Is alcoholism a disease or a choice? A debate I overheard.

September 29, 2006 11:31 AM

'Cancer is a disease; Alcoholism is a choice'.....This is a conversation / debate I heard on the train this morning.

So, I was on the train this morning, and heard two guys suprisingly debate this topic without it getting heated. I had to exit the train before it's conclusion, but although I saw points on both sides, one really struck with me. People say that alcoholism is a disease just like cancer.

One guys point was that getting cancer is not an option. You are inflicted with it; you can't simply choose not to have it or rid yourself of it. It's chemo and radiation and pills, etc...Sometimes it can be fatal from the outset. He then describes alcoholism as being a choice from start fo finish. His explanation. A person always has the option and choice to put the bottle of alcohol to his or her mouth. No matter how tough the mental strain is or the physical symptoms and withdrawals are, that person always has the choice whether to drink or not.

I know this is much more 'grey' then that, but I kind of agree. I am a diabetic on a strict diet. I also have a major MAJOR sweet tooth, and there are times when i simply crave cookies and or donuts. The craving is overwhelming, and I almost in a zombie like state seek out a sugar rush. I am fully aware of the consequences of my actions, short term as well as long term. In the short term, after the initial blast of energy, I crash hard and am usually useless for the next 8-10 hours after a binge. We all know the long term affects.

So I understand the intense craving. But I also full understand accept the fact that it was my choice to gotot the sotre andf buy the sweets; my choice to open the package; my choice to put the sweets in my mouth. No matter how much I craved, I still had the option and choice to do it or not.

Now, I am not comparing having a sweet tooth to alcoholism, but based on the conversation I had overheard, is it really that much different??

I am not an alcoholic by any means, so there is no way for me to get inside the head of one to see what goes on in their mind that makes them unable to not drink. As bad as the craving and need gets, don't they still have the choice not to drink? That's why I really connected with that one side of the debate...

But I know it's alot 'greyer' then that, and curious to what other people thought?

posted by TwilightKid to health & fitness (38 comments total)

Would it be better to phrase it as "Alcholism is a disease, drinking is a choice"? I mean, diabetes is a disease you have. It doesn't go away just because you don't eat some candy, right?

(Not saying I necessarily agree with my phrasing of the issue above, but I think it's clearer than what you're asking.)
posted by occhiblu at 11:35 AM on September 29, 2006

So you are arguing that diabetes is not a disease? The analogy you lay out to support your conclusion seems to imply that. You say:

I am a diabetic. I want candy. I can't have any because it would be BAD for me -- much worse than for other people.

How is that different from:

I am an alcoholic. I want booze. I can't have any because it would be BAD for me -- much worse than for other people.

I'm not taking a position either way, just wanted to point out a glaring hole in your logic.
posted by TonyRobots at 11:39 AM on September 29, 2006

...the disease theory is still controversial and there is disagreement on the issue after 200 years of debate.

For some reason I can't imagine reaching a resolution during this chatfilter session...
posted by prostyle at 11:40 AM on September 29, 2006

AA has always treated it as a disease. I believe that there is enough medical evidence to support the fact that nearly all addictions are diseases.
posted by JJ86 at 11:41 AM on September 29, 2006

So I understand the intense craving. But I also full understand accept the fact that it was my choice to gotot the sotre andf buy the sweets; my choice to open the package; my choice to put the sweets in my mouth. No matter how much I craved, I still had the option and choice to do it or not.

That's not necessarily true, right? It all depends where you want to define the "I" (or "you"). Addicts can literally be driven by an animalistic urge to get what they crave.. but is this something they 'decided'? That's where the argument is, I feel. The same could be said for certain types of sexual predator. They can be strongly driven by hormones (sexual drive is an insanely strong animal drive in many).

FWIW, I am playing devil's advocate here. I pretty much follow what you say, but I can't help but feel many people are 'controlled' by elements that are very much outside of their personality (what I would call 'them'). Is a person a personality, or is a person a body?
posted by wackybrit at 11:42 AM on September 29, 2006

"Alcoholism" supposedly runs in my family. I had psychology professors that claimed it was a myth (anything enjoyable can be addictive, likewise anything consumable) and others who swore by it.

Personally I think it is initially a choice and eventually a choice tainted with powerful metal and chemical dependency. But with addiction the first sip/taste/snort/bet is always a choice, and no other diseases can be treated/cured by choosing not to have it and commiting to it. Others can be treated by removing risky behavior (lung problems:smoking) but in this case the risky behavior is the disease.

