Disease Concept Of Alcoholism Research Articles

A great race of drinkers? Irish interpretations of alcoholism and drinking stereotypes, 1945–1975

AbstractFrom the 1930s, psychiatrists and sociologists documented the prevalence of Irish alcohol-related psychiatric admissions in the United States. These studies seemed to suggest that the Irish, as a race, had a remarkable relationship with drink, therefore reinforcing the enduring ‘drunken Irish’ stereotype. By the 1960s, the alleged Irish susceptibility to alcoholism gained increasing attention from researchers and officials in Ireland itself. Significantly, this renewed awareness coincided with a shift in Ireland’s place on the international landscape and was intertwined with the broader social, cultural and political environment. While anxieties about the apparently rising incidence of alcoholism and alcohol-related harm were not unique to Ireland, the specific cultural meanings attached to excessive drinking in a nation internationally renowned for this problem mapped onto shifting international frameworks, informing medical perceptions and shaping policy developments. This article explores expert and official interpretations of alcoholism and the ‘drunken Irish’ stereotype from 1945 to 1975. This period saw a number of important developments, including the introduction of the Irish Mental Treatment Act of 1945, the establishment of the Irish National Council on Alcoholism in 1966 and the creation of specialist alcohol treatment facilities in several psychiatric hospitals. In the same era, the contexts for understanding problem drinking began to shift from the disease concept of alcoholism towards the public health perspective on alcohol. As will be argued, in Ireland, these frameworks were coloured by concerns that social and cultural factors were contributing to rising levels of alcohol consumption and psychiatric admissions for alcoholism.

E. M. Jellinek's Disease Concept of Alcoholism.

E. M. Jellinek's Disease Concept of Alcoholism.

Reward Deficiency Syndrome (RDS): Is there a Solution?

In the early sixties we knew relatively very little about the workings of the brain especially the interrelatedness of the brain reward circuitry and the Pre-frontal cortices. Understanding the importance of the main neurotransmitters such as serotonin, GABA, dopamine and acetylcholine were unknown for the most part and endorphins was not even a part of our scientific acumen. The 1956 doctrine of Jellinek and the disease concept of alcoholism was new and not generally accepted [1]. At that time most scientists working in the field of addiction agreed that alcoholism is the result -at least in part -of deficiencies or imbalances in brain chemistry-perhaps genetic in origin. However so little was known that nothing specific was espoused by the then newly called neuroscientists.

Fifty years of brief intervention effectiveness trials for heavy drinkers

Fifty years of brief intervention effectiveness trials for heavy drinkers

Civilized Drinking: Alcohol and Society in New Brunswick, 1945-1975

Alcohol policy in New Brunswick was contested terrain. Following the political defeat of prohibition, the province introduced government liquor stores in 1927, but refused for more than three decades to license public establishments, although Legions and private clubs enjoyed a quasi-legal status. By the end of the Second World War, the province had one of the lowest liquor consumption rates in Canada, a small but vocal temperance movement, and a fairly dry hospitality sector. During the 1960s and 1970s, access to alcohol was liberalized with the licensing of taverns and dining rooms, the decriminalization of public drunkenness, and the lowering of the drinking age to 19. Meanwhile, the public health, social service, legal and voluntary sectors lobbied for prevention and treatment programs based on the disease concept of alcoholism, rather than the moralistic arguments of the older temperance movement. By 1975, it was clear that New Brunswick's alcohol control policies mirrored the wider Canadian experience as residents were treated to competing discourses: drinking was a modern, reasonable, and fashionable recreation but alcohol was society's most widespread and costly addictions problem.

