Some people are not surgical candidates because of certain factors that include lifestyle habits such as drinking. The issue with surgery is that the patient and the doc have to weigh risks and benefits. Factors such as drinking may tip the scale in the direction of more risk than benefit, in which case a self-respecting surgeon would not proceed with an operation. It’s not about punishing alcoholics, it’s all about trying to maximize benefits and minimize risks.
Internists and GPs have a different calculus because they don’t operate. It’s better to have someone engaged with treatment and under observation to reduce existing risk factors. Not only can you work with your GP to stop drinking, but also you can get your cholesterol checked, get your colonoscopy, lose weight, and other things to reduce risk of other bad illnesses. I am a psychiatrist and I work with a lot of alcoholics. There is a bunch of stuff I work with in my patients before they stop drinking, but some things cannot be done if the alcoholic is actively and heavily drinking. For example, I won’t prescribe several different classes of medications because of higher risk of side effects. I also won’t do serious psychotherapy because the patient is always in escape mode with the booze.
I do think addiction is a disease. It does not make sense to see it as a moral flaw. It’s etiologically complex with genetic, psychological, and environmental causal components. Genetics can’t change, but other factors are within our power to modify. Most heavy drinkers never become alcoholics, about 10% do. These 10% are genetically predisposed If you never drink or never drink heavily, you will never get addicted even if you genetically predisposed. Bottom line, it’s a disease within the pt’s ability to control – much like diabetes.