One Drunk to Another An Illness of This Sort
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1 2 3 4 5 6 7 8 9 10 11 12 BRAIN IMAGING AssessmentAlcohol use disorderDSM-5 · criteria in the past 12 monthsDrank more, or longer, than meant toTried to cut down and couldn’tCravingKept on despite the trouble it causedToleranceSeverity: moderate A.A. as aResource forthe HealthCareProfessionalThe A.A. Member—Medicationsand OtherDrugs ℞
Illustration · A doctor’s desk today: a checklist for alcohol use disorder on the screen, a prescription pad and a pill bottle, a stethoscope, and AA pamphlets in a stand, under a clock and a poster of brain scans. Imagined; not drawn from a photograph, and the screen’s words are written for the picture.

1994 and after

Legacy

One more name in the manual, an argument over the brain, medicines for it, and AA, careful to keep out of it.

“…because it could imply a point of view or an opinion.”

AA’s General Service Conference, changing a phrase in one of its pamphlets in 1993 · Box 4-5-9, June–July 1993

One more name

In 1994 the fourth edition of the psychiatrists’ manual, DSM-IV, kept the two names of 1980, alcohol abuse and alcohol dependence. The fifth, in May 2013, folded them into one, alcohol use disorder, found in “anyone meeting any 2 of the 11 criteria during the same 12-month period,” as the National Institute on Alcohol Abuse and Alcoholism sums it up, and called mild, moderate or severe by how many. The institute calls it “a medical condition,” and adds, “Considered a brain disorder, AUD can be mild, moderate, or severe.”

The brain had come in from the laboratories. In 1997 Alan Leshner, director of the National Institute on Drug Abuse, argued in Science that addiction is a brain disease, and that it matters. “Addiction is a brain disease expressed in the form of compulsive behavior,” he wrote in 2001. The American Society of Addiction Medicine wrote the brain into its definition of addiction in 2011, and in 2019 called addiction “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.”

Others answered. In 2014 about ninety scientists wrote to Nature that they disagreed with its “one-dimensional view that addiction is a disease.” That year the psychiatrist Sally Satel and the psychologist Scott Lilienfeld argued that the model “obscures the dimension of choice in addiction,” and in 2015 the neuroscientist Marc Lewis called his book The Biology of Desire: Why Addiction Is Not a Disease. Six researchers defending the model in 2021 granted that “some of these criticisms have merit,” but held that “the foundational premise that addiction has a neurobiological basis is fundamentally sound.”

There were medicines for it, too. The Food and Drug Administration approved disulfiram, sold as Antabuse, for alcohol dependence in 1951, naltrexone in 1994 and acamprosate in 2004. AA’s pamphlet on medications, which replaced an older one in 1984, says that “No A.A. member should ‘play doctor’; all medical advice and treatment should come from a qualified physician.”

These pages take no side, and nothing on them is medical advice. Questions about drinking and its treatment belong with a doctor; Come Early, Stay Late answers a newcomer’s questions about AA.

Listen Legacy About 1 minute

Where the word stands

Four words, today

What the bodies that name it, the researchers who argue over it and AA’s own pamphlets call it now, grouped by the word each one uses.

From the National Institute on Alcohol Abuse and Alcoholism, the World Health Organization, the Surgeon General’s report of 2016, the papers named, and AA’s pamphlets as aa.org gives them in 2026. Each is quoted in its own words; the grouping is this page’s, and AA’s card is marked in the accent because its word is where this piece began.

  1. “disorder”

    The manuals and the federal institute

    • 2013The psychiatrists’ manual, DSM-5One “alcohol use disorder” in place of abuse and dependence, mild, moderate or severe.
    • 2022The World Health Organization, ICD-11“Disorders due to use of alcohol.”
    • 2025The National Institute on Alcohol Abuse and Alcoholism“Considered a brain disorder,” it is “a medical condition characterized by an impaired ability to stop or control alcohol use.”