Construing clients with substance abuse problems as alcoholics

The article is concerned with the way that a 12-step treatment programme construes a certain kind of image of its clients and their substance abuse problems. The main focus is on how the basic assumptions of the treatment programme are reproduced and maintained at the weekly meetings of the multiprofessional team running the programme. The article offers a behind-the-scenes look at the 12-step treatment programme: in particular, we are interested in the ways that the staff process and use the background information available on the clients admitted. We want to know how the methods and approaches used by the multiprofessional team shape and influence the kind of treatment that the clients will receive. Based originally on the AA recovery programme, the 12-step treatment programme draws on the disease concept of alcoholism. One of our main observations is that this disease concept is conducive to selective and purposive working methods in the programme. Information on the patients' background or their test results are systematically so interpreted that the outcome confirms the view that the clients are indeed alcoholics who can only be treated by methods that are consistent with the programme ideology. Strict normative expectations are placed upon clients in the programme, and any sign of deviation will be interpreted as resistance and reluctance on the part of substance abusers to deal with their own alcohol problems. In this way the programme itself may produce resistance among clients and the staff may easily elicit the resistance and denial that they regard as symptoms of alcoholism. A key focus in the article is on the interactive techniques and tactics applied in the programme to construe clients' alcohol problems in a manner that fits in with the institution's treatment culture. These techniques and tactics are studied using the methods of conversation analysis. The material consists of videorecordings from seven staff meetings in spring 1997, which have been transcribed in line with CA conventions. The focus of our analysis is not on spoken interaction, but we are chiefly interested in demonstrating how the institutional beliefs and values of the treatment programme determine the interactive planning of treatments.

Alcoholism: beliefs and attitudes among Canadian alcoholism treatment practitioners.

To explore differences in views concerning adjunctive medications and theoretical orientation among Canadian practitioners from different professional backgrounds who treat alcoholism. A survey of clinicians from different disciplines was conducted by mail. The response rate was 56%: 95 drug and alcohol counsellors, 46 social workers, 81 nonpsychiatrist addiction physicians, and 74 addiction psychiatrists. The number of items in the questionnaire was reduced using principal component analysis. Group differences were explored using analysis of variance with Bonferroni correction and Scheffé's posthoc comparisons. Physicians and nonphysicians differed in their views on the utility of medications in treating alcohol problems, the disease concept of alcohol problems, and the classification of alcohol abuse or dependence as psychiatric conditions. No group differences emerged on views regarding cognitive-behavioural treatment, pharmacological-only interventions, combined treatment, and recovery without treatment. Psychopathology in the alcoholic was significantly more likely to be considered as secondary to the use of alcohol by nonpsychiatrist physicians. Nonphysician practitioners viewed alcoholic behaviour as self-medication. Groups differed on questionnaire items concerning medication use and the disease concept of alcoholism. Agreement on several areas may facilitate bridging the gap across disciplines. The implications of these results are discussed.

Reply to Lilienfeld: Why Alcoholism is a Disease

Lilenfeld's attack on my conceptual examination of the disease concept of alcoholism suffers from erroneous interpretations, fallacious reasoning, and a lack of fam iliarity with relevant alcoholism research. He offers an alternative nominalist interpretation of the disease concept of alcoholism based on a fuzzy boundary between disease and well ness. He fails to recognize that the basic issue between nominalist and realist accounts of a lower-order concept such as alcoholism is the presence or absence of general principles that may account for the observed signs and symptoms characterizing a specific disease entity, not fuzzy boundaries between higherorder categories. Extensive evidence (which Lilienfeld ignores) of biological bases for the pathognomic signs and symptoms of alcoholism, particularly loss of control, demonstrates that the disease concept of alcoholism refers to a disease entity that has a biological basis. It is not a “mental construct.”

Gender and patterns of alcohol problems: Pretreatment responses of women and men to the comprehensive drinker profile

Gender differences were analyzed in a sample of 233 (83 women, 150 men) problem drinkers treated at the same clinic. Demographic and family history measures showed few gender differences. Men reported more alcohol consumption than did women, but patterns of drinking and intoxication levels were similar. Males reported drinking and intoxication at an earlier age, more beer and less wine drinking and more drinking away from home and driving after drinking. Women reported more negative emotional effects of drinking and more spouses with alcohol problems. Despite similar problem duration, men showed more lifetime alcohol problems but not dependence signs. Men were more likely to accept a disease concept of alcoholism. Rates of smoking, other drug use, and other life problems were similar.

When Belief Systems Collide: The Rise and Decline of the Disease Concept of Alcoholism

This article uses the Disease concept of Alcoholism to show how ideas constitute the realities within which individuals organize their day to day lives. The shifts in power that occur as new realities challenge the old ones are explored.

Slaying the disease model dragon—again?

