Reframing Alcoholism: Researcher Argues Against ‘Disease’ Label

For more than 100 years, alcoholism has been viewed as a disease; however, this framing has created barriers to diagnosing, treating and even understanding the condition, one psychologist argues.

“By adhering so strictly to the disease model…I think that we miss the opportunity to frame alcoholism in ways that could help some people,” said Lance Brendan Young, a postdoctoral research fellow with the Department of Veterans Affairs’ Center for Comprehensive Access & Delivery Research and Evaluation in Iowa City, Iowa.

Thinking of the condition in as a disease diminishes the moral stigma of it. However, this framing introduces the stigma of disease, Young said.

“It introduces the stigma of abnormality — of being permanently deviant in body and mind,” Young said.

While the disease model may be useful for treating people who consider themselves alcoholics, it may be harmful to people trying to determine whether their drinking is problematic, Young said. To be diagnosed with alcoholism means a person has to give up their identity as a “normal” person, and take on the identity of someone with a disease, Young said.

“Individuals are faced with this identity-threatening choice they have to make,” Young said. As a consequence, some people change their behavior so they can continue to think of themselves as normal. For instance, a person might believe “alcoholics” only drink alone, so he will try to get his friends to go drinking with him frequently. This way, he can continue consume alcohol excessively without needing to believe he is an “alcoholic,” or seeking treatment.

Young said he is not advocating eliminating the disease model, but hopes instead to move beyond it. The medical community should find away to frame the condition so it is less threatening to people’s identify, perhaps by using different words to describe it, Young said. And more research should investigate social and cultural influences on alcoholism, rather than focusing on biological causes of it, he argued.

Young published his views in the September issue of the journal Culture & Psychology.

Who is an “alcoholic?”

Alcoholism is a physical addiction to alcohol in which people continue to drink even though the drinking causes physical, mental and social problems, including problems with job responsibilities and relationships, according to the National Institutes of Health. As is the case with other addictions, alcoholism is considered a disease by many in the medical community, including the American Medical Association.

A drawback to framing alcoholism as a disease is that we tend to think of diseases as something that needs to be diagnosed by a professional, Young said. However, physicians often only meet with patients for a short time and cannot possibility have the same insight into an individual’s habits as she herself.

“I know of addicts who have been able to get a professional to tell them they are not addicted,” and then use that as justification to continue their excessive drinking, Young said.

The disease model also gives the false impression that alcoholism is solely a biological disorder, Young said, leading some researchers tend to adopt a narrow view, focusing on particular chemicals or brain cells that might be involved.

“We tend to look at smaller and smaller parts of the human body, and the human mind and the human brain,” to find the cause of something, Young said. In doing so, we lose sight of the bigger picture, including social and cultural influences that may play a role in alcoholism development. Factors including who you spend time with, how many liquor stores are near you and your religious affiliation all are linked with how much you drink, Young said.

Solutions

Young said he prefers to use the word “allergy” to describe alcoholism.

“It is less threatening to consider the idea that one might have an allergy than to consider the idea that one might be permanently diseased,” Young said.

“With alcoholism, there’s a dichotomy — you either are [an alcoholic] or you’re not. And that sort of marks you as an individual — you’re either normal or you’re deviant.” Young said. “With allergies, the deviance is much less significant.”

In addition, drinkers should not feel they have to leave their diagnosis to a physician. People should give weight to their own experiences, including what they perceive their drinking is doing to their lives, Young said.

Other experts point out that the problem of disease stigmatization or identity crisis is not unique to alcoholism.

“It really doesn’t matter what illness you have; people have a sense of loss,” said Dr. Ihsan Salloum, chief of the Division of Alcohol and Drug abuse at the University of Miami Miller School of Medicine; who also called the Young’s article “more philosophical than scientific.”

The disease model has helped us understand alcoholism and develop drugs for the condition, Salloum said.

However, Salloum agreed there is a need to take into account subjectivity when diagnosing and treating the condition.

“When somebody is suffering, it’s not only the organ that’s suffering, it’s the whole person,” Salloum said.

If doctors want to help patients accept their diagnosis as an alcoholic, they should work to understand how the patient is processing what’s happening to him or her, Salloum said.

