Comments on: Native Americans, Alcoholism, and the Failure of Treatment http://www.goodtherapy.org/blog/native-americans-alcholism/ Exploring Healthy Psychotherapy Sun, 21 Mar 2010 03:00:58 +0000 http://wordpress.org/?v=2.9 hourly 1 By: Cal http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-22442 Cal Wed, 23 Sep 2009 15:42:13 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-22442 I agree with the fact that the disease model reinforces continued and increased alcohol abuse. I believe that through the history of abuse with our native peope. There were times where the traders had these get togethers where everyone drank to excess, the native americans did what they were shown and thought it the right way to drink. Even our elders stated this was a way of learning. Today you hear from all of our cultures in America, learn from your elders. But yet we also learn good as well as bad. This habit of learning to drink is something that we have taken in and accepted as a community. Where the learning stops with change is at the community level. We can individually get sober, we can have a circle of spiritual friends that are also sober and support one another. But when we face the communities, its our communities that are not healthy. So Community as Prevention needs to be explored further and changes need to be made. As for someone saying that the idea of success being living in an urban setting, or being employed and making good money, I believe it's an individual perception. I agree with the fact that the disease model reinforces continued and increased alcohol abuse. I believe that through the history of abuse with our native peope. There were times where the traders had these get togethers where everyone drank to excess, the native americans did what they were shown and thought it the right way to drink. Even our elders stated this was a way of learning. Today you hear from all of our cultures in America, learn from your elders. But yet we also learn good as well as bad. This habit of learning to drink is something that we have taken in and accepted as a community. Where the learning stops with change is at the community level. We can individually get sober, we can have a circle of spiritual friends that are also sober and support one another. But when we face the communities, its our communities that are not healthy. So Community as Prevention needs to be explored further and changes need to be made. As for someone saying that the idea of success being living in an urban setting, or being employed and making good money, I believe it’s an individual perception.

]]> By: Mary Ellen and Ed http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-16271 Mary Ellen and Ed Wed, 18 Mar 2009 16:03:52 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-16271 Thank you - there is always the tendency to want to afix a label as though that would somehow fix the problem, and, yes, it's nice to have one that eases responsibility. But that's always a two edged sword. If I'm not responsible for my behavior, then I am excused from changing it. Of course there are always causes, and these are frequently understandable, which still allow an individual the responsibility, and the dignity, to create a better life for themselves. Unhappily the "disease" model merely reinforces continued and increased alcohol abuse. Thank you – there is always the tendency to want to afix a label as though that would somehow fix the problem, and, yes, it’s nice to have one that eases responsibility. But that’s always a two edged sword. If I’m not responsible for my behavior, then I am excused from changing it.

Of course there are always causes, and these are frequently understandable, which still allow an individual the responsibility, and the dignity, to create a better life for themselves. Unhappily the “disease” model merely reinforces continued and increased alcohol abuse.

]]> By: Sage http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-16257 Sage Wed, 18 Mar 2009 12:41:26 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-16257 Excellent post. I agree that the disease model is a problematic way to look at alcoholism in Native Americans, just as it is problematic to label physically active children in financially challenged, overcrowded inner city schools as having ADHD or to diagnose borderline personality disorder in women from abusive family backgrounds. I think some people worry that if we discard the disease model completely, we will go back to stigmatizing people with problems and failing to recognize the ways in which they are actually unable to choose to be healthy, but what you're saying is that we can adopt a compassionate point of view that rejects the disease model and at the same time fully acknowledges all the many challenges people face in the process of trying to change their behavior. Excellent post. I agree that the disease model is a problematic way to look at alcoholism in Native Americans, just as it is problematic to label physically active children in financially challenged, overcrowded inner city schools as having ADHD or to diagnose borderline personality disorder in women from abusive family backgrounds. I think some people worry that if we discard the disease model completely, we will go back to stigmatizing people with problems and failing to recognize the ways in which they are actually unable to choose to be healthy, but what you’re saying is that we can adopt a compassionate point of view that rejects the disease model and at the same time fully acknowledges all the many challenges people face in the process of trying to change their behavior.

