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Sociological aspects of the disease concept of alcoholism
... Its rapid growth and wide acceptance were due to the melding of its strong ethnoreligious support with its backing as medical dogma. Following World War II, public opinion polls indicated a continuous increase in the belief that alcoholism is a disease (Room, 1983). More recently, in August 1982, a Gallup poll (Alcohol Abuse, 1982 found that 79% of Americans accepted alcoholism as a disease requiring medical treatment. ...
... Nondisease conceptions have not fared well in this atmosphere. Although psychologists and others present alternate views of alcoholism (many of which will be discussed in this article), educational and other public information programs typically ignore nondisease perspectives (Room, 1983). The markets for psychological services in alcoholism appear to be eroding and beleaguered (Marlatt, 1983;Miller, 1983b;Nathan, 1980). ...
... Many subsequent investigations have failed to confirm either the stages or the types of alcoholism that Jellinek outlined (Room, 1983). Disease notions have been further undermined by a series of laboratory studies that found that the drinking of chronic alcoholics is not characterized by loss of control (Mello & Mendelson, 1972;Nathan & O'Brien, 1971;Paredes, Hood, Seymour, & Gollob, 1973). ...
Argues that the unique history of alcohol use in the US has led to the ascendance of disease theory as the dominant conception of alcoholism. Social-scientific research has consistently conflicted with disease theory, but psychological and other nondisease conceptions of alcoholism are not well-represented in the public consciousness, in treatment programs, or in policies for affecting nationwide drinking practices. Conflict in the field has intensified in the last decade, most notably surrounding the issue of controlled drinking in alcoholism treatment. It is suggested that the current cultural attitude toward alcoholism in the US, one strongly influenced by disease notions, has not led to an improvement in society's drinking problems and that there continues to be a need for psychologists to present alternative views of alcoholism. The concepts of dependence and addiction as related to alcohol and to drugs are discussed. (3 p ref)
... Deconstructionist approaches to alcoholism, however, indicate that sociocultural learning may be a significant influence on drinking behaviours, and that new forms of learning can lead to different outcomes (Heath, 1988, Room, 1983. Specifically, it has been found that heavy drinkers have consistently shown autonomy regarding the quantity, quality and situational elements in their drinking patterns (Foddy and Savulescu, 2010). ...
... This approach, says Fingarette (1989: 18), is "in essence a mixture of pseudomedical, psychological, and religious ideas" and he argues that it was mainly due to Jellinek"s publications on the disease concept of alcoholism that AA"s popularity suddenly surged. Jellinek"s model of the alcoholic closely matches that embraced by AA, and his liberal use of tables, charts and statistics are said to have been widely embraced as scientific authentication for their beliefs (Fingarette, 1989, Room, 1983). Jellinek"s disease concept, however, was not based on medical data, 7 "Success" in this model, as with the others that have been discussed in this review, is measured by the length of time an "alcoholic" remains abstinent from alcohol. ...
... They incorporate the admission that one"s addiction has become uncontrollable, surrender to a Higher Power, examination and amends for past errors and service to others with similar problems. but rather the results of 98 responses to a questionnaire which was designed and distributed by members of AA (Fingarette, 1989, Room, 1983. Jellinek cautioned that his data was limited, that essential categories were missing from the questionnaire, and that the responses from females were omitted due to the differences in their responses as compared to the men. ...
Alcohol abuse and dependence are major problems in Australia. Current approaches to understanding and managing these issues are not curbing increasing costs and harms to society; while research across multiple disciplines shows that the predominant biomedical model of treatment is outdated and reflects limited understandings. Research postulates that the incorporation of spiritual practice into treatment significantly improves outcomes for the heavy drinker. The „disease model of addiction‟, however, continues to predominate as a treatment model. The twelve step programme developed by Alcoholics Anonymous (AA) incorporates spiritual practice, is widely acclaimed as the most successful treatment programme for alcoholism in the world and is often utilised in support of biomedical treatment. Critiques of AA, however, indicate that the Judeo-Christian foundations of the programme may limit its appeal, and gaps have been identified in addiction literature exploring alternative spiritual and religious approaches. In this research, semi-structured interviews were conducted with spiritual leaders from the Catholic, Jewish, Islamic, Pentecostal, Krishna Consciousness and Buddhist faiths. Generally, the heavy drinker was represented in terms of constriction and isolation, tightly bounded and separated from both their communities and their spirituality. Treatment and support options were presented with a focus on „softening‟ the boundaries of the heavy drinker, encouraging them to reconnect with their community and with God or their Higher Understanding. The Catholic and Jewish interviewees represented alcohol dependence in terms akin to the disease model, requiring ongoing support from the spiritual and secular communities. The Islamic representation incorporated anomie, reflecting the belief that appropriate cultural and communal support would allow the heavy drinker to reintegrate the practice of abstinence which is integral to their faith. The remaining three prioritised a lived, embodied experience of God or Higher Understanding by the heavy drinker, positing that the eradication of boundaries between them can lead to cure for alcohol dependence. A focus on boundaries opens possibilities for future research on tailored individual programmes which may include induced spiritual experiences and incorporation of secular activities which encourage the experience of „flow‟.

