Is alcoholism considered a mental illness or a moral condition?
There are many factors that may contribute to a person eventually becoming an alcoholic. Of course, the first risk factor is alcohol intake. If a person never drinks, they cannot become an alcoholic.
Is everyone who drinks at risk for developing an alcohol problem? Of course not. Many people drink moderately, occasionally, or even rarely.
There are people who have a glass of wine with dinner once or twice a week. Then, there are people who go out drinking with friends once every month or two. There are even people who only have a sip of champagne on New Year’s Eve.
What about people who binge-drink? Are they at higher risk for alcohol dependence because of their occasional heavy alcohol consumption?
The binge drinker, sometimes referred to as a “gray area drinker,” is often in a pre-alcoholism state, where they can still make a choice. With some effort, they can make the decision to stop drinking and commit to a sober lifestyle.
Sometimes, the gray area drinker does need additional help to quit alcohol. A specialized coaching program may help. Another option is to see a doctor about The Sinclair Method.
The Sinclair Method is a harm reduction treatment for eliminating binge drinking and alcohol misuse. Naltrexone is used in conjunction with minimal alcohol intake to erase the alcohol habit from the brain.
Naltrexone is also used to treat addiction to opioids and for more serious alcohol abuse problems. It is also used for other types of substance abuse.
Alcohol addiction is not a moral problem.
Someone might get the idea, after studying the Alcoholics Anonymous program, that alcoholism is a moral condition. There are steps to deal with shortcomings and defects of character.
There is even a specific step to address taking a moral inventory. Later in the steps, the AA member is expected to make amends to people who they have harmed.
There is no medical condition or psychiatric disorder in which the doctor recommends taking a moral inventory or making amends as part of the treatment. However, doctors often refer patients to go to AA meetings for treatment of their alcohol addiction.
This pattern of doctors handing over the responsibility for providing treatment to a spiritual fellowship would seem to indicate that alcohol dependence is a moral condition rather than a true medical condition. Yet, alcohol abuse is clearly a mental health condition, and often part of a dual diagnosis.
While group support meetings may be helpful to some people, they are not a form of medical treatment. If people find that developing a connection with a higher power, taking a moral inventory, making amends, carrying the message are helpful activities, then that is great, but AA does not provide medical treatment for any mental health problem.
What is a dual diagnosis?
Alcohol use disorder is a mental disorder by itself. Alcoholism is considered to be a chronic disease that can be treated, but has no permanent cure.
That is, unless you consider not drinking a permanent cure. It is possible for a person who has achieved sobriety and freedom from active alcohol addiction to make the decision to not drink and therefore no longer require further medical treatment.
While alcoholism itself is a mental health disorder, it is often accompanied by a co occurring disorder. When there are two psychiatric disorders, one being an addiction, this is referred to as a dual diagnosis.
What mental health conditions typically accompany alcohol use disorder?
Mood disorders include mental health conditions such as depression and bipolar disorder. Anxiety is a condition that often accompanies depression. Anxiety and depression can be debilitating, making it difficult to get through the day.
A person with a mood disorder may try treating their mental health issue with alcohol consumption. They do not necessarily do this intentionally.
For example, imagine someone with panic disorder who cannot function in a public setting where they are in a large crowd. After alcohol or drug use, they find that they can mingle and socialize successfully. Without meaning to, they have just self-treated their psychiatric symptoms.
Other conditions, such as antisocial personality disorder and borderline personality disorder often lead to alcohol misuse or another substance abuse disorder.
Substance abuse with another comorbid condition, such as anxiety disorder or depression, presents as a challenge to the healthcare provider. The mental health condition that led to alcoholism or drug addiction must be addressed, or it may lead to relapse in the future.
Generalized anxiety disorder, for example, often leads to substance misuse, and particularly alcohol abuse. If a person with severe anxiety achieves sobriety, the symptom of anxiety is still there.
Untreated anxiety often leads to depression. Addiction treatment should include psychological and psychiatric evaluation and treatment to prevent a return to alcohol or drug abuse.
Is alcoholism an uncurable brain disease?
In Alcoholics Anonymous 12-step meetings, members typically identify as recovering alcoholics, and not as recovered alcoholics. They want to emphasize that they are never cured of their condition, and they must continue to work on themselves to remain sober.
There is a saying in AA that once you are a pickle, you can never go back to being a cucumber. This saying usually gets laughs in a meeting, because of the imagery of an alcoholic being pickled by the alcohol they are consuming.
Yet, the meaning of the saying is that once a chronic condition develops, it is here to stay. It is similar to when a person first gets diagnosed with diabetes.
Diabetes is a chronic disease that never goes away, but it can be managed with lifestyle changes and medical treatment. Diabetics are often in denial at first, and they like to believe that they can get over their disease and become cured.
But, is alcohol use disorder an actual brain disorder? Are their physical changes in the brain that cause a person to experience cravings for alcohol and a loss of control when they have a drink?
There are certainly changes in the various parts of the brain that contribute to the reward system, such as the nucleus accumbens and VTA. When a person gets drunk or high, there is an increase in dopamine in these areas which are part of the mesolimbic dopamine system.
Endorphins stimulating opioid receptors also play a role in reinforcing behavior. When that behavior involves taking another drink, the reward system is programmed to encourage an unhealthy habit.
