Chemical Dependency, Particularly Alcoholism, Within the History Of Psychology
Since the dawn of humankind, people have been experimenting with various chemicals for recreation, to alter their conscious state for religious purposes, or for medicinal applications. Indeed, a vast cornucopia of pharmaceutical preparations has been identified over the millennia that provide modern healthcare consumers with remedies for many human ailments, and more are being developed and identified every day. Used properly and under the supervision of healthcare providers, these chemical substances can deliver analgesic relief, reduce fevers and inflammations, cure diseases and much more. Used improperly, though, the abuse of many chemicals, particularly alcohol, has been a plague on humankind since fermented berries were first discovered, creating the need for timely and effective psychological interventions today. To gain some additional insights into the history of psychology as it relates to chemical dependency in general and alcoholism in particular, this paper provides a critical review of the relevant peer-reviewed and scholarly literature, followed by a summary of the research and important findings in the conclusion.
Review and Discussion
Context in which the topic was born and developed
The roots of modern psychotherapy are attributed to the ancient Greeks, and the context in which the practice emerged remains largely unchanged today. For example, McGillicuddy-De Lisi and De Lisi (2002) report that, "The ancient Greeks counseled people to seek moderation in all things. But the history of psychology shows that not many people heeded this advice. The literature is filled with either/or debates" (p. 183). Given its subsequent influence on shaping psychological thought, it is not surprising that a majority of modern psychology textbooks include specific references to this period. In this regard, Henley and Thorne (2005) report that:
Most history of psychology textbooks cover the Ancient World in some detail. For example, such books often discuss the importance of rational medicine, the contributions of Plato to all subsequent conceptions of mind, and Aristotle's thoughts on many topics covered in an introductory psychology course (associative learning, the causes of behavior, dreams, emotions, free will, language, memory, motivation, perception, reasoning, etc.). (p. 104)
The so-called "modern period" of psychology began in the 16th and 17th centuries based on the work of principal figures such as Descartes, Leibniz, and Locke) (Henley & Thorne, 2005). In addition, Henley and Thorne suggest that, "Understanding Wundt requires at least a cursory consideration of the various empirical, associative, faculty, and rational traditions that preceded him" (p. 104).
By the fin de siecle and heavily influenced by Freud, Jung and other human developmental theorists, psychologists increasingly turned their attention to the deep-seated motivations that drove behavior (McGillicuddy-De Lisi & De Lisi, 2002). Although the context in which psychology has developed over the years continues to be defined by the frailty of the human condition, the fact that people have been unwilling or unable to practice moderation in their lives throughout history suggests that when people find a substance that makes them feel good, some will abuse this substance to the point where it interferes with their lives.
Today, the need for psychological interventions for chemical dependency is based on the multifaceted manner in which the problems associated with the condition are manifested. For instance, people with chemical dependencies tend to experience a wide range of adverse outcomes, including problems with their personal and social relationships, employment, financial difficulties, involvement with the criminal justice system, as well as a host of health-related conditions (Esterly & Neely, 1999). Moreover, psychological interventions for chemical dependency are frequently necessary because of the numerous ways that individual problems are experienced. For instance, Esterly and Neely add that, "The problems may be extremely severe or relatively mild, and they may or may not be recognized by the person involved. The problems may have existed over a long period of time or they may be of a more recent vintage. Whatever the case, without proper help or treatment, the problems are sure to worsen" (1999, p. 1). Moreover, the costs that are associated with chemical dependencies are truly alarming. In this regard, McKay and Hiller-Sturmhofel (2011) report that, "Alcohol and other drug (AOD) use disorders (i.e., AOD abuse and AOD dependence) are substantial public health problems, affecting approximately 10% of the population and resulting in economic costs to the Nation of around $360 billion annually, with roughly half of this amount attributable to alcohol use disorder" (p. 356). Given the enormous human and economic impact that chemical dependencies have, it is therefore important to determine the manner in which psychological treatment regimens have been developed and administered over the years to identify trends and current best practices and these issues are discussed further below.
How changing times have influenced topic area
As a helping profession, psychology would not exist unless there was a need for such services and the demand that exists at a given point in time will likely be a driving force in shaping the specialty areas pursued by psychology students. This has certainly been the case with the evolution of psychology in response to the increasing use and abuse of various substances that can have mind-altering and life-changing implications. For instance, Pacione and Jaskula (1999) report that, "The drug epidemic and the resulting 'war on drugs' markedly increased the demand for drug and alcohol treatment" (p. 55). The long-term psychological interventions that are required for chemical dependencies, though, are expensive and there has been a push to identify efficacious treatment interventions. In this regard, Pacione and Jaskula add that, "This demand, coupled with heightened concern over the escalating cost of mental health and chemical dependency care, creates a challenge for clinical and administrative social workers to provide quality chemical dependency treatment that is cost-effective" (p. 55). This combination of growing demand and the need for more cost-effective treatment modalities has continued to fuel the search for optimal clinical interventions, and these issues are discussed further below.
Topic's role in contemporary psychology
While a growing number of psychologists currently recognize the need to treat the whole person, the complexities of chemical dependencies and the difficulties that have been associated with treating them have influenced contemporary psychology in various ways. For instance, according to Moon (2002), "In the field of psychology, the past several decades have witnessed a jockeying for preeminence by various psychologies, each devoted to a different dimensions of the person (e.g., behavior, cognition, relationship, etc.) each attempting to explain changes in emotion" (p. 265). As Moon points out, though:
The history of psychology mirrors the difficulty a person may find in being able to raise the microscope high enough to get the big picture -- which is necessary if we are to gain a vantage point that will allow us to view the person in its interactive entirety. Authentic transformation, it follows, must involve the whole person or it will be something other than authentic and less than transforming. (p. 265)
This expansion of psychological approaches to the whole person has largely mirrored the need to treat the comorbid conditions that are frequently associated with chemical dependencies. For example, chemical dependency has been highly correlated with a number of compulsive behaviors, including eating disorders, compulsive sex and relationship problems, gambling, workaholism, stealing, overexercising, overspending and excessive shopping (Esterly & Neely, 1997).
The impact the area had on psychology, the impact today, and the prospects for future impact
The need for efficacious treatments for chemical dependencies in general and alcoholism in particular has been a driving force in shaping psychology in recent years. For example, Neimeyer (1998) reports that, "Only the most cynical observer of psychotherapeutic trends could fail to be impressed by the remarkable recent proliferation of cognitive treatments for various disorders, a trend that has been matched in the history of psychology only by innovative extensions of psychodynamic treatments in the 1940s and '50s, and the explosion of behavior therapies in the 1960s and '70s" (p. 58). These various treatment modalities have enjoyed mixed results for substance abusers, with some clinicians preferring one approach over another for personal or professional reasons, but with a common goal of developing something that works and sticks for this difficult-to-treat population.
Based on the need for evidence-based best practices and cost-effective treatment interventions for chemical dependencies, one of the more controversial solutions that has been introduced in recent years has been treatment manuals. For instance, Schumate (2002) reports that, "The prevalence and use of treatment manuals for specific mental disorders has become a prominent trend in recent years. Typically, these manuals are rooted in cognitive-behavior theory and they provide a coherent foundation and structure for counseling" (p. 69). Some critics charge that these treatment manuals are just "cookbooks containing recipes for treatment" for clinicians that fail to address the whole person while proponents emphasize the need for some level of standardization to help ensure that quality of the psychological services that are provided. In this regard, Shumate emphasizes that, "Advocates for their use assert that treatment manuals help establish a standard of care, apply current research to…