Download alcoholism: "toasting" your health

ALCOHOLISM: "TOASTING" YOUR HEALTH
Randy W. Green, Ph.D.
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 prizewinning 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 intent.
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