Alcoholism is the gradual addiction that a person builds up to consume alcoholic drinks. With time, the person builds up a dependency on alcoholic drinks to feel good or to self-console (Mehta, 2016). This can lead to dysfunction and stress in a person’s life. There are so many reasons why a person can develop alcoholism. One of the main reasons is that when a person is exposed to alcohol at a very young age, that person has a higher chance of developing alcoholism. Even depression and exposure to a stressful environment can lead to the development of alcoholism (Mehta, 2016).

The biological perspective views genetics as stating that it is caused by improper gene expression and abnormalities in the dopamine-2 receptor gene in a person’s genes (Ferraguti et al., 2015). Alcoholism is high among people who have been subjected to alcohol abuse by their parents. Drugs like alcohol affect the brain’s reward circuit by increasing dopamine levels when alcohol is consumed, making the person feel happy, and this leads to reward deficiency syndrome later on. Alcohol contains ethanol, which reduces the neurons’ inhibitory and excitatory neurotransmitter activity. This causes restrictions in brain activity, and opioid receptors are activated due to the ethanol, which then causes an increase in dopamine levels (Ferraguti et al., 2015).

The behavioral perspective explains the causes of alcoholism as a behavior that we learn through observing and imitating peers and role models, according to the social learning theory (Hogarth, 2020). Once consumed, it makes the person feel happy and stress-free. The more often a person uses alcoholic drinks, that person’s behavior is reinforced, making it an addiction according to operant conditioning. The behavioral perspective states that when a person is under substances like alcohol, the person’s stress levels decrease, and this makes the person consume more alcohol into the body when stressed. This behavior is a negative coping mechanism used to cope with stress in a person’s life by behaviorists (Hogarth, 2020).

The cognitive perspective views alcoholism as having trouble with controlling behavior in a person (Bernardin et al., 2014). Since high amounts of alcohol reduce inhibitory and excitatory neurotransmitter activity in the neurons, it delays the transmission of electrical signals from the brain to the body. It reduces motor activity (Gould, 2010). According to the expectancy theory, a person acts or behaves in certain ways because they are motivated by the result of the behavior, which then leads to addiction to that behavior (Zamboanga et al., 2012). In alcoholism, people are motivated by getting intoxicated by alcoholic drinks. The feeling of goodness makes the need for the behavior occur more frequently, resulting in the person’s increased dependence and addiction to alcohol (Sayette, 2017).

According to the social perspective, a person develops alcoholism because alcohol consumption is valued and accepted in one’s social group. If their parents and friends are addicted to alcohol, it aggravates the situation (Prakash et al., 2020). Research has proven that the rate of patients with alcoholism is higher in Eastern European countries where there are more males compared to females. Males tend to get addicted to alcohol more than females, since females are not socially accepted to consume alcohol or drugs in large volumes (Ceylan-Isik et al., 2010). It is also proven that people who live in stressful socioeconomic conditions and discriminatory work environments can provoke alcoholism (Sayette, 2017).

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Many treatments are available now to help control alcoholism through classical conditioning, operant conditioning, and social learning theories. These theories are types of learning processes in which we learn through associations, reinforcements, observations, and imitations.

What is classical conditioning (CC), and what are the treatments for alcoholism?

Classical conditioning is a process of learning where two stimuli are paired together, which will then produce a new learned response (Rehman et al., 2017). According to CC, we learn through association. CC was founded by Russian physiologist Ivan Pavlov in the year 1899 (Rehman et al., 2017).

Pavlov conducted an experiment using dogs. First, a tube was inserted into the dog’s mouth to measure the amount of salivation (Bichler et al., 2013). Then a bell was rung in front of the dog, and initially, the dog showed no response. The dog was then shown food while the bell was ringing in the background. After a few trials, Pavlov rang the bell but did not show food to the dog. However, the dog continued to salivate. From this, Pavlov concluded that behavior can be conditioned by pairing two stimuli (Bichler et al., 2013). CC explains alcoholism as an association built between cues and alcohol that provokes the behavior of getting addicted. For example, bars are cues that are associated with alcohol that provoke a person to consume alcohol in a bar (Cheng et al., 2015).

Taste Aversion Therapy (TAT) was discovered by American psychologist John Garcia in 1966 while studying laboratory rats under radiation, where he observed that rats avoid drinking water from plastic cups in radiation chambers (Baker et al., 1978). TAT is not used extensively to treat people with alcoholism in some countries, while others do. TAT is a type of conditioning that works by repeating the pairing of unwanted behavior with an unpleasant stimulus like taste so that the person will not repeat the unwanted behavior.

Clinical psychologists give their clients a chemical drug like disulfiram before the client is given an alcoholic drink. This creates a disulfiram reaction, causing a bad taste in the client’s mouth, making the client vomit the alcohol out, nausea, and bad headaches. This process is repeated a couple of times until the unwanted behavior, which is the alcohol-drinking behavior, is paired with the unpleasant stimulus, which is the bad taste and after-effects of drinking alcohol. However, it is important that the unpleasant stimulus works soon after the unwanted behavior to make a connection between the unpleasant stimulus and the unwanted behavior. This makes the brain avoid alcohol consumption because of the paired discomfort with alcohol (Baker et al., 1978).

Research has found that TAT is a fast type of treatment that shows results within a month compared to other types of treatments for alcoholism. TAT is an easy treatment that can even be conducted at home and has some effectiveness in treating alcoholism (Baker et al., 1978). The biggest con is that TAT is a short-lived treatment because it focuses more on behavior and less on the psychological factors that cause the unwanted behavior in the person. Another con is that TAT uses chemical drugs like disulfiram to give the client unpleasantness and discomfort, and this is considered unethical (Baker et al., 1978).

Cue Exposure Therapy (CET) is a type of treatment that focuses on reducing the craving for alcohol in alcoholics (Mellentin et al., 2017). CET works by pairing the alcohol-related cue with the physiological response in a treatment setting. In the treatments, actual alcohol is absent, which will then decrease the physiological response to the alcohol cue and reduce the craving with time (Mellentin et al., 2017). Many applications in the modern world are made to give virtual stimulations of a bar or a restaurant or even smell (Hone-Blanchet et al., 2014).

Psychologists proceed by giving a virtual headset showing the person a virtual environment and giving the person non-alcoholic drinks while the person is virtually stimulated. The more realistic the environment is, the greater the outcomes of the treatment (Hone-Blanchet et al., 2014). Since the person is virtually stimulated by a bar or restaurant environment and does not get high with the drinks provided, the brain gets tricked. After a few trials of the treatment, the person’s