Pass it on: Viewing alcoholism as a disease may create problems in terms of diagnosing, treating and understanding the condition.

This story was provided by MyHealthNewsDaily, a sister site to LivScience. Follow MyHealthNewsDaily staff writer Rachael Rettner on Twitter @RachaelRettner. Find us on Facebook.

Read more http://ca.news.yahoo.com/reframing-alcoholism-researcher-argues-against-disease-label-185203992.html

September is Alcohol and Drug Addiction Recovery Month

OSWEGO – The Oswego County Legislature recently proclaimed September as Alcohol and Drug Addiction Recovery Month with a presentation to the Oswego County Division of Mental Hygiene. All county residents are encouraged to embrace this year’s theme, “Join the Voices for Recovery: Recovery Benefits Everyone.”

More than 13,000 Oswego County residents, an estimated 12.9 percent, have a chemical dependence service need. Education is essential to prevention, overcoming misconceptions, and achieving long-term recovery. Treatment and recovery improve a community’s welfare; provide a renewed outlook on life for those who struggle with substance use disorders and gambling addictions, and offer hope and encouragement to their families and friends.

The Oswego County Division of Mental Hygiene works throughout the county to increase public awareness of substance abuse and gambling addiction issues and recognize the achievements of those in recovery. Dedicated local agencies such as the County of Oswego Council of Alcoholism and Addictions, Farnham Family Services, Harbor Lights, and OCO Arbor House provide support to individuals with addictions as well as their families and reach out to those in need of support. Service providers are also able to offer community outreach and prevention presentations to schools, churches, community groups and organizations.

If you or someone you know is affected by addiction, or if you would like to schedule a prevention presentation, contact one of the following community organizations:

• Oswego County Division of Mental Hygiene: 315/963-5361

• County of Oswego Council on Alcohol and Addictions (COCOAA): 315/342-2370

• Farnham Family Services: 315/342-4489

• Harbor Lights: 315/963-0777

Additional resources that also offer services include:

• NYS Hope Help-Line: 1-877-8-HOPENY (1-877-846-7369)

• Alcoholics Anonymous: www.aa.org

• Al-Anon Family Groups: www.al-anon.org

• Alateen: www.alateen.org

For more information, contact the Oswego County Division of Mental Hygiene at 315/963-5361, or visit the department’s Web site at http://www.oswegocounty.com/dss/mental.html.

 

Read more http://oswegocountytoday.com/?p=69757

Vietnam Drug Centers Abuse Inmates, Says Rights Group

HANOI, Vietnam – An international human rights group urged Vietnam to shut down drug rehabilitation centers that it said subject inmates to abuse and forced labor. It also called Wednesday on international donors to check the programs they fund inside the centers for possible ties to human rights violations.

New York-based Human Rights Watch accused Vietnam of imprisoning hundreds of thousands of drug addicts over the past decade without due process and forcing them to work long hours for little pay.

It also alleged that the U.S. and Australian governments, the United Nations, the World Bank and other international donors may “indirectly facilitate human rights abuses” by providing drug dependency or HIV treatment and prevention services to addicts inside some of the centers.

About 309,000 drug users nationwide passed through the centers from 2000 to 2010, with the number of facilities more than doubling – from 56 to 123- and the maximum length of detention rising from one to four years, the report said, citing government figures.

The report called drug treatment at the centers “ineffective and abusive,” claiming donor support for health services inside such facilities allows Vietnam to “maximize profits” by detaining drug addicts for longer periods and forcing them to do manual labor.

“People who are dependent on drugs in Vietnam need access to community-based, voluntary treatment,” Joe Amon, health and human rights director at Human Rights Watch in New York, said in a statement. “Instead, the government is locking them up, private companies are exploiting their labor and international donors are turning a blind eye to the torture and abuses they face.” Vietnamese Foreign Ministry spokeswoman Nguyen Phuong Nga called the report “groundless,” saying compulsory drug rehabilitation in Vietnam is “humane, effective and beneficial for drug users, community and society.” Vietnam’s drug rehabilitation centers comply with Vietnamese law and are “in line” with drug-treatment principles set by the U.S., the U.N. and the World Health Organization, Nga added. Officials from the U.S., Australia and the United Nations declined to comment. The U.S. last year provided $7.7 million to the country for methadone treatment and community-based drug intervention, according to the US Embassy website. Injecting drug users are a driving force behind HIV infections across Vietnam. The World Bank funded an HIV/AIDS prevention program in 20 drug rehabilitation centers across Vietnam that ended last year.