I vote choice, possibly mixed with contributing metal illnesses (anxiety, dependence, depression).
posted by JeremiahBritt at 11:46 AM on September 29, 2006

The DSM IV calls it a disease.

CDC Says this:

"Alcoholism or alcohol dependence is a diagnosable disease characterized by several factors including a strong craving for alcohol, continued use despite harm or personal injury, the inability to limit drinking, physical illness when drinking stops, and the need to increase the amount drunk in order to feel the effects (4)."

By the same line of reasoning of your train riders... the cancer that is a consequences of smoking that leads to lung cancer is not a disease, it is a choice. I call bullshit on the sloppy reasoning.

The point is... the craving is almost, if not, inconceivably difficult for some people to control. That may indicate that their brains lack critical control circuits that MAY be common to non-alcoholics. I'm not saying that's the case, I'm suggesting that it's a possibility.
posted by FauxScot at 11:46 AM on September 29, 2006

Alcoholism is not a disease, it's a choice.
You choose to drink for whatever reason, and because it feels good, you choose to continue.
It is not a disease.
AA makes it sound like a disease so "God" can save you from it; it makes you powerless.
I quote the 12 steps:

"
1 We admitted we were powerless over alcohol--that our lives had become unmanageable.

2 Came to believe that a Power greater than ourselves could restore us to sanity.

3 Made a decision to turn our will and our lives over to the care of God as we understood Him.

4 Made a searching and fearless moral inventory of ourselves.

5 Admitted to God, to ourselves and to another human being the exact nature of our wrongs.

6 Were entirely ready to have God remove all these defects of character.

7 Humbly asked Him to remove our shortcomings.

8 Made a list of all persons we had harmed, and became willing to make amends to them all.

9 Made direct amends to such people wherever possible, except when to do so would injure them or others.

10 Continued to take personal inventory and when we were wrong promptly admitted it.

11 Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12 Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.
"

Alcoholics anonymous is a cult.

The only person that can save you from alcoholism is yourself.
posted by PowerCat at 11:52 AM on September 29, 2006

***So you are arguing that diabetes is not a disease? The analogy you lay out to support your conclusion seems to imply that. You say:

I am a diabetic. I want candy. I can't have any because it would be BAD for me -- much worse than for other people.

How is that different from:

I am an alcoholic. I want booze. I can't have any because it would be BAD for me -- much worse than for other people.

I'm not taking a position either way, just wanted to point out a glaring hole in your logic.***

I'm not saying that diabetes is not a disease. I'm meant that whether you have diabetes or alcoholism, isnt it your choice whether to indulge in the items that can make it worse?

I was afflcited with diabetes several years ago, and have made radical changes in my lifestyle. The best way for me to fight this disease is by watching my sugars and carbs, and all the other stuff that comes along with it. So, by choice i can either help my cause or allow my urges to eventually kill me, by taking care of it. I will still have diabetes.

If someone has a problem with alcohol though, I am simply curious to what goes on in the brain of the person to simply make them unable to not drink? i was using diabetes only as a metaphor and something i saw as a (albeit bad comparison). As bad as the craving gets, dont they always have the choice to buy the alcohol, open the bottle, and drink it?

im not looking to argue either side. Just the one argument seemed to make more sense in my mind. im not looking for answers, just different opinions, cause i know i have spent the last few days with it on my mind.
posted by TwilightKid at 11:52 AM on September 29, 2006

alcoholism is a mental disease. i know of a couple of alcoholics that would love to stop drinking ... but they can't. it sounds so easy if you don't have the problem, but if it was that simple, alcoholism wouldn't be that big of a deal.
posted by lester's sock puppet at 11:53 AM on September 29, 2006

I have no science to offer but this distinction seems obviously correct.

It seems to me that the discourse around alcoholism - alcohol addiction - gets muddied by the AA-type orthodoxy (the 'you're not strong enough to do this alone'/higher power business). occhiblu has the right of it, I think - a tendency to drink uncontrollably isn't the same thing as being a drunk, being drunk all the time. Of course you only discover it by becoming a drunk...but they're not the same, and the elision of the difference is of a piece with any number of other pathological 'moral' discourses in the U.S.

i.e. We shouldn't help drug addicts because they take drugs every day, we should help them because when they stop taking drugs every day, when they conquer that desire, they enable a richer humanity. But don't tell the GOP, for instance - they just hear 'They're giving money to junkies.'

