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PostPosted: Wed Mar 07, 2012 7:09 am 
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We all know about the disease concept. It's been the dominant school of thought to define addiction since way back 1935, when Dr. Silkworth first published in the AA big book that alcoholism was a disease. As the 12-steps went viral, so did this concept.

But for those like me who may not, or no longer identify with the disease concept of addiction, there are other models out there. The one that stuck out for me was the life-process model of addiction. It is in many ways the polar opposite to the disease concept.

Stanton Peele's wiki provides a good summary:

Quote:
The Disease Model
1. Alcoholism is inbred
2. Everyone gets the same therapy
3. Focus on drinking
4. Person must accept he/she is alcoholic
5. Therapy and goals are dictated to person
6. Person with drinking problem must be alcoholic
7. Abstinence is only resolution for a drinking problem
8. Primary social supports are fellow alcoholics
9. Person must always think self as alcoholic.

Peele asserts that the disease model is wrong and that every major tenet of the “disease” view of addiction is refuted both by scientific research and by everyday observation, including that: People do not necessarily lose control of themselves whenever they are exposed to the object of their addiction and addiction usually does not last a lifetime. Thus, "once an addict always an addict" holds no merit. Progression is not inevitable—it is the exception. Contrary to all advertising, treatment for addictions is often no more effective than letting addiction and recovery take their natural course. The number of self-curers is triple or more the number of successful treatment or A.A cases. But such self-curers are often not visible, because they are individuals without an organized group to publicize their success.

Peele also addresses the many disadvantages of the disease approach to treatment: The disease theory attacks people’s feelings of personal control and can thus become a self-fulfilling prophecy; it makes mountains out of molehills, since it fails to differentiate between the worst alcoholics and addicts and those with minor substance-use dependence; stigmatizes people—in their own minds—for life; interrupts normal maturation for the young, for whom this approach is completely inappropriate; holds up as models for drinking and drug use the people who have shown the least capacity to manage their lives; isolates alcoholism and addiction as problems from the rest of the alcoholic’s or addict’s life; limits people’s human contacts primarily to other recovering alcoholics or addicts, who only reinforce their preoccupation with drinking and drug use; dispenses a rigid program of therapy that is founded—in the words of the director of the government’s National Institute on Alcohol Abuse and Alcoholism (NIA.A.A)—“on hunch, not evidence, and not on science,” while attacking more effective therapies.

Life Process Model

1. Person uses alcohol permanent trait to cope with life
2. Treatment is tailored to individual
3. Focus on problems, not labels
4. Person participates in therapy goals and plans
5. There are all kinds of drinking problems
6. Focus on coping
7. Improved control and successful relapse reduction sought as well as abstinence
8. Primary social supports: work, family, friends
9. Person need not think of self as alcoholic.

Peele's outline of the life process approach to treatment: Addiction is a way of coping with yourself and your world. The solution requires self-awareness, new coping skills, and changing your environment. Addiction is a continuum; your behavior is more or less addicted. Addiction can be outgrown. You should identify problems and solutions in ways that work for you. Those without an addiction problem are the best models. Addiction stems from other life problems you have. You should associate with a normal range of people. Getting better is not a matter of believing a dogma. You must develop your own power to get better.

Peele further notes that for many people treatment is not necessary and in his review makes his key points.
Vaillant reported that over 60 percent of those who overcame their alcoholism didn't enter any kind of treatment, including AA. Later in the decade, research by Kaye Fillmore, Ph.D., of the University of California, San Francisco, found that from 60 to 80 percent of problem drinkers stopped abusing alcohol, usually without treatment Canadian addiction research investigators Linda Sobell, Ph.D., and Mark Sobell, Ph.D., recently reported that more than three-quarters of randomly selected adults in a national study who had recovered from alcohol problems for a year or more did so without formal help or treatment. According to Helzer and the ECA study, over half of all problem drinkers who stop abusing alcohol do so within five years of the start of their problem—usually by reducing their drinking, not quitting altogether. America's alcohol treatment industry attacks the idea of self-cure, saying people who believe they've recovered on their own are in denial.[20]


For those that identify with these words, or don't feel the disease concept ring true to them, here's some stuff to read:

[web]http://peele.net/index.html[/web]
[web]http://www.thecleanslate.org/[/web]


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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