Is Alcoholism a Disease or a Choice?

Short answer: alcoholism behaves like a disease because heavy, repeated drinking changes reward, stress, and self-control circuits, making stopping far harder than “just decide.” Choice explains the first drinks; it does not explain continued use despite harm, withdrawal, and craving. If you are seeing the early signs of alcoholism, act early, get assessed, and plan the right detox and treatment path.

Is Alcoholism a Disease?

Yes, alcoholism is treated as a disease because repeated heavy drinking changes how the brain’s reward, stress, and self-control systems work. Those adaptations drive craving, make cues feel irresistible, and shrink the gap between “wanting” and “doing,” so stopping isn’t just a decision problem. Clinically, this is Alcohol Use Disorder, a chronic, relapsing condition that improves with the same approach we use for other long-term illnesses: assessment, a safe detox plan when needed, structured therapy, relapse-prevention skills, and support over time. Framing it as a health condition isn’t “letting people off the hook” it’s choosing the model that actually leads to better outcomes.

In addition, there’s a genetic component to alcoholism. While we can’t entirely blame alcohol misuse on genetics, some people are born with an increased risk of AUD. For instance, metabolism and neurotransmitter function can be influenced by genetics. Differences in these functions can make some people more susceptible to alcohol addiction.

Is Alcoholism a Choice

Early drinking is a choice; progressing alcoholism isn’t. With repeated heavy use, brain changes narrow control, so “just stop” becomes unrealistic without support. You’ll see it in real life:

• someone means to have two, but finishes the bottle;
• swears off in the morning, drinks by evening because of craving;
• tries to quit, but alcohol withdrawal symptoms (shakes, sweating, anxiety) drive them back.

Accountability still matters, boundaries, honest disclosure, and treatment adherence, but blaming “weak will” delays care. If this pattern fits, book an assessment and plan a safe detox instead of white-knuckling.

Is Alcoholism a Mental Health Disorder?

Yes, alcoholism is a mental health disorder. In addition to being classified as a disease, the DSM-5-TR classifies the condition as a mental health disorder. This means that there’s a complex interaction between psychological, biological, and social factors when it comes to addiction. 

When people drink, alcohol causes significant brain changes that can lead to compulsive drinking and impaired decision-making. It becomes a mental health issue characterised by cravings, loss of control, and continued use despite negative consequences.

Alcoholism and Co-Occurring Disorders

While alcohol use disorder is classified as a mental health condition, it typically doesn’t exist on its own. Many people with this disease experience co-occurring mental health disorders. 

Unfortunately, co-occurring disorders can make suffering from either alcoholism or mental health struggles more challenging. It also makes the diagnosis more complex since the symptoms of one condition can mimic or mask the other. 

As such, they need a specialised treatment called Dual Diagnosis to address both disorders.

Can Mental Illness Contribute to Alcohol Dependence?

Many people with mental illnesses turn to alcohol as a way to cope with the negative emotions they experience. Although alcohol can relieve negative emotions for a little bit, it shouldn’t be used as a long-term solution. Drinking alcohol to “get over” mental illnesses can even do more harm than good.

Alcohol has a lot of negative effects on the brain and body. Repeatedly drinking alcohol can cause tolerance, where a person will need to drink more alcohol to achieve the same impact. Eventually, when a person drinks more, the brain and body will start to rely on alcohol to function correctly (dependence). 

Additionally, some mental illnesses may also experience addictive tendencies that affect how they use alcohol. When this is the case, it can be difficult for people to control their drinking. Proper treatment is needed to manage the symptoms of both diseases. 

Arguments Against Alcohol Misuse as a Disease

A few would say that alcoholism isn’t a disease and have arguments to back them up. This section will discuss these arguments and see why they might be harmful assumptions about the disease. 

Alcoholism as a Moral Failing or a Lack of Willpower

Alcoholism is often seen as a moral failing or a lack of willpower. Some may think that alcoholics can just quit if they want to, but that’s far from the truth.  

Many people are willing to receive alcoholism treatment, but the pain of going through withdrawal is what stops them. Withdrawal can be challenging to overcome, even with the help of professionals. The constant struggle of dealing with how the brain and body react to withdrawal becomes like a never-ending battle for those struggling with AUD. 

Additionally, whether we like to admit it or not, there is still a stigma associated with seeking help for the disease. Since many people still believe that AUD is a moral failing, some may ignore or minimise the signs of alcoholism, making it even harder for individuals to acknowledge they need help.

Environment and Lifestyle as Potential Causes 

Some people will argue that a person will never be an alcoholic if they don’t drink at all. While this is true, it’s not a perfect argument because triggers are everywhere in everyday life. And once a person starts drinking, alcoholism becomes less of a choice because of how the substance affects the brain. 

