Treatment implications of chemical dependency models an integrative approach

Five basic models of chemical dependency and their treatment implications are described. The moral model, although disdained by most treatment professionals, actually finds expression in over half the steps of Alcoholics Anonymous. The learning model, albeit the center of the controlled drinking controversy, is also utilized by most abstinence-oriented programs. The disease model, which enjoys current popularity, sometimes ignores the presence of coexisting disorders. The self-medication model, which tends to regard chemical dependency as a symptom, can draw needed attention to coexisting disorders. The social model emphasizes the importance of environmental and interpersonal influences in treatment, although the substance abuser may endorse it as a justification to adopt a victim's role. A sixth model, the dual diagnosis model, is presented as an example of how two of the basic models can be integrated both to expand the treatment focus and to increase treatment leverage. Whereas the five basic models are characterized by a singular, organizing treatment focus, the dual diagnosis model is viewed as an example of a multifocused, integrative model. It is concluded that effective therapy requires (a) flexibility in combining elements of different models in order to individualize treatment plans for substance abusers, and (b) careful assessment of both the therapist's and the substance abuser's beliefs about treatment models in order to insure a treatment match based on a healthy alliance.