]]> By: Alan http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-15133 Alan Sun, 08 Feb 2009 05:09:08 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-15133 Alcoholism is a disease, with well documented variability to susceptibility. But drinking is not a disease, it is a choice. And the effects from the disease of alcoholism can be avoided by making the choice not to drink. So in my book, both assumptions are correct. That is, there is a disease or at least a susceptibility process, but it can be controlled by choices that we make. We cannot get around the responsibility factor. It is not unlike adult onset diabetes. Diabetes is a disease, but in many cases it can be controlled simply by diet (choices). The disease of diabetes does not result in such problematic societal ills as alcoholism so it is treated differently in the social spectrum. But for alcoholism, because of the underlying currents that lead to drinking in the first place, our approach to treatment and right choices has to be sensitive, broad based, intuitive, strong and forgiving, all at the same time. Alcoholism is a disease, with well documented variability to susceptibility. But drinking is not a disease, it is a choice. And the effects from the disease of alcoholism can be avoided by making the choice not to drink. So in my book, both assumptions are correct. That is, there is a disease or at least a susceptibility process, but it can be controlled by choices that we make. We cannot get around the responsibility factor. It is not unlike adult onset diabetes. Diabetes is a disease, but in many cases it can be controlled simply by diet (choices). The disease of diabetes does not result in such problematic societal ills as alcoholism so it is treated differently in the social spectrum. But for alcoholism, because of the underlying currents that lead to drinking in the first place, our approach to treatment and right choices has to be sensitive, broad based, intuitive, strong and forgiving, all at the same time.

]]> By: Ed & Mary Ellen http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14621 Ed & Mary Ellen Fri, 16 Jan 2009 16:27:02 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14621 Genetic markers are the Holy Grail of alcohol research, but none have surfaced. The best work has come out of the MN Twin Study which indicated that possibly a 6% increase in vulnerability to alcoholism might exist - but that's an insignificant number. Granted, everyone wants to avoid responsibility for their alcohol abuse, and hence responsibility for overcoming it, but it's really counterproductive thinking. There really are no lack of social, emotional, social, and psychological causes that could be addressed if the will existed and if those who profit from business as usual would find something productive to do. Genetic markers are the Holy Grail of alcohol research, but none have surfaced. The best work has come out of the MN Twin Study which indicated that possibly a 6% increase in vulnerability to alcoholism might exist – but that’s an insignificant number.

Granted, everyone wants to avoid responsibility for their alcohol abuse, and hence responsibility for overcoming it, but it’s really counterproductive thinking. There really are no lack of social, emotional, social, and psychological causes that could be addressed if the will existed and if those who profit from business as usual would find something productive to do.

]]> By: Isabel http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14619 Isabel Fri, 16 Jan 2009 13:24:00 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14619 Do you think there is something about the Native American genetic line that leaves them predisposed to alcoholism? It seems to be so prevalent in that culture and I wonder if there has ever been any kind of common genetic marker discovered for those who suffer with this. Do you think there is something about the Native American genetic line that leaves them predisposed to alcoholism? It seems to be so prevalent in that culture and I wonder if there has ever been any kind of common genetic marker discovered for those who suffer with this.

]]> By: Carson http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14597 Carson Thu, 15 Jan 2009 14:48:15 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14597 I feel very sad for the Native Americans in this country whose needs and the care of have been completely ignored and overlooked by our country. They were the original inhabitants and we should do a better job to take care of any of our people, no matter the culture that they are from. I feel very sad for the Native Americans in this country whose needs and the care of have been completely ignored and overlooked by our country. They were the original inhabitants and we should do a better job to take care of any of our people, no matter the culture that they are from.

]]> By: nicollete http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14589 nicollete Thu, 15 Jan 2009 12:49:32 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14589 What a very controversial article. Although I am not familiar with the disease model, it seems like it is very well stated here along with many responses. I guess no one knows really how the Native Americans really felt and except they, themselves and I am sure to the native americans, they had their reasons. What a very controversial article. Although I am not familiar with the disease model, it seems like it is very well stated here along with many responses. I guess no one knows really how the Native Americans really felt and except they, themselves and I am sure to the native americans, they had their reasons.

]]> By: Ed & Mary Ellen http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14557 Ed & Mary Ellen Wed, 14 Jan 2009 20:23:15 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14557 In reviewing the research, look at the resources page on our website http://www.non12step.com and look both at the "Orange Papers" link )which has some problems but a lot of good citations) and the "Alcohol Problems and Solutions" site at the State Univassity of New York which is easily the best unbiased source on the web. We'll also happily look at the diesase model in more depth in another entry. Thank you!! In reviewing the research, look at the resources page on our website http://www.non12step.com and look both at the “Orange Papers” link )which has some problems but a lot of good citations) and the “Alcohol Problems and Solutions” site at the State Univassity of New York which is easily the best unbiased source on the web. We’ll also happily look at the diesase model in more depth in another entry.

Thank you!!

