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Treatment Services for At-Risk Women


Alcoholism as a Disease

The discussion about alcoholism has been long and controversial. Some say it is due to inherent bio-chemical abnormalities (Milam & Ketcham, 1991). Others blame family dynamics (Steiner, 1971), social learning processes (Peele, 1985), and personal choice (Fingarette, 1988).

Definition of Alcoholism

People drink because alcohol affects a specific reinforcement system in the brain. There are alcohol abusers and there are alcoholics. Alcohol abuse is problem drinking which may result in health or social problems, or both. Chronic exposure to alcohol can result in the development of tolerance for and physical dependence on alcohol. Tolerance develops as a result of changes in alcohol's effect on the brain as well as an increased capacity of the body to reduce alcohol levels via metabolism. Alcohol dependence is alcoholism. While alcohol abusers may experience the same effects from excessive drinking as do alcoholics, alcoholics are distinguished by their physical dependence on alcohol and their impaired ability to control alcohol intake (U.S. Department of HHS, 1993). Physiological dependence is manifested by the development of withdrawal symptoms.

Role of Genetics

Research has shown that the interaction of genetic and environmental factors determines vulnerability to alcoholism. While researchers have not yet been able to identify the specific genes that convey susceptibility, they have found that genes do have an impact (U.S. Department of HHS, 1993). Some studies indicate that alcoholism may often be controlled by a major genetic effect involving a number of genes located at two or more chromosomal locations (Aston & Hill, 1990). However, the mode of inheritance still remains unclear.

Research among twins has identified two types of alcoholism-Type I (milieu-limited) and Type II (male-limited)-which appear to have different mechanisms of inheritance. This suggests that various typologies of alcoholism may exist. Reviews of twin studies among identical and fraternal twins-both intact and separated-showed genetic processes affect frequency and quantity of drinking and play a role in determining vulnerability for alcoholism (Bohman et al, 1981). Adoption studies suggest that persons with an alcoholic biological parent have approximately a 2.5-fold increase general risk for alcoholism, regardless of the home environment (Merikangas, 1990).

Models of Alcoholism and its Treatment

While the above findings are relatively new, alcoholism and alcohol treatments have been around for a long time. Eleven models of alcoholism have developed over time, and treatment is based on the treatment facility's model and particular philosophy. These models are briefly described below (from Miller and Hester, 1989). Current thinking in the field recommends the Public Health Model for both prevention and treatment, since it takes into account the many factors that cause alcoholism.

PUBLIC HEALTH MODEL - This model integrates the many factors involved in alcoholism:

  • The agent - alcohol
  • The host - the individual and all his/her physical and psychological characteristics;
  • The environment - the physical and social conditions in which the individual lives.
    It is a comprehensive model that can be used to understand alcoholism and how to prevent and/or treat it. The Public Health Model acknowledges that:
  • Alcohol is a drug which can be hazardous to those who use it unwisely;
  • Individual differences caused by heredity, tolerance, brain sensitivity and metabolic rates are important factors;
  • The environment and the availability and promotion of alcohol must be addressed in the prevention and treatment of alcoholism.

MORAL MODELS - These models emphasize personal choice as a cause of alcohol problems. Alcoholism is viewed as a moral deficit, a demonic possession, or willful violation of societal rules and norms. In short, it is either a moral or criminal issue.

TEMPERANCE MODEL - Alcohol itself is seen as the cause of alcohol problems, with the dangers from its use being similar to those of heroin and cocaine. Temperance or abstinence are seen as the solutions to alcohol-related problems.

AMERICAN DISEASE MODEL - Developed at the same time as Alcoholics Anonymous came into being, this model is based on the concept that alcoholism is a progressive condition in which the individual loses control over alcohol. The disease is irreversible, incurable and can only be arrested through total abstinence from alcohol.

EDUCATIONAL MODELS - These models assume that alcohol problems come from a lack of knowledge about alcohol and related issues. Knowledge and motivation to change are expected to lead individuals to avoid its abuse.

CHARACTEROLOGICAL MODELS - Abnormalities in personality , including arrested development, etc., are considered to be the cause of alcoholism in these models. The solution is to restructure the personality through psychotherapy.

CONDITIONING MODELS - These models view excessive drinking as a learned habit developed because of the rewards associated with drinking. The solution, seen in such treatment models as aversion therapy, is to "unlearn" the habit through experiencing the negative consequences of drinking.

SOCIAL LEARNING MODELS - The focus in these models is on the interactions between the individual and the environment. Modeling of drinking behavior by peers, family and peers are all factors that must be taken into consideration in the prevention and treatment of alcoholism.

GENERAL SYSTEMS MODEL - This model views the individual as an inherent part of a larger social system -i.e., the family. Thus, dysfunctional families are contributors to the alcoholic's difficulties.

SOCIOCULTURAL MODELS - In these models, the greater systems of society and subculture shape an individual's drinking patterns and problems. Limiting advertising is a major consideration, along with taxation and reducing availability through limiting the location and hours of sale.

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