Intervention/Treatment
In this model there are many ways to try to get an alcoholic for example, to stop drinking, including forcing church attendance, firing one from the job, pouring “booze” down the sink, marrying one off to someone strong enough to control him/her, divorce, shunning him/her, ridiculing him/her, giving one aversion treatments, and so forth. In short, behaviour therapy, fines and jail sentences may help (Boss, 2004). However, the prognosis is poor unless a way is found to threaten alcoholics or punish them so that they stop drinking. The only hope is to make alcohol unavailable. Young drinkers should have the example of the alcoholic before them.
ii) Wet Moral Model: The Wet Moral Model promotes controlled addiction. In this model, an addict is someone who doesn’t follow the rules set down by society. They behave badly when drunk, and they cannot hold their liquor. The emphasis is on “will power”. The behavior of alcoholics is anti-social. They spoil the happy, congenial occasions that social drinking can provide (Boss, 2004).
Intervention/Treatment
A person in the drinking society including the alcoholic knows how to treat alcoholics: by juggling around rewards and punishments. A spouse may refuse sex, refuse to speak, withhold the family money, and reduce housekeeping standards. His/her doctor may give him/her hell, tell the alcoholic to grow up and not be a crybaby, and so on. If the correct formula of rewards and punishments could be found, everything would be all right, otherwise, prognosis is gloom.
Application to Client Groups
The moral model is widely applied to dependent users, perhaps purely for social or political reasons, but is no longer widely considered to have any therapeutic value. Elements of the moral model, especially a focus on individual choices, have found enduring roles in other approaches to the treatment of dependencies (Boss, 2004).
2. Disease Model
Unlike the moral theory, the Disease Model has a more humanistic approach, advocating treatment instead of punishment (Hulse, White, & Cape, 2002). The model holds that addiction is an illness, and comes about as a result of the impairment of healthy or behavioral processes. While there is some dispute among clinicians as to the reliability of this model, it is widely employed in therapeutic settings. Furthermore, the Disease model is based on the idea that alcoholism (or drug addiction) is a progressive condition in which the individual loses control over drinking (or drugs). The disease is irreversible, incurable and can only be detained through total abstinence from alcohol (Hulse, White, & Cape, 2002). Moreover, the person with the addiction is not to blame for the disease. Burman (1994) explains that the disease concept provides a means of identification with an illness that creates physical, psychological, social and spiritual impairment. It also serves as a forceful intervention strategy that modifies behaviour, attitudes, belief systems and values.
Interventions/Treatment
Addiction is a treatable disease. Many people who are addicted feel hopeless about their situation. They feel that they cannot stop using and cannot face life without the help of drugs or alcohol. The disease model offers a hopeful alternative. Treatment and sobriety can allow people to lead fulfilling lives. The assumption here is that there is no cure, and one will be an addict or alcoholic for the rest of his or her life (Hulse, White & Cape, 2002). Through abstinence, one can achieve remission. Another assumption is that the alcoholic or addict has no willpower, poor judgment, and one drink leads to an increased desire for another. Moderate drinking is not viewed as an option and abstinence is viewed as the only acceptable treatment goal. There are many programs based on these models such as Alcoholics Anonymous, Narcotics Anonymous, 12 step programs. Many people have been helped through these programs.
Application to client group
People who have developed severe problems with alcohol and drugs have a consistent profile of alcohol and drug related problems that can appropriately be classified as a disease. Most individual who develop severe problems with alcohol and drugs share the following signs and symptoms: (1) Severe subjective distress; (2) severe interpersonal conflicts; (3) severe social and occupational problems; and (4) incapacitation as a result of severe physical, psychological or social problems (Boss, 2004). By generating hope in the individuals they are able to gain confidence in themselves and believe that they can overcome substance abuse, reducing feelings of guilt as a result of the mutual support Alcoholics Anonymous (Boss, 2004).