... Addiction Theory Peele (1995) has noted that the vigorous promotion of alcoholism as a chronic, relapsing disease by the scientific medical community in the 1950s and 1960s (Glatt, 1952;Jellinek, 1952Jellinek, , 1960Keller, 1962) has effectively embedded the notion of addiction-in both the public consciousness and (to a lesser, though significant extent) within the academic discourse-as an incurable condition that can, at best, be managed and contained. Room (1983) has charted the opposition to this position by sociological researchers and proponents of the behaviorist schools, but, although these arguments gained significant ground during the 1970s and early 1980s, the increasing focus, during the past two decades, upon infection control and crime reduction has resulted in a general return to a medical model of addiction treatment, predicated upon the management of the problem and containment of its physiological and criminological sequalae. ...
... The publication of Jellinek's 1952 work on phases of alcoholism, and its subsequent incorporation into World Health Organisation guidelines (Room, 1983), significantly influenced discussions on the nature of addiction and recovery for most of the 1950s and 1960s. This disease model of addiction was not without its critics. ...
... The controversy that surrounded the publication of this report, with its finding that not only was a reversion to controlled drinking possible, but that it was the most likely successful outcome, sparked a public argument, which refused to die down. Room (1983) has noted that some studies of controlled drinking had their funding withdrawn at this time and that the debate became, at times, extremely emotive. The authors were accused of providing struggling abstainers with a "scientific excuse for drinking" (Room, 1983) and numerous commentators predicted dire consequences as a result of its publication (Roizen, 1987). ...
An understanding of addiction as a complex disorder involving biological/physiological, psychological, sociocultural, and socioeconomic elements is well established as a foundation for good practice in treatment interventions. More recently, we have begun to view recovery from this disorder as being reliant upon a realignment of all these elements within the context of a sustained structure of encouragement and support rather than as an illness that will respond to a short, time-limited intervention such as treatment. Drug treatment-seeking populations have been rigorously researched, and we know much about their journey toward and through treatment and even into post treatment. However, nontreatment-seeking populations are far less well known, and we know almost nothing about their experiences of long-term recovery. What is known is that “natural” recovery from even the most serious episodes of addiction is widespread, perhaps even commonplace. In Europe, the majority of these natural recovery episodes appear to take place outside formal treatment and even in defiance of the injunctions and advice of treatment providers. Understanding this process of natural remission and the structures or elements that both make remission possible and sustain it over the long term will help to identify the most critical aspects of treatment interventions in general and after-care processes in particular. This chapter reviews the history of recovery movements, the implications of the accepted theories of addiction, and argues for the need to create communities of recovery in order to limit the intergenerational transmission of addiction
Recovery Capital, Addiction Theory, and the Development of Recovery Communities. Available from: https://www.researchgate.net/publication/273298707_Recovery_Capital_Addiction_Theory_and_the_Development_of_Recovery_Communities?origin=mail [accessed Jan 14, 2016].
... Nella nuova fase post-UCLA, come già accennato in precedenza, i fenomeni alcol-correlati acquisiscono sempre più prominenza tra gli interessi di ricerca di Lemert. Le sue prime pubblicazioni in materia, tra anni Cinquanta possono essere interpretate come un tentativo di contrastare il dogmatismo della definizione medica di alcolismo (Room 1983), mentre le esplorazioni antropologiche compiute tra nativi americani e polinesiani allargarono e resero maggiormente articolato il suo contributo. Il focus non è solo più sul comportamento problematico e le patologie alcol-correlate, ma anche motivi e forme del bere, il rapporto tra organizzazione sociale e modelli del bere, il bere come fattore di integrazione sociale. ...
