“We have consensus in the U.S. about what alcoholism is and what it is not, a consensus so nearly complete that to question its basic assumptions is to be either rejected as a dangerous heretic or pitied as misguided and misinformed.”

William R Miller

In his paper Haunted by the Zeitgeist Miller goes on to question those basic assumptions.  And yet I don’t think anyone would label Bill Miller – of MI fame – a dangerous heretic, misguided or misinformed. HauntedZeitgeist

Haunted by the Zeitgeist is a great piece for ACT team teaching!  Though published in 1986 it remains just as relevant today.

Miller touches on six assumptions on alcoholism that are still firmly held on this side of the Atlantic. He asks:

So what is alcoholism, really? If you ask most any informed American you are likely to have it explained to you that alcoholism is an irreversible disease that causes a person to lose control over drinking. Broken down into its component assumptions, the elements of this traditional American conception of alcoholism are as follows:

  1. Alcoholism is a disease. It is recognizable as a unitary syndrome with certain symptoms and a predictable progression.
  2. Alcoholism is a disease. Although the etiology is not completely known at present, it probably has a physical cause as well as psychological and spiritual elements.
  3. Loss of control is the central symptom. An alcoholic loses the ability to control his or her drinking. “One drink, one drunk.”
  4. Alcoholism is irreversible. One can never become a recovered alcoholic, only a recovering alcoholic. Return to drinking causes resumed deterioration. “Once an alcoholic, always an alcoholic.”
  5. The only possible hope for an alcoholic is total and permanent abstinence from alcohol.
  6. Far and away the most effective means for achieving this is through the fellowship of Alcoholics Anonymous (AA)…

The origin of these assumptions is not scientific data… The pervasiveness of this view in the US is difficult to explain to those living in other nations, where wholly different assumptions may be held…

He goes on to address each of these assumptions, presenting evidence to support or challenge them. For example on the idea that Alcoholism is Irreversible he writes “…to any reasonable reader of the scientific research on alcoholism treatment outcome, this assertion must be regarded as soundly refuted…Suffice it to say that there is no scientific basis for maintaining the possibility of nonproblem drinking outcomes, and that there is substantial evidence to the contrary.”Alcohol and Culture

He concludes with “Perhaps our best guiding principle through all of this is to remain close to the data. The current American conception of alcoholism and the treatment system that has been perpetuated by it exemplify how far it is possible to stray when a particular theory becomes more important than evidence itself… It is premature to claim to have the answers when we are still searching for the right questions.”

The ideas Miller presents are still very true and this article provides food for thought and discussion.  It’s worth taking small pieces of it and using it for a team education session. Get someone on the team to distil it down and present some of the ideas – perfect role for the team psychiatrist!  (Don’t make everyone read through the whole paper.)  After such a session your team members should have more questions, not less.  And isn’t that the goal?- to have better questions, not simplistic answers.

Sorry I can’t post a pdf of the whole article- I did ask the NY Academy of Sciences and was politely told that it is accessible online for a fee (as little as $6 – click here to view).  Or you can still buy a used copy of this publication (click to view via Amazon) for about the cost of a venti pumpkin spice frappuccino.at Starbucks.

Shalom Coodin

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