Introduction

According to those who believe in an underlying genetic misfortune leading to ‘alcoholism’, my future is not looking too bright. My brother, paternal aunt and grandmother and maternal grandfather all died alcohol-related deaths. My father has illnesses complicated by years of ‘drinking’, my parents’ relationship has been marred by alcohol, while I binged my way through my mid-twenties to thirties. To be frank, a disease model offers me an easy way out, a set script to frame my ‘alcoholism’ as a genetic malfunction that denies me agency for the future. It would add that my only hope would be total abstinence and any slippage from this would lead to either a lapse (a partial but recoverable return to alcohol) or relapse (which means less chance of recovery), while both are more than likely to lead to more years of helplessness and hopelessness as I fight my ‘demons’.

The alternative – a social learning model that allows for a better understanding of social context in relation to alcohol use, and suggests that alcohol is a way of coping but has the potential to lead to physiological dependency – has all but lost out in the past few years. Constant reductions in funding have led to services being slashed and only those most willing to compromise their work to rationalisation and efficiency can possibly survive.

I am in favour of the social learning model. Twenty years of working with people who had alcohol-related problems has told me that no one woke up one morning and decided to drink until they dropped. Patterns of drinking sit inside social systems that influence attitudes, approaches and understanding about the use and serious abuse of alcohol.