forward on the path and the solution is clear.


  3. From Dr. Lance Dodes,writing in Psychology Today:

    This becomes clear if you compare addiction with true diseases. In addiction there is no infectious agent (as in tuberculosis), no pathological biological process (as in diabetes), and no biologically degenerative condition (as in Alzheimer’s disease). The only “disease-like” aspect of addiction is that if people do not deal with it, their lives tend to get worse. That’s true of lots of things in life that are not diseases; it doesn’t tell us anything about the nature of the problem. (It’s worthwhile to remember here that the current version of the disease concept, the “chronic brain disease” neurobiological idea, applies to rats but has been repeatedly shown to be inapplicable to humans.

    I worked in nightclubs for 12 years and have seen my fair share of alcoholics. Good people and many were friends,some even mentors. The fact is that no one forced them to pick up a drink,many times its peer pressure and desire to fit in is what drives one to decide to pick up a drink.
    As I pointed in the blog entry that you read,Ben Affleck wasn’t “sick” when he decided to drink. He told the film director that he needed to drink for his “character”. He chose on his own freewill to drink.
    And you Sara,you chose not to drink on Easter….free will. I believe your spirit and desire not to drink will prevail here. You control your life because you made the choice to do so. I wish you well.


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