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Tuesday, July 19, 2011

Is there a generally accepted physical mechanism that explains alcohol addiction?

In May and June 2011, I participated in a number of LinkedIn discussions with self-proclaimed addiction specialists - dealing with a number of topics that had to do with alcohol addiction and treatment.  As a group, everyone who participated was very experienced treating alcoholics, and had hands-on experience with implementing treatments based on at least one of three loosely aligned models of the disease process.

To get this blog rolling, I want to post my own interpretation of the three dominant viewpoints that seemed to dominate the LinkedIn discussions:
1) LEARNING MODEL: Motivational learning model - based on the assumption that alcoholism represented learned behavior that can, therefore, be unlearned or reconfigured using cognitive behavioral methods.
2) SELF-HELP MODEL: All of the LinkedIn discussants were very familiar with the Program of Alcoholics Anonymous.  While AA does recognize physical and emotional components of alcoholism, the differentiating focus is on the recognition and correction of the alcoholics impaired value system - the spiritual submission that leads toward profound character change and away from environmental triggers.
3) MEDICAL MODEL:  This was the least talked about and most universally maligned view point that takes the position that alcoholism is an error of metabolism that has less to do with learning and values than with defective bio regulatory systems.


As we gather information about these separate approaches, we must bear in mind that all of them are probably significant and contributory to some important aspect of alcoholism.  The question we will ultimately try to confront is to identify pivotal defect(s) that materially causes the addict to crave alcohol and have irrational relapses into uncontrollable drinking.  To talk of a "cure" is to talk about a critical phase of the illness, that, if modified, would  reduce the risk of morbidity and mortality for every patient, prevent further outbreakes to such an extent that remission could be sustained with minimal intervention and without any appreciagble risk of endangerment either to the former alcoholic or to his ecology.     


  1. Hi Dr. Bill, Kirk here in Winnipeg.
    In your 1st Model, Learned behavior can originate from a number of different perspectives. In addiction, I believe the prime motivator is coping mechanisms which develop in an unhealthy way from unmet needs & how people respond to those unmet needs which wounds a person even deeper and generally trauma, either through an event or developmental trauma which occurs over a period of time.
    In the 2nd Model, Self Help, I would venture to say that most (not all) individuals come from a mildly to a severely dysfunctional family system. If I were to hold up a model of what constitutes a healthy family we would find such things included as unconditional love, respect, values & morals, nurturing, acceptance, belonging, intimacy, safety/security, significance and purpose name a few. For many people attempting to recover from addiction the Self Help Model may be the first healthy family that these addicts come in contact with.
    In your 3rd, or Medical Model, I must confess that I really don't have a lot of knowledge about this area. I know that a physical change occurs in the brain that is essentially irreversible, other than complete abstinence. Whether there are drugs capable of affecting tolerance I don't know.
    I've been sober over 15 years and have worked with a lot of people over that period of time. I've been a counselor for 3 1/2 years at a wonderful Treatment Centre: and although I found my way here by accident love the work.
    I believe the chances of any breakthrough in addictions treatment will come as a result of working together. Thanks for posting your comments and directing people to your blog.

  2. Thank you for emending my poor attempt at defining the dominant treatment modalities available at most facilities for managing chronic alcoholism. If I understand you correctly, you are stating that any person who grew up in a severely dysfunctional family where there was no unconditional love, respect, values & morals, nurturing, acceptance, belonging, intimacy, safety/security, significance and purpose would define a chronic alcoholic. Please help me understand whether any of these environmental deficiencies is pathognomonic for alcoholism - that means that every person who had chronic alcoholism would have the same environmental deficiency, and that the person's chronic alcoholism would be relieved when that deficiency was resolved. Does the family dysfunction cause the alcoholism or does genetically inherited alcoholism result in dysfunction? In instances where identical twins were raised apart from birth, family style (loving affectionate, moral, or severely dysfunctional) does not alter the outcome- when one twin is alcoholic, the other has over 90% chance of also turning out to be an alcoholic. Only the presence or absence of alcoholism in the birth parents determines the presence of the disease in the twins who never knew their birth parents or each other. What have you found in your own clinic population?

  3. This blog has been inactive for several months, during which time I have the opportunity to refine my proposal for a pathophysiological model for alcoholism. In addition, I have founded a 501(c)(3) nonprofit organization: A Voice of Concerned Alcoholics to foster improved medical understanding of alcoholism and to advocate for improved medical treatments and legal protections for the individual alcoholic and for all people who are afflicted with any unwanted consequence of consuming alcohol. I will publish the URL for the new organization and links to legal documents in the near future.