The origins and evolution of the disease concept of treatment.

OBJECTIVE

The disease concept of treatment (DCT) has been the dominant treatment model for alcoholism in the United States for the last 30 years. This article sheds light on this treatment model by tracing its historical origins and its evolution in institutions.

METHOD

Accounts from the published literature on Alcoholics Anonymous (AA) and early alcoholism treatment programs were culled for insights regarding the development of DCT. Early examples of AA facilities, state mental hospital alcoholism units, detoxification units, and outpatient alcoholism clinics are described as they evolved. The important role of AA in this process is detailed. Accounts are given of the interaction between professionals and alcoholism counselors during the period in which DCT was developed in these institutions.

RESULTS

It was found that all of the current types of alcoholism treatment programs had their origins in early, informal AA facilities except for outpatient alcoholism clinics. DCT evolved concurrently in AA facilities, state mental hospitals and detoxification units.

CONCLUSIONS

The historical accounts summarized here suggest that DCT was primarily a structured and didactic presentation of AA principles that incorporated some additional treatment elements, notably, the confrontation group. Thus, it can be argued that most alcoholism treatment today (i.e., DCT) derives from the original AA model. It is suggested that studies be undertaken to distinguish the degree to which AA recovery principles are different from DCT methods by researching the clinical beliefs and practices of alcoholism counselors and comparing them with those of AA members.