Edwin M. Lemert è uno dei maestri della sociologia della devianza, in grado di rivoluzionare il rapporto tra soggetto e società con la sua teoria della reazione sociale e di influenzare la teoria dell’etichettamento. Grazie a figure come Franco Basaglia, questo autore ha ricevuto anche in Italia un immediato riconoscimento che purtroppo si è scontrato con il limitato numero di traduzioni dei suoi scritti. Tuttavia, negli ultimi anni si è assistito ad una riscoperta del pensiero lemertiano, iniziata nel 2019 con la ripubblicazione di una nuova edizione riveduta e corretta di Devianza, problemi sociali e forme di controllo. Sociologia del male e altri scritti rappresenta un altro tassello fondamentale di questo percorso, perché sono presentati per la prima volta ai lettori italiani i percorsi di ricerca battuti da Lemert nella seconda parte della sua carriera: la teoria della devianza; le forme di devianza, stigmatizzazione e controllo; la sociologia del tribunale penale minorile; il problema del male. L’obiettivo del libro è quindi approfondire la conoscenza e contemporaneamente celebrare l’anticonformismo, l’eclettismo e l’innovazione di un autore unico all’interno del panorama sociologico internazionale.
Volume a cura di Enrico Petrilli e Cirus Rinaldi, con prefazione di Dario Melossi.
... However, the disease approach to alcoholism has been recognised as carrying some positive connotations, notably in engendering a more tolerant attitude from a medical standpoint (Collins 1990) ; a more sympathetic understanding from family, friends and employers (Room 1984); as well as from the general public (Crawford and Heather 1987). Alcoholism as a disease may also have added appeal when applied to women, as it continues to emphasize feminine vulnerability and qualities consistent with traditional female functions (Morrisey 1986;Littlewood 1994). ...
p>The research explored the life experiences of women who had histories of drinking problems, to illuminate new understandings about why women may develop alcohol problems, and how they may succeed in achieving sobriety.
A feminist approach and a qualitative, life history method was used to collect and analyse 13 in-depth, autobiographical accounts. The research participants comprised of a heterogeneous group of self-referred women volunteers, from a non-clinical population, who had personally identified having experienced drinking problems. Each participant's life story was taped over several sessions, and lasted approximately eight hours. Thematic analyses was used across fully transcribed life histories to identify the common themes which had contributed to, or exacerbated, alcohol misuse.
Significant common themes which emerged from the life histories included childhood sexual abuse, other childhood unhappiness, difficult or violent heterosexual relationships or marriage, lesbian sexuality, and depression. These themes revealed significant continuums of individual victimisation and abuse across life course, which were associated with the oppressive social and political gendered contexts of these women's lives. Life stories were also surveyed to identify influences during personal recovery, and two concluding themes were revealed concerning help-seeking behaviours associated with alcohol misuse, and the ways in which recoveries were achieved and sustained. Findings identified inadequate support or understanding about research participants' problem drinking from health care gatekeepers, helping professionals and intimate partners. The notion of individual self-reliance and sustained personal motivation to reach and maintain recovery emerged as pivotal among this group of women who eventually all achieved sobriety without professional help. These findings contrast with much traditional theory which has negatively viewed women's motivation and capacity for recovery from drinking problems. Additionally, the research revealed that participants regularly used alcohol as a strategy for personal survival and control in their lives.</p
... The collegial ambivalence sometimes expressed as "why would you study that?" is not a single, uniform stigmatization, but reflects and refracts every facet of alcohol's weird positioning in U.S. culture, including beliefs that such work is not "real" sociology and perhaps not even worth the energy. In a different twist, Straus had earlier elaborated on the experience of being an alcohol researcher, noting the possibility of various moral entrepreneurs "jumping on" one's reported findings in a whole variety of ways that threaten scientific integrity (cited in Room, 1983). Although Bob was referring to the premature use of findings that reinforced cherished beliefs, the converse has another set of realities, namely evidence that threatens these same entrepreneurs' ideologies and the resulting bombasts hardly need elaboration. ...
