Alcohol and Alcoholism Vol. 35, No. 4, pp. 412, 2000
© 2000 Medical Council on Alcoholism
Book Reviews
Problem Drinking (3rd edn).
This book has been updated for professionals interested in the alcohol field and particularly the student reader. Earlier editions were targeted towards the ‘intelligent general reader’. Although there are several statements alluding to the purposes of the book, one single aim emerges which is to improve understanding of problem drinking by arguing that it is a learned behavioural disorder and not a disease.
The authors believe success in this argument would have several desirable effects, including the ‘protection’ of those (like me) new to the field from misconceptions widely held by the public, more informed public debate through media and government, more rational and effective national policy including better prevention measures, and better treatment for individuals. They believe that treatment based on social learning theory principles is not only more relevant (in any given problem drinker), but more so in attracting those at the ‘milder’ end of the problem drinking spectrum. This is in contrast to treatment based on the disease model, which despite any claims of being widely applicable, in the authors' opinion, essentially targets only those established ‘alcoholics’ at the severe dependence end of the drinking spectrum.
It is a book of two halves. The first is an argument against the disease view. The second is an argument for the learned behaviour view. The first half includes an entertaining history of the ‘alcoholism movement’, and what led up to it. It also recognizes that genetic research will eventually yield increasingly reliable data, but it does not discuss the advent of new pharmacotherapies. It also states that it has often been in the interest of governments and the alcohol industry to promote and perpetuate the disease view. The second half provides an excellent summary of social learning theory principles and explains their application to origins and maintenance of problem drinking.
In that the argument is attractively logical, accessible, systematic, ‘sustained’, and improves understanding then I would argue that the major aim of the book is met. However, the danger in arguing against an extreme view (such as the disease view in the authors' opinion) is that one moves too far towards an opposite but equally extreme view. Disease is both a medical and social construct and one could argue for a model which successfully integrates biological and psycho-social understanding of problem drinking. The improved understanding that advances in genetic and neurochemical research will bring should complement the improved understanding achieved when the body of principles of social learning theory described here is more ‘closely knit’ and refined in its particular relation to problem drinking.
The book ends with an excellent chapter on the relevant practical implications of the argument put forward and includes a useful summary of the Project MATCH results; and stimulating sections on the influence of the alcohol industry, government policy, and the public health perspective that advises the use of taxation as a means to lower per capita consumption and subsequently alcohol-related morbidity and mortality.
Although possibly only a minor point, I found it misleading and odd that the authors should put forward a convincing argument in the book's introduction for an abandonment of the term ‘alcoholism’, given its association with the disease perspective which they also wish to abandon, but that they should then go on to use it ‘for convenience’, as a synonym for ‘problem drinking’ throughout the entire book.
In arguing so strongly in favour of one model, an improved understanding of the opposing model also emerges and, because of this, the book remains an excellent means of introducing students in the alcohol field to different explanatory models of alcohol dependence.
FOOTNOTES
By Nick Heather and Ian Robertson, Oxford University Press. 1997, 238 pp., £19.95. ISBN: 0 19262 8615.
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