There are many theories of alcoholism, and some approaches explain and treat certain alcoholics better than others. One of the common themes throughout the readings is that addicts display a range of personal and situational problems. There is no "typical" addicted personality or emotional problem (Allen, 1996). Because of these facts, it comes as no surprise that there are also no typical assessment or treatment for these individuals. For instance, a medical/disease model of alcoholism may be more useful to some alcoholics than others. The point is that instead of rigidly applying one model, a counselor's goal is to use the models that are most effective to the particular alcoholic in question.
A primary thesis is that the way we construe alcoholism highly determines the way we diagnose, treat, and feel about alcoholism. Therefore, it is important for us to clearly and consciously know our own personal views (theories, beliefs, assumptions, expectations) toward drinking and addiction. I believe that each one of us hold theories about alcoholism which may be more or less helpful and/or harmful.
For example, if we view an alcoholic only as one who is on skid row, frequently drunk, out of control, and blatantly disruptive and embarrassing, then our theory of alcoholism must be modified for successful assessment and treatment. Although such a view does include some alcoholics, it excludes most of them and therefore precludes helping them. Instead of one "alcoholism," I have come to believe that there are many "alcoholisms." And as reflected in the referenced readings, instead of one theory, there are many theories and treatments. This is rather frightening to the new MSW! How will I know?
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Raskin, M. S., & Daley, D. C. (1991). Assessment of addiction problems. In. D. C. Daley & M. S. Raskin (Eds.), Treating the chemically dependent and their families, pp. 22-56. Newbury Park, CA: Sage. Assessment can be one of the most difficult steps in the helping process, especially when addiction is the "hidden" problem.
Vaillant, G. E., & Hiller-Sturmhofel, S. (1996). The natural history of alcoholism. Alcohol Health & Research, 20, pp. 152-162. There is strong evidence to support psychiatric disorders developed as consequences of alcoholism and that alcoholism in most patients is not secondary to other psychiatric disorders.
Woody, G. (1996). The challenge of dual diagnosis. Alcohol Health & Research World, 20, pp. 76-81. Patients with dual disorders may be misdiagnosed and improperly treated, often "falling through the cracks" in the health care system.
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