Theory vs. Model

Theory An idea/explanation about how things work Causes, implications Not a fact!

Model Based on theory Detailed description of why and how something happens Suggests a course of action

4 “Views” of addiction: Moral  “Addicts” are sinful and weak-willed. Treatment = punishment Biological/Disease  addiction caused by biological abnormality that the person has no control over. Treatment = Abstinence Sociological  addiction created by social conditions (i.e. media). Treatment = macro and micro social change Psychological  affect of substance/behaviour on body and mind causes addiction. Treatment = various therapeutic designs.

Moral View Early 1700’s “free will” Drunkenness = moral weakness, lack of self-control Taverns considered meeting places of the “ungodly” Problem behaviour dealt with by legal punishment, public shame, and religious counseling. Alcohol’s effect on working ability not an issue

Disease View Beginning late 1700’s “Disease of the Will”  alcoholism symptom of physical or mental illness 1852, term “alcoholism” first used Treatment = admission to “insane asylum”

Disease View : mid-1800’s “blending” of moral and disease models Industrial revolution & mass urbanization Work performance and safety now focus of concern Public pressure for stiffer social controls Temperance movement gains momentum Prohibition Act passed in 1919 (repealed in 1933 in reaction to gangsterism)

Late 1800’s Public concern expands to include other substances Three main events: Animosity toward Chinese immigrants and “opium dens” Cocaine (isolated in 1855) became most common anaesthetic by 1884 Large scale manufacturing of heroin (isolated in 1874) by Bayer beginning in 1898

Coming into the Present: 1900 -- Refinement of etiologies and treatment modalities 1935  AA founded 1937  Jellinek proposes a model of the progressive nature of alcoholism “Jellinek curve”  consists of three phases: pre-addiction, addiction, & chronic alcoholism

Pre-addiction phase Drinking becomes the main source of “relief” (distinguishes this person from a true “social drinker” or user Drinking pattern includes: Drinking more heavily and frequently than friends Experiencing blackouts Devising ways of avoiding criticism Experiencing more frequent & severe hangovers

Addiction Phase Drinker no longer has control Patterns include: Finding excuses to drink Needing a drink to “get started” (i.e. the day) Preferring to drink alone or with other alcoholics Beginning to avoid family/friends who might criticize

Chronic Alcoholism Physical dependence Patterns include: Binging for extended periods in attempt to re-experience initial euphoria Experiencing tremors and/or DT’s when not drinking Ensuring supply is always readily available Experiencing nameless fears and anxiety

WHO 1952  first major, in-depth, world-wide study conducted by WHO  5 types of alcoholism identified: Alpha = alcohol used to relieve pain, but creates additional pain/problems Beta = regular heavy drinking, but within cultural confines.

3) Gamma = alcohol abused so frequently that biological changes occur. Delta = a step beyond Gamma  complete loss of control Epsilon = binge drinking associated with blackouts

According to researchers, only Gamma and Delta alcoholics were considered “treatable” Medical treatment regarded as “waste of money” for other types For next several decades, alcoholics could not receive treatment unless they were diagnosed accordingly

1960’s and 70’s: Growth in Social Science Research 1976  term “alcoholism” replaced with “alcohol dependent”  treatable if have at least some of the following: Salience of behaviour Tolerance Withdrawal Continuous drinking to avoid withdrawal Self-awareness of compulsion Relapse following periods of cessation

1980’s Renaming to “alcohol dependent” opened door for application of criteria to “psychoactive” substances By 1980’s alternatives to medical model began to emerge and become influential (Sociological model; psychological model)