The strength of one's reaction to alcohol isn't in one's power to change, I suppose, not normally. And yet...I tend to find the whole 'Not one drop!' attitude miserable; after all, I tend to drink to excess when I drink, but I don't need to drink every day, and I can't imagine what it's like to feel a daily compulsion to drink. Seems to me one can accustom one's body to limitation, and that in what I've read of alcoholics there's a fear or selfish unwillingness to undergo that suffering to better oneself - the desire to substitute instead 'I am suffering just by being me,' a culture of (self-)righteous victimhood. Choosing to live as a 'dry drunk' seems no solution at all, a rejection of strong discipline for a weaker kind.

But then I have a very opaque relationship with my own compulsions and their management, and am in no strong position to lecture people about theirs. And I have no understanding of what it is to live with OCD or Tourette's or any such cognitive compulsion-framework, so perhaps this strong discipline I'm imagining isn't possible.

I just wonder whether there could be a better way to address such compulsions - a way of making-productive one's tendency to addiction, in which the mind/body could be trained not to find fulfillment in a bottle.

I do apologise for the wandering-about.
posted by waxbanks at 11:53 AM on September 29, 2006

Drinking does not equal alcoholism. You can be a "dry" alcoholic. Indeed, many of us believe our president is such a person.
posted by jasper411 at 11:53 AM on September 29, 2006

Tanks for the other responses. I know there is so much more out there. Im getting a better grasp and my opinions are changing. They didnt teach me any of this in business school. lol
posted by TwilightKid at 11:54 AM on September 29, 2006

I wonder if some of what you're interested in teasing out is the issue of personal responsibility. Too far down the road of alcoholism is a disease, and it comes to seem as if alcoholics bear no responsibility for their actions, which is, obviously, the kind of manipulative thinking that can make folks with addictions so hard to deal with in the first place. But I don't think it follows that "choice" obviates the notion of something being a disease. Even with cancer, if you chose to smoke, you can still end up with lung cancer as a result; similarly if you chose to work mining asbestos. The cancer is no less cancer because you did something which facilitated its development.
posted by OmieWise at 11:56 AM on September 29, 2006

People can get cancer w/o outside obvious outside influences such as smoking, etc...
posted by TwilightKid at 11:58 AM on September 29, 2006

Indeed, many of us believe our president is such a person.

And then there are those of us who totally think he still drinks.

Alcoholics anonymous is a cult.

We're in the green, so I'll refrain from speaking my whole mind here, but be advised that I'd not be as genteel about this in the blue. I am very close to several recovering alcholics, and the notion that AA is a cult results from misinformation or stupidity or both. Actually working the 12 steps requires a bravery I don't possess, and I have nothing but admiration for those people in my life who have become sober through AA.
posted by eustacescrubb at 12:01 PM on September 29, 2006

Its indeed bullshit if its cancer due to smoking...but what about the various forms of cancer that are not traceable to any physical behavior / choice.

Breast cancer, prostate cancer, brain cancer, etc.. Nobody has a choice in these. I think its still a valid arguement. Even if we do determine Alcoholism to be a disease, there is still some manner of choice involved in putting yourself in harm's way, whereas with these other forms of cancer, the person may very well have done nothing to cause themselves to get said cancer.

I've always personally struggled with this when it comes to stuff like supporting the fight against AIDS. Is it a terrible thing? Yes. Are there people who get it through no choice of their own? AIDS babies, mostly, sure. Do most people get this disease because of a poor decision on their part? Yes. I have trouble diverting funds to these causes when I could be helping out causes like Multiple Sclerosis. My mother made no poor choice to deserve that disease.
posted by allkindsoftime at 12:04 PM on September 29, 2006

The answer is going to depend on what you want to accomplish in defining it.

If you're dividing health issues up into dissease vs. disorders, then it's probably a disorder.

If your wondering about treatment options, does it matter? Just go with whatever has a track record of people you not end up living in the bushes behind 7-11.

If you just want to feel morally superior, hell, call it a disease and assume that people who have diseases are being punished by God. Just like everyone who happens to live in on a flood plain, earthquake zone, or state prone to hurricanes.
posted by Kid Charlemagne at 12:05 PM on September 29, 2006

And I'm seconding the respect for those who have the courage to go through AA. Cult my ass.
posted by allkindsoftime at 12:06 PM on September 29, 2006

Anyone who is addicted to [substance of choice] remains addicted to [substance of choice] even long after they quit actively using it. They never completely stop thinking about the object of their addiction. They have cravings even years after they quit using [substance of choice]. They miss it, they could go back even after years of being clean. Ask anyone who has quit smoking.