... Jellinek betegségkoncepciójának kritikájaként ekkor jelennek meg az első tanulmányok arról, hogy az alkohol nemcsak az alkoholbeteg számára jelent problémát, és a probléma nemcsak a betegségben fejeződik ki, hanem az egyén szűkebb-tágabb környezete számára is problémát jelenthet. A szociológiai gondolkodás számára ekkortól jelenik meg a problémás ivó és a problémás alkoholfogyasztás fogalma (Bruun és társai 1975, Room 1983, Andorka 1984. A problémás elnevezés ma már egyre gyakrabban jelen van a tiltott szerekkel foglalkozó irodalomban is (lásd pl. ...
... Adherence to the contradicting disease model, Barnett et al. argue, helps lessen the stigma on alcohol and drug addiction. Stigma reduction is, of course, one of the main reasons that political advocates for addicted patients have historically promoted the disease concept [3,4]. ...
... Considérée initialement par les tenants de l'école sociologique du « contrôle social » comme un mouvement irrésistible et irréversible de mise sous tutelle médicale de populations et de comportements déviants et d'extension indéfinie du pouvoir des professions médicales (Chorover, 1973 ;Szasz, 1974 ;Illich, 1975 ;Conrad et Schneider, 1980), la « médicalisation » a suscité par la suite des travaux plus équilibrés s'attachant à en détailler les diverses formes et surtout, les limites et contraintes tant internes qu'externes (Fox, 1977 ;Srong, 1979 ;Conrad, 1992 ;Ballard et Elston, 2005 ;Rose, 2007). 3 Or curieusement, le champ d'étude de l'alcoolisme aux Etats-Unis a échappé presque entièrement à ces oppositions polémiques et la vision clairement dominante est celle d'une médicalisation difficile mais libératrice, émancipant définitivement les alcooliques de la réprobation morale et du risque pénal d'emprisonnement (Levine, 1978 ;Room, 1983 ;Roizen, 1991Roizen, , 1996Roizen, , 2000White, 2000 ;White et al., 2001). Au milieu de ce consensus, les voix discordantes sont rares et maintenant anciennes (Fingarette, 1988 ;Peele, 1989). ...
... Enskilda medlemmar inom AA, och organisationer knutna till rorelsen, har utovat ett betydande inflytande på de professionella behandlingssysternen och på den amerikanska behandlingslagstiftningen (Johnson 1973;Room 1983). Fram till nu har emellertid enskilda AA-medlemmar inte varit aktiva inom alkohol-och drogpolitiken. ...
... Vad galler specielIt dryckenskap, hanfor han upptackten av den till uppkomsten av medelklassens individualistiska varldsåskådning. Room (1983) diskuterar det satt på vilket begreppet alkoholism definierades och introducerades i den offentliga debatten i USA i borjan av 1940-talet genom något som kalla-des alkoholismrorelsen, en grupp av forskare och foretagare som hangav sig åt uppgiften att få bort det stigma, som avhåller folk med alkoholproblem från att saka hjalp for denna "behandlingsbara sjukdom". ...
... The model attained dominance in the field by 1950, and versions of it-for instance, the "brain disease" model (Courtwright 2010)-are of continuing importance today. It may be noted that in quiet ways, from the 1950 onward, many of the North American sociologists contributing to the field dissented from this alcoholism model and published work which tended to undercut it (Room 1983). ...
... The idea that deviant drinkers had a disease and should receive treatment, he shows, was the product of Alcoholics Anonymous, the Yale Center for Alcohol Studies, and E. M. Jellinek's formulation of alcoholism as a disease. The scientific research said to support the idea that alcoholism is a disease, as well as its endorsement by the American Medical Association, generally followed the alcoholism movement's assertion of this view (Room 1983). As John Seeley long ago noted, "The statement that 'alcoholism is a disease' is most misleading, since it conceals that a step in public policy is being recommended, not a scientific discovery announced" (1962a: 587). ...
... In this sense, the facts of diseases, addiction included, are socially produced-they comprise historically and culturally situated ideas about relevant symptoms and sufferers and ideas about causes, outcomes and treatments, all shaped by prevailing ideas of what is philosophically and scientifically reasonable at a given time or, in other words, with what corresponds with established ideas and objects and the instruments seen to capture them ( Duffin, 2005;Fraser & Seear, 2011). Thus, as our second author, Fraser, along with other scholars, has noted elsewhere, definitions and meanings of addiction are multiple and contested, showing considerable historical and socio-cultural variation (Fraser, 2015;Fraser et al., 2014;Reinarman, 2005;Room, 1983). Indeed, influenced by scholars from science and technology studies, we proceed from the view that knowledges, such as those generated by addiction tools, 'produce realities in a process of ongoing enactment' (Fraser, 2015, p. 7;Fraser et al., 2014). ...