  2. “disease”

    The addiction doctors and the brain researchers

    • 2016The Surgeon General’s report“Addiction is a chronic brain disease that has the potential for both recurrence (relapse) and recovery.”
    • 2016Nora Volkow and George Koob, heads of the drug and alcohol institutes, with A. Thomas McLellan“…neuroscience continues to support the brain disease model of addiction.”
    • 2021Markus Heilig and five colleagues“…denying that addiction is a brain disease is a harmful standpoint.”

  3. “learning,” “choice”

    The critics

    • 2014About ninety scientists, to Nature“…we disagree with your one-dimensional view that addiction is a disease.”
    • 2014Sally Satel and Scott Lilienfeld“…the brain-disease model obscures the dimension of choice in addiction.”
    • 2018Marc Lewis, in the New England Journal of MedicineThe title of his review: “Brain Change in Addiction as Learning, Not Disease.”

  4. “illness”

    AA’s pamphlets

    • NowThis Is A.A.“…a progressive illness that can never be ‘cured,’ but which, like some other illnesses, can be arrested.”
    • NowA.A. as a Resource for the Health Care Professional“From the beginning, A.A. members have regarded alcoholism as an illness.”
    • NowIs A.A. for You? and A.A. at a GlanceAnd here and there “the disease of alcoholism.”

No last word

The manuals say disorder; the addiction doctors and brain researchers, disease; their critics, learning or choice; and AA’s pamphlets mostly illness, two centuries after Benjamin Rush called drunkenness a disease.

For a closer look

Go deeper

How the brain came into the argument, the medicines and AA’s pamphlet about them, and how carefully AA’s own literature words it.

The brain

Leshner’s article of 1997 was titled “Addiction Is a Brain Disease, and It Matters.” In 2001 he wrote that “the majority of the biomedical community now considers addiction, in its essence, to be a brain disease.”

His institute’s own words have varied. An older guide it wrote for journalists called addiction “a chronic, relapsing brain disease”; its 2018 booklet on the science calls it “a chronic, relapsing disorder” that “is considered a brain disorder.” Among the critics, the psychologist Gene Heyman had called his 2009 book Addiction: A Disorder of Choice, and Marc Lewis followed his book with a review of the brain research in the New England Journal of Medicine in 2018.

The medicines

Disulfiram was found by accident. In Copenhagen in 1947, researchers testing it against stomach parasites took small doses themselves, then fell ill after a drink, as a federal treatment guide tells it. Today the alcohol institute counts three medications approved to help people stop or reduce their drinking, and says, “All these medications are nonaddictive.” Few people take them: in a national survey of 2019, “only 1.6% reported using an approved medication for AUD,” the National Institutes of Health reported.

AA’s pamphlet came out of a correction. In 1983 a committee of AA’s trustees recommended that the old one, The A.A. Member and Drug Abuse, “no longer be printed or circulated, because of its inaccuracies.” The Conference kept it in print until its replacement, which it approved in 1984. That pamphlet says that “Some A.A. members must take prescribed medication for serious medical problems,” and that, just as it is wrong to help any alcoholic become addicted again to any drug, “it’s equally wrong to deprive any alcoholic of medication that can alleviate or control other disabling physical and/or emotional problems.” It was revised in 2011, and in 2026 the Conference asked for it to be revised again, with a report due in 2027.

AA’s own words

The change of 1993 was to a pamphlet called A.A. in Your Community: the phrase “A.A.’s position in the field of alcoholism” became “A.A. and alcoholism.” The same care runs through AA’s pamphlets now. Among the things AA does not do, one of them lists: “Make medical or psychological diagnoses or prognoses.”

The pamphlet AA writes for doctors and nurses speaks for its members rather than for AA, and a footnote in it gives the 1992 definition that calls alcoholism “a primary, chronic disease” (Willful misconduct tells where that came from). A far safer term counts the Big Book’s own words for it.