AddictionVolume 90, Issue 8 p. 1039-1041 Free Access Slaying the disease model dragon—again? T. R. Stockwell, T. R. Stockwell National Centre for Research into the Prevention of Drug Abuse, Curtin University of Technology, GPO Box U 1987, Penh 6001, Western Australia.Search for more papers by this author T. R. Stockwell, T. R. Stockwell National Centre for Research into the Prevention of Drug Abuse, Curtin University of Technology, GPO Box U 1987, Penh 6001, Western Australia.Search for more papers by this author First published: August 1995 https://doi.org/10.1111/j.1360-0443.1995.tb01057.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References Chick, J. (1980) Is there a unidimensional alcohol dependence syndrome British Journal of Addiction, 75, 265 – 280. Cloniger, C. R., Sigvardsson, S., Gilligan, S. B., von Knorring, A.-L., Reich, T. & Bohman, M. (1989) Genetic heterogeneity and the classification of alcoholism, in: E. Gordis, B. Tabakoff & M. Linnoila, (Eds) Alcohol Research from Bench to Bedside, pp. 13 – 16 ( New York , Hayworth Press). Edwards, G. & Gross, M. M. (1976) Alcohol dependence: provisional description of a clinical syndrome, British Medical Journal, 1, 1058 – 1061. Hodgson, R., Rankin, H. & Stockwell, T. (1979) Alcohol dependence and the priming effect, Behaviour Research and Therapy, 17, 379 – 387. Jellinek, E. M. (1960) The Disease Concept of Alcoholism ( New Haven , CT , College & University Press). Kahler, C. W., Epstein, E. E. & McCrady, B. S. (1995) Loss of control and inability to abstain: The measurement of and the relationship between two constructs in male alcoholics, Addiction, 90, 1025 – 1036. Orford, J. (1985) Excessive Appetites: Psychological Approaches to the Addictions ( London , John Wiley). Orford, J. & Hawker, A. (1974) A note on the ordering of onset of symptoms in alcohol dependence, Psychological Medicine, 4, 281 – 288. Rankin, H., Hodgson, R. & Stockwell, T. (1979) The concept of craving and its measurement, Behaviour Research and Therapy, 17, 389 – 396. Rankin, H., Hodgson, R. & Stockwell, T. (1980) The behavioural measurement of dependence, British Journal of Addiction, 75, 43 – 47. Rankin, H., Stockwell, T. & Hodgson, R. (1979) Cues for drinking and degrees of dependence, British Journal of Addiction, 77, 287 – 296. Stockwell, T., Hodgson, R. & Rankin, H. (1982a) Tension—reduction and the effects of prolonged alcohol consumption, British Journal of Addiction, 77, 65 – 73. Stockwell, T., Hodgson, R. & Rankin, H. (1982b) Alcohol dependence, beliefs and the priming effect, Behaviour Research and Therapy, 20, 513 – 522. Stockwell, T., Sitharthan, T., McGrath, D. & Lang, E. (1994) The measurement of alcohol dependence and impaired control in community samples, Addiction, 89, 167 – 174. Citing Literature Volume90, Issue8August 1995Pages 1039-1041 ReferencesRelatedInformation

The disease concept of alcoholism: Its impact on women's treatment

The disease concept of alcoholism has had a dynamic impact on attitudes, policies, and treatment orientations. Despite its demonstrable effects on changing behaviors and belief systems, it remains both an acceptable and controversial entity amongst researchers and treatment personnel alike. This report provides a current focus of the disease concept as it applies to the characteristics and experiences of women alcoholics and their treatment. It especially targets the need for empowerment in this population and questions whether this important trait can be developed by the disease concept's emphasis on illness and the sick role, which inadvertently validates the feelings of powerlessness and helplessness of these women who already have been intensively socialized in dependent and subordinate roles.

Why alcoholism is a disease.

Arguments of proponents and critics of a disease concept of alcoholism are reviewed. It is concluded that the disease concept of alcoholism is in accord with modern usage of the concept of disease in the philosophy of science and the practice of biomedical science. Ascription of the term "disease" involves a value judgment by experts that observed lawfully recurring signs and symptoms are a significant deviation from a norm or standard of health. Value judgments of this and other kinds are inherent in biobehavioral science and its application. Criticisms of the traditional conception of the disease concept fail to distinguish empirical questions of etiology, treatment, and the characteristic features of alcoholism from the conventional and evaluative nature of the classification "disease." A critical review of the empirical research purporting to question the signs and symptoms of loss of control in alcoholics is also provided.

