Treatment for alcoholism in older adults

Alcoholism Reading Critique

Alcoholism has been a present and persistent problem since the time alcoholic beverages were first fermented, meaning that it has been an issue of one degree or another since human civilization first began, and possibly even earlier. The past twenty years however, as the authors of this article note, have led to dramatic changes in the medical and social understandings of the disorder. According to the findings listed in this study in fact, the concept of alcoholism has not simply undergone a refinement of understanding, but truly a re-conception and re-definition. Viewing alcoholism not as a discrete disease but rather as a continuum of disorders has had a huge effect on the way it is viewed by both medical and social establishments, and the way that the condition(s) is/are treated in practical and individual settings. Some of the conclusions drawn by the authors of this piece actually seem to run counter to the general wisdom regarding alcoholism that has become a part of the public's -- or at least some of the public's -- consciousness.

This does not invalidate the claims of the authors. Of course, nor of the voluminous number of sources that they cite in drawing their conclusions, but it does require the careful reader to regard both these conclusion and the heretofore accepted knowledge regarding alcoholism with a greater deal of skepticism. One wonders, for instance, at the conclusion that most alcoholics can control their drinking without fully abstaining; would the same conclusion be drawn with a cocaine addict, or a cigarette smoker? These substances, of course, have different chemical effects and levels of social acceptance and availability, but in the past addiction was studied as a single phenomenon, not dependent on the particular substance.

It is difficult, however, to argue with the methodology employed by the authors here. There is no direct experimentation, which would necessarily have been limited in size and scope and therefore would have yielded results that would have been more suspect when extrapolated to the wider population. Instead, the authors relied on an extensive review of contemporary and historic (as far back as 1849) sources, many of them published results of experimental studies, to show that despite the perceived rate of relapse in patients treated for alcoholism, treatment is actually highly effective at reducing mortality and preventing continued degradation of general circumstances and quality of life. Their careful analysis of the various treatment methods offered is also a reliable method of determining best practices for providing treatment and long-term care for alcoholic patients.

The logic presented in this article stems directly form the methodology; the careful and extensive analysis that the authors engage in cannot help but lead to logical conclusions, assuming such analysis is actually undertaken carefully and is truly extensive -- i.e. unbiased -- in its reach. They are very careful to examine the ramifications and implications of each facet of their conclusions. As an example, they note that the shift to outpatient treatment has been generally more effective for many patients with alcoholism, but at the same time this has reduced the number of beds available (and institutions, though the authors do not come to this direct conclusion) for inpatient treatment, which is still necessary and/or recommended in some cases. This ability and willingness to examine all sides of the issue is the greatest proof of the logic of these author's conclusions.

The findings presented in this article also have a high degree of utility for social workers and social work in general. Alcoholism has been and largely still is considered a life sentence. It has been viewed as a disease that the patient must spend the rest of their life combating, often in very difficult circumstances. While the struggle to resist over-indulgence is certainly still very real for some patients, at some times more than others, this study shows that there is still a great deal of hope for those struggling against the disorder(s). Rather than viewing the problem as an all-or-none issue with abstention as the only positive outcome, the spectrum view of both alcoholic disorders and its treatments and possible "cured" outcomes allows the patient to find a level of comfort with alcohol; when an patient in treatment for alcoholism has one drink, they will not see it as a failure that allows them to have as much alcohol as they want and thus suffer a full relapse, but instead an be seen as a normative behavior rather than a relapse of their condition at all.