alcoholism has been more extensive and reviews of this literature can be found elsewhere
(Peele 1984; Schuckit 1985). However, it has been estimated that a male child may be up
to four times more likely to develop alcoholism if they have a biological parent who is an
alcoholic.
A pre-existing psychological abnormality
Some theories suggest that certain individuals may become addicts due to a pre-
existing psychological problem. For example, Freud argued that an addiction may be
the result of either latent homosexuality, or a need for oral gratification. It has also
been suggested that alcoholism may be related to a self-destructive personality or a
need for power (e.g. McClelland et al. 1972). This perspective emphasizes a psycho-
logical abnormality that is irreversible and pre-dates the onset of the addictive
behaviour.
Acquired dependency
Models within the 2nd disease perspective have also viewed addiction as the result of
excess. For example, Jellinek in the 1960s developed a theory of species of alcoholism
and phases of alcoholism (Jellinek 1960). This suggested that there were different types
of addiction (alpha, gamma, delta) and that increased consumption of alcohol caused
the individual to progress through different stages of the illness. He suggested that
addiction resulted from exposure to the addictive substance and resulted in (1) acquired
tissue tolerance; (2) adaptive cell metabolism; (3) withdrawal and craving; and (4) loss of
control. In a similar vein, Edwards and Gross’s (1976) theory of alcohol dependence
syndrome argued that consistent alcohol use resulted in cell changes and subsequent
dependency. Applied to smoking, this perspective suggests that nicotine causes addiction
through its constant use. Although this perspective is classified as a 2nd disease concept,
it is reminiscent of the 1st disease concept as the emphasis is on the substance rather
than on the individual.
PROBLEMS WITH A DISEASE MODEL OF ADDICTION
Although many researchers still emphasize a disease model of addictions, there are
several problems with this perspective:
The disease model encourages treatment through lifelong abstinence. However,
lifelong abstinence is very rare and may be difficult to achieve.
The disease model does not incorporate relapse into its model of treatment. However,
this ‘all or nothing’ perspective may actually promote relapse through encouraging
individuals to set unreasonable targets of abstinence and by establishing the self-
fulfilling prophecy of ‘once a drunk always a drunk’.
The description of controlled drinking, which suggested that alcoholics can return to
‘normal drinking’ patterns (Davies 1962; Sobel and Sobel 1976, 1978) challenged
SMOKING AND ALCOHOL USE 107