What is alcoholism?

Alcohol Health & Research World, Fall, 1991 by Daniel K. Flavin, Robert M. Morse

Serious challenges to standardized treatment approaches have helped to support this principle of individualized treatment. Current emphasis on the use of a 28-day inpatient rehabilitation program, popularized over the last 40 years by the Minnesota Model (Goodwin 1991), has come under increasing scrutiny by the Federal Government, third-party payers, and health professionals (Morse 1991), in part because of escalating health care costs. While studies of varying quality have cast doubt on the efficacy of a rigidly applied inpatient treatment approach for all alcoholics, a recent well-constructed and well-controlled study has observed a superior outcome associated with inpatient treatment in a population of industrial employees (Walsh et al. 1991). On balance, however, it has become clear that a single approach to alcoholism treatment falls short of meeting the needs of all alcoholics (Institute of Medicine 1990).

Yet in emphasizing the needs of the individual, it is important to realize that there are core treatment needs experienced by the majority of alcoholics. An optimum approach to treatment, therefore, is one that addresses these core issues and also incorporates individualized interventions that deal with biopsychosocial aspects of disease evolution and presentation.

The core syndrome of addiction may be therapeutically approached by facilitating detoxification, abstinence from the drug of dependence, confrontation of denial mechanisms, changes in lifestyle, and education about the nature of the disorder. Within this approach, most alcoholics will require individual consideration for any medical, psychiatric, social, occupational, and legal complications associated with their alcohol use.

As the definition of alcoholism has expanded, so has the perspective with which researchers and clinicians view alcoholism treatment. A new approach, known as the alcohol problems approach, is the subject of a recent report titled Broadening the Base of Treatment for Alcohol Problems (Institute of Medicine 1990). The alcohol problems approach acknowledges the need for certain core treatment components, and also mandates an evaluative component that matches individuals, according to their particular treatment needs, to appropriate therapeutic interventions. In practical application, however, it is difficult to find clinical programs that offer alternatives beyond a few long-established treatment approaches.

CONCLUSION

In a recent editorial, published in the Journal of the American Medical Association, Berwick has noted that learning sometimes requires courage; to become a learner is to become vulnerable, especially for the expert (Berwick 1991). Although Berwick is not writing about the alcoholism field, his words are applicable nevertheless:

The dilemma is painful. On the one hand, improvement depends on learning from information about performance. Yet, on the other hand, that same information can easily be used to make and enforce judgments that provoke fear and prevent learning.... Instead of asking how we could be better, we spend our time and money proving that we are good enough.