BEYOND THE INFLUENCE

A convincing argument for the medical model of alcoholism, with resulting recommendations for treatment. Ketcham (Under the Influence: A Guide to the Myths and Realities of Alcoholism, not reviewed), psychologist Ciaramicoli, and recovered alcoholics Asbury (former editor of the Seattle Post-Intelligencer) and Shulstad (cofounder of the National Association of Alcoholism and Drug Abuse counselors) maintain that alcoholism is “a true medical disease rooted in abnormalities in brain chemistry.” Alcoholics’ bodies simply respond differently to alcohol than everyone else’s—a difference that is either rooted in genetics or acquired by “intense and sustained exposure to alcohol.” Alcoholism is not, they emphasize, a personality disorder or character defect. The authors examine what is known about the action of alcohol upon the body (both normal and alcoholic), then look at how a diagnosis of alcoholism can be established (most often, it is an inexact art—a simple series of questions). They go on to explore the most effective treatments (first and foremost is lifelong abstinence from alcohol and drugs), particularly addressing the question of why a physical disease requires psychological and spiritual components in treatment. Finally, the authors name the beer, wine, and distilled-spirits industries as principal players in promoting our society’s view of alcoholism as a psychological disease—and propose educational, prevention, and treatment programs to institute change.

A thorough, responsible presentation.