]]> By: Kate http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14553 Kate Wed, 14 Jan 2009 17:57:06 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14553 Thank you for this very interesting and informative article. I found it compelling. Your reasons for the development of the disease model are well stated. However, given the lack of evidence supporting this model (by the way, would love a quick summary!), why does it remain so popular among mental health professionals? The disease model was still being taught when I was in graduate school 8 years ago. Especially with the push for evidence-based practice, why are programs based on the disease model still being funded? Thanks! Thank you for this very interesting and informative article. I found it compelling. Your reasons for the development of the disease model are well stated. However, given the lack of evidence supporting this model (by the way, would love a quick summary!), why does it remain so popular among mental health professionals? The disease model was still being taught when I was in graduate school 8 years ago. Especially with the push for evidence-based practice, why are programs based on the disease model still being funded? Thanks!

]]> By: Ed & Mary Ellen http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14551 Ed & Mary Ellen Wed, 14 Jan 2009 15:29:49 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14551 Alison makes a number of excellent points, not least of which is the sometimes very "dual diagnosis" problem. Yet this too gets confusing as so many "mental illnesses" disappear along with the alcohol abuse and it takes a very aware and skilled physician to figure out the chicken and egg progression here. Aside from these actual combined cases however, there is no research that supports a "disease model" and no lack of research which shows exactly the opposite. The model was initially put forth to justify insurance coverage but companies quickly caught on to that and have, mostly, refused to cover "treatment" with a less than 5% efficacy. While the disease model does purport to lessen stigma it doesn't seem very effective in this regard either. Frankly, it merely reinforces the "victum" mentality which usually justifies continued and expanded abuse. We, and our clients, have never had any problem understanding circumstances, habits, background, and other considerations as ample grounds for forgiving our history while preserving personal ability to make and maintain change without any continued and counter-productive focus on alcohol. Finally (sorry to be long wonded this morning, apparently my coffee fix has kicked in) thank all of you for the thoughts and insights that keep us thinking and changing. Alison makes a number of excellent points, not least of which is the sometimes very “dual diagnosis” problem. Yet this too gets confusing as so many “mental illnesses” disappear along with the alcohol abuse and it takes a very aware and skilled physician to figure out the chicken and egg progression here.

Aside from these actual combined cases however, there is no research that supports a “disease model” and no lack of research which shows exactly the opposite. The model was initially put forth to justify insurance coverage but companies quickly caught on to that and have, mostly, refused to cover “treatment” with a less than 5% efficacy.

While the disease model does purport to lessen stigma it doesn’t seem very effective in this regard either. Frankly, it merely reinforces the “victum” mentality which usually justifies continued and expanded abuse. We, and our clients, have never had any problem understanding circumstances, habits, background, and other considerations as ample grounds for forgiving our history while preserving personal ability to make and maintain change without any continued and counter-productive focus on alcohol.

Finally (sorry to be long wonded this morning, apparently my coffee fix has kicked in) thank all of you for the thoughts and insights that keep us thinking and changing.

]]> By: Steph http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14541 Steph Wed, 14 Jan 2009 14:09:26 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14541 The disease model as an explanation for alcohol abuse has always bothered me as well. I think that completely takes away the matter of choice from the problem, and ultimately that is not right. We all make choices in our lives, some good and some bad, and that is what the millions of people who have issues with alcohol are doing as well. Nothing is stopping them for getting it together and making better choices. I am not being judgemental but just stating the facts as I see tham. The disease model as an explanation for alcohol abuse has always bothered me as well. I think that completely takes away the matter of choice from the problem, and ultimately that is not right. We all make choices in our lives, some good and some bad, and that is what the millions of people who have issues with alcohol are doing as well. Nothing is stopping them for getting it together and making better choices. I am not being judgemental but just stating the facts as I see tham.