Human practices of all kinds–substance use, gambling, sex, even eating–are increasingly being reframed through the language of addiction. This ‘addicting’ of contemporary society is achieved, in part, through the screening and diagnostic tools intended to identify and measure addiction. These tools are a key element in the expert knowledge-making through which realities of addiction emerge. Promoted as objective and accurate, the tools are given legitimacy through application of scientific validation techniques. In this article, we critically examine the operations of these validation techniques as applied to substance addiction tools. Framed by feminist and other scholarship that decentres the epistemological guarantees of objectivity and validity, we structure our analysis using Ian Hacking's (1999) concepts of ‘refuting’ (showing a thesis to be false) and ‘unmasking’ (undermining a thesis). Under ‘refuting’, we consider the methodological validation processes on their own terms, identifying contradictory claims, weak findings and inconsistent application of methodological standards. Under ‘unmasking’, we critically analyse validation as a concept in itself. Here we identify two fundamental problems: symptom learning and feedback effects; and circularity and assumptions of independence and objectivity. Our analysis also highlights the extra-theoretical functions and effects of the tools. Both on their own terms and when subjected to more searching analysis, then, the validity claims the tools make fail to hold up to scrutiny. In concluding, we consider some of the effects of the processes we identify. Not only do these tools make certainty where there is none, we contend, they actively participate in the creation of social objects and social groups, and in shaping affected individuals and their opportunities. In unpacking in detail the legitimacy of the tools, our aim is to open up for further scrutiny the processes by which they go about making (rather than merely reflecting) the disease of addiction.
... Downloaded from see themselves as being in recovery from it, and among people in general (Reinarman, 2005). Yet as Levine (1978), Room (1983Room ( , 1984, and others have convincingly shown, "addiction as disease" (and "addiction" in and of itself) is a historical creation of a particular epoch and in a specific cultural location. Levine (1978) describes addiction as a modern invention, emerging in the late 18th and early 19th centuries. ...
Based on qualitative interviews with adult children of alcoholics, this article analyzes three different ways of conceptualizing drinking problems: alcoholism as disease, alcoholism as volitional behavior, and alcoholism as a socially conditioned phenomenon. The interviewees (13 women, 12 men, average age 39 years) were recruited among employees at a large workplace who in a preceding survey had classified their parents as having “alcohol problems.” The analysis reveals a pattern in which adult children’s understandings of their parents’ drinking problems, in essence the ways they think alcoholism should be explained, are associated with the ways they describe their relationship to their parents and the hardships of their childhood. The article suggests that differences in childhood experiences may lead to different ways of understanding the phenomenon of alcoholism, just like differences in understandings of alcoholism may affect recollections of childhood experiences.
Substance use disorders (SUDs) have long been misinterpreted as character flaws rather than ailments. With the evolving body of medical research, a dichotomy has been formed between drunkenness and the disease we now know. Art has served a special role in the reflection of the human condition. It serves as both a third-party storyteller and an influencer of our perception of the world around us. For a modern analysis of SUD streaming technology was used to study film and the depiction of addiction through the last 70 years. This paper will explore the topic of film’s ability to reliably report on this issue. Beautiful Boy is the most modern and the central film to the analysis. Research questions include: Can film accurately portray SUD? Specifically, the human suffering associated with addiction on the individual level and the family unit. Can it help people, who might not otherwise be exposed to its effects, understand the intricacies of addiction and reform? Now that we understand SUD to be a disease, art’s role in portraying it to the public is crucial to recovery for all.
L’article explore le problème social des dépendances et amorce la réflexion sur le deuil qui s’ensuit dans la perspective de son impact sur les dynamiques familiales. Devant l’ampleur des formes de décès possibles dans le champ des dépendances, le texte traite d’abord la question à partir d’une lecture des perspectives de contrôle social pénal et thérapeutique. La deuxième partie décrit la façon dont les toxicomanies et les dépendances sont en rapport avec la mort et le deuil. Il analyse en troisième lieu en quoi le deuil des familles est particulièrement affecté par les décès en contexte de dépendances pour ensuite traiter des modes d’intervention en fonction de l’association dépendances-mort-deuil.