I think occhiblu puts it well: "Alcoholism is a disease, drinking is a choice"

Addiction is a mental illness, so it does work somewhat differently than diseases of the flesh. Think of it more like OCD than like cancer. There are therapies that can reduce or eliminate the problematic behaviours in people with OCD (like repetitive handwashing, for example) but the compulsion will still be there to some degree. If you've never lived with OCD, it's difficult to relate to the experience of not having a choice in doing those ritual things, since you also wash your hands, but you've never felt the urgent requirement to do it over and over again.
posted by raedyn at 12:08 PM on September 29, 2006

I think occhiblu and jasper411 get closest to the point here...

Just as diabetes makes a person have an atypical response to sugar, so does alcoholism make a person have an atypical response to alcohol. A diabetic is a diabetic regardless of their behavior; whether they eat sweets or not, they still have diabetes. The same thing goes for an alcoholic. Whether they choose to drink or choose not to drink, an alcoholic will always be an alcoholic. They may not have had a drink for twenty years, but they still have the disease.

On preview: what raedyn said.
posted by CtrlAltDelete at 12:15 PM on September 29, 2006

I don't mean to suggest that an addict doesn't have a choice of whether to indulge. Of course he or she makes a choice each and everytime. But it isn't the same as when someone without an addiction makes that same choice.

I've never smoked, so anytime someone offers me a cigarette there's no thinking involved, there's no reason I'd want to touch it. I can easily wave it away. But my husband is addicted to cigarettes, so if someone offers him a cigarette it's a completely different emotional psychological and physical experience for him than it was for me. He's drawn to the cigarette in a way I'm not. he can still refuse it, but it's not as simple as a shurg and a wave away.

Don't forget that there is a physical aspect to chemical dependency. There are chemical reinforcements to keep an addict using.
posted by raedyn at 12:17 PM on September 29, 2006

People who have drinking and drugging problems are often self-medicating for other mental illnesses, and anyone drinking alcohol to excess will become physically addicted with enough dedication to the task.

No one sets out to be addicted to anything. And until you take that first drink or drug, you have no idea where it will take you.

AA has a self-admitted five percent retention of membership after a year. That figure does not include the many who go and still struggle with sobriety. It's not for everyone. But it's wonderful if it works for you.
posted by wordswinker at 12:19 PM on September 29, 2006

I think there's an unspoken assumption in this thread:

ASSUMING THERE'S SUCH A THING A FREE WILL, is alcoholism (or drinking) a choice?

My guess is that we don't want to argue Free WILL/Determinism here, but if you follow this question to its logical conclusion, that's where it leads.

But even assuming that choices exist, they are limited by all sorts of factors:

-- I can't choose to fly, because they violates physical laws.

-- I can't choose to stop loving my wife. Others might have some latitude in a similar scenario, but I've never found my feelings to be deeply under my control. Feelings apparently just happen to me.

You could argue that I just don't know how to control my feelings, and that's fine. But I still can't alter them, either because they are unalterable or because I don't know how.

-- I can't choose to like Hip hop. This one is interesting. The fact that I dislike it is learned and cultural. The world is full of people who like Hip hop, so obviously it's possible to like Hip hop. Yet I'm powerless to make myself like it.

Sure, with long term exposure, I might learn to like it. But that's a little different from making a choice, right here and now, that has a real effect. The question isn't whether or not you can, after a lot of hard work, get to a point where you're not drinking; the question is whether or not you can choose not to pick up THAT glass of wine, right here and right now.

Assuming we have some sort of free will, that freedom is whittled away by genetics, upbringing, recent circumstances, health, mood, beliefs, level of intelligence, etc. It's entirely possible that a particular person, given access to alcohol, will be unable to stop himself from drinking it.

Some philosophers (e.g. Danial Dennett) think we use the word "choice" when we can IMAGINE a world in which things would have turned out differently. In other words, I can't help reaching for the drink, but since I've seen myself not reach for things, I can imagine an alternate reality in which I didn't reach for the drink.

