Toward the end of the 19th century and the beginning of the 20th century, addicts were often viewed as morally wrong and even shunned as being bad people or sinners. This type of thinking led many physicians of the time to fight to change common perceptions and try to help addicts instead of punish them. The formation of AA – Alcoholics Anonymous – in the 1930s and the publication of noted psychiatrist and Director of the Center of Alcohol Studies at Yale Medical School E. M. Jellinek’s famous book defining the concept of alcoholism as a medical disease facilitated moving alcoholism into a different light. The shift towards the disease model gained validity when the American Medical Association recognized alcoholism as a disease in a 1966 policy statement. Jellinek is often called the father of the disease theory or model of alcoholism. His theory listed alcoholism as having stages that drinkers progressively passed through. These stages are:
- Pre-alcoholic phase, (Initiation) which includes social drinking when drinkers often start to develop a tolerance for alcohol and drink to relieve stress or feel better. The disease will lie dormant until the first use. Therefore abstinence as prevention is the best way to go.
- Prodromal phase, (Continuation) also considered the early-alcoholic stage where blackouts begin to occur, the drinker begins to drink alone and in secret, and thinks about alcohol frequently while their alcohol tolerance continues to grow. The user will continue to alcohol use despite negative consequences.
- Crucial phase (Continuation) characterized by a spiral of out-of-control drinking at inappropriate times and problems with daily life such as job, relationship problems, absenteeism, financial problems, or change in moral behavior as well as physical changes to the brain and body.
- Chronic phase (Addiction) which includes daily drinking, drinking as the main focus of life, health problems cropping up, cravings and withdrawal symptoms, and physical and mental long-term alcohol abuse issues. This phase the loss of choice to drink is gone because user is dependent.
Recovery in this disease theory, an alcoholic or addict is never considered cured, only “in remission,” “recovering” or a “non practicing” alcoholic or addict. Recovery is therefore focused on abstinence. Relapse in the disease model, relapse is seen as “failure” on the part of the individual who is working a recovery program. But, it is also viewed as part of the recovery process.
Alcohol works largely as a depressant on the central nervous system and due to the relatively small size of alcohol molecules, it can affect many parts of the brain and body simultaneously. Alcohol changes brain chemistry, initially increasing neurotransmitters that drive the brain’s pleasure centers, but over time and with chronic abuse, depleting them. As the tolerance to alcohol increases, the abuser must take in more in order to feel the effects, which further damages both the body and brain. While Jellinek’s theory referred only to alcoholism, in today’s treatment world alcoholism and other substance abuse are many times treated in the same way. (dualdiagnosis.org)
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