In this blog article, I shall delve into and quote directly from the “Handbook of Alcoholism Treatment Approaches: Effective Alternatives” (Hester & Miller, 2003), a text often regarded as the definitive guide on alcoholism treatment since the 1970s. However, I must confess a possible bias in my perspective. It appears to me that the predominant approach to treating People Who Use Alcohol and Drugs (PWUAs, PWUDs, and those with various other substance and behavioural challenges) has been narrowly focused through the lens of the Disease Model, in conjunction with the 12 Steps Models (such as Alcoholics Anonymous, Narcotics Anonymous, and numerous other groups supported by the Hazelden group and endorsed in FDA-approved journals). This approach has certainly been beneficial for some, yet it lacks a substantial base of evidence-backed research to this day.

I would like to express, with utmost respect and caution, that these views are not my original work or truths, but rather my opinions formed through research and extensive discussions with various academics over the years. It is essential for you, as an individual, to conduct your own thorough research. 

This chapter, “Treating Alcohol Problems: Toward an Informed Eclecticism,” by William R. Miller and Reid K. Hester, provides an overview of various treatment approaches for alcoholism, emphasizing the importance of an eclectic approach informed by empirical evidence.

The chapter begins by discussing the shift from a “one size fits all” perspective, where one method was considered superior, to eclecticism, which recognizes the value in a wide range of treatment alternatives. It critiques both the “one size fits all” and uncritical eclecticism, advocating instead for an informed eclecticism that is grounded in empirical evidence. – something I am a big fan of… peer-reviewed, where’s the proof/evidence-based….

Several conceptual models of alcohol problems are presented, each with its own implications for intervention. These include:

  1. Moral Model: Views alcohol problems as a result of personal choice, advocating for social sanctions.
  2. Temperance Model: Sees alcohol itself as the issue, leading to policies of moderation or prohibition.
  3. Spiritual Model: Suggests a spiritual deficit is at the core of alcoholism, with recovery through spiritual growth.
  4. Dispositional Disease Model: Treats alcoholism as a unique, irreversible condition requiring abstinence.
  5. Biological Model: Emphasizes genetic and physiological factors, sometimes advocating for abstention or controlled use.
  6. Educational Model: Aims to resolve alcohol problems through the provision of information, assuming that knowledge can lead to behavior change.
  7. Characterological Model: Focuses on personality traits and suggests psychotherapy for treatment.
  8. Conditioning Model: Regards excessive drinking as a learned habit, treatable by relearning behavior patterns.
  9. Social Learning Model: Concentrates on the role of the environment and peer influences, employing strategies to alter relationships to the environment.
  10. Cognitive Model: Attributes alcohol problems to expectations and beliefs about alcohol’s effects, using cognitive restructuring in treatment.
  11. General Systems Model: Views individual behavior as part of a larger system, often requiring family therapy for treatment.
  12. Sociocultural Model: Considers societal and cultural norms as influencing drinking patterns, with interventions targeting social policy and supply control.
  13. Public Health Model: Integrates agent, host, and environmental factors, advocating for a comprehensive approach to treatment.

 In conclusion, the chapter advocates tailoring treatment options to individual needs and allowing independent agents to conduct assessment and referral processes. It emphasizes the absence of a single superior treatment approach and the necessity of offering a variety of empirically supported treatments while considering individual differences.

This summary provides a high-level overview, and the chapter itself provides much more detail. Please contact me if you need further information or have questions about any models or concepts.

Part 2 of this discussion will look at a study that was done on all the various treatment models and many more practices and therapies, that have been tried, tested, journaled and peer-reviewed. Follow me on Facebook to be informed of new blog posts on this website.


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