Note that this has nothing to do with whether or not I can actually restrain myself from drinking. But I CAN imagine a person -- much like me but maybe with a little more control -- not reaching for the drink.

Whereas I can't imagine any person -- in any non-sci-fi world -- willing away their cancer.
posted by grumblebee at 12:19 PM on September 29, 2006 [1 favorite]

I am very close to several recovering alcholics, and the notion that AA is a cult results from misinformation or stupidity or both.

It may not meet the textbook definition of a "cult," but it spreads misinformation itself. It's not nearly as effective as other methods and the costs are high:

William Miller and Reid Hester, editors of the most comprehensive and most methodologically sound evaluation of treatment methods ever published, state that, "We were pleased to see that a number of treatment methods were consistently supported by controlled scientific research." But they continue, "On the other hand, we were dismayed to realize that virtually none of these treatment methods was in common use within alcohol treatment programs in the United States...

They list the treatment methods showing the most positive results, as shown by controlled studies, as brief intervention, social skills training, motivational enhancement, community reinforcement approach, and behavior contracting. Importantly, 12-step treatment was nowhere in evidence in the list of effective treatments; but it was quite likely a com­ponent of four modalities for which a number of studies show significant negative results: unspecified “standard” treatment; confrontational coun­seling; milieu therapy; and general alcoholism counseling. As for AA, Miller and Hester list only the two controlled studies discussed above, both of which showed negative results. (source)
posted by callmejay at 12:23 PM on September 29, 2006

I think we have to find the definition for "disease" and then work it out from there.
posted by wfc123 at 12:38 PM on September 29, 2006

A non-alcoholic who claims to know what alcoholism is about it like a guy who claims to know what it's like to give birth. Granted, this thread has offered up some very open-minded and measured perspectives (sorry PowerCat, you're not included here,) but I don't think alcoholism can be fully understood through intellectual means.

AA describes the disease as a physical compulsion coupled with a mental obsession. I think it's the latter that most people don't fully understand. Alcohol (and drugs, for that matter) create an insanity that removes the individuals ability to choose to abstain. People drink themselves to death every day, and it's not because they're suicidal, at least not in strictest sense. The typical untreated alcoholic simply lacks the ability to put a stop to the downward spiral without some kind of intervention.

I don't see the comparison with diabetes to be a valid one, given that zeitgeist around it seems to be that the compulsion to eat sugar as something that can be overcome through dicipline and will power. But, if someone were to come forward and disagree on that point, I certainly won't argue.

Honestly, I don't really understand what motivates people to insist that alcoholism isn't a disease. Hey, maybe it's not, but if the disease perspective helps a person to beat their drinking problem, there's no harm in just playing along.

I only meant to leave my .02, but I'm going to need change for a $20 now.
posted by bicyclingfool at 12:38 PM on September 29, 2006

I've decided to become an alcoholic. What do I do now?

The answer to this question is very simple: yes, alcoholism is a disease. Those who say it's a choice are confused about what alcoholism means--they seem to think it means "drinks a lot." It doesn't.

Whether you do anything to cause your disease or aggravate your disease has nothing to do with its definition as a disease. If you think alcoholism is not a disease, fine, but you need more reasons than this. And you should probably go to medical school before you come to a final decision. Or, as wfc123 points out, at least look up the definition of "disease."

Yes, you can get cancer or diabetes with or without doing anything harmful to your health. Drinking in and of itself is not harmful to your health. And it's the only thing you have to do to become an alcoholic. But it may not work.
posted by lampoil at 12:43 PM on September 29, 2006

As I see it, there are two main reasons to think of alcoholism as a "disease":

1. There is a strong physical component to it. For example, there seems to be some inheritable susceptibility to it, suggesting that it has a good deal to do with the brain or body chemistry one is born with, rather then being purely a matter of environment and choice and will-power.

