Week 2 of 7: It's a Disease (and Why That Matters) 🩺

In the 1930s, a physiologist named E. M. Jellinek was given an unusual task: study alcoholism properly. No moral judgement or assumptions. Just rigorous, honest science.

What he found changed everything. Jellinek discovered alcoholism is a disease with identifiable stages, predictable progression, and the possibility of recovery. He identified four main stages of alcoholism: pre-alcoholic, prodromal, crucial (or critical), and chronic, each marked by increasing loss of control, compulsive drinking, and physical dependence. This wasn't weakness. It was biology. By 1960, he'd built the case that alcoholism was a genuine disease, not a character flaw and the World Health Organisation agreed. So did the American Medical Association. For the first time, alcoholism had medical legitimacy.

And that changed everything that came next — research funding, treatment programmes, hospital admissions instead of prison sentences. Doors that had been shut for centuries finally opened, forming the foundation for modern approaches to treatment and understanding of alcohol use disorders

But here's what I want to say clearly, especially after some of the comments on last week's post: calling something a disease doesn't erase the damage it does. It can be simultaneously true that someone couldn't help the grip alcohol had on them and that they are responsible for the harms they inflict on themselves and others. Understanding addiction as a disease isn't about excusing harm. It's about understanding it well enough to actually treat it, and well enough to hold both compassion for the person and honesty about the impact at the same time.

That's a hard balance. But I think it's the right one.

Next week: what's actually happening in the brain — and why willpower was never going to be enough on its own.

 Has reframing addiction as a disease changed how you think about someone in your life? I'd love to hear your thoughts.