Treatment of Alcoholism in Australia from the 1950s to the 1980s

Within Australian medicine, interest in the treatment of alcoholism revived in the 1950s, and in the following decade the various states introduced special legislation and established special facilities. Psychiatrists tended to dominate treatment and evaluation of treatment in this period, and state psychiatric centres continued to treat a large number of alcoholics. In the 1970s, the work of voluntary agencies was increasingly subsidised by the state, and the state services to a large extent assumed a supervisory role. In the same decade, criticism of the disease concept of alcoholism and questioning of the effectiveness of treatment began to emerge in Australia as it had overseas. By the mid-1980s, many health professionals saw treatment as a strategy of last resort and were looking to control of consumption as the primary means by which to reduce alcoholism.

Conceptions of alcoholism.

Alcoholism educators have assumed that endorsement of the disease concept of alcoholism would reduce the moral stigma associated with the condition, thereby promoting a more humanitarian approach to the alcoholic. The present study presents data relevant to these assumptions. Measures of beliefs about the medical and moral nature of alcoholism were collected from 1,446 work supervisors in federal agencies. Additionally, social acceptance, tolerance of the alcoholic's absenteeism, and charitable responses to the alcoholic were measured. Results indicated that beliefs about the moral character of the alcoholic and beliefs about the medical nature of alcoholism are significant predictors of social acceptance of the alcoholic, tolerance of work behavior of the alcoholic, and a charitable response to the alcoholic. Findings are discussed in terms of the importance of educational efforts aimed at dispelling beliefs about the moral nature of alcoholism.

Attitudes toward alcoholism among psychologists and marriage, family and child counselors.

This study examines the attitudes of 589 randomly chosen licensed California psychologists and marriage, family and child counselors toward alcoholism. Their anonymous replies revealed that the two professional groups were relatively homogeneous in nature. The majority of each subscribed to the disease concept of alcoholism, recognized the importance of abstinence in problem resolution and as a treatment goal, rejected insight as a prerequisite of sobriety, believed in a positive prognosis and were extremely willing to be involved in the treatment of alcoholics. Negative attitudes toward alcoholics were expressed with respect to attribution of responsibility and a persistence of stigmatization of the alcoholic.

The Disease Concept of Alcoholism

Concern over those individuals who drink alcohol to excess goes back many centuries, this concern being directed at the effect alcohol has on the individual and on society. Levine (1978) pointed out that the idea of alcoholism as a progressive disease with the key symptom of ‘loss of control’ did not simply start with the foundation of Alcoholics Anonymous or the publication of Jellinek's monograph. Such a concept is, in fact, at least 200 years old.

Fingarette on the disease concept of alcoholism

Herbert Fingarette argues that alcoholism is not a disease and that the alleged alcoholic under certain circumstances has the power to control his or her drinking disorders. I shall analyze Fingarette's argument and show that his position rests on some logical and conceptual confusions. In analyzing Fingarette's argument for the self-control theory of drinking disorders I conclude that it is problematic for the following reasons: (1) his argument assumes that the identification of a single cause of alcoholism is a necessary condition of its being a disease; (2) unless it is already assumed (a priori) that persons with drinking disorders possess freedom and self-control to the extent that Fingarette assumes they do, then such persons are likely to suffer from apathy or defeatism regarding their condition; (3) even if Fingarette is correct in his criticism of certain health care programs for those with drinking disorders, it does not follow from this that certain theories about the possible causes of such disorders are false; (4) Fingarette's claim that those with drinking disorders are morally responsible for their actions that result from their disorders is problematic, that is, unless it can be shown that such persons act freely; and (5) Fingarette attempts to support the self-control theory of alcoholism by refuting a 'straw man' conception of the disease model of alcoholism.

Individualized care for the treatment of alcoholism

Through a discussion of several case vignettes, the author emphasizes the utilization of an individually tailored treatment approach when working with people experiencing problem related to alcohol consumption. Patients may achieve abstinence without believing in the disease concept of alcoholism, and attending Alcoholics anonymous meetings need not always be a part of the treatment. Furthermore, for some patients, controlled drinking may be as desirable an outcome as abstinence. The importance of entertaining a multiplicity of perspectives when conducting clinical work with such patients is discussed.

Nursing Attitudes Toward Geriatric Alcoholism

Nurses play a critical role in public education regarding the assessment of medical problems related to alcoholism or alcohol abuse. Nurses must assess their personal attitudes toward the disease concept of alcoholism before they can effectively provide services to geriatric patients who are alcoholics or who abuse alcohol. Among the geriatric population, there is a constellation of medical problems related to alcoholism and alcohol abuse. Potentially dysfunctional attitudes exist among nurses and other health-care professionals who are involved in the provision of medical care to geriatric patients who have alcoholism or who abuse alcohol.