Dr. Mark Willenbring is an American psychiatrist and addiction researcher who fundamentally challenges the traditional view of alcohol dependence as a “chronically progressive disease.” He served for many years as research director at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and later founded the Alltyr Clinic in Minnesota. His work and public appearances are regarded as milestones in establishing a modern, biopsychosocial understanding of alcohol addiction.
In an interview, Willenbring essentially said that the existing addiction treatment system needs to be “rebuilt with bulldozers and dynamite.” The interviewer was referring to the outdated foundation of the treatment system, which Willenbring confirmed: the current model originated in the 1940s and has hardly changed since. Even the earliest treatment programs primarily served as an introduction to the Alcoholics Anonymous movement. The full interview has been transcribed and archived together with the original video file. Both sources are securely preserved and can be accessed upon request.
Willenbring criticizes the strict abstinence orientation of many therapies, which stems from E. M. Jellinek’s disease model. In his view, alcohol dependence is not a uniform, incurable disease but a spectrum of behavioral disorders with varying biological and psychological causes. The goal should be to promote individual strategies for harm reduction, control, and improved quality of life—not necessarily complete abstinence.
He advocates treating alcohol dependence more like other chronic health conditions—with ongoing, evidence-based support rather than time-limited “therapies.” Medications such as naltrexone, acamprosate, or baclofen can, in his opinion, be just as integral to successful treatment as psychotherapeutic and behavioral approaches. Voluntary motivation, respect for personal autonomy, and realistic intermediate goals take center stage.
A key empirical basis for his criticism is the NESARC study (National Epidemiologic Survey on Alcohol and Related Conditions), a large-scale NIAAA investigation. It revealed that alcohol dependence occurs far more frequently in the U.S. population than previously assumed—and at the same time, that in most cases it remits spontaneously or with moderate support. Approximately 72 percent of respondents with lifetime alcohol dependence reported only one episode, typically lasting three to four years, with no subsequent relapses. These findings contradict the assumption of an inevitably chronic-progressive illness. Willenbring sees clear evidence here that the common image of an “incurable disease” is not empirically sustainable and that many affected individuals can permanently change their drinking behavior without having to abstain completely.
For this reason, Willenbring considers E. M. Jellinek’s classic model—with its idea of irreversible loss of control—outdated. He views the treatment system shaped by the “12 Steps” as a culturally evolved but scientifically inadequate paradigm. Instead of moral categories and group rituals, he calls for differentiated, medically sound, and individualized treatment pathways.
Willenbring’s positions have strongly influenced the discussion on modern addiction treatment. His lectures and publications are widely received internationally, even though they encounter resistance in traditional addiction support structures. In the United States, his approach has significantly contributed to the establishment of individualized and medication-assisted therapies.
The key paper by Mark Willenbring, in which he presents his view of alcohol dependence as a modifiable behavioral disorder, was temporarily unavailable in the National Library of Medicine. This text has also been archived and can be requested if needed. Thus, both the central written source and the video interview are preserved for scientific and documentary purposes.
See also: E. M. Jellinek – Developer of the traditional disease model of alcohol dependence.
Frequently Asked Questions about Dr. Mark Willenbring
The image of “bulldozers and dynamite” comes from an interview in which Willenbring emphasized that addiction treatment must be rebuilt from the ground up. The current system originated in the 1940s and has barely changed since. Both the interview and its full transcript are archived and available upon request.
The NIAAA’s NESARC study found that about 30 percent of the adult U.S. population meets criteria for an alcohol use disorder at some point in life. However, around 72 percent experienced only one episode—usually lasting three to four years—and then remained stable long-term, often without formal treatment. These data refute the idea of an inevitably chronic disease.
He rejects the notion of an “incurable disease” and views alcohol dependence as modifiable behavior with biological, psychological, and social causes. For him, treatment means individualized harm reduction rather than moral conversion.
Willenbring supports the targeted use of evidence-based medications such as naltrexone, acamprosate, or baclofen. These drugs can alleviate withdrawal symptoms, prevent relapse, and help individuals better control their alcohol consumption.