[This is part one of a series that examines alcohol use disorder as a brain disorder and how public perceptions prevent those with the disorder from seeking treatment.]

Alcoholism, along with mental illnesses, are among the most stigmatized health conditions today. However, through public education, gaining an understanding of what alcoholism actually is can dispel preconceived ideas and misconceptions regarding the condition.

Whether referred to as alcoholism, alcohol addiction, or alcohol dependence, in January 2024, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), defined the condition as Alcohol use disorder (AUD), a medical condition and a brain disorder, AUD can be mild, moderate, or severe, states NIAAA.

AUD is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.

The New England Journal of Medicine (NEJM), in a January 2016 article, Neurobiology Advances from the Brain Disease Model of Addiction, reported that in the past two decades, research has increasingly supported the view that addiction is a disease of the brain.

Yet, despite the scientific evidence and the resulting advances in treatment and changes in policy, the concept of addiction as a disease of the brain is still being questioned, the report states. The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility that frame drug use as a voluntary, hedonistic act. In this view, addiction results from the repetition of voluntary behaviors.

As the article points out, part of the reason much of the public rejects the evidence that AUD is, in fact, a brain disease, or disorder, is that it does not allow for condemnation (or stigma) of the person with AUD as a human being.

“This concept of addiction appears to some to excuse personal irresponsibility and criminal acts instead of punishing harmful and often illegal behaviors,” the article points out.

The Harvard Medical School’s article, Is Addiction a “Brain Disease,” also published in 2016, concurred with the NEJM report:

“An addicted person’s impaired ability to stop using drugs or alcohol has to do with deficits in the function of the prefrontal cortex — the part of the brain involved in executive function,” the Harvard article states.

Lekshmi Venugopal, M.D., in a March 31, 2023, article, wrote that mental illnesses and substance use disorders are among the most stigmatized of health conditions.

“Stigma stems from inaccurate beliefs that mental illness and/or addiction are a moral failing, or that people with these diseases are at fault for their condition,” Venugopal explained.

“When a person with a mental illness or SUD experiences stigma,” Venugopal wrote, they may begin to internalize it, increasing that person’s stigma of himself.” 

Venugopal continued, stating that research shows that self-stigma can lead to lower self-worth and create barriers to treatment and recovery.

Since the New England Journal of Medicine article was first published eight years ago, more scientific research has been done to further understand the disorder. For those who become willing to become subject to the stigma they will encounter and endure should they choose treatment, the National Library of Medicine (NIH) there is good news: AUD is treatable.

“Most people with an alcohol use disorder can benefit from some form of treatment,” says NIH. “Medical treatments include medicines and behavioral therapies. For many people, using both types gives them the best results. People who are getting treatment for AUD may also find it helpful to go to a support group such as Alcoholics Anonymous (AA).”

Behavioral therapies are also effective in treating AUD, says the NIH report, including Cognitive Behavioral Therapy (CBT).

CBT states the article, “helps you identify the feelings and situations that can lead to heavy drinking. It teaches you coping skills, including how to manage stress and how to change the thoughts that cause you to want to drink.”

It can also include marital and family counseling, which includes spouses and other family members. It can help to repair and improve the damaged family relationships. Studies show that strong family support through family therapy is effective in recovery and avoiding relapse.