Alcoholismo Fisch

Journal of Systemic Therapies, Vol. 29, No. 4, 2010, pp. 49–59

Special Section

   THE BRIEF TREATMENT OF ALCOHOLISM
RICHARD FISCH, M.D.

Age-old mystiques and current therapy models about “alcoholics” tend to limit the scope of research on abusive drinking. A non-pathologic, non-normative model formulated by the Brief Therapy Center of MRI is offered as a possibility for expandingdirections of research. The model and its application to abusive drinking is illustrated by a case description.

Excessive uses of behavior altering substances have always been surrounded by a mystique and this certainly has been the case for alcohol. Prior to the late nineteenth century and the invention of “mental illness” drunkenness had been considered a work of the devil or a peculiar defectof character setting the drunkard apart from the mainstream of his or her society. The “town drunk” was a unique character, an object of ridicule or amusement and often the prime example of waywardness in the minister’s sermons to his congregation. Concomitantly, magical qualities were attributed to alcohol itself, a fiendish invention of the devil to tempt the weak into his control: “the evilsof drink.” The fact that the vast bulk of the drinking population had no problem in using alcohol made little difference in these mystical attributions about drunkards and alcohol and, for that matter, these concepts played a significant part in the Constitutional amendment known as “Prohibition.” Beginning in the mid-nineteenth century, many forms of deviance were explained as being caused by anillness, and, in particular, an illness of the mind. Originally intended as a metaphor allowing for the humane treatment of the “mad” and to offset the brutalizing typified by “Bedlam,” the metaphor came to be regarded as fact and ushered in the era of what is currently called “mental illness” and the “mental health movement.” Because of the moral judgments made about excessive drinking, it wasslower to catch up with other forms of deviance in being viewed as a “mental illness” rather than characterilogical weakness or sin. I think more than any professional developments, the creation of Alcoholics Anonymous (A.A.) did the roost in legitimizing excessive drinking as a “disease” and thereby endowing “alcoholics” with the uneasy respectability accorded other forms of deviance that hadgraduated from “badness” to “illness.” For good or bad, however, the in-grouping of drinkers
Originally published in the Journal of Systemic & Strategic Therapies, (1986). 5: 3; 40–49.

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inherent in the social organization of A.A. has tended to confirm the traditional concept that the excessive user of alcohol is a “breed apart” from the mainstream of the general population, andin recent years, this has extended to the families of A.A. members with the creation of Alanon and Alateen organizations. Despite the humanizing of “treatment” of the drinker, traditional psychiatric models, as well as the model of A.A., continued to view alcoholism as stemming from a basic defect within the individual, a defect so intrinsic to the problem drinker that “curing” the drinker is notregarded as possible: “once an alcoholic always an alcoholic,” regardless of extended periods of sobriety. Much as schizophrenia is regarded, the sober drinker is an “alcoholic in remission.” This, of course, is clearly and firmly supported by the model used in A.A. in which excessive drinking is regarded as the manifestation of an inherent “allergy to alcohol” and it is explicitly emphasized tomembers that to risk one drink is to be thrown back into the depths of uncontrolled drinking. In the nineteen fifties, a different conceptualization evolved to explain deviance, the application of cybernetic principles, “systems.” Thus, the individual was no longer viewed as having or being the problem, but rather the “symptom bearer” of the integrated unit, usually the family unit. Further, it...