The model of alcoholism treatment that exemplifies the disease concept emerged from three programmes based in the US state of Minnesota: Pioneer House (1948), Hazelden (1949) and Wilmar State Hospital (1950). The Minnesota Model is based upon disease concept of addiction and views chemical addiction as a primary, chronic, and progressive disease. The disease of addiction is construed as primary because it is an entity in itself and not caused by other factors. In the UK the foremost proponent of this model is
AA’s web pages state that “Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism” and goes on to state that “The only requirement for membership is a desire to stop drinking”.
AA groups run locally and are frequently ‘referred to’ by mainstream addiction services as a stand alone or adjunct to treatment. There is a growing international body of evidence demonstrating that total abstinence from drinking is not always a desired goal for some and that controlled drinking can be a successful route to recovery. In some cases where people with significant alcohol problems have serious health concerns controlled drinking may not be appropriate.
Other forms of group treatment such as Smart Recovery groups take a different approach and may be more suited to people who decide that they wish to explore control and moderation of their drinking.
is a commonly used approach in addiction treatment and enables the person who is experiencing alcohol problems to understand risks associated with harmful drinking and promote simple interventions that reduce such harms. A common example would be to support people to choose to alternate alcoholic drinks with soft drinks to reduce their overall consumption.
Language and stigma
Stigma on the part of healthcare providers who tacitly see a patient’s drug or alcohol problem as ‘their own fault’ may lead to negative outcomes for patients including delivery of substandard care or even to rejecting individuals seeking treatment. A number of recent research papers have focussed on the stigma that people with drug and alcohol issues face. There is a consensus amongst researchers that stigma and negative attitudes can be a significant barrier to accessing treatment and help for people who experience alcohol problems. Addressing stigma is not easy, in part because the rejection of people with addiction arises from violations of social norms. Avoiding the use of labelling and negative imagery associated with alcohol problems can help people develop a more optimistic perspective for recovery and help build their motivation for change.
Key concepts of anti-stigma talk in addiction are:
- avoiding the use of labelling for example “being an alcoholic” may reinforce a person’s sense of shame, lack of control and influence over their problems
- nurses are often the first points of contact for a person with an alcohol problem, and they should take all steps necessary to reduce the potential for stigma and negative bias
- using first person language (e.g. “a person with an alcohol problem”) can help distinguish the person from their problem and enable people to begin to release themselves from the negative connotations of their problem and improve their likelihood of help seeking behaviours
- being supportive and non-judgemental whilst helping a person explore reasons to make changes (motivational approaches) can positively influence treatment uptake.