Sources
  • National Institute on Alcohol Abuse and Alcoholism, “Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5,” revised 2021 (niaaa.nih.gov); American Psychiatric Association, “History of the DSM” (psychiatry.org).
  • National Institute on Alcohol Abuse and Alcoholism, “Understanding Alcohol Use Disorder,” updated January 2025 (niaaa.nih.gov).
  • World Health Organization, Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders (2024), p. 442 (drugsandalcohol.ie).
  • Alan I. Leshner, “Addiction Is a Brain Disease, and It Matters,” Science 278 (October 3, 1997), pp. 45–47; and “Addiction Is a Brain Disease,” Issues in Science and Technology 17, no. 3 (Spring 2001) (issues.org).
  • National Institute on Drug Abuse, Drugs, Brains, and Behavior: The Science of Addiction, revised July 2018 (nida.nih.gov); and its media guide for journalists, The Science of Drug Abuse and Addiction: The Basics (nida.nih.gov).
  • American Society of Addiction Medicine, “Definition of Addiction,” 2019 (asam.org), and its public policy statement of 2011 (asam.org).
  • 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 (November 2016), p. 1-6 (hhs.gov).
  • Nora D. Volkow, George F. Koob and A. Thomas McLellan, “Neurobiologic Advances from the Brain Disease Model of Addiction,” New England Journal of Medicine 374 (January 28, 2016), pp. 363–371 (nejm.org).
  • Markus Heilig and others, “Addiction as a brain disease revised: why it still matters, and the need for consilience,” Neuropsychopharmacology 46 (2021), pp. 1715–1723 (nature.com).
  • Derek Heim and others, “Addiction: Not just brain malfunction,” letter, Nature 507 (March 6, 2014), p. 40 (nature.com).
  • Sally Satel and Scott O. Lilienfeld, “Addiction and the Brain-Disease Fallacy,” Frontiers in Psychiatry 4 (2013), article 141, published March 3, 2014 (frontiersin.org).
  • Marc Lewis, The Biology of Desire: Why Addiction Is Not a Disease. PublicAffairs, 2015; and “Brain Change in Addiction as Learning, Not Disease,” New England Journal of Medicine 379 (October 18, 2018), pp. 1551–1560.
  • Gene M. Heyman, Addiction: A Disorder of Choice. Harvard University Press, 2009.
  • Substance Abuse and Mental Health Services Administration, Incorporating Alcohol Pharmacotherapies Into Medical Practice, Treatment Improvement Protocol 49 (2009), chapters 3–5 (ncbi.nlm.nih.gov); “New Medication Reduces Alcohol Cravings,” Psychiatric News, September 3, 2004.
  • “Few are prescribed medications to treat alcohol problems,” NIH Research Matters, July 13, 2021, on Han and others, JAMA Psychiatry (2021) (nih.gov).
  • AA World Services, The A.A. Member—Medications and Other Drugs, as reprinted in the appendix to Living Sober, pp. 89–92 (aa.org).
  • Box 4-5-9, June–July 1983 (aa.org), June–July 1984 (aa.org), June–July 1993 (aa.org), Summer 2011 (aa.org) and Summer 2026 (aa.org).
  • AA World Services, This Is A.A., large-print edition (aa.org); A.A. as a Resource for the Health Care Professional (aa.org); Is A.A. for You? (aa.org); A.A. at a Glance (aa.org); Information on A.A. (aa.org).
  • AA World Services and the General Service Office, letter on the fifth edition of the Big Book, August 26, 2026, as posted by Area 15 (area15aa.org); Alcoholics Anonymous World Services, call for stories for a proposed fifth edition of the Big Book.
  • Alcoholics Anonymous (the Big Book). Works Publishing, 1939, “There Is a Solution”; fourth edition, 2001, Appendix I, “The A.A. Tradition” (aa.org).