Theory vs. Model

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Theory vs. Model
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Theory

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

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Model

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

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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.

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Moral View

• Early 1700s
• 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.
• Alcohols effect on working ability not an issue

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Disease View

• Beginning late 1700s
• Disease of the Will ? alcoholism symptom of
  physical or mental illness
• 1852, term alcoholism first used
• Treatment admission to insane asylum

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Disease View mid-1800s

• 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• Prohibition Act passed in 1919 (repealed in 1933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)

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Late 1800s

• 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

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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

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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

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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

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Chronic Alcoholism

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

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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.

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• 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

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• 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

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1960s and 70s 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

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1980s

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