Problem Drinking: Disease or Choice? Or Both?

An article I recently read described a precedent-setting 1968 US court case in which the defendant, chronic drunky-drunk Leroy Powell, was found guilty of public intoxication[1]. The judge in this case reasoned that Leroy, an alcoholic, had nonetheless chosen to only have one drink in the morning because he knew he needed to semi- have his act together in court. Because he’d been deliberate about this, he demonstrated that he chose to drink and therefore could be held responsible for his drunken conduct.

As I considered in an earlier blog, this whole “disease of alcoholism” thing invokes a lot of questions around morality and personal responsibility. The question is whether problem drinking is something that happens to us (like a disease), or something we do to ourselves. The distinction influences the way people judge alcoholics. If someone determines, like the judge in the Powell case, that drinking is a choice, it’s easier to dismiss the suffering of addiction as lying in the bed one makes. The “disease” model more compassionately views the addict as someone who needs and can respond to treatment and “get better.”

The distinction also influences how we judge ourselves, and act on those judgments. Here’s the problem and paradox: On the one hand, if we don’t accept responsibility for our drinking, we dwell in denial. In the Land of Denial, something outside of ourselves can always be invoked to explain why we drink. “My job sucks. My life is stressful. The weather is bad. I’m celebrating. I’m pissed off. It’s Tuesday.”

On the other hand, those moments of clarity where one either recognizes or wonders about her problem drinking, are often accompanied by deep guilt and self-recrimination. And then these awful feelings lead to pain, which leads to… more drinking!

When I think hard about this for myself, I realize that I need to be compassionate with myself because it isn’t easy to quit drinking, and many of the sources of stresses in my life (and others’ lives) are legitimate. It seems fair to acknowledge these things. Also, I know that if I fall in to beating the hell out of myself, this can contribute to sadness, frustration, anger and relapse.

But then I ask: Where is that line between being compassionate and forgiving with yourself, and making excuses for yourself? What if being compassionate with yourself spins in to “I’ve had such a hard day. I deserve this drink. Poor me.”

Maybe the difference is between self-compassion and self-pity? It’s not always easy to see this. Self-pity, for me, is always accompanied by a feeling of entitlement and deprivation: that I deserve something I’m not getting. Self-compassion, on the other hand, feels like an easing. I feel like a little rest happens inside: “It’s okay if this is hard and you get tired and cranky sometimes.” But that feeling doesn’t extend to it being okay to stop trying.

So the whole responsibility and disease thing seems to be a “both/and” rather than an “either/or.” Whether you call it a disease or not, you can recognize that alcoholism comes out of pain, vulnerability and fatigue. Sometimes its just hard to be a human being. But that doesn’t mean we can’t work toward controlling and changing how we respond to our own suffering. That’s the responsibility part, and also something that invites us to focus on the road ahead instead of the baggage of the past.

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[1] Levi, D. S. (2016). The power of powerlessness. Philosophical Investigations, 39(3), 237–253. http://doi.org/10.1111/phin.12099

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