My brother has end-stage liver disease, commonly called cirrhosis, which means that scar tissue has replaced most of the healthy cells in his liver. Until three months ago, I knew almost nothing about the three-pound organ and its crucial role as garbage disposal (eliminating toxins) and refrigerator (storing and releasing vitamins). But once I stepped in as my brother’s health advocate, I became an expert in how it functions and what happens when it fails.

But once I started telling people about Joey’s prognosis, I discovered that cirrhosis carries a deep societal stigma.

I first noticed it with my chiropractor, a widower in his fifties who lost his wife to cancer a few years ago. “Cirrhosis?” he asked, nodding his head slowly and squinting. “How did he get it?”

“He’s been a heavy drinker for 25 years,” I said, not understanding why he would ask.

“Yeah, that’ll do it,” he retorted, going back to adjusting my back without another word. He may as well have said, “So he got what he deserved.”

About 31,000 people die from liver disease annually in the U.S. There are some genetic causes, but the leading ones are hepatitis C, which is sometimes contracted through sharing drug needles, and alcoholism, or what researchers now call alcohol use disorder (AUD). Thus, people think of it as an addict’s disease and don’t have much compassion for those who get it.

I considered never seeing my chiropractor again, but quickly learned his response was on the kinder end of the spectrum. The hardest slap came from my cousin when I called her one night to make sure she knew what was going on with Joey. “Well, we’ve been waiting for him to drink himself to death — and now he has,” she blurted out over the phone, and then laughed. I was so stunned that I involuntarily chuckled along, too stunned to manage anything else. By the end of the conversation, she had thanked me for calling and told me that I could count on her, which, despite her opening remark, I’m sure she meant.

After we hung up, I realized that neither she nor my chiropractor had any idea how harsh their comments had been. Joey’s doctor wasn’t much better. I remembered the conversation I’d had alone in the hallway with him, just after he had broken the news to us that Joey didn’t have long to live. He started to ask if my brother was still drinking, but then stopped himself and said, “He can’t possibly still be drinking. How could he be? I mean look at him — his liver is in such bad shape he can barely drink water.”

It then hit me that as a society, we not only have a hard time feeling empathetic toward people who suffer from alcohol use disorder, we feel entitled to blame them.

Believe me — I get it. I’ve seethed through innumerable meals that tasted delicious thanks to Joey’s cookery, but were ruined by his slurred words and off-color remarks. For the last decade, I’ve mostly vacillated between feeling numbness and rage towards him, although now I can see that I was masking my heartbreak. My cousin probably feels frustrated as well, which would account for her callousness.

Societally, we are more addicted than ever, but some addictions are more accepted than others. For example, I’m a workaholic; I overwork in part to numb the places where I feel bad about myself. This type of compulsive behavior is rewarded in our economic system with promotions and accolades. If I were to have a heart attack, no one would mumble that they had been waiting for me to work myself to death.

Eighteen million people in the U.S. suffer from alcohol use disorder. Why do we think about their addiction differently? We think they have to hit “rock bottom” and there’s “nothing” we can do to help.

Some researchers suggest this would be the equivalent of prescribing insulin shots only after a person has fallen into diabetic coma or offering antidepressants to people only after attempted suicide.

If we can move past stigmatizing them for their struggles, we might be able to see how our healthcare system and society have failed them. In 1956, the American Medical Association named alcoholism a disease, but sixty years later, addiction medicine is the only branch of medicine that is still rooted in religion instead of modern science.

Most doctors believe that Alcoholics Anonymous (AA) is the only way to treat AUD. And to be sure, many people have turned their lives around thanks to AA. Its grassroots approach and peer-support network pushes against the isolation that many alcoholics face. Also, it’s free, which makes it accessible to people who may not be able to afford treatment otherwise. However, it’s unreasonable that our medical system does not offer alternatives.

Joey tried AA at different times, but even though we grew up in a Catholic family and he believes in God, he couldn’t stick with it. As a very private person, opening up to a room full of strangers couldn’t have been easy.

One of our cousins, on the other hand, hasn’t had a drink since we were in our twenties and swears by AA. So it does work for some people; we just don’t know how many, since members are anonymous and statistics are therefore hard to track. The most precise statistic Gabrielle Glaser was able to track for an Atlantic story earlier this year suggested a five to eight percent success rate — against AA’s own claim of 75 percent.

There are alternative AUD treatment options, although rarely used. Naltrexone, the subject of the documentary One Little Pill, has a 78 percent success rate in helping people control or stop drinking. The U.S. Food and Drug Administration approved it for alcohol-abuse treatment in 1994, yet doctors prescribe it to fewer than one percent of patients due to the taboo of giving drugs to people with a history of addiction. While naltrexone wouldn’t work for my brother because he already has cirrhosis, it may have helped a decade or two ago.