2. Thinking of it as a disease frames it in a more pragmatically useful light than thinking of it as a character flaw. If it's just a character issue, a pure matter of choice, then it should be easy to quit by just choosing differently -- and also, alcoholics are to blame for not just quitting. But if it's a disease, that emphasizes that there's more to it than merely making a choice. It also removes some of the blame from the alcoholic, which makes mental room for the person to seek help. (That is, she can say "I have a physical condition I can't control on my own. I need training -- like physical therapy -- or medical help to quit. But this is ok, because it's a physical problem, not a personal failing. I'm not admitting to personal weakness by seeking help, any more than I would be by seeking medical treatment for cancer.") This point has to do with some of our irrational ideas about praise and blame and "toughing things out" and the difference between physical and psychological problems -- but since we as a society do have these attitudes, right or wrong, if we want people to be able to seek treatment it's more pragmatically useful to think of alcoholism as a disease.
posted by LobsterMitten at 12:44 PM on September 29, 2006

Following on from what grumblebee said. A predisposition does not exclude free will. A predisposition can be a disease. Alcoholism can be a disease and not preclude free will. It's not a binary thing.
posted by edd at 12:53 PM on September 29, 2006

Perhaps the essential difference is only how we react when confronted with someone suffering from a given disease -- whether it's cancer, diabetes, or alcoholism. I would wager (and this is based on nothing other than my own experience) that people are far more sympathetic to, say, a child suffering from leukimia or a woman suffering from breast cancer than someone suffering from lung cancer brought on by smoking. By the same token, people are more sympathetic to someone suffering from naturally occurring diabetes to someone who is diabetic because they are grossly overweight.

The key factor in both of these scenarios is not the disease, but the origin, or "cause", of the disease. In contrast, alcoholism has no "natural" cause -- both it and drug addiction began with a conscious choice. People know that, and react differently. Whether or not this reaction is moral, justified, or appropriate is a different argument.

All may be diseases of one form or another, but all that's what the point is not.
posted by modernnomad at 12:54 PM on September 29, 2006

People who have drinking and drugging problems are often self-medicating for other mental illnesses,

This line of reasoning is what drives a lot of us non-alcoholics to stick in our unrosy noses and demand that the "disease" train be stopped. The "self-medication" excuse foreshadows a population of pill-popping, happy zombies.
posted by Doctor Barnett at 1:02 PM on September 29, 2006

What about people who eat bacon every day. Is it just a random occurence when they come down with some kind of heart disease? The issue that warrants discussion here is not who deserves the money it's why aren't we as a society working more towards prevention of the actions we know lead to these diseases. Condoms for homosexuals, new clean needles for addicts, a more well-rounded diet for those addicted to meat, Excercise for the obese, mandatory spa vacations for those with high stress. (they have these in Germany) . We as a nation can save billions of dollars if we actually practiced "health" care instead of "sick" care. But then again, those billions saved will come right out of the pockets of big pharma and big HMO so I doubt they will be interested - and if they are not interested their whores in Congress are certainly not going to be interest. So here we are. Time for a revolution huh?
posted by any major dude at 1:15 PM on September 29, 2006

It's a mental illness that has roots in a chemical dependency. It's true that it is a conscious choice to pick up a glass or bottle with booze in it and drink it. It's a different sort of conscious choice to continue drinking when you have an issue with alcohol dependency -- one that is informed by an altered brain chemistry and social patterns. No mentally well person tries to drink mouthwash or aftershave when liquor's not available.

To claim that alcoholics have a choice every time they drink may be true, but only on the the most basic level of logic.
posted by mikeh at 1:16 PM on September 29, 2006

The belief that AA is a cult is nonsense spread by people with axes to grind. It works and provides a social support network to keep people away from the drink.

The notion of a disease has changed over the years and continues to change. Some people rely on a traditional definition of disease which is limiting. Alcoholism is difficult to fit in that definition because the road to becoming an alcoholic varies. I closely know many alcoholics and it permanently changes a person much like a disease does.
posted by JJ86 at 1:28 PM on September 29, 2006

Is alcohol a disease?

Well, is depression a disease? Is any mental disease actually a disease? Most people would probably say that it is -- not a physical disease like cancer, but a mental illness. Saying that alcoholism is a choice is much like going around telling depressed people to cheer up.
posted by reklaw at 1:44 PM on September 29, 2006

It might help to understand the compulsion aspect if you think of alcoholism as a love affair. We all fall in love in our lives and we all know how it can make us behave irrationally on occasion. Some people, however, behave very irrationally on an ongoing basis. They become stalkers or they hit the person they claim to love and need, they put up with abuse, they kill and main and steal for love. This may be down to circumstance, genetics, family history or a diagnosed mental or organic illness or just who knows what. The relation many alcoholics have with drinking is like the bad relationships you can have with other people.
posted by fshgrl at 1:47 PM on September 29, 2006

Well, it basically depends on the definition of 'disease'. So it's a semantic/philosophical question, really.
posted by delmoi at 1:47 PM on September 29, 2006