The role of psychiatry in alcoholism treatment
Psychiatrists have virtually controlled the alcoholism field for many years, holding the top posts in national organizations in the UK and USA, including funding agencies. They have received significant research grants and helped to shape the general public opinion of alcoholism as a mental health problem with psychological or emotional roots.
In the past twenty years or so, however, the “mental health” view of alcoholism has come under increasing attack. Psychiatrists have gradually phased out of leadership positions in federal, state and local alcoholism programs. Large chunks of the available research money have been funnelled from psychiatry into the biological and neurophysiological sciences.
New leaders in the field, influenced by the abundance of research showing that alcoholism is a physiological disease, have suggested that psychiatry, by ignoring or downplaying the physiological aspects and concentrating instead on the superficial psychological symptoms, may even harm the affected individual by delaying treatment, increasing his guilt and shame, and allowing him to deny his drinking problem or blame it on someone or something else (denial).
The following comments illustrate the changing attitudes:
- 1n 1973, NIAAA (National Institute on Alcoholism and Alcohol Abuse) Deputy Director Kenneth Eaton told a special task force that alcoholism is “not a mental health problem,” adding that the psychiatric approach to alcoholism is “not only the most expensive, but probable the least effective.”
- Peter Bourne, MD, President Jimmy Carter’s Special Assistant for Health Issues and a psychiatrist himself, told a December 9, 1977, board meeting of the Alcohol and drug Problems Association (ADPA) that “one of the big battles you are going to face in the next few years is whether psychiatrists should have any involvement at all in treating people with alcoholism problems.” He predicted that this battle would be resolved in favour of the “non-psychiatric position as the primary treatment for the alcoholic.”
- In January 1978, Peter Brock, then Director of Education and Research for the Group Health Association America, reported to the President’s Commission on Mental Health: “Too frequently in the past, the mental health professionals have approached the alcoholic patient with the idea that if his aberrational behaviour were corrected, his drinking would go away. They have not addressed the underlying problem and have struck out.”
- Psychiatrist David Ohlms gave a pointed warning to psychiatrists and mental health practitioners at the June 8, 1979, mid-central regional meeting of the National Association of Alcoholism Counsellors:
…as long as the mental health field insists on viewing alcoholism as a symptom rather than a primary disease that creates its own symptoms, it should keep its nose out of this (alcoholism) field.
Underlying the revolt against psychiatric treatment o alcoholism is the accumulation of evidence that it simply does not work. Research reports attest to psychiatry’s failure, and many individual psychiatrists openly admit to it.
In a survey of members of the Southern California Psychiatric Association, over one-half of the psychiatrists who treated alcoholics reported no success with any of their alcoholic patients; for the remainder, success occurred in only 10 per cent of their cases.
The reason that psychiatric treatment does not work, of course, is that alcoholism is not primarily a psychological disease. Once psychiatrists understand the physiological bases of the disease, their role changes dramatically. They can learn to diagnose alcoholism as alcoholism – not as a symptom of something else – and they can help usher patients into the alcoholism recovery sequence. This transformation is immensely beneficial for the alcoholic’s recovery.
The worldwide organization of AA has saved hundreds of thousands of lives, spurred research, and given hope where there was none. But even this remarkable fellowship can improve. In the past, AA has been able to change and adapt with the times, a quality which has allowed the organization to expand and grow, reaching ever-increasing numbers of alcoholics. As professionals correct their understanding of alcoholism with factual knowledge, AA can also be expected to adapt its philosophy.
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