Recognizing Alcoholism as a Disease

One of the difficulties in recognizingalcoholism as a diseaseis it doesn’t quite seem like one. It doesn’t look, sound or act like most diseases we know. And, generally, alcoholism remains hidden and resists treatment.

Mental Obsession

Have you ever woken up in the morning with a song playing over and over in your head? It might have been a commercial jingle you heard on television or a song from the radio, but it kept playing … and playing and playing.

Remember what that was like? No matter what you did, the silly tune kept on playing. You could try to whistle another song, or turn on the radio to listen to another tune, but the one in your head just kept on playing. This thought was taking over your mind, even though you didn’t want it there and tried hard to get it out out.

This is an example of amental obsession– a thought process over which you have no control.

Such is the nature of alcoholism. When the drinking “song” starts playing in the mind of an alcoholic, they are powerless. The alcoholic didn’t put or want the thought there, the only way to get it to stop is to have another drink.

The problem is the alcoholic’s mental obsession with alcohol is much more subtle than a song playing in one’s mind. In fact, a person may not even know it’s there. All they know is there is a sudden urge for a drink, a physical compulsion.

The Difference Between an Addiction and a Compulsion

The Neurobiology of Alcoholism

In 2016, the U.S. Surgeon General issued a report, “Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health,” which details the changes in the regions of the brain of someone with an addiction in a section entitled, “The Neurobiology of Substance Use, Misuse, and Addiction.”

According to the report,substance use disordersresult from changes in thebrainthat occur with the repeated use of alcohol or drugs. These changes take place in brain circuits involved in pleasure, learning, stress, decision-making and self-control.

Understanding Alcoholism and the Signs of Severe Drinking Problems

When someone drinks alcohol—or takes drugs like opioids or cocaine—it produces a pleasurable surge of dopamine in the brain’s basal ganglia, an area of the brain responsible for controlling reward systemsand the ability to learn based on rewards.

With continued use of alcohol or drugs, nerve cells in the basal ganglia “scale back” their sensitivity to dopamine, reducing alcohol’s ability to produce the same “high” it once produced. This is how one builds atolerance to alcohol, which causes people to consume larger amounts to feel the same euphoria they once did.

Drinking Linked to Other Cues

When so many things in life become reminders of drinking, it becomes more and more difficult for people to not think about drinking.

Recognizing Alcoholism as a Disease

Drive to Avoid Pain

While the brain’s dopaminetransmittersdrive us to seek pleasure, the stress neurotransmitters found in the extended amygdala region of the brain drive us to avoid pain and unpleasant experiences.

Substance abuse, including alcohol use disorders, can disrupt the normal balance between these two basic drives, research has found.

Avoiding the Pain of Withdrawal

Asalcohol use disorderprogresses from mild to moderate to severe, the drinker experiences increasing distress when they are not drinking. Symptoms from alcohol withdrawal can become very uncomfortable or painful.

Alcohol use can progress to a point where the only thing that can relieve thewithdrawal symptomsis more alcohol.

At this stage, the person is no longer drinking to experience pleasure. In fact, drinking may not even bring any feeling of pleasure anymore. The drinker is drinking to avoid pain, not to get those feelings of euphoria.

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The Cycle of Addiction

Alcoholics build such a tolerance that they are no longer able to reach the high they once did, however, the lows they experience when not drinking become lower and lower. Other pursuits in life that once brought pleasure and balanced out the lows no longer do so.

When the drinkers were still relatively healthy, they could control their impulse to drink because the judgment and decision-making circuits of their prefrontal cortex would balance out those impulses. But, once addicted, substance use also disrupts prefrontal circuits.

When this happens, research shows, alcoholics and addicts have a reduced ability to control theirpowerful impulse to usethe substance, even when they are aware it is not in their best interest. At this point, their reward system has become pathological, or, in other words, diseased.

If you or a loved one are struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with substance use or addiction, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

What to Know About Alcohol Use Disorder

Compromised Self-Control Explained

The Surgeon General’s report on the neurobiology of substance abuse, explains alcoholics’loss of self-controlin this way:

Progressive Disease

The progression of the disease is subtle, and usually takes place over such an extended period, that even the alcoholic themselves fails to notice the point at which they lost control and alcohol took over their life.

For this reason,denial is an almost universal symptomof the disease. For those who have realized they have a problem,helpmay be as close as the white pages of the telephone directory. And, for those who need help and do not want it, help is still out there.

Are you worried you or a loved one have a drinking problem? Take a look at theAlcohol Abuse Screening Quizto see how symptoms compare.

How to Stop an Addiction

2 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Morse RM, Flavin DK.The Definition of Alcoholism.JAMA.1992;268(8):1012-1014. doi:10.1001/jama.1992.03490080086030U.S. Department of Health and Human Services, Office of the Surgeon General.Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC; 2016.

2 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Morse RM, Flavin DK.The Definition of Alcoholism.JAMA.1992;268(8):1012-1014. doi:10.1001/jama.1992.03490080086030U.S. Department of Health and Human Services, Office of the Surgeon General.Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC; 2016.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Morse RM, Flavin DK.The Definition of Alcoholism.JAMA.1992;268(8):1012-1014. doi:10.1001/jama.1992.03490080086030U.S. Department of Health and Human Services, Office of the Surgeon General.Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC; 2016.

Morse RM, Flavin DK.The Definition of Alcoholism.JAMA.1992;268(8):1012-1014. doi:10.1001/jama.1992.03490080086030

U.S. Department of Health and Human Services, Office of the Surgeon General.Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC; 2016.

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