General Theory of Alcoholism

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?
Through the years, I have pieced together a general theory of alcoholism. First, alcoholics are more or less obsessed with the thoughts of drinking (manifested in idle thinking, dreams, fantasies, intrusive thoughts, and concrete plans). Alcoholics look forward to drinking, think about and give reasons for not drinking, justify their drinking, lie about and hide their drinking, or think about the comfort of drinking. Simply put: A lot of thought is given to drinking. Furthermore, the promise of drinking in the near future helps alcoholics to relax in the present, and conversely the thought of not being able to drink for an indefinite time evokes anxiety and subtle sadness. Non-alcoholics simple do not think this way.
Alcoholics feel compelled to use alcohol as a means of effecting changes in mood, thinking, or over-all well-being. They feel a desire that drives them to use alcohol – to achieve contentment, to affect a buzz, to reduce tension, to numb feeling, to forget, to relax, to reward, and to feel better. And, their pleasant feelings reinforce the compulsion to use again.
Why are some people compelled to drink alcoholically, while others are not? No one knows for sure. There are many ways to explain alcoholism. Some approaches accent organic/genetic/biochemical factors, others emphasize non-organic/psychogenic/environmental factors, and others try to integrate both nature and nurture. Depending on the person, there can be many reasons (and combinations thereof) to feel compelled to drink – such as genetics, biochemistry, habit, stress mismanagement, expectations, environmental pressure, cultural and societal sanctions, etc.
One drink can compel some alcoholics to drink until they pass out or get sick. For them, one drink is too many. Other alcoholics feel compelled to drink daily while managing to function without blatant disruption. Others feel compelled to drink only on weekends, during holidays, or at festive occasions. Others seldom drink, but when they do, they drink alcoholically. Many alcoholics feel that they are entitled to drink and that life without alcohol is somehow not right, incomplete, or difficult. Although many alcoholics can abstain, they miss it. Their efforts to abstain, which include intense willpower (white knuckle approach), making great sacrifices, irritability, constant complaints, or dry drunks give evidence of their compulsion.
Another of alcoholism’s powerful dynamics, which reinforces its obsessive ness and compulsiveness, is the relative certainty and immediacy of its rewards. Unlike the risk and uncertainty of interpersonal fulfillment, alcoholics can safely count on the effects of drinking. Drinking seldom lets them down; it usually gives them what they ask for. Alcoholic effects are easy to come by and occur quickly. There is little waiting; the rewards are immediate. Compounding the certainty and immediacy of