Think about how many times you were invited to an event that involved drinking alcohol. These environments are not easy to avoid; sometimes, they’re even necessary commitments. We can’t just tell people with AUD to avoid these scenarios. The best way to not give in to harmful drinking behaviours again is to develop healthy coping mechanisms. 

Other Misconceptions About Addiction

Here are some other misconceptions about addiction and why they might be harmful ideas:

• It’s easy to point out someone with addiction: Addiction may have some physical symptoms, but they aren’t always evident. Many people with addiction are good at hiding their symptoms, with some even being functional alcoholics. Functional alcoholics are still able to attend to their responsibilities despite struggling with them. 
• A person will be addicted forever: While it’s true that addiction is a chronic, relapsing disease, there are still ways to overcome it. Proper long-term management and risk relapse strategies can help prevent people with addiction from using it.  
• People with addiction don’t care about others: Most of the time, people are aware of how their addiction is affecting others and want to get better. However, quitting addiction is not an easy feat due to withdrawal symptoms and other triggers. 
• Rehab doesn’t work: Rehab is a proven method for treating different types of addiction. Although relapse rates are high (hence the misconception that it doesn’t work), it’s still an effective way to address the disease. 

What Is Alcoholism?

Alcoholism is a disease characterised by the inability to stop drinking despite negative consequences. People with this disorder have a difficult time quitting drinking since the substance has permanently altered their brains.

Even if a person wants to quit drinking, they have a difficult time doing so because they experience different withdrawal symptoms. As such, people struggling with alcoholism need professional treatment to manage the disease. 

Symptoms of Alcohol Use Disorder

Here are some symptoms that indicate that someone is suffering from AUD:

• Constantly drinking more than the recommended amount or more than they intended to.
• Neglecting responsibilities, such as school or work, in order to continue drinking.
• Getting into financial problems to keep consuming alcohol.
• Engaging in harmful behaviours, such as drunk driving or unprotected sex, when drinking.
• Intense cravings for alcohol when they’re not able to drink.
• Experiencing other withdrawal symptoms when trying to stop drinking.
• Failing to quit drinking despite multiple attempts.

Once you or a loved one starts to show some of these symptoms, it’s time to consider alcohol addiction treatment. Don’t wait until the symptoms get worse or progress through the different stages of alcohol addiction. The earlier someone gets treatment, the better their chances of recovery.

What Is Unhealthy Drinking?

Unhealthy drinking is when a person drinks above the recommended alcohol intake. According to the NHS, it’s not recommended to drink more than 14 units of alcohol regularly per week. A person who engages in excessive drinking isn’t necessarily addicted or dependent on alcohol, but it’s a habit that can eventually cause addiction. 

Unhealthy drinking can also cause long-term effects, such as an increased risk of liver or heart disease. Engaging in this amount of alcohol use for a long time will also cause cognitive impairments, which affect decision-making and memory. 

What Increases the Risk of Alcohol Use Disorder?

Many factors can increase the risk of alcohol misuse, such as:

• Genetics: Those with a family history of alcohol have a higher risk of developing alcohol misuse issues. It’s not the sole factor in developing AUD, but it does have an effect. 
• Peer pressure: Many people start drinking because their friends influenced them to do so or because they’ve found themselves in situations where it’s difficult to say no to drinking.  
• Environmental factors: Certain memories or places can be associated with drinking. People who often find themselves thinking about these memories or going to these places have a higher risk of developing AUD.
• Cultural influences: In some cultures, drinking is often seen as a way to celebrate. Whether it’s weddings, graduations, or birthdays, it can be hard to disassociate drinking from these events. 
• Unhealthy habits: Some people have associated certain times of the day with drinking. They may struggle to go about the rest of their day without engaging in this habit. 
• Co-occurring disorders: As mentioned earlier, co-occurring mental health conditions may increase the likelihood of substance use. This is because people struggling with these disorders often turn to substances to escape negative emotions. 

What This Means for Treatment of AUD

Seeing alcoholism as a health condition changes the plan from “try harder” to “treat it properly.” Here’s what good care looks like in practice:

1. Assessment
   Medical and mental-health history, current use, meds, risks, and withdrawal screening. This decides if alcohol detox is needed and how to do it safely.
2. Pick the safe detox route
   Non-acute alcohol detox can be managed at Liberty with medical oversight and monitoring. If risk is high, stabilise first in our partner hospital in Cape Town, then step down into structured care.
3. Core programme
   Daily structured therapy, weekly 1:1s, skills for craving and triggers, optional 12-step support, family involvement, and real relapse-prevention planning.
4. Treat co-occurring issues
   Psychiatric review and medication when indicated. Address anxiety, depression, trauma, sleep, and pain so alcohol is not doing that “job.”
5. Relapse prevention and aftercare
   Clear trigger map, coping routines, medication adherence if prescribed, family boundaries, and a written plan with check-ins or online outpatient.

If you need a place to start, talk to our team about alcohol rehab in Cape Town so we can assess risk and map the safest path into treatment.