Alcoholism: disease or symptom? The challenges of managing advanced alcoholism and chronic illness

The negative consequences of alcoholism are well established.1 Although there have been recent improvements in interventions, some of them acknowledging that abstinence may be rejected by problem drinkers,2 most treatments focus on readiness to change.3 This may be problematic for people with advanced dependence, as alcoholism is associated with: (a) psychological issues4 and memory loss,5 which may reduce motivation for treatment compliance; and (b) damage to the frontal lobes,6 which can reduce risk appreciation and forward planning. In other words, the disease itself serves to reduce readiness to change.