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
Definition of Alcoholism
People drink because alcohol affects
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
Research among twins has identified
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,
Models of Alcoholism and
While the above findings are relatively new, alcoholism
and alcohol treatments have been around for a long time.
models of alcoholism have developed over time,
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 individual and all his/her
physical and psychological characteristics;
- 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.
Public Health Model acknowledges that:
Alcohol is a drug
which can be hazardous
to those who use it unwisely;
Individual differences caused
tolerance, brain sensitivity and metabolic rates are important
The environment and the availability
and promotion of alcohol must be addressed in the prevention
and treatment of alcoholism.
MORAL MODELS -
emphasize personal choice
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.
Alcohol itself is seen as the cause
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
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
EDUCATIONAL MODELS -
These models assume that alcohol problems come from a
knowledge about alcohol
and related issues. Knowledge and motivation
to change are expected to lead individuals to avoid its abuse.
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
CONDITIONING MODELS -
These models view excessive drinking as a
learned habit developed
because of the rewards associated with drinking.
seen in such treatment models as aversion therapy, is to "unlearn"
the habit through experiencing the negative consequences of drinking.
SOCIAL LEARNING MODELS -
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.