The advantages of the disease model of alcoholism are well known, but the disadvantages have received little attention. The model's dominance has forestalled consideration of alternative and potentially valuable theories. It reinforces the value of normality even as it marks alcoholics as deviant. It suggests problem drinkers can diagnose themselves. These disadvantages are traceable to narrowly constructed scientific discourses: science-as-positivism, alcoholism-as-disease, and the individual-as-scientist. As a result, problem drinkers pondering a diagnosis of alcoholism emphasize the positivist concepts of central tendency, objectivity, and prediction/control. Positivism reinforces the value of normality even as a disease diagnosis threatens to mark the personal identity as deviant. In this circumstance, continuing to drink while manipulating drinking variables is rational. Alcoholism theory would benefit if researchers extended conceptualizations beyond the disease model. Alcoholism treatment would benefit if treatment professionals challenged social norms, emphasized subjectivity, and determined the parameters of the drinker’s self-control.
Ahern, J., Galea, S., Hubbard, A., Midanik, L., & Syme, S.L. ( 2008). ‘‘Culture of drinking’’ and individual problems with alcohol use. American Journal of Epidemiology , 167(9), 1041-1049.
2.
Alcoholics Anonymous World Services Inc. ( 2001). Alcoholics Anonymous: The story of how many thousands of men and women have recovered from alcoholism (4th edn.). New York: Alcoholics Anonymous World Services Inc.
3.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn., text revision.). Arlington, VA: American Psychiatric Association.
4.
Babor, T.F., Hofmann, M., Del Boca, F.K., Hesselbrock, V.M., Meyer, R.E., & Dolinsky, Z.S. , et al (1992). Types of alcoholics: I. Evidence for an empirically derived typology based on indicators of vulnerability and severity. Archives of General Psychiatry, 49, 599-608.
5.
Bakhtin, M.M. ( 1984). Problems of Dostoevsky’s poetics. Minneapolis, MN: University of Minnesota Press.
6.
Bateson, G. ( 1971). The cybernetics of ‘‘self’’: A theory of alcoholism. Psychiatry, 34, 1-18.
7.
Beck, M., Dietrich, S., Matschinger, H., & Angermeyer, M.C. (2003). Alcoholism: Low standing with the public? Attitudes towards spending financial resources on medical care and research on alcoholism. Alcohol and Alcoholism, 38(6), 602-605.
8.
Bertholet, N., Daeppen, J.-B., Wietlisbach, V., Fleming, M., & Burnand, B. ( 2005). Reduction of alcohol consumption by brief alcohol intervention in primary care: Systematic review and meta-analysis. Archives of Internal Medicine, 165(9), 986-995.
9.
Bird, A. ( 1998). Philosophy of science. Abingdon: Routledge.
10.
Borsari, B., & Carey, K.B. ( 2001). Peer influences on college drinking: A review of the research. Journal of Substance Abuse, 13(4), 391-424.
11.
Bourdieu, P. ( 2001). Masculine domination. Stanford, CA : Stanford University Press.
12.
Bowker, G., & Star, S. ( 2000). Sorting things out: Classification and its consequences . Cambridge, MA: MIT Press.
13.
Bride, B., & Nackerud, L. ( 2002). The disease model of alcoholism: A Kuhnian paradigm. Journal of Sociology & Social Welfare, 29(2), 125-142.
14.
Bruner, J.S. ( 1986). Actual minds, possible worlds. Cambridge, MA: Harvard University Press.
15.
Bruner, J.S. ( 1991). The narrative construction of reality. Critical Inquiry, 18(1), 1-21.
16.
Burke, K. ( 1969). A grammar of motives. Berkeley, CA : University of California Press.
17.
CNNPolitics.com. (2008). Palin, Biden ready to face off in St. Louis debate. Retrieved November 15, 2009, from http://www.cnn.com/2008/POLITICS/10/01/debate.veeps/index.html.
18.
Cohen, A.K. ( 1966). Deviance and control. Englewood Cliffs, NJ: Prentice Hall.
19.
Dare, P.A.S., & Derigne, L. ( 2009). Denial in alcohol and other drug use disorders: A critique of theory. Addiction Research & Theory, 18(2), 181-193.
20.
Daston, L. ( 1992). Objectivity and the escape from perspective. Social Studies of Science, 22(4), 597-618.
21.
Dean, J.C., & Poremba, G.A. ( 1983). The alcoholic stigma and the disease concept. Substance Use & Misuse, 18(5), 739-751.
22.
Denzin, N.K. ( 1991). Hollywood shot by shot: Alcoholism in American cinema . New York: Aldine De Gruyter.
23.
