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:

1. Moral “Addicts” are sinful and weak-willed. Treatment = punishment

2. Biological/Disease addiction caused by biological abnormality that the person has no control over. Treatment = Abstinence

3. Sociological addiction created by social conditions (i.e. media). Treatment = macro and micro social change

4. 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• Prohibition Act passed in 1919 (repealed in 1933 in reaction to gangsterism)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:

1) Animosity toward Chinese immigrants and “opium dens”

2) Cocaine (isolated in 1855) became most common anaesthetic by 1884

3) 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:1) Drinking more heavily and frequently than

friends2) Experiencing blackouts3) Devising ways of avoiding criticism4) Experiencing more frequent & severe

hangovers

Addiction Phase

• Drinker no longer has control• Patterns include:1) Finding excuses to drink2) Needing a drink to “get started” (i.e. the

day)3) Preferring to drink alone or with other

alcoholics4) Beginning to avoid family/friends who

might criticize

Chronic Alcoholism

• Physical dependence• Patterns include:1) Binging for extended periods in attempt

to re-experience initial euphoria2) Experiencing tremors and/or DT’s when

not drinking3) Ensuring supply is always readily

available4) Experiencing nameless fears and anxiety

WHO

• 1952 first major, in-depth, world-wide study conducted by WHO 5 types of alcoholism identified:

1) Alpha = alcohol used to relieve pain, but creates additional pain/problems

2) Beta = regular heavy drinking, but within cultural confines.

3) Gamma = alcohol abused so frequently that biological changes occur.

4) Delta = a step beyond Gamma complete loss of control

5) 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)