]]> By: Alison Bowles http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14535 Alison Bowles Wed, 14 Jan 2009 04:40:52 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14535 I found this article to be very informative as were the responses. On the matter of choice, however, beyond social and political influences, there are neurological/physiological influences although I am not comfortable with the disease model either. I think of, for instance, my patient who suffers from a psychotic disorder. It is quite common for individuals who experience auditory hallucinations to drink in order to quell the voices. These individuals also have a very difficult time letting others know that they hear voices due to stigma. So, yes, they do "choose" to drink but they do not "choose" to hear voices and they certainly don't "choose" to be stigmatized. Ultimately, I do have to bring her to the realization that she does have some choice now that she has more of an understanding of her dilemma. But I would have to say that there are many circumstances wherein people are abusing alcohol in order to ameliorate symptoms of mental illness, symptoms that are impossible to bear. This makes the matter of "choice" one of degree. It is not black and white -- quite colorful like the rest of the world. I found this article to be very informative as were the responses. On the matter of choice, however, beyond social and political influences, there are neurological/physiological influences although I am not comfortable with the disease model either. I think of, for instance, my patient who suffers from a psychotic disorder. It is quite common for individuals who experience auditory hallucinations to drink in order to quell the voices. These individuals also have a very difficult time letting others know that they hear voices due to stigma. So, yes, they do “choose” to drink but they do not “choose” to hear voices and they certainly don’t “choose” to be stigmatized. Ultimately, I do have to bring her to the realization that she does have some choice now that she has more of an understanding of her dilemma. But I would have to say that there are many circumstances wherein people are abusing alcohol in order to ameliorate symptoms of mental illness, symptoms that are impossible to bear. This makes the matter of “choice” one of degree. It is not black and white — quite colorful like the rest of the world.

]]> By: Ed http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14533 Ed Wed, 14 Jan 2009 01:00:54 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14533 I would be hard pressed to think of any individual or group that can't claim to have been "treated unfairly" and as long as that excuse is acceptable to justify self-destructive behavior then very few people are going to change. I would be hard pressed to think of any individual or group that can’t claim to have been “treated unfairly” and as long as that excuse is acceptable to justify self-destructive behavior then very few people are going to change.

]]> By: Pat http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14531 Pat Wed, 14 Jan 2009 00:31:20 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14531 I agree that the disease model doesn't really work all that well, although it seems to be a good place to start once a person decides they want to stop the abuse. However, I think the idea that it's a choice certainly turns the model on its head. Along with that comes so many other possibilities, but no less challenge than trying to change a serious set of behaviors/habits. I agree that the disease model doesn’t really work all that well, although it seems to be a good place to start once a person decides they want to stop the abuse. However, I think the idea that it’s a choice certainly turns the model on its head. Along with that comes so many other possibilities, but no less challenge than trying to change a serious set of behaviors/habits.

]]> By: Ashlee http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14519 Ashlee Tue, 13 Jan 2009 12:24:36 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14519 Sarah, you have a good point there. Native americans were treated unfairly. It seems like nothing has changed and we wonder why a lot of us turn to alcohol, even if it is a temporary fix. Sarah, you have a good point there. Native americans were treated unfairly. It seems like nothing has changed and we wonder why a lot of us turn to alcohol, even if it is a temporary fix.

]]> By: Sarah http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14501 Sarah Mon, 12 Jan 2009 20:24:42 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14501 Perhaps Native Americans have turned to alcohol to help drown their misery over the conditions and the ways in which they are continually treated in this country. Perhaps Native Americans have turned to alcohol to help drown their misery over the conditions and the ways in which they are continually treated in this country.

]]> By: keely http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14489 keely Mon, 12 Jan 2009 12:10:44 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14489 I think many people face this, not just Native Americans.... There are things that trigger someone who wants to depend on alcohol, whatever that may be. The different situation mentioned in this article just goes to show why people turn to alcohol. I think many people face this, not just Native Americans…. There are things that trigger someone who wants to depend on alcohol, whatever that may be. The different situation mentioned in this article just goes to show why people turn to alcohol.

]]> By: Karla http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14487 Karla Mon, 12 Jan 2009 12:09:03 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14487 I agree that when you drink, it's a choice you take upon yourself, whether it starts as a stressful situation, or because you are missing something in your life. Alcohol seems to make you forget for a moment the things that you do not want to face or accept. I know many people believe it's a disease and I often wonder myself if its a disease or a habit as in smoking. I agree that when you drink, it’s a choice you take upon yourself, whether it starts as a stressful situation, or because you are missing something in your life. Alcohol seems to make you forget for a moment the things that you do not want to face or accept. I know many people believe it’s a disease and I often wonder myself if its a disease or a habit as in smoking.

]]> By: Gina http://www.goodtherapy.org/blog/native-americans-alcholism/comment-page-1/#comment-14479 Gina Mon, 12 Jan 2009 10:27:23 +0000 http://www.goodtherapy.org/custom/blog/?p=1383#comment-14479 I totally agree with alcohol making the things it temporarily solves much worse. Ethnicity and traditions is only an excuse. Most times people dont want to leave their comfort zone and help themselves making that the primary reason for not wanting help with alcoholism. I totally agree with alcohol making the things it temporarily solves much worse. Ethnicity and traditions is only an excuse. Most times people dont want to leave their comfort zone and help themselves making that the primary reason for not wanting help with alcoholism.

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