DeWitt, R. ( 2004). Worldviews: An introduction to the history and philosophy of science. Malden, MA: Wiley-Blackwell .
24.
Donley, C., & Buckley, S. (Eds.) (1996). The tyranny of the normal: An anthology. Kent, OH: Kent State University Press.
25.
Donley, C., & Buckley, S. (Eds.) (2000). What’s normal? Narratives of mental and emotional disorders. Kent, OH: Kent State University Press.
26.
Draper, J. ( 1875). History of the conflict between religion and science . New York: D. Appleton.
27.
Engel, G. ( 2002). The need for a new medical model: A challenge for biomedicine . In D. F. Marks (Ed.), The health psychology reader (pp. 50-65). Thousand Oaks, CA: Sage.
28.
Ferrari, J.R., Groh, D.R., Rulka, G., Jason, L.A., & Davis, M.I. ( 2008). Coming to terms with reality: Predictors of self-deception within substance abuse recovery. Addictive Disorders & Their Treatment, 7(4), 210-218.
29.
Fiedler, L. ( 1996). Tyranny of the normal: Essays on bioethics, theology & myth. Lincoln, MA: David R. Godine.
30.
Fingarette, H. ( 1988). Alcoholism: The mythical disease. Public Interest, 91, 3-22.
31.
Gieryn, T. ( 1999). Cultural boundaries of science: Credibility on the line . Chicago, IL: University of Chicago Press.
32.
Gitlow, S. ( 1973). Alcoholism: A disease. In P. Bourne & R. Fox (Eds.), Alcoholism: Progress and treatment (pp. 1-9). New York: Academic Press.
33.
Glanville, R. ( 2004). A (cybernetic) musing: Control, variety and addiction . Cybernetics and Human Knowing, 11(4), 85-92.
34.
Goffman, E. ( 1959). Presentation of self in everyday life. Garden City, NY: Doubleday.
35.
Goffman, E. ( 1963). Stigma: Notes on the management of spoiled identity. New York: Simon & Schuster.
36.
Goodman, J. ( 2008). On being alcoholic: Identity crisis during the diagnostic stage of treatment. Retrieved June 7, 2010, from http://www.women-addiction.com/Course05.pdf.
37.
Harman, W. ( 1996). The shortcomings of western science. Qualitative Inquiry, 2(1), 30.
38.
Hasin, D.S., Stinson, F.S., Ogburn, E., & Grant, B.F. ( 2007). Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 64(7), 830-842.
39.
Hauser, J., & Rybakowski, J. (1997). Three clusters of male alcoholics. Drug and Alcohol Dependence, 48(3), 243-250.
40.
Heath, D.B. ( 2000). Drinking occasions: Comparative perspectives on alcohol & culture. Philadelphia, PA: Taylor & Francis.
41.
Hecht, M.L., & Driscoll, G. ( 1994). A comparison of selected communication, social, situational, and individual factors associated with alcohol and other drugs. Substance Use & Misuse, 29(10), 1225-1243.
42.
Heider, F. ( 1958). The psychology of interpersonal relations. New York: Riley.
43.
Hempel, C. ( 1965). Aspects of scientific explanation and other essays in the philosophy of science. New York: Free Press.
44.
Jellinek, E.M. ( 1960). The disease concept of alcoholism. New Haven, CT: College and University Press.
45.
Joffe, H., & Staerklé, C. (2007). The centrality of the self-control ethos in western aspersions regarding outgroups: A social representational approach to stereotype content. Culture & Psychology, 13(4), 395-418.
46.
Keller, M., & Doria, J. ( 1991). On defining alcoholism. Alcohol Health and Research World, 15, 253-260.
47.
Kelly, G.A. ( 1965). The threat of aggression. Journal of Humanistic Psychology, 5(2), 195-201.
48.
Kelly, G.A. ( 1969). The autobiography of a theory. In B. Maher (Ed.), Clinical psychology and personality: The selected papers of George Kelly (pp. 46-65). New York: Krieger Publishing Company.
49.
Kiesler, D. ( 1999). Beyond the disease model of mental disorders. Praeger.
50.
Kirschner, S.R. ( 2006). ‘‘Good babies’’ or ‘‘Goodness of fit?’’ Normalizing and pluralizing dimensions of contemporary temperament discourse. Culture & Psychology, 12(1), 5-31.
51.
Kleinman, A., Eisenberg, L., & Good, B. ( 2006). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Focus, 4(1), 140-149.
52.
Le Poire, B.A., Hallett, J.S., & Erlandson, K.T. (2000). An initial test of inconsistent nurturing as control theory: How partners of drug abusers assist their partner’s sobriety. Human Communication Research, 26, 432-457.
