Professional Counselor magazine, 8/92.

THE ALCOHOLISM REVOLUTION

"This conformity makes them not false in a few particulars, authors of a few lies, but false in all particulars. Their every truth is not quite true...so that every word they say chagrins us and we know not where to begin to set them right. " Emerson

No problem in America has been more costly in lives, misery and money than alcoholism, and no problem has generated more stubborn conflict and confusion in all areas of society. In a historic development during the 1970s, the intense focus on alcoholism research exposed the underlying polarity, the clash of irreconcilable premises that has always generated so much conflict. Although not yet widely known, by the early 1980s this root conflict had been resolved by a scientific and professional revolution, a paradigm shift.

This paper describes the polarity and the shift to the new model that is transforming our entire view of alcoholism (and other drug addictions). I have adapted the terms "psychogenic" (of psychological origin) for the old paradigm and "biogenic" (of biological origin) for the new.

The psychogenic model is based on the nearly universal belief that alcoholism is a symptom or consequence of an underlying character defect, a destructive response to psychological and social problems, a learned behavior. The biogenic model recognizes that alcoholism is a primary addictive response to alcohol in a biologically susceptible drinker, regardless of character and personality. It will help at the outset to realize that compromise is not possible, that the two are not complementary but mutually exclusive alternatives, like a perceptual figure-ground reversal.

The contrast between the two paradigms can be illustrated by Robert Louis Stevenson's classic parable of addiction, "Dr. Jekyll and Mr. Hyde." In the psychogenic view, the insane, murderous Hyde is the real person, with Jekyll merely a facade. It taps deep currents in American thought--the notions of original sin and the Freudian Id--that beneath the inhibiting veneer of civilization man is inherently evil. Alcoholism merely releases this deeper ugliness by removing the inhibitions. In vino veritas [in wine is truth]. The task of therapy is to engage and civilize Hyde. Treatment fails because the contemptible Hyde is willfully incorrigible. He deserves the stigma and scorn of society.

Within the biogenic paradigm Jekyll is the real person, Hyde a neuropsychological distortion created by the addictive chemical. Hyde exhibits the same kind of deterioration of personality and character as victims of such other progressive brain pathologies as brain syphilis or a brain tumor. Body, mind and spirit (including will-power) are biologically compromised and subverted to serve the addiction. Given time for the healing, in alcoholism the brain syndrome is reversible. The task of therapy is to restore Jekyll to sanity and selfhood, and to start him on a path that will preclude a return to the addictive, transforming chemical.

Although it is conformity to the psychogenic belief that continues to distort and falsify all scientific and clinical knowledge of alcoholism, as the given truth throughout history it has had the advantage of being invisible, of not appearing to be a belief system at all, but simple reality. This was the fatal flaw in the Jellinek "disease concept" of alcoholism. For all his helpful descriptions of the progression of the disease, he endorsed the false belief that alcohol is primarily a sedative drug, and that alcoholism is caused by excessive "relief drinking," drinking to relieve psycho-social stress. Thus, as a secondary consequence or symptom, the biology of alcoholism could be largely ignored by the establishment in its diligent search for the presumed primary psychiatric cause of the relief drinking.

Following Jellinek, many leading proponents of the disease concept still try to have it both ways, to assimilate the fragments of biological knowledge within the lingering psychogenic hegemony. This conformity necessarily condones the misinformation that continues to tear the country to pieces and helps to delay the emergence of the biogenic paradigm.

- more to come -

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