Alcohol intoxication is unwelcome to a majority in modern societies, though tolerated in specific circumstances. Societal responses have generally sought to minimise harm and discourage recurrence. Public intoxication, seen as impairing community amenity, was traditionally criminalised, with chronic cases imprisoned or compulsorily treated. Where decriminalised in recent decades, other discouragements have been substituted. Recognising alcohol’s role in domestic violence has brought renewed attention to intoxication in private. Intoxication is involved in many serious crimes and torts and enters into consideration in many ways in legal proceedings. Prevention policies have had the greatest recent success in deterring intoxication prior to driving. Otherwise, discouragement of intoxication has had limited success, with effective steps in the neoliberal era resisted by political elites and alcohol industry interests.
In recent years, the reduction of alcohol-related harm has emerged as a major policy issue across Europe. Public health advocates, supported by the World Health Organisation, have challenged an approach that targets problem-drinking individuals, calling instead for governments to control consumption across whole populations through a combination of pricing strategies, restrictions on retail availability and marketing regulations. Alcohol, Power and Public Health explores the emergence of the public health perspective on alcohol policy in Europe, the strategies alcohol control policy advocates have adopted, and the challenges they have faced in the political context of both individual states and the European Union. The book provides a historical perspective on the development of alcohol policy in Europe using four case studies - Denmark, England, Scotland and Ireland. It explores the relationship between evidence, values and power in a key area of political decision-making and considers what conditions create - or prevent - policy change. The case studies raise questions as to who sets policy agendas, how social problems are framed and defined, and how governments can balance public health promotion against both commercial interests and established cultural practices. This book will be of interest to academics and researchers in policy studies, public health, social science, and European Union studies.
There is a richness and diversity of alcohol history. At the international level, alcohol historians are animated by an esprit de corps which helps facilitate the development of cross-national trends and comparisons. The work of the Social History of Alcohol Conference at Berkeley in 1984, the alcohol epidemology section of ICAA and now the Kettil Bruun Society should be mentioned. The US and Scandinavian traditions of work are notable. Why is this so? The names and places mentioned above give a clue.
The starting point of this article is the American paradox on the issue of alcohol: The vitality of the temperance movement has not deterred some of the medical profession to seek early pragmatic therapeutic solutions to treat alcoholism. However, can we speak of a true medicalization of alcoholism in the sense of Irving Zola and his successors? To answer this question the article goes back over the difficult development of an alcoholism medicine in the United States examining whether this amounted to anything more than the proclamation that alcoholism is a disease. From the collapse of the initial alcoholism medicine in the early twentieth century until its resurgence after the Repeal of prohibition, something profoundly original finally emerges but it's not a conventional medicine: it's rather a social medicine, a medicine of restoration of free will in a specifically American paradigm.
What is 'addiction'? What does it say about us, our social arrangements and our political preoccupations? Where is it going as an idea and what is at stake in its ongoing production? Drawing on ethnographic research, interviews and media and policy texts, this book traces the remaking of addiction in contemporary Western societies. © Suzanne Fraser, David Moore and Helen Keane 2014. All rights reserved.
Through applications of the WPR approach from several policy fields, this chapter explores the proposition that policies produce “objects”. It draws upon theory introduced in Chapter 3, with emphasis upon the notions of discursive practice, genealogy, and governmentality. The following questions guide the analysis: What does it mean to problematize an assumed “object for thought”? How are “objects” constituted through governing practices? What role do expert knowledges play in constituting “objects for thought”? How do concepts become “objects” through measurement? How does rethinking “objects” as the products of practices open up space to cultivate alternative problematizations?
Generalization of scientific findings is contingent on replication of results. This is particularly critical for research concerning the correlates and prediction of human behavior where cultural and temporal factors may alter findings. Alcohol-related longitudinal research is rich and bountiful; it permits exploration of the degree to which replication of findings has taken place, particularly replication across differing cultural and temporal frames, and the development of research strategies that might provide tests of replication.
One of the most significant difficulties in dealing with alcoholism on any level is that so few people agree on what it is. In American society, there are differing and controversial perspectives current in the medical professions, the academic and scientific communities, and the population at large as to whether habitual and excessive consumers of alcohol are suffering from a disease, are victims of conflicting cultural norms, are weak-willed and irresponsible persons, or a combination of these possibilities. The stigmatizing aspects of alcoholism and the general paradigmatic differences among professionals have had far-reaching implications not only for prevention and treatment programs, but also for the affective behavior of the afflicted drinker and his or her family.