53.
Levine, H.G. ( 1984). The alcohol problem in America: From temperance to alcoholism . Addiction, 79, 109-119.
54.
Lightdale, H., Mack, A., & Frances, R. ( 2008). Psychodynamics: The American Psychiatric Publishing textbook of substance abuse treatment (4th edn.). Arlington, VA: American Psychiatric Publishing Inc .
55.
Longino, H. ( 1990). Science as social knowledge: Values and objectivity in scientific inquiry. Princeton, NJ: Princeton University Press.
56.
MacAndrew, C. ( 1969). On the notion that certain persons who are given to frequent drunkenness suffer from a disease called alcoholism. In S. C. Plog & R. B. Edgerton (Eds.), Changing perspectives in mental illness (pp. 483-501). New York: Holt, Rinehart and Winston.
57.
MacAndrew, C., & Edgerton, R.B. (2003). Drunken comportment: A social explanation. Clinton Corners, NY: Percheron Press.
58.
Mailly, P. ( 2005). Fine wine and ideal theory: The questionable denial of liver transplantation in alcoholics. Windsor Yearbook of Access to Justice, 23, 95.
59.
Mandelbaum, D.G. ( 1965). Alcohol and culture. Current Anthropology , 6, 281-293.
60.
Marlatt, G.A., & Witkiewitz, K. (2002). Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment. Addictive Behaviors, 27(6), 867-886.
61.
Marsh, A., & Dale, A. ( 2005). Risk factors for alcohol and other drug disorders: A review. Australian Psychologist, 40, 73-80.
62.
McCartney, J., & O’Donnell, P. (2009). The perception of drinking roles by recovering problem drinkers. Psychological Medicine , 11(04), 747-754.
63.
Meyer, R.E. ( 1996). The disease called addiction: Emerging evidence in a 200-year debate. Lancet, 347(8995), 162.
64.
Miceli, M., & Castelfranchi, C. (1998). Denial and its reasoning . British Journal of Medical Psychology, 71(2), 139-152.
65.
Mokros, H.B. ( 2003). A constitutive approach to identity. In H. B. Mokros (Ed.), Identity matters: Communication-based explorations and explanations (pp. 3-30). Cresskill, NJ: Hampton Press.
66.
Moore, A.A., Gould, R., Reuben, D.B., Greendale, G.A., Carter, M.K., Zhou, K., et al. (2005). Longitudinal patterns and predictors of alcohol consumption in the United States. American Journal of Public Health, 95(3), 458-465.
67.
Moscovici, S. ( 1981). On social representations. In J. P. Forgas (Ed.), Social cognition: Perspectives on everyday understanding (pp. 181-209). London: Academic Press.
68.
Moscovici, S. ( 1988). Notes towards a description of social representations . European Journal of Social Psychology, 18(3), 211-250.
69.
Moscovici, S., & Hewstone, M. ( 1983). Social representations and social explanations: From the ‘‘naive’’ to the ‘‘amateur’’ scientist. In M. Hewstone (Ed.), Attribution theory: Social and functional extensions (pp. 48-125). Oxford : Blackwell.
70.
Moscovici, S., & Marková, I. (1998). Presenting social representations: A conversation. Culture & Psychology, 4(3), 371-410.
71.
Nathan, P.E. ( 1991). Substance use disorders in the DSM-IV. Journal of Abnormal Psychology, 100, 356-361.
72.
National Institute on Alcohol Abuse and Alcoholism. ( 2008). Percent distribution of current drinking status, drinking levels, and heavy drinking days by sex for persons 18 years of age and older: United States: NHIS, 1997-2008. Retrieved June 21, 2010, from http://www.niaaa.nih.gov/Resources/DatabaseResources/QuickFacts/AlcoholConsumption/dkpat25.htm.
73.
Neighbors, C., Dillard, A.J., Lewis, M.A., Bergstrom, R.L., & Neilt, T.A. ( 2006). Normative misperceptions and temporal precedence of perceived norms and drinking. Journal of Studies on Alcohol, 67(2), 290-299.
74.
Pauly, P.J. ( 1994). Is liquor intoxicating? Scientists, prohibition, and the normalization of drinking. American Journal of Public Health, 84(2), 305-313.
75.
Peele, S. ( 1989). Diseasing of America: Addiction treatment out of control . Boston, MA: Houghton-Mifflin.
76.
Popper, K. ( 1959). The logic of scientific discovery. London: Hutchinson.
77.
Porter, T. ( 1996). Trust in numbers: The pursuit of objectivity in science and public life. Princeton, NJ: Princeton Univiversity Press.