“We have not received any reports of human rights violations in the drug rehabilitation clinics supported by the project,” said Victoria Kwakwa, World Bank Vietnam’s country director. “If we had, we would have conducted a supervision mission to ensure bank policies were met and concerns fully examined.” Detainees inside the Vietnamese drug centers report beatings and spells of solitary confinement, and some who attempted escape say they were captured and shocked with an electric baton as punishment, according to the 126-page report that interviewed 34 former detainees in 2010 who were held at 14 centers in and around southern Ho Chi Minh City. It also charged Vietnam with forcing prisoners to sew clothing, lay bricks or husk cashews for between $5 and $20 per month, a violation of domestic labor law, which guarantees a minimum monthly wage of about $40. Instead of providing health services inside the centers, donors should focus on releasing detainees back into their communities, the report said, citing government reports that place the relapse rate for drug users treated inside the centers at 80 percent or higher. China and other Southeast Asian countries have also come under fire from rights groups in recent years for alleged human rights violations inside similar drug rehabilitation facilities.

Several large escapes from Vietnam’s drug rehabilitation centers have been reported in recent years. The centers, which began opening after the end of the Vietnam War in 1975, are one facet of Vietnam’s ongoing campaign against drug abuse, prostitution and other so-called “social evils.” Most detainees are young male heroin users, the Human Rights Watch report said, citing government data. Some are rounded up by police while others are sent to the centers by family members. Vietnam says there are 138,000 drug addicts in the country and 30 percent them are HIV positive, down from 60 percent in 2006.

Source: Yellowbrix

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Read more http://www.thirdage.com/news/vietnam-drug-centers-abuse-inmates-says-rights-group_09-07-2011

Australia ‘funding’ abusive rehab centres

AP

The federal government has denied using taxpayer dollars to fund Vietnamese drug rehabilitation centres which one advocacy group has labelled nothing more than “forced labour camps”.

Human Rights Watch (HRW) says Vietnam is imprisoning hundreds of thousands of drug addicts and subjecting them to abuse and forced labour through its compulsory drug detention centres.

It’s called on international donors, including Australia, the United States and the United Nations to halt funding, accusing them of helping “facilitate human rights abuses”.

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But an AusAID spokeswoman said Australia did not fund the mandatory drug centres, and was actively lobbying Hanoi to have them shut down.

She said Australian dollars are, however, provided directly to drug users in the centres through the HIV/AIDS Asia Regional program, to which AusAID has contributed $4 million over five years.

“Evidence has shown compulsory drug detention centres to be both ineffective and counterproductive in the treatment of intravenous drug users and in containing the spread of HIV,” she said in a statement on Wednesday.

“The Australian government continues to make regular representations to the government of Vietnam urging it to close these centres in favour of more effective community-based support centres and to focus on the treatment of intravenous drug users in their own communities.”

Australia’s ambassador to Vietnam visited two detention centres just last month advocating for a closure of the mandatory facilities and the punitive treatment of drug users.

HRW has called drug treatment at the centres “ineffective and abusive,” claiming donor support for health services allows Vietnam to “maximise profits” by detaining drug addicts for longer periods and forcing them to do manual labour.

It said the centres were little more than “forced labour camps”.

“People who are dependent on drugs in Vietnam need access to community-based, voluntary treatment,” said Joe Amon, HRW’s health and human rights director.

“Instead, the government is locking them up, private companies are exploiting their labour and international donors are turning a blind eye to the torture and abuses they face.”

The AusAID spokeswoman said the department was not aware of any reports from its staff about abuse in the centres.

Inmates inside the Vietnamese drug facilities have detailed beatings and spells of solitary confinement, and some who attempted escape say they were captured and shocked with an electric baton as punishment.

The claims are detailed in a HRW report, which took in the accounts of 34 former detainees in 2010 who were held at 14 centres in and around southern Ho Chi Minh City.

The report also accused the Vietnamese government of forcing prisoners to sew clothing, lay bricks or husk cashews and then paying them below the minimum monthly wage.

