Motivation, responsibility and sickness in the psychiatric treatment of alcoholism

Two dominant themes of alcohological thinking and practice are considered in this paper; the disease concept and the concept of motivation. Both are examined in terms of (a) the rights, obligations and responsibilities associated with different types of illness and degrees of severity, and (b) the routine care and treatment of alcoholism in two out-patient alcoholism clinics. The allocation of responsibility and attribution of motivation in psychiatric alcoholism consultations are examined. Finally, the relationship between responsibility allocation, motivation attribution and judgements of a potentially moral nature is considered. It is concluded that a Mutual Participation model of sickness behaviour and doctor-patient relationship is operative in the psychiatric treatment of alcoholism, based upon patients' self-responsibility and strength of character (will-power). In this respect, the psychiatric treatment of alcoholism contrasts with other (particularly non-psychiatric) conditions and treatments.