3. Social Learning Theory
In contrast to the Moral and Disease models, the Social Learning Theory supports that the cause of substance abuse is associated to factors external to the individual in their environment (Naegle & D’Avanzo, 2001). The environmental factors include peer groups, families, friends, neighbours, and those in the community who surround them. Therefore, substance abuse is learned from other individuals who teach and model behaviours of using drugs. It proposes that drug or alcohol use is learned and continues because the user gets some desired outcome from it, for example, acceptance in peer groups and feelings of power (Naegle & D’Avanzo, 2001). Bandura’s social learning theory concentrates on the power of example. His major premise is that one can learn by observing others. He considers vicarious experience to be the typical way that human beings change (Kosslyn & Rosenberg, 2001).
Adolescence that have goals for the future that are inconsistent with substance use and who are aware of the negative consequences of substance use, would be expected to be less likely to smoke, drink or use drugs (Kosslyn & Rosenberg, 2001). It would appear that susceptibility to social influences generally, and some influences promoting substance use in particular, are related to low self-esteem, low self-satisfaction, low self-confidence, greater need for social approval, low level of assertiveness and impatience to assume adult roles or to appear grown up (Kosslyn & Rosenberg, 2001).
Interventions/Treatment
Under this model the individual works to unlearn drug and alcohol use behavior, and to learn new behaviors to replace them in order to get the benefits he or she received from alcohol or drugs (Naegle & D’Avanzo, 2001). Social learning theory treatment models for substance abuse have demonstrated good treatment efficacy. Structured Relapse Prevention (SRP) is a highly useful behavioural program that equips the client with strategies to allow him/her to cope more appropriately with high-risk drinking or drug-using situations (Dyer, 2004). It is suitable for delivery in groups or individually, as core treatment or as continuing care. Social learning theory models for substance abuse have included Social Skills Training (SST) components. Social skills training, like relapse prevention, requires active participation by the individual client and acceptance of the responsibility for learning the self-control skills to prevent future substance abuse (Dyer, 2004). Most of the applications of SST occur in alcohol treatment programs, but researchers suggest that SST applications are relevant to addicts experiencing difficulty in interpersonal situations. The belief is that for many individuals there may be an underlying dysfunction across addictive disorders that warrant the use of SST as a core component of treatment (Dyer, 2004).
Application to client group
Adolescents are the most appropriate client group which fits the social learning theory. Substances which are commonly tried at their age such as alcohol, tobacco and marijuana should be targeted as these are drugs which are common at the beginning of the developmental progression of drug use. On the continuum of drug use, the lower end of the scale would be the most appropriate area. Drug use is not a huge problem at this stage but it could develop into dependence if intervention does not occur. Substance abuse can be prevented by intervention or taking away negative social influences and unlearning the undesirable behaviours.
While each of the models discussed contributes to our understanding of the nature of alcohol or drug related problems, these models emphasize one aspect, either the host, the agent, or the environment, to the exclusion of the others (Lewis, 1994). For example, the Moral and Disease models emphasize aspects of the host that lead to the susceptibility for alcohol abuse while excluding effects of the environment and the agent (Lewis, 1994). On the other hand, the Social Learning model considers the environment as the key element in the etiology of alcoholism and minimizes or excludes its interaction with the agent and the host and their separate contributions. The temperance model (not discussed) emphasizes the agent—alcohol—as the cause of alcohol problems and excludes the role of the environment and the host (Lewis, 1994).
Conclusion:
In the addiction field there are many models from which the treatment community views alcohol and other drug problems. Every addiction has biological, psychological and social components that must be taken into account in order for prevention or treatment to be successful (Lewis, 1994). The perspective of the potential client and that of the family tend to indicate which approach will benefit the person long term. A less categorical approach is currently favored, in which the problem is viewed from many perspectives, and at this time is the trend in alcohol and drug abuse treatment.
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Cape, G., Hulse, G., & White, J. (2002). Management of alcohol and drug problems.
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Kosslyn, S., & Rosenberg, R. (2001). Psychology: The brain, the person and the world.
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