| One of the great controversies in respect of | | | | Hence he was describing a particular type of alcoholic |
| treatment of alcohol problems is the debate of | | | | (the typical AA member) and there may be many |
| whether alcoholism is a disease. There is little doubt | | | | different types of alcoholics/addicts for whom these |
| that regarding alcoholism as a disease, rather than as | | | | symptoms do not apply. AA members often point to |
| a moral weakness, has brought benefits to alcoholics | | | | the "Doctor's opinion" written by Dr Silkworth in 1939, |
| addicts. To some extent it reduced the stigma | | | | who discusses alcoholism as an allergy. However, it |
| experienced by sufferers and has opened the door to | | | | begs the question, if these same people were to |
| treatment rather than punishment. It is the mainstay of | | | | attend their Dr with a different condition and that Dr |
| the belief system of AA and NA groups who have | | | | used a journal written in 1939 as the definitive text for |
| been responsible for helping many to recover from a | | | | treatment, would they be quite so happy to accept this |
| hopeless state. However there are many critics of the | | | | Dr's opinion. I suspect a second opinion, or more likely a |
| disease model, both on the grounds that there is little | | | | different doctor, would be sought rapidly. |
| evidence to support it and that it may in fact be | | | | In respect of treatment, the current view is that, in the |
| detrimental to recovery. | | | | disease model the alcoholic/addict is portrayed as |
| Far from supporting the model, much of the evidence | | | | someone who has no control over his/her behavior |
| that has been produced is in direct opposition to it. For | | | | and hence requires treatment to recover. This is often |
| example a famous study of alcoholics (Mendelson and | | | | viewed as engendering feelings of helplessness and |
| Mello 1978) found that alcoholics could and did control | | | | encouraging an abnegation of responsibility. In contrast |
| their craving and consumption. In this experiment they | | | | the current view of treatment is that in order for |
| were given the opportunity to work in exchange for | | | | recovery to occur the client needs to take |
| alcohol and to consume it when and as they wanted. | | | | responsibility for his/her behavior and to be |
| Instead of being constantly drunk, it was found that the | | | | empowered to change. |
| subjects worked and consumed alcohol selectively, | | | | Moreover rather than enforced abstinence the client |
| sometimes saving some for consumption at a later | | | | should have a choice of possible outcomes (ie |
| time. Other studies have found that alcoholics (both | | | | abstinence, reduction in consumption or controlled |
| treated and untreated) have returned to patterns of | | | | drinking), so the client is made to feel greater |
| problem free consumption. These people are in the | | | | ownership of his/her recovery and is more motivated |
| minority but they do nevertheless represent a | | | | to succeed. Interestingly the research suggests that |
| significant number. Finally a new topic in addiction | | | | most subjects given a choice of outcomes still end up |
| research is what is known as natural recovery, that is | | | | abstinent, however having a 'choice' of outcomes has |
| changing addictive behaviour without the aid of | | | | the effect of increasing motivation. |
| treatment. | | | | While the disease model has had some benefits by |
| Many studies have found that this is a common route | | | | initially introducing treatment for alcoholics/addicts, |
| out of addiction. Indeed one large scale study found | | | | ironically it is now viewed by many modern |
| that not only is it common, it is by far the most | | | | commentators as being detrimental to treatment. Many |
| common route. All of these findings undermine the | | | | of the concepts of the disease model have been |
| validity of the disease model. Even the seminal work | | | | found to be fallacious and indeed explainable by other |
| of Jellinek, which described the disease model originally, | | | | mechanisms. Nevertheless it continues to be the |
| was based on work carried out entirely with members | | | | mainstay of AA and NA and provides benefits for its |
| of AA. | | | | millions of members. |