As maintained by Toulmin [1], a certain event or condition can appear as a phenomenon — something that is problematic and needs explaining — only against the background of some inferred’ state of natural order’. This proposition is worth bearing in mind when revisiting and trying to summarize the key findings and major implications of some of the studies that have historically been most often cited in the debate over the existence, incidence, and character of self-change from addictive behavior. Admittedly, the selection of studies for the following brief review has by necessity been somewhat arbitrary. Nonetheless, it is evident that the vast majority of what may be termed the ‘classics’ in this field originated in the USA, in the 1960s and 1970s. To some extent this may be explained by the dominance, in a global perspective, of American alcohol and drug research at the time. However, the attention paid to these studies and the controversy raised by the issue of self-change may also be reflective of a cultural setting particularly conducive to making this topic stand out. Through the influence of the alcohol movement, the popular ‘disease model’ of drinking problems had by the early 1960s become an almost uncontested foundation for alcohol research as well as policy in the USA [2]. According to this model, alcoholism is an irreversible and inexorably progressive process, due to some inborn characteristics in certain people. Similarly, but for different reasons, narcotic drugs (i.e. at the time, opium and its derivatives) were assumed to have chemical properties making them capable of enslaving users, more or less instantly and for life.
This chapter proposes a narrative theory of action. From a narrative perspective, actions are viewed as meaningful expressions which are integrated into a larger whole: the story of life. Explanation of action takes the form of interpretation or hermeneutic understanding. The phenomenology of Merleau-Ponty provides an example of a narrative approach to human action. The notions of dialogue and style in Merleau-Ponty’s philosophy are especially relevant. A narrative theory of action may actually play a role in contemporary human sciences. Such a role is demonstrated through a discussion of a possibile narrative approach to the psychology of addiction.
Der Beitrag untersucht die Struktur und Entwicklung des Suchtmodells. Gemeinhin galt der Säufer als Sünder. Erst um 1800 kommt die Vorstellung auf, dass er an einer »Krankheit des Willens« leidet: der »Trunksucht«. Lange eine ärztliche Mindermeinung, setzt sich diese Sichtweise um 1900 durch. Durch Jellinek wird sie dann als »Krankheitsmodell des Alkoholismus« neu formuliert und prägt in dieser Form unser Alltagswissen. In der Forschung hingegen findet das »klassische« Modell kaum noch Anhänger; einigen gilt die Sucht sogar generell als ein »Mythos«. Und doch nimmt der Einfluss dieses empirisch und theoretisch weithin obsoleten Modells sogar noch zu, indem es unkritisch auf andere Substanzen und Verhaltensmuster übertragen wird, zumal seit die WHO den Suchtbegriff durch einen vagen Abhängigkeitsbegriff ersetzte. Diese hoch moralische »Suchtinflation« zeitigt nicht-intendierte Negativfolgen. Daher wird hier abschließend für eine Rückkehr zu einem strengen Suchtbegriff plädiert. --- Teaser below
This chapter reviews several domains of sociological research conducted in the field of alcohol studies during the last decade. The domains are organized within the sociostructural, social constructionist, and distribution of consumption theoretical perspectives. Discussions of the current state of the field and definitional and measurement issues are also included. Within the sociostructural perspective, sociocultural theories, social deviance theories, age, gender, ethnic, and occupational group differences, and other related deviant behaviors are examined. Several examples of applications of social constructionist theory are included covering the new temperance movement, the Mothers Against Drunk Driving movement, Alcoholics Anonymous, and the Children of Alcoholics movement. In the section on distribution of consumption models, alcohol availability and drunk driving control policies are discussed. There are several sociopolitical issues that need to be addressed in the next decade and further collaboration across disciplines is warranted.
