Four Models of Alcoholism Used for Treatment in the US
4/8/2021 12:00:00 AM

Four Models of Alcoholism Used for Treatment in the US

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Many different descriptive and etiologic models of alcoholism have been proposed . We will focus here only on four which have been blended in current U.S. beliefs about alcoholism.

 Many different descriptive and etiologic models of alcoholism have been proposed (Chaudron & Wilkinson, 1988; Miller & Hester, 1989; Paredes, 1976; Tarter & Schneider, 1976). We will focus here only on four which have been blended in current U.S. beliefs about alcoholism.

Volitional-Moral Model 

The oldest model of drunkenness, which long predates Huss=s (1849) coining of the term Aalcoholism,@ saw it as volitional, the result of personal choice (Keller, 1979; Sournia, 1990). The ancients at times honored this choice, but the understanding that drunkenness was chosen, that people become intoxicated by their own willful actions, moved most in later times to pass negative moral judgment on such drinkers (Trotter 1778, as quoted by McCarthy 1958). In this view, social sanctions (punishment, loss of status or freedom) are appropriate responses to drunkenness. If adherents to this model adverted to any "loss of control" on the part of chronic drinkers, it may be interpreted as further evidence that drunkards are generally of weak and depraved character -an understanding furthered by temperance movements (Lender & Martin, 1987; McCarthy, 1958; an entertaining treatment may be found in Lender & Karnchanapee, 1977). This perspective- that alcoholism is a matter of choice - is very much alive. Civil and criminal courts in the U.S. continue to show a reluctance to hold defendants blameless for actions committed under the influence (e.g., toughening laws on impaired driving).The U.S. Supreme Court has ruled that alcoholism can be regarded and treated as "willful misconduct (Connors & Rychtarik, 1989). An assumption of freedom of moral choice lies behind all "Just say no campaigns". 

Personality Models 

The second view emerged with the rise of psychoanalysis around the turn of the century. Alcoholism here is assumed to be a symptom of an underlying personality disorder, a disturbance of normal development. Though varying in specific content, writings in this area generally cast alcoholics as immature, fixated at an early childish level of development (Strecker, 1937). Thus arose the notion of the alcoholic personality the idea that alcoholics share a common set of (undesirable, immature) traits which precede and continue or worsen with the development of drinking problems. Despite the elusiveness of such a personality in hundreds of studies of alcoholics (e.g., Miller, 1976; Vaillant, 1983), the belief strongly persists that alcoholics have a consistent and abnormal personality.

Current popular manifestations include: (1) the notion that alcoholics characteristically overuse primitive ego defense mechanisms such as denial; (2) the belief that alcoholism in particular and addictive behaviors in general are results of growing up in dysfunctional families, and the idea that there is a pervasive personality disturbance (e.g., co-dependence) which characterizes all people with addictions as well as those who live with them. The treatment, it follows, is psychotherapy, or some other process of working through, reparenting, etc.

American Disease Model

Within U.S. society, a third view emerged in the 1930s and 1940s, growing rapidly in popularity after World War II (B. Johnson, 1973; Wilkerson, 1966). Inspired by the observations of Dr. Benjamin Rush at the end of the 18th century, some 19th-century scientists had investigated the senses in which Ainebriety,as "chronic drunkenness" was then generally termed, might be a disease. By century's end, however, the pressures of Prohibitionist political correctness had forced the abandonment of such research. With the repeal of Prohibition in 1933, a new Aalcoholism movement appeared in the United States, soon revealing itself to be dedicated less to research than to propagating the view not only that alcoholism is a disease, but that it is a particular kind of disease (B. Johnson, 1973). This model is succinctly set forth in one of the most popular and representative books of this movement (Milam and Ketcham, 1983).

Alcoholics Anonymous

Alcoholics Anonymous is fundamentally a spiritual program. It is not a treatment, but a way of living and being. Though its sole purpose is to help alcoholics become and stay sober, the program attends to much more than the mere imbibing of alcohol. Only the first of" Twelve Steps" even names alcohol. The rest are concerned with spiritual processes: knowledge of and relationship with God or a Higher Power, self-searching, confession, openness to being changed, amends, prayer, seeking God=s will, carrying 6 the message to others (Kurtz, 1979; Kurtz & Ketcham, 1992). Alcoholic drinking is seen as a reflection of the human need -gone wrong-  for spiritual life and growth. Abstinence, then, signals only embarkation on the A.A. way of life, which is seen as a continuing journey toward wholeness and serenity (Alcoholics Anonymous 1953, Wilson 1967). Spiritual experience is not a byproduct, but the means by which an alcoholic recovers. Many A.A. writings in fact question whether it is even possible to recover by nonspiritual means.

by: Dr. Ernie Kurtz


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