Is Alcoholism a Mental Illness?

Alcoholism, the common term for problem drinking or alcohol addiction, is a complex disease that has psychological, biological, and social components. According to the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), alcoholism—known clinically as alcohol use disorder—is a mental disorder.[1]

Because alcohol is a common and acceptable part of social occasions in the US and across the world, the line between acceptable and problematic drinking is often blurred. To make things more confusing, different categories of problematic drinking aren’t necessarily alcohol use disorders.

Causes and Risk Factors for Alcohol Addiction

Alcohol use disorder is not as simple as choosing to drink excessively. Multiple risk factors affect whether someone develops alcohol addiction, including genetics, biology, and environmental and social influences.

The brain’s reward center reinforces naturally pleasurable behavior, such as listening to music, exercising, eating good food, or having sex, by releasing the feel-good chemical dopamine.

Addiction research suggests that people who are more susceptible to substance use disorders, including alcohol use disorder, might have differences in their brain’s dopamine system, which could include variations in dopamine levels, receptors, or dopamine-related reward pathways. For them, using alcohol or other drugs brings powerful feelings of pleasure, causing their brain to become hardwired to want more alcohol or drugs instead of natural pleasures.

According to the National Institute on Drug Abuse, people who misuse substances eventually feel numb, depressed, or lifeless, no longer deriving pleasure from activities or experiences they once enjoyed.[2] Ultimately, substances are the only way for them to have that rewarding feeling, leading to a vicious circle of substance use.

Is Alcohol Addiction Considered a Disease?

In 1956, the American Medical Association (AMA) classified “alcoholism” as a major medical problem. This marked a shift in how the medical community viewed alcoholism. With this new classification, alcoholism was seen as a disease rather than a behavioral problem.[3]

Later, alcoholism was further defined as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations.[4] Alcoholism is often progressive and fatal, marked by impaired control and preoccupation with alcohol, use of alcohol despite consequences, and distortions in thinking.

Is Alcoholism a Mental Illness?

Substance use disorders, including alcohol use disorder, were more comprehensively recognized and categorized in the DSM-III in 1980.  Alcoholism had a category in the DSM-II, but it was based on subcategories of dependence, episodic excessive drinking, and habitual excessive drinking.[5]

Currently, alcohol use disorder is classified as a mental disorder in the DSM-5 with specific diagnostic criteria and levels of severity. It’s defined as a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following occurring within 12 months:

• Consuming large amounts of alcohol or for a longer period than intended
• A desire to cut back or stop alcohol use without success
• An inordinate amount of time spent obtaining, using, or recovering from alcohol
• Experiencing cravings for alcohol
• Missing responsibilities at work, school, or home
• Continuing alcohol use despite social or interpersonal problems
• Giving up activities once enjoyed because of alcohol use
• Using alcohol in dangerous situations, such as driving
• Continuing to use alcohol despite health or psychological problems[6]

What Makes Alcohol Addiction a Mental Disorder?

Mental disorders – also known as mental illnesses – are conditions that affect thinking, feeling, mood, and behavior.[7] They can be occasional (acute) or long-lasting (chronic), affecting your ability to interact with others or function daily.

Many factors contribute to mental health disorders, including biological factors like chemical imbalances in the brain. Alcohol addiction may also be rooted in changes in the brain, as well as other causes.

According to the American Society of Addiction Medicine (ASAM), addiction is a chronic disease of the brain reward, motivation, memory, and related circuitry caused by dysfunction, leading the person to pursue rewards or relief through substance use in an extreme manner.[8] Alcohol addiction is a primary disease, which means it’s due to a root cause of illness, compared to a secondary disease, which is a complication of a primary disease.

For decades – centuries, even – alcohol use was viewed as a social, moral, or criminal problem, with derogatory terms like “drunk” or “alcoholic” only fueling the stigma. In reality, it’s a problem with the function of the brain, like any other disease and its associated organ. Behavioral problems are associated with alcohol addiction, including possible criminal acts, but it’s still about the brain and not morality or willpower.

Alcohol addiction is a mental health condition that often leads to various physical complications and behavioral effects. When untreated, it can result in severe health issues, including liver damage, brain damage, and an increased risk of death.

Co-Occurring Alcohol Addiction and Mental Health Disorders

As a mental illness, alcoholism can occur on its own. However, it often occurs in people who have other severe mental illnesses like anxiety disorder, depression, and bulimia nervosa.[9]

With co-occurring disorders, the symptoms of both disorders can exacerbate psychiatric, medical, and family issues. Alcohol use may worsen as the co-occurring mental illness symptoms intensify, and as the symptoms intensify, more alcohol may be used to alleviate them. Co-occurring conditions can also make the treatment of both illnesses more complicated.

