What one tries to achieve with patients who drink too much, is to encourage them to have a more conscious relationship with alcohol.
It seems to me, that the frequency and volume of alcohol usage traverses a wide spectrum of different situations. Not all regular drinkers are “alcoholics”.
The term “alcoholic” and “addict” is indeed appropriate for certain people, but is an over-used “diagnosis.” I have great respect for the 12-step programme, but one needs to refrain from a “one size fits all” approach when dealing with the complex issue of people’s relationship with alcohol.
The “disease model” adopted by Alcoholics Anonymous is a necessary approach for people ruining their health and their social and work life, due to uncontrolled drinking. The group support from AA and the individual support from sponsors, as well as family and friends that are “on board” in a non-judgmental empathic manner, is a vital prognostic determinant regarding the patient’s recovery. Jung was right there with Bill W the founder of AA to introduce the idea of a "greater power". Most people rationalise their way out of this, saying they don't believe in "God."The two million year old Homo Sapien repository of images we inherit accompanying our short sojourn in life is enough of a God for me. As W.H. Auden famously stated: "we are lived by forces we pretend to understand."
However, there are many people who drink too much, but are not alcoholics. They need to be made aware of how they are using alcohol (which is an addictive substance), as a “medicine” to cope with challenges in their lives. Personality problems may be impeding their capacity to manage personal and work relationships, which then results in various emotional symptoms and psychological problems, relieved by drinking.
People then drink alcohol to cope. Some may even have underlying psychiatric problems, which are distressing and go undiagnosed, the symptoms of which are then self-medicated with the over-use of alcohol.
A comprehensive history and evaluation by a professional, who is trained in psychiatry, psychology and psychotherapy, needs to be made, for the correct diagnosis and treatment. Being labelled an alcoholic, when there are deeper issues at hand, is negligent, because it merely categorises people, but leaves out their inner struggles as individuals.
We are all complex beings trying to manage many needs and demands in life, and increasing one’s repertoire of self-care by acquiring more personal insight, psychological tools, and perhaps even medication, will assist in the journey towards an authentic identity and less overuse of alcohol.
“Psychotherapy” should be seen merely as a professional arrangement when people engage in an open, safe, non-judgemental discussion, where there is emotional trust and confidentiality. The professional involved must be experienced through years of training and working in depth in the field of mental health.
This archetypal situation of seeking out a healer, should never become stultified into a rigid, theoretically based, doctor-patient persona type dynamic, which actually is inimical to real psychological experience and transformation.
The high relapse rate after attending prolonged and expensive rehabilitation programmes, is because the “disease model” hangs like a Damocles sword over many people, and causes unnecessary stress on them. A relapse drives people into secret drinking, accompanied by self-loathing and shame due to their sense of failure. They are made to feel guilty that having been told they are “sick”, they didn’t submit to their treatment in a responsible manner!
Setting new realistic goals and continuing the work towards recovery through enlarging consciousness, requires courage and support in a more comprehensive treatment model, than the medical “disease model”.