1. Theory vs. Model

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

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

4. 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.

5. 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

6. 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”

7. 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Prohibition Act passed in 1919 (repealed in 1933 in reaction to gangsterism)

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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.

14. 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

15. 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

16. 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

17. 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)