Alternate means “one after the other,” whereas alternative means “one instead of the other”¹—and option and alternative are essentially the same thing. Easy peasy, no?

Well, no. At least not quite.

Although few writers would incorrectly use alternative in place of alternate in the sense of “one after the other,” there are subtle differences between these words—and between option and alternative, as well—when they are used in other senses. The potential for confusion is readily apparent when one considers, for example, that option has been defined as “something that may be chosen”^2(p871); alternative as “one of two or more things, courses, or propositions to be chosen”^2(p37); and alternate as “one that substitutes for or alternates with another”.^2(p37) And that’s considering only the use of these words as nouns. As an adjective, alternative has been defined as “offering or expressing a choice” and alternate as “constituting an alternative.”^2(p37)

So—is there a way through this thicket?

Option and choice are usually considered interchangeable, but an alternative is an option or choice that stands “instead of the other.”¹ Thus, a person faced with numerous options (choices) will always have one more option than alternatives.³ (Some authorities have proposed that alternative should be used only when no more than 2 choices are available. However, few writers observe this distinction.^3,4) For example, a diner presented with a dessert menu that lists 4 desserts will—assuming a 1-dessert limit—have 4 options (ie, choices) but only 3 alternatives. Furthermore, it is usually assumed that one of the options will be the original or preferred one, to which the others are alternatives. For example, on that dessert menu, the red velvet cake, tiramisu, and crème brûlée might be alternatives to that triple fudge ganache lava brownie that one has been ogling, in the event that the server comes back with the sad news that the brownie has apparently been everyone else’s first choice as well.

But things get a bit fuzzy when it comes to the choice between alternative and alternate. As suggested above, these words have acquired meanings that are quite close. When a distinction is made, it would seem to hinge on whether a degree of compulsion is in play, with alternative preferred when such compulsion is not present. For example, a person selected to serve as an alternate juror has little choice in the matter; similarly, whereas a person planning a trip might well map out several alternative routes, the same person faced with an unexpected road closure is forced to take an alternate route.⁵ And, although option and choice can be used interchangeably, alternative has a bit more nuance than choice, suggesting “adequacy for some purpose.”⁴ Alternative also can suggest a “compulsion to choose”⁴—although in this case the compulsion is to choose between alternatives (eg, “The alternatives are liberty and death,”⁴) rather than, as is the case with alternate, a compulsion or duty to serve in place of another (eg, alternate juror, alternate batter).

In practice, although some authorities still advocate maintaining the traditional distinctions between alternative and alternate, actual usage is changing rapidly, and alternative is now often used when a noun is called for and alternate when an adjective is called for.⁶ However, a big nota bene for medical writers: alternative is used as an adjective in medical contexts when referring to nonallopathic medicine, treatments, or therapies, such as acupuncture, homeopathy, etc. So, the adjective alternate is certainly preferred when referring, for example, to different allopathic treatment choices available to a patient (eg, “the consulting physician recommended surgery but also proposed 3 alternate approaches”).

The bottom line:

● Looking for a word that indicates “one after the other”?¹ Use alternate (eg, “Alternate smiles and frowns, both insincere.”⁷)

● An alternative is by definition an alternative to something else—usually a preferred choice or original plan of action—so one will always have 1 more option than alternatives.

● Although some authorities still maintain the traditional distinctions between alternative and alternate, usage is changing rapidly, and alternative is now often used when a noun is called for and alternate when an adjective is called for—but in medical contexts, the adjective alternative is often used in reference to nonallopathic medicine, treatments, or therapies.—Phil Sefton, ELS

1. Alternate/Alternative. In: O’Conner PT. Woe Is I: The Grammarphobe’s Guide to Better English in Plain English. 3rd ed. New York, NY: Riverhead Books; 2009:88.

2. Merriam-Webster’s Collegiate Dictionary. 11th ed. Springfield, MA: Merriam-Webster Inc; 2003.

3. Fogarty M. Quick and Dirty Tips: “Alternate” Versus “Alternative.” Grammar Girl website. http://grammar.quickanddirtytips.com/alternate-versus-alternative.aspx. Accessed January 16, 2013.

4. Alternate; alternative. In: Garner BA. The Oxford Dictionary of American Usage and Style. New York, NY: Oxford University Press; 2000:18.

5. Alternate vs. alternative. Grammarist website. http://www.grammarist.com/usage/alternate-alternative/. Accessed March 27, 2013.

6. Alternate, alternative. English Forums website. http://www.englishforums.com/English/AlternateVsAlternative?bzxvg/post.htm. Accessed January 16, 2013.

7. The Compact Oxford English Dictionary. 2nd ed. Oxford, England: Oxford University Press; 1991:41.