by Terence T. Gorski
I have reprinted a section of the website of the National Institute of Alcohol Abuse and Alcoholism (NIAAA). In the past I have always been impressed by the up-to-date and in-depth information presented. I am sorry to report that my opinion has changed. As you read the information on the website below please note the following in mind:
1. There is no attempt to organize the information on alcoholism in a biopsychosocial framework, which is the current working standard for the field. (See: The Biopsychosocial Revolution http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495036/ )
2. The distinctions among alcohol use, abuse, and addiction (Alcoholism) is not clearly established. The operational definitions of these terms is implied but not made specific and related terms are not clear related to the current diagnostic language.
3. This summary is still based upon DSM-IV when the current standard is the DSM 5. (https://terrygorski.wordpress.com/2013/10/15/dsm-5-substance-use-disorders-a-concise-summary/ ) This is not a bad thing. I believe the DSM 5 is a step backward, at least in terms of understanding addiction and mirroring current research.
4. There is no reference made to the definition of addiction of the American Society of Addiction (ASAM), which is the most comprehensive integration of biopsychosocial research available. (http://www.asam.org/for-the-public/definition-of-addiction )
5. There is no reference made to the extension of the term “addiction” to include gambling in DSM 5 and its widespread applications in treatment to other compulsive problems know as Behavioral Addictions. (https://terrygorski.wordpress.com/2013/10/15/dsm-5-substance-use-disorders-a-concise-summary/ )
6. There is no reference made to the level of care system of ASAM. (See: http://www.samhsa.gov/co-occurring/topics/screening-and-assessment/ASAMPatientPlacementCriteriaOverview5-05.pdf and http://www.ncdhhs.gov/dma/lme/UMASAM.pdf )
7. There is no discussion of the treatment provisions of the Affordable Care Act (ACA) which will economically shape the next decade of treatment develop for Alcoholism (if that is the correct term to be used), chemical dependence, chemical addictions.(See: http://www.samhsa.gov/SAMHSANewsletter/Volume_18_Number_3/AffordableHealthCareAct.aspx and http://beta.samhsa.gov/health-reform )
8. There is no reference made to move toward evidence-based treatment. (http://www.nrepp.samhsa.gov) Again, this is not necessarily a bad thing. Some of the most effective treatment methods like active listening and helping characteristics are not evidence-based. One of the most important research-based finding is ignored. That is that the most important single factor in all psychotherapy is the relationship between the patient and the therapist. Manualized treatment, when based upon this foundation and allowing clinicians freedom to respond in the moment to emerging patient needs, is then an improvement.
For non-nonsense clarification of these issues you can read: Straight Talk about Addiction by Terence T. Gorski.
I am seriously concerned because without strong leadership from the NIAAA and its parent organizations, The National Institute Of Health (NIH) and The Substance Abuse and Mental Health Services Administration (SAMHSA), the entire framework if addiction as we know it today is at risk of being lost. The addiction field has already been absorbed behavioral health, a code word for mental health, and is now being pushed into general health care under the ACA.
If you are feeling confused you are not alone. I don’t feel confident that the guidance being given by the highest levels of our government is current or reliable in the area of addiction, recovery, relapse, or comprehensive treatment.
Below is the information in the NIAAA website. Read it on the Internet at: http://www.niaaa.nih.gov/alcohol-health
Alcohol Use Disorders
Alcohol use disorders are medical conditions that doctors can diagnose when a patient’s drinking causes distress or harm. In the United States, about 18 million people have an alcohol use disorder, classified as either alcohol dependence—perhaps better known as alcoholism—or alcohol abuse.
Alcoholism, the more serious of the disorders, is a disease that includes symptoms such as:
Craving—A strong need, or urge, to drink.
Loss of control—Not being able to stop drinking once drinking has begun.
Physical dependence—Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking.
Tolerance—The need to drink greater amounts of alcohol to feel the same effect.
People who are alcoholic often will spend a great deal of their time drinking, making sure they can get alcohol, and recovering from alcohol’s effects, often at the expense of other activities and responsibilities.
Although people who abuse alcohol are not physically dependent, they still have a serious disorder. They may not fulfill responsibilities at home, work, or school because of their drinking. They may also put themselves in dangerous situations (like driving under the influence) or have legal or social problems (such as arrests or arguments with family members) due to their drinking.*
Like many other diseases, alcoholism is typically considered chronic, meaning that it lasts a person’s lifetime. However, we continue to learn more and more about alcohol abuse and alcoholism; and what we’re learning is changing our perceptions of the disease. For instance, data from NIAAA’s National Epidemiological Study on Alcohol and Related Conditions has shown that more than 70 percent of people who develop alcohol dependence have a single episode that lasts on average 3 or 4 years. Data from the same survey also show that many people who seek formal treatment are able to remain alcohol free, and many others recover without formal treatment.
However severe the problem may seem, many people with an alcohol use disorder can benefit from treatment. Talk with your doctor to determine the best course of action for you.
Addendum: December 4, 2013
The following comment was submitted by firstname.lastname@example.org and I wanted to share it in the body of the blog. Thank you Linda.
Thanks Terry for the review. The links were useful. In the spirit of pointing out some of the inconsistencies between agencies and definitions, I was a little surprised to see the definition of addiction on the ASAM site:
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations.”
It didn’t seem like the ASAM definition was entirely consistent with the biopsychosocial framework. I looked further for how ASAM defined spiritual as an additional component to the biopsychosocial framework. ASAM says:
“Other factors that can contribute to the appearance of addiction, leading to its characteristic bio-psycho-socio-spiritual manifestations, include: [below are the two manifestations that seem to relate to spiritual]
f. Distortion in meaning, purpose and values that guide attitudes, thinking and behavior;
g. Distortions in a person’s connection with self, with others and with the transcendent (referred to as God by many, the Higher Power by 12-steps groups, or higher consciousness by others)”
ASAM goes on to say:
“The diagnosis of addiction requires a comprehensive biological, psychological, social and spiritual assessment by a trained and certified professional.”
Perhaps a disconnection from God may be part of the addiction manifestation, but in light of the recent court rulings on separation of church and state, is this the proper role for an addiction counsellor who may be acting in the role of “agent” of the government with criminal or family court ordered patients? I don’t know quite what the answer is, but if disconnection from God is part of the disease, then perhaps there’s some other way to do the religious assessment than having the counsellor ask questions or probe into and document the patient’s relationship with God. If the counsellor is in the “agent” role this could create issues of mixing in a religious assessment, Or, a waiver from the patient for the religious part of the assessment that involves a relationship with God might be a good protection for the counsellor,
And perhaps I misunderstood how assessments are done, but I felt it was worth mentioning in the effort to align with how government or “agents” of the government shouldn’t be involved in religion.
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