78.
Psillos, S. ( 2002). Causation and explanation. Montreal , QC: McGill-Queen’s University Press.
79.
Reinarman, C. ( 2005). Addiction as accomplishment: The discursive construction of disease. Addiction Research & Theory, 13(4), 307-320.
80.
Room, R. ( 1997). Alcohol, the individual and society: What history teaches us. Addiction, 92, 7-12.
81.
Room, R. ( 1998). Controlled drinking as a moral achievement and a social program. Paper presented at the Alcohol Policy and the Welfare State in Consumer Society Conference, Lillehammer, Norway. http://www.doctordeluca.com/Library/AbstinenceHR/CDasMoralAchievement98.pdf.
82.
Room, R. ( 2001). Intoxication and bad behaviour: Understanding the cultural differences in the link. Social Science and Medicine, 53, 189-198.
83.
Rosenquist, J.N., Murabito, J., Fowler, J.H., & Christakis, N.A. (2010). The spread of alcohol consumption behavior in a large social network. Annals of Internal Medicine , 152(7), 426-433.
84.
Ross, L. ( 1977). The intuitive psychologist and his shortcomings: Distortions in the attribution process. In L. Berkowitz (Ed.), Advances in experimental social psychology (Vol. 10, pp. 173-220). Orlando, FL: Academic Press.
85.
Royce, J., & Scratchley, D. (1996). Alcoholism and other drug problems (Revised edn.). New York: Free Press.
86.
Rush, B. (1798). Essays, literary, moral and philosophical. Philadelphia, PA: Thomas and William Bradford.
87.
Saad, L. ( 2009). Drinking habits steady amid recession. Retrieved June 21, 2010, from http://www.gallup.com/poll/121277/Drinking-Habits-Steady-Amid-Recession.aspx .
88.
Salmon, W. ( 1998). Causality and explanation. New York : Oxford University Press.
89.
Schuckit, M.A. ( 2009). Alcohol-use disorders. The Lancet, 373(9662), 492-501.
90.
Sedgwick, E. ( 1992). Epidemics of the will (Vol. 4). New York: Zone.
91.
Shi-Xu. (2002). The discourse of cultural psychology: Transforming the discourses of self, memory, narrative and culture. Culture & Psychology, 8(1), 65-78.
92.
Shryock, R. ( 1969). Empiricism versus rationalism in American medicine: 1650-1950 . Proceedings of the American Antiquarian Society , 79, 99-150.
93.
Slunecko, T., & Hengl, S. ( 2006). Culture and media: A dynamic constitution. Culture & Psychology, 12(1), 69-85.
94.
Stanford, P.K. ( 2010). Exceeding our grasp: Science, history, and the problem of unconceived alternatives. New York: Oxford University Press.
95.
Sturgeon, S. ( 1998). Physicalism and overdetermination. Mind , 107(426), 411-432.
96.
Suissa, A. ( 2003). Alcoholism as a disease in North America: A critical social analysis. Journal of Addictions Nursing, 14(4), 201-208.
97.
Thommen, B., & Wettstein, A. ( 2010). Culture as the co-evolution of psychic and social systems: New perspectives on the person-environment relationship. Culture & Psychology, 16(2), 213-241.
98.
To, S., & Vega, C. ( 2006). Alcoholism and pathways to recovery: New survey results on views and treatment options. Medscape General Medicine , 8(1), 2.
99.
Valverde, M. ( 1998). Diseases of the will: Alcohol and the dilemmas of freedom . Cambridge: Cambridge University Press.
100.
Veatch, H.B. ( 1954). Realism and nominalism revisited. Milwaukee, WI: Marquette University Press.
101.
Venner, K.L., Matzger, H., Forcehimes, A.A., Moos, R.H., Feldstein, S.W., Willenbring, M.L., et al. (2006). Course of recovery from alcoholism. Alcoholism: Clinical and Experimental Research, 30(6), 1079-1090.
102.
Weitzer, R. (Ed.) (2001). Deviance and social control: A reader. New York: McGraw-Hill. Windle, M., & Scheidt, D.M. (2004). Alcoholic subtypes: Are two sufficient?Addiction, 99, 1508-1519.
Wise, M. ( 1997). The values of precision. Princeton, NJ: Princeton University Press.
105.
World Health Organization. (2004). Global status report on alcohol 2004. Retrieved from http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf.
106.
Zukier, H. ( 1986). The paradigmatic and narrative modes in goal-guided inference . In R. M. Sorrentino & E. T. Higgins (Eds.), Handbook of motivation and cognition: Foundations of social behavior (pp. 465-502). New York: Guilford Press.
