“Drink not the third glass, which thou canst not tame when once it is within thee”                                                      George Herbert (1593-1633)

Alcoholism is a disorder containing a multitude of pernicious symptoms that satisfy a variety of purposes– conscious or otherwise–for over 13 million Americans. Whether defined as a disease, addiction or behavioral disorder, the symptoms are the same: Frequent alcohol consumption, ever-increasing tolerance for alcohol, impaired judgment, emotional distancing from family and friends, difficulties with routines at home or work, and physical problems, including blackouts.
The impact of this disorder is alarming. Alcoholism kills between 100,000 and 200,000 people per year. It is second only to Alzheimer’s disease as a cause of mental deterioration in adults. People who abuse alcohol are more likely to commit suicide, die in fires or from accidental falls. Compared with individuals who are not alcohol abusers, they are more likely to engage in domestic violence, traffic accidents and violent crimes.
Alcoholism has many ramifications for families, through which it is passed from one generation to the next. Some family members come to accept drinking as the norm rather than the exception in a variety of situations and become alcoholics, themselves. Whether or not this actually occurs, living with an alcoholic creates tension, frustration and uncertainty for the family. An initial coping strategy, “denial” of the problem, soon leads to “fragmentation” of responsibilities and expectations; and attempts to reorganize by shifting roles in order to compensate for the “sick” family member. This evolution enables (reinforces) the alcoholic and creates a highly dysfunctional environment for the family.
A costly legacy, 28.6 million children have alcoholic parents and live in constant tension, wondering whether on a given day a parent will be drunk or sober. They rarely bring friends home, feel isolated– often depressed. Not surprisingly, 80% – 90% of teenage suicides are related to alcoholism in the family.
An outgrowth of decades of identifying, classifying and treating alcoholism is the controversy of whether or not alcoholism is an addictive disease. The concept of alcoholism as a disease is widely accepted by both professionals and the general community. “Addictive disease” has the connotation of being out of control, and a variety of diagnostic and treatment modalities are established based on that premise. The importance of the Disease Model are its consequences, which have included a heightened awareness of the destructive effects of alcohol on individuals and their families; and the supportive treatment modalities that were generated such as Alcoholics Anonymous.
There is, however, a well-articulated alternative perspective that alcoholic behavior is a social phenomenon, capable of being controlled. In their prize-winning sociological study, Deviance and Medicalization: From Badness to Sickness (1980), Conrad and Schneider describe the trend in our society to “medicalize” deviant behavior. They note that the disease called, “alcoholism” in many ways does not satisfy strict medical criteria. The description of this “disease” is not in terms of its physiological effects, but more predominantly, its interference with social functioning. They believe that while the “medicalization” of this aberrant behavior was an attempt to deal with an important problem, it is nevertheless an inappropriate model for alcohol abuse. A more useful endeavor involves designing a model of effective treatment.
One approach, called, “reframing”, refers to changing the meaning of a behavior in a particular context. Underlying the concept is the assumption that an unhealthy pattern of behavior has secondary gains– that it benefits the person in some ways– and treatment takes this into account. Alcoholic behavior has many secondary gains: Stress management (self tranquilization); a kind of intimate relationship– a reliable “friend”; a way of avoiding confrontation; a form of aggression against a “persecutor” in whose presence one may feel powerless, and so forth.
A presupposition of reframing is that there are always alternative ways to behave– see, hear and feel– in the world. Once the “intent” or benefit of an alcoholic’s behavior is identified, there are other patterns of behavior that can provide that individual with whatever payoffs or benefits alcoholic behaviors have given him; and these new patterns would be healthier and more satisfying! Furthermore, most people already have the resources (powerful experiences) available to access and develop these new patterns of behavior. Therein lies the value of AA, psychotherapy and other treatment modalities: To help the individual generate new choices of behavior in which to satisfy a useful intention.