China and other south-east Asian countries have also come under fire from rights groups in recent years for alleged human rights violations inside similar drug rehabilitation facilities.

There are 138,000 drug addicts in Vietnam and 30 per cent them are HIV positive, down from 60 per cent in 2006.

Read more http://news.smh.com.au/breaking-news-national/australia-funding-abusive-rehab-centres-20110907-1jxvt.html

Rights group: Forced labor in Vietnam drug centers

HANOI, Vietnam (AP) — An international human rights group urged Vietnam to shut down drug rehabilitation centers that it said subject inmates to abuse and forced labor. It also called Wednesday on international donors to check the programs they fund inside the centers for possible ties to human rights violations.

New York-based Human Rights Watch accused Vietnam of imprisoning hundreds of thousands of drug addicts over the past decade without due process and forcing them to work long hours for little pay.

It also alleged that the U.S. and Australian governments, the United Nations, the World Bank and other international donors may “indirectly facilitate human rights abuses” by providing drug dependency or HIV treatment and prevention services to addicts inside some of the centers.

About 309,000 drug users nationwide passed through the centers from 2000 to 2010, with the number of facilities more than doubling — from 56 to 123— and the maximum length of detention rising from one to four years, the report said, citing government figures.

The report called drug treatment at the centers “ineffective and abusive,” claiming donor support for health services inside such facilities allows Vietnam to “maximize profits” by detaining drug addicts for longer periods and forcing them to do manual labor.

“People who are dependent on drugs in Vietnam need access to community-based, voluntary treatment,” Joe Amon, health and human rights director at Human Rights Watch in New York, said in a statement. “Instead, the government is locking them up, private companies are exploiting their labor and international donors are turning a blind eye to the torture and abuses they face.”

Vietnamese Foreign Ministry spokeswoman Nguyen Phuong Nga called the report “groundless,” saying compulsory drug rehabilitation in Vietnam is “humane, effective and beneficial for drug users, community and society.”

Vietnam’s drug rehabilitation centers comply with Vietnamese law and are “in line” with drug-treatment principles set by the U.S., the U.N. and the World Health Organization, Nga added.

Officials from the U.S., Australia and the United Nations declined to comment.

The U.S. last year provided $7.7 million to the country for methadone treatment and community-based drug intervention, according to the US Embassy website. Injecting drug users are a driving force behind HIV infections across Vietnam.

The World Bank funded an HIV/AIDS prevention program in 20 drug rehabilitation centers across Vietnam that ended last year.

“We have not received any reports of human rights violations in the drug rehabilitation clinics supported by the project,” said Victoria Kwakwa, World Bank Vietnam’s country director. “If we had, we would have conducted a supervision mission to ensure bank policies were met and concerns fully examined.”

Detainees inside the Vietnamese drug centers report beatings and spells of solitary confinement, and some who attempted escape say they were captured and shocked with an electric baton as punishment, according to the 126-page report that interviewed 34 former detainees in 2010 who were held at 14 centers in and around southern Ho Chi Minh City.

It also charged Vietnam with forcing prisoners to sew clothing, lay bricks or husk cashews for between $5 and $20 per month, a violation of domestic labor law, which guarantees a minimum monthly wage of about $40.

Instead of providing health services inside the centers, donors should focus on releasing detainees back into their communities, the report said, citing government reports that place the relapse rate for drug users treated inside the centers at 80 percent or higher.

China and other Southeast Asian countries have also come under fire from rights groups in recent years for alleged human rights violations inside similar drug rehabilitation facilities.

Several large escapes from Vietnam’s drug rehabilitation centers have been reported in recent years.

The centers, which began opening after the end of the Vietnam War in 1975, are one facet of Vietnam’s ongoing campaign against drug abuse, prostitution and other so-called “social evils.”

Most detainees are young male heroin users, the Human Rights Watch report said, citing government data. Some are rounded up by police while others are sent to the centers by family members.

Vietnam says there are 138,000 drug addicts in the country and 30 percent them are HIV positive, down from 60 percent in 2006.

Read more http://www.seattlepi.com/news/article/Rights-group-Forced-labor-in-Vietnam-drug-centers-2158202.php