I was at lunch with some coworkers recently and the subject of alcoholism came up. One woman said she had been dealing with a family friend who was an alcoholic. Watching him cycle through rehab and relapse over and over had led her to believe that he truly couldn�t prevent himself from drinking. I expressed some disbelief. Did she mean he really, physically and mentally, was incapable of not drinking? She said yes, she really thought so. Then I said he must be mentally ill. Then I shut up because I sensed I was talking out of my ass and needed to think more about it.

The inability to prevent oneself from doing irrational and destructive things is certainly part of the definition of mental illness. (Of course that definition is malleable and changes over time.) OCD and schizophrenia strike me as good examples of well-established mental illnesses that involve the inability to stop oneself from doing irrational and destructive things. It seems to follow that some �alcoholics� could be suffering from a similar form of mental illness involving the inability to stop drinking.

Are there, then, two types of problem drinkers -- those who are totally incapable of quitting, and those who just aren�t trying hard enough? How do you know which you are? More importantly, how can a treatment program decide which is which? Can you start out as one and turn into the other?

Even considering the mental illness possibility, I find it hard to believe there are drinkers who really can�t stop themselves. I know physical addiction is real and withdrawal can dangerous and even fatal. But still, I believe people have a choice, even if they are not aware of it. Maybe my belief is so strong because the alternative is so bleak.

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