For example, individuals with anxiety or depression might use alcohol to self-medicate, seeking temporary relief from their symptoms, which can include reducing anxiety or temporarily elevating mood rather than specifically seeking heightened mood or lowered inhibitions. People with mental illness may also experiment early because of peer pressure.

Treatment for Alcohol Use Disorder

The treatment for alcohol use disorder has many of the same treatment approaches and therapies as other mental health disorders. This comprehensive approach is necessary to address both the addiction itself and the social or environmental factors that contribute to it.

Cutting back or stopping alcohol use is not a matter of willpower or determination. In fact, with regular alcohol use, the body builds up a tolerance. Quitting abruptly can lead to intense and possibly life-threatening withdrawal symptoms, including seizures and delirium tremens (DTs).[10]

Often, alcohol addiction treatment begins with medically supervised detoxification, medical detox to manage the symptoms of withdrawal and ensure that you are as safe and comfortable as possible.

While medical detox is a critical first step in managing physical withdrawal symptoms, it is not sufficient on its own for long-term recovery. Comprehensive treatment for alcohol use disorder, a mental health condition, typically involves a combination of behavioral therapies, counseling, and possibly medication-assisted therapy (MAT), which can be provided in both inpatient and outpatient settings. Treatment plans are always tailored to the individual but may include psychotherapy, mutual-support groups, and medication-assisted therapy (MAT).[11]

Seek Help for Alcohol Addiction

Alcohol use disorder, which was once known as alcoholism, is a medical diagnosis and a mental disorder that’s related to biological, genetic, environmental, and social factors. If you or a loved one is struggling with alcohol use disorder, help is within reach. Treatment approaches like those at Recovery Unplugged focus on whole-person healing, addressing alcohol addiction as a disease, and considering the mental, emotional, and behavioral factors that contribute to it. Contact us today to learn about your treatment options.

Frequently Asked Questions

Sources

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[1] National Institute on Alcohol Abuse and Alcoholism. (2021, April). Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5 | National Institute on Alcohol Abuse and Alcoholism (NIAAA). https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-use-disorder-comparison-between-dsm

[2] National Institute on Drug Abuse. (2020, July). Drugs, Brains, and Behavior: The Science of Addiction: Drugs and the Brain | NIDA. https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain

[3] Henry, T. A. (2019, August 16). Court listened to AMA on defining alcoholism as a disease, not a crime. American Medical Association. https://www.ama-assn.org/delivering-care/public-health/court-listened-ama-defining-alcoholism-disease-not-crime

[4] Morse, R. M., & Flavin, D. K. (1992). The definition of alcoholism. The Joint Committee of the National Council on Alcoholism and Drug Dependence and the American Society of Addiction Medicine to Study the Definition and Criteria for the Diagnosis of Alcoholism. JAMA, 268(8), 1012–1014. https://doi.org/10.1001/jama.268.8.1012

[5] Norko, M. A., & Fitch, W. L. (2014). DSM-5 and Substance Use Disorders: Clinicolegal Implications. Journal of the American Academy of Psychiatry and the Law Online, 42(4), 443–452. https://jaapl.org/content/42/4/443#:~:text=In%20the%20second%20edition%20(DSM,2%2C%20p%2045).

[6] PsychDB. (2024, February 1). Alcohol Use Disorder (AUD). PsychDB. https://www.psychdb.com/addictions/alcohol/1-use-disorder

[7] MedlinePlus. (2023, March 16). Mental Disorders. National Library of Medicine. https://medlineplus.gov/mentaldisorders.html

[8] American Society of Addiction Medicine. (2019, September 15). What is the Definition of Addiction? Default. https://www.asam.org/quality-care/definition-of-addiction

[9] Palzes, V. A., Parthasarathy, S., Chi, F. W., Kline-Simon, A. H., Lu, Y., Weisner, C., Ross, T. B., Elson, J., & Sterling, S. A. (2020). Associations Between Psychiatric Disorders and Alcohol Consumption Levels in an Adult Primary Care Population. Alcoholism, Clinical and Experimental Research, 44(12), 2536–2544. https://doi.org/10.1111/acer.14477

[10] Jesse, S., Bråthen, G., Ferrara, M., Keindl, M., Ben‐Menachem, E., Tanasescu, R., Brodtkorb, E., Hillbom, M., Leone, M. A., & Ludolph, A. C. (2017). Alcohol withdrawal syndrome: Mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135(1), 4–16. https://doi.org/10.1111/ane.12671

[11] NIAAA. (2017, June 1). Types of Alcohol Treatment | Alcohol Treatment Navigator | NIAAA. https://alcoholtreatment.niaaa.nih.gov/what-to-know/types-of-alcohol-treatment