This process is not unique to alcohol addiction. Gambling, food, sex, and other activities can overstimulate the reward system. Most people do not become addicted, but those who are susceptible may easily become addicted to a behavior that they enjoy or that relieves pain and helps them to function better in the short term.
While the changes in the brain may be difficult to see on an MRI or CT scan, they are real. Over long stretches of time, the brain recovers, overcoming addiction with less risk for cravings and relapse.
Unfortunately, there is some truth to the cucumber and pickle analogy in AA. While relapse many years later is less likely, it can still happen at any time. In a sense, while not affecting cognitive functioning, the permanent changes to the brain’s reward system might be seen as a form of permanent brain damage.
What happens to the brain with alcohol withdrawal?
Withdrawal symptoms caused by stopping alcohol consumption suddenly can be very serious. There is a real risk of causing brain damage if not treated properly.
Wernicke–Korsakoff syndrome (WKS) is one of the most severe consequences of untreated alcohol withdrawal. It is caused by thiamine deficiency, which is often a consequence of alcoholism.
WKS often results in death or permanent brain damage. Patients who develop this condition often require long-term care, due to permanent brain damage.
Delirium tremens (DTs) is the name for a condition that occurs when a person suddenly quits drinking. It is a life-threatening alcohol withdrawal syndrome.
Delirium tremens causes confusion, hallucinations, fever, and possibly seizures. Medical management of the alcohol detox process is critically important to prevent this condition.
Is it possible to avoid acute alcohol withdrawal by cutting back on drinking gradually?
Controlling alcohol intake as an alcoholic is not easy. At least, it is not easy without medical treatment.
Traditionally, experts believed that a person addicted to alcohol was incapable of managing their consumption of alcohol. A cornerstone of the definition of addiction as a chronic disease is a lack of control.
The foundation of medical treatment for alcohol use disorder is based on the principles of the Alcoholics Anonymous program. AA started in 1935 and predates modern medical treatment for alcohol dependence.
During the past few decades, a new protocol for treating alcoholism, based on harm reduction, has been proven to be effective in helping people to gradually reduce their alcohol intake and eventually quit.
The Sinclair Method is a protocol based on pharmacological extinction that progressively erases the habit of drinking from the brain. Part of the treatment involves a doctor prescribing oral naltrexone tablets.
The patient is instructed to take a tablet one hour before taking a drink. The specifics may vary, depending on the patient and the severity of their drinking problem.
The medication helps the patient to control their craving for alcohol in the short term. In the long term, it reduces their drive to seek out alcohol as a solution to solving life problems.
Reducing alcohol consumption gradually can help patients to avoid acute alcohol withdrawal. It can also help to prevent alcohol deprivation syndrome, which is a condition that may arise several months after quitting alcohol.
Alcohol deprivation syndrome causes the recovering alcoholic to experience severe cravings for alcohol. The Sinclair Method helps patients to avoid this condition, which helps to prevent relapse.
Even with the high rate of success of TSM, patients should still seek out mental health treatment. Psychiatric conditions should be diagnosed and treated to ensure long-term success.
Is there still a place for abstinence-based treatment of alcoholism?
The traditional method of detoxing people off of alcohol and instructing them to not drink afterwards is still appropriate for many people. Addiction can be a difficult thing to overcome when a person is not quite ready.
If a person is a harm to themselves and others, and they refuse to participate in their recovery, they will be unlikely to comply with taking medication, such as a daily naltrexone tablet.
Sometimes, family must perform an intervention and help their loved one to get help. Traditional rehab programs, such as those provided by American Addiction Centers, and others, are still relevant.
Where should a person go to get started when they are ready to quit drinking?
Now is the best time to protect your brain from being further damaged by alcohol. Also, the sooner you get started, the more time your brain will have to heal and recover.
Quitting alcohol can seem like an impossible task. Because it seems to be overwhelming, people often put it off for just one more day.
The problem with putting off the inevitable is that days turn into weeks and weeks turn into months and years. Now is the best time to make a decision to get help to quit binge-drinking and alcohol misuse.
It is possible to enjoy life without alcohol. In fact, you can enjoy life in ways you never imagined when you finally give up drinking.
If quitting altogether seems particularly impossible, and you are not ready to take time off from life to go away to rehab, you might want to consider The Sinclair Method as an alternate form of treatment.
In order to get started with TSM, you simply make an appointment with a doctor who is experienced in providing this treatment. There are treatment providers available in most areas.
For more information on this medication-assisted treatment for alcohol use disorder, check out the C3 Foundation website. This organization provides education for the public and for healthcare providers about how to reduce alcohol intake with the goal of quitting.
They also provide links to local doctors and coaches, as well as information about support meetings. If you find their website helpful, you may want to consider supporting their effort.
If you have an alcohol problem, then you should be concerned about your health and mental health consequences. Now is the best time to get treatment.
In addition to medical treatment to quit drinking, you should also consider seeing a psychologist and a psychiatrist. Addressing any underlying mental health issue is important for achieving long-term happiness and success.
To learn more about alcohol and mental illness, please listen to our alcohol recovery podcast. We are a part of the Mental Health News Radio Network, providing information on alcohol addiction and mental health.