Two main models, the spiritual and the physiological, have been put forward to explain the cause of drunkenness. While the spiritual model was dominant prior to the rise of modern science and medicine, it has been largely replaced during the past two centuries by the physiological model. This paper summarises both models, traces their history, and notes a contemporary new perspective and re-emergence of the older spiritual model. The paper suggests that theorists and therapists who remain unwilling to consider a spiritual cause of drunkenness in favour of a strictly physiological one, do so at the risk of adopting an inadequate working model of drunkenness and alcohol addiction.