This chapter recounts what is known about the international development of treatment institutions for inebriates in the century before 1940. It begins with the origins of treatment in the self-help temperance movement of the 1830s and 1840s and the founding of the first inebriate homes, tracing in the United States the transformation of these small, private, spiritually inclined programs into the medically dominated, quasipublic inebriate asylums of the late 19th century. A similar institutional development occurred in other English-speaking countries. Both in the United States and Britain, these institutions almost disappeared by the end of the First World War. In Germany and Switzerland, a three-tier system of community advice bureaus, inpatient sanatoria, and work camps developed at the turn of the century; an analogous system, with temperance boards at the community level, developed in Nordic countries between 1912 and 1940. The societal emphasis on the problem of impoverished inebriates often turned inebriate treatment efforts in the direction of coercive and custodial handling.
Concepts of addiction differ across time and place. This article is based on an international research project currently exploring this variation and change in concepts of addiction, in particular in the field of alcohol and other drug (AOD) use. Taking AOD policy in Australia and Canada as its empirical focus, and in-depth interviews with policy makers, service providers and advocates in each country as its key method (N=60), the article compares the addiction concepts articulated by professionals working in each setting. Drawing on Bruno Latour's theoretical work on the body and his proposal for a better science based on the 'articulation of differences', it explores the accounts of addiction offered across the Australian and Canadian project sites, identifying a shared dynamic in all: the juggling of difference and unity in discussions of the nature of addiction, its composite parts and how best to respond to it. The article maps two simultaneous trajectories in the data - one moving towards difference in participants' insistence on the multitude and diversity of factors that make up addiction problems and solutions, and the other towards unity in their tendency to return to narrow disease models of addiction in uncomfortable, sometimes dissonant, strategic choices. As I will argue, the AOD professionals interviewed for my project operate in two modes treated as distinct in Latour's proposal: in turning to reifying disease labels of addiction they take for granted, and work within, a 'universe of essences', but in articulating the multiplicity and diversity of addiction, they grope towards a vision of a 'multiverse of habits'. The article concludes by addressing this tension directly, scrutinising its practical implications for the development of policy and delivery of services in the future, asking how new thinking, and therefore new opportunities, might be allowed to emerge.
Purpose
– There is limited research documenting recovery experiences of residential service users. The purpose of this paper is to explore the perceptions service users on methadone have about recovery. In depth, semi structured 1-1 interviews with seven poly drug using homeless males between the ages of 37 and 46 and analysed using NVivo software. Results are presented thematically. Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to former addict identities. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms that equate recovery with abstinence. Tensions were revealed in true motivations for active rather than passive participation in adopting group work norms.
Design/methodology/approach
– A qualitative design utilises small numbers of participants to gather rich data. In depth, semi structured 1-1 interviews conducted with seven poly drug using homeless males who have completed between ten and 15 weeks of a minimum 26-week residential treatment programme. Participants were aged 37-46. Results were analysed thematically using NVivo software.
Findings
– Participants conform to “recovery” norms allowing stigma and shame of illicit drug use to be attributed to a former stigmatised addict identity. Participants on methadone maintenance report inner conflict arising from changing societal and cultural norms regards recovery and abstinence. A significant process of recovery involved adopting the norms of 12-step groups and TC therapy to gain enough trust to leave the therapeutic community (TC) unsupervised. This created tension regards motivation, were these individuals in recovery, or merely “faking it”?
Research limitations/implications
– A female perspective may have provided a more balanced discussion and yielded greater depth in results. Only one service was studied and the findings may be specific to that cohort. The duration of stay at the service of ten to 15 weeks is a relatively short time and excluded participants resident for six months or more. Longer term residents may have been more reflective and informative.
Practical implications
– Encourage active options and increased debate on the variety of treatment options available to long term homeless opiate users who have failed to comply with previous treatments. While this is a small modest study, the rich data yields practical advice for policy makers and service providers.
Social implications
– This research study adds to an informed perspective by encouraging debate on methadone as a challenge to definitions of recovery that infer abstinence as a key definition of success.
Originality/value
– There is a paucity of research documenting a Scottish TC service user perspective using qualitative methods on experiences of addiction, treatment and recovery.
Activists in seven US cities were interviewed about why they thought people in their communities mobilized against alcohol-related problems. The data were analyzed in light of the focus on resource mobilization theory in the social movement literature. In contrast with claims that resources are the primary catalyst for change, informants emphasized the role of grievances, and to a lesser extent, bridging factors that caused residents to be more aware of or frustrated by problems, and thus ready for change. Resources seemed to provide necessary but insufficient conditions for explaining movement participation, suggesting that, to be effective, resources must be channeled to address and be linked to the grievous social conditions of inner city communities.
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