"EXPLANATORY MODELS OF 'ALCOHOLISM' AND/OR 'ADDICTION"

Uni-dimentional Models

1.   Psychodynamic Model: any number of intra-psychic conflicts 
     might lead to fixation at or regression to the "oral dependent" 
     stage of development; alcohol provides oral gratification.
2.   Social Learning Model: drinking behaviors are learned as a part of
     socialization and then are reinforced.
3.   Tension Reduction: anxiety/stress leads to alcoholism or addiction which is
     a "secondary" phenomenon.
4.   Disease Model (Jellinek): mixed etiology has five identified "types" of
     alcoholics.

Multi-dimensional Model

Biopsychosocial Model: explanatory model implicates numerous biologic,

psychologic, and social factors as being responsible for a "disease" of

addiction.

SOME COMMON MODELS ABOUT ALCOHOLISM

1. The Impaired Model

Definition: An alcoholic is a drunk, souse, toper, tippler, soak, lush. When he/she gets drunk, he/she is plastered, bombed, stoned, tight, oiled.

Etiology. Some people are just that way for unknown reasons.

Behavior. Drunks are repulsive and dirty; nice people do not like to get close to them. Sometimes they are comical they fall down, talk to lamp posts, try their door key in the wrong house, get their words mixed up, and so forth. But it is wrong to laugh at them and make fun of them because they cannot help it.

2. The "Dry" Moral Model

Definition. Alcoholism is a moral failing, not an illness. It is the natural penalty for drinking.

Etiology. Alcoholism occurs because drinking occurs. Some strong-willed people can apparently drink without becoming alcoholics. but the social risk in drinking is too great to allow any acceptance.

Behavior. The alcoholic behaves immorally because he/she drinks.

Treatment. There are many ways to try to get an alcoholic to stop drinking, including forcing church attendance, firing him/her from the job, pouring whiskey down the sink, marrying him/her off to someone strong enough to control him/her, divorce, shunning him/her, ridiculing him/her, giving him/her aversion treatments, and so forth. In short, behavior therapy. Fines and jail sentences may help.

Prognosis The prognosis is poor unless a way is found to threaten alcoholics or punish them so that they stop drinking. The only hope is to make alcohol unavailable. Young drinkers should have the example of the alcoholic before them.

3. The "Wet" Moral Model

Definition. Alcoholics are drinkers who do not obey the rules of the drinking society. They behave badly when drunk, and they cannot hold their liquor. Alcoholism is an unacceptable form of drinking behavior.

Etiology. It is a mystery why some people who drink become alcoholics.

Behavior. The behavior of alcoholics is anti-social. They spoil the happy, congenial occasions that social drinking can provide.

Treatment. Everybody in the drinking society including the alcoholic knows how to treat alcoholics: by juggling around rewards and punishments. A spouse may refuse sex, refuse to speak, withhold the family money, reduce housekeeping standards. His/her doctor may give him/her hell, tell the alcoholic to grow up and not be a crybaby, and so on.

Prognosis. If only the right formula of rewards and punishments could be found, everything would be all right. Otherwise, prognosis is gloomy.

4. The Alcoholics Anonymous Model

Definition. Alcoholism is an incurable, progressive, and often fatal disease Alcohol is a poison to an alcoholic though not to others. An alcoholic is a person whose life has become intolerable through the use of alcohol AA is a close community of those afflicted with this disease

Etiology. Alcoholics are emotionally impaired people who drink to compensate for their inadequacies and then, because of their body chemistry become addicted to alcohol, creating a circular process of further inadequacy and further drinking.

Behavior. At the height of his/her drinking career, the behavior of the alcoholic derives largely from the need to get enough to drink to control withdrawal symptoms. Earlier variety of behavior is due to complex physical, mental, and/or spiritual problems of an enduring nature.

Treatment. The best treatment for an alcoholic is permanent, continuous involvement in AA.

Prognosis. With the help of AA, alcoholism can be arrested although never cured. Without AA, the prognosis is usually hopeless.

5. The Psychoanalytic Model

Definition. Alcoholism is a symptom of a deep, underlying neurosis. Alcoholics are addictive personalities.

Etiology. Since the alcoholic is an infantile person, the key to understanding his/her inability to achieve maturity lies in early emotional experiences.

Behavior. The behavior of the alcoholic is to be interpreted as a symbolic means of expressing unconscious conflict

Treatment. For alcoholism, as for all neurosis, psychotherapy is required.

Prognosis. The prognosis for alcoholics is not encouraging

6. The Family Interaction Model

Definition. Alcoholism, like drug addiction and schizophrenia, is best seen as a form of family interaction in which one person is assigned the role of the alcoholic while others play the complementary roles, such as the martyred wife, the neglected children, the disgraced parents, and so forth. As this deadly game is played by mutual consent, any attempt to remove the key factor, the alcoholic, is bound to create difficulties for the other family members, who will attempt to restore their former game.

Etiology. As these family games are circular and self-reinforcing, it is useless to inquire how it began. In general, the basic personality inadequacies are transferred from generation to generation. The behavior of the alcoholic and other family members is a series of moves in a continuous and long, drawn-out family game.

Treatment. Family therapy is the only treatment

Prognosis. Prognosis depends on the availability of family therapy. With it the prognosis is good; without it, poor.

7. The "Old" Medical Model

Definition. Alcoholism is a serious, progressive, and eventually fatal disease which is incurred by the immoral behavior of excessive drinking.

Etiology. The etiology of alcoholism is the excessive drinking of alcohol. The reason for the immoderate drinking is unknown. Alcoholics seem to be unable to control themselves.

Behavior. Alcoholics are destroying their lives and ruining their bodies by drinking so much, and this is immoral.

Treatment. The doctor's problem in the treatment of acute states of illness in alcoholism is the management of the patient in a toxic state. Attention must be given to systemic dehydration, cirrhosis of the liver, nutritional deficiencies, and so on.

Prognosis. The prognosis is poor because the patient will not care for himself/herself

8. The "New" Medical Model

Definition. Alcoholism is a progressive, often fatal disease, possibly hereditary. Alcoholics are ill people whose body chemistry is such that they can become addicted to alcohol. In emergency treatment, alcoholism must be distinguished from schizophrenia depressions, head injuries, and so forth.

Etiology. It appears that alcoholics may have a defect in metabolism, possibly involving one of the major amino acids. There are probably also psychological and sociocultural contributing factors.

Behavior. Much of the alcoholic's behavior stems from the alcoholic's need to control withdrawal symptoms.

Treatment. Any treatment which helps the alcoholic abstain from drinking is valuable, provided that it does not impair his/her health.

Prognosis. Prognosis at the present time is not good. However, there is hope that medical science will provide new information, new treatments, and preventive measures.