“Once an Alcoholic, Always an Alcoholic:” ‘Destigmatizing a Chronic Disease: The Power of Words’

A group of people clapping during a sobriety support group
December 23, 2021
|   Updated:
November 1, 2023

The phrase “Once an alcoholic, always an alcoholic” is one that many are familiar with. For those who either struggle with Alcohol Use Disorder (AUD) or those who have someone close to them who does, this saying continuously haunts those who have this disease.

While there may be some truth behind “Once an alcoholic, always an alcoholic,” the stigma it creates and maintains for those who struggle with AUD can be detrimental to one’s growth and recovery. This saying gives off the interpretation that overcoming this disease is hopeless, and those with an AUD should not expect to ever be “on the other side” of recovery.

What is the Issue With the Phrase “Once an Alcoholic, always an Alcoholic?” 

Friends talking about their alcohol issues

The connotation associated with this saying needs adjustment, not necessarily the phrase itself. Alcoholism is a chronic disease and needs to be treated like one. Therefore, people who have AUD will always have to maintain it. Just as people with type 1 diabetes have to manage their chronic illness their whole lives, so do those who struggle with AUD; maintenance is a factor in all chronic diseases, and alcoholism is no different.

However, by changing the language to something more sympathetic, understanding, and hopeful, those who have AUD do not need to feel ashamed or embarrassed of their disease and the lifelong maintenance it requires.

Understanding Alcoholism or Alcohol Use Disorder as a disease and why this particular language is so harmful could ultimately change the trajectory of someone’s treatment, recovery, and, ultimately, their life.

Understanding Alcohol Use Disorder

A man with a cup of coffee staring at the ocean through his window

Understanding what AUD is, the causes, symptoms, and treatments can help one see that remaining in recovery takes careful planning and meticulous care, just like any other disease, and, because of this, should be treated as such.

What is Alcohol Use Disorder?

Alcohol Use Disorder, which is colloquially referred to as alcoholism, is defined by the National Institute of Alcohol Abuse and Alcoholism (NIAA) as a “medical condition” in which someone is unable to function in their everyday life without the substance of alcohol with a spectrum ranging from mild to severe. Known as a brain disorder, AUD can also be referred to as alcohol abuse, dependence, or addiction.

Many who struggle with AUD have a desire to stop drinking, but their addiction is too strong to do so, even with a desire to change. Regardless of what it is referred to, it is essential to understand that, above all, AUD is considered a chronic disease.

Understanding Addiction as a Disease

A woman drinks coffee while on a video chat with her alcohol support group

As previously mentioned, AUD is a brain disorder or disease explicitly described by The American Society of Addiction Medicine as "a primary, chronic disease of brain reward, motivation, memory and related circuitry."

Being labeled a “primary disease” means AUD or addiction is not the result of one decision or action. Instead, it means there are many different factors that can contribute to the disease, and it may take many years to get it under control and remain manageable. 

What Causes AUD?

Like other diseases, there are various reasons why someone may struggle with AUD. Personal history, both medical and non-medical, as well as environment, can all affect one’s relationship with alcohol.

Level of Alcohol Consumption

One cause of AUD is the volume in which someone drinks. The more drinking one does, the higher the risk of addiction becomes. While AUD and binge drinking are not the same thing, one who binge drinks needs to be cautious of the possibility of struggling with substance abuse as continuing with that behavior could lead to AUD.

Beginning Drinking Age 

The age at which one starts indulging in alcohol may also cause someone to develop AUD. According to the NIAA, the risk of AUD is five times higher for those who start drinking extremely early in life, before 15 years old to be exact. When waiting until the legal age in the United States (21), the risk is five times less likely.


One of the most significant risks for AUD is genetics; those who have substance abuse in their families are more at risk. Genetics are responsible for between 50-60 percent of AUD, making it a possible cause. However, genetics alone cannot make someone have a substance abuse problem. It takes other factors like environment, parents' drinking patterns, or an early drinking age to establish AUD.

Environmental Factors

Trauma, mental illness, or other psychological disorders can also cause someone to become reliant on alcohol. Using alcohol as a way to numb pain or forget past experiences can cause one to over-consume and ultimately end up with AUD.

What are the Symptoms of AUD?

Because AUD is a chronic disease, the symptoms associated with this disorder should be seen as manageable and ultimately treatable. Some of the main symptoms of AUD, according to The Hazelden Betty Ford Foundation, can be both behavioral or physical.

Behavioral Symptoms

Some changes in behavior can be attributed to an AUD, including drinking at random or inappropriate times, anger issues or a rise in temper, moodiness, change in social circle, stealing or excessively borrowing money from friends or family, and missing work or other responsibilities.

Physical Symptoms

Physical symptoms are also connected to AUD, including sudden weight loss or gain, red or glossy eyes, depression, nausea and vomiting, bruises, cuts or scrapes due to stumbling or falling, puffiness or swelling in the face, and little to no energy are just a few of the possible physical symptoms.

What are the Risks of AUD?

There are many different risks associated with AUD that are detrimental to one physically, emotionally, and mentally. They can be both short-term and long-term. Some of the former include physical accidents like falling or car accidents, violence with strangers or someone close to you, or alcohol poisoning and a stint at the hospital.

Long-term risks include liver and kidney disease or failure, high blood pressure or heart disease, cancer in multiple parts of your body, cognitive decline, and mental illness like depression or anxiety.

Those who suffer from AUD are aware of these risks, but this disease makes it impossible to stop even when they want to. With risks this severe, many with AUD try and stop, but because it is a disease, it is not always as simple as a desire to get better. A treatment plan similar to other chronic illnesses may need to be implemented to achieve long term recovery.

Treatment and Recovery

A woman talks to her friend about alcohol treatment and recovery

The saying  “Once an alcoholic, always an alcoholic” exists because recovery is not an easy process, and it can sometimes take years to find a methodology that works and is sustainable for an individual; there are often relapses that take place on the road to recovery.

Understanding that treatment can and should be individualized can also help break the stigma surrounding AUD. What works for one person may not work for another, and like other chronic diseases, treatment and recovery for AUD needs to be specialized for the individual.

Fortunately, many different tools can be used when seeking recovery from AUD. A combination of these resources can help one who suffers from alcoholism maintain their sobriety and live a healthy life in recovery.

Rehabilitation Programs

There are many different types of rehabilitation programs that include outpatient and inpatient and that last for different amounts of time; some programs last 30 days, some 60. Each of these programs has its own specialties and, again, what works for one person may not work for another.

Group Accountability

One of the most significant ways to maintain AUD and remain in recovery is surrounding yourself with people who can support your sobriety. In addition to rehabilitation programs, attending Alcoholics Anonymous (AA) meetings and forming a supportive recovery circle will help keep one who struggles with staying sober on track as they have people in their corner rooting for them and continually supporting them.


Self-accountability can be a fantastic tool for those motivated by goals and rewards. With tools like Soberlink’s remote breathalyzer on the market, an individual can self-monitor themselves, tracking progress, restoring relationships, and crossing off goal after goal.

Having the autonomy over one’s sobriety can give someone with an addiction power and control over their life again, and in turn, help them treat their AUD.

Destigmatizing a Chronic Disease: The Power of Words  

Two colleagues talking about AUD while walking

For those who struggle with AUD, it can be destructive to their recovery and sobriety to hear the saying “Once an alcoholic, always an alcoholic,” because they are aware that they struggle with a disease that needs lifelong care and treatment; the negative reminder from others does not help support them in their recovery.

Instead of conforming to believing in the stigma, it is crucial to acknowledge alcoholism as a disease and come from a place of sympathy and understanding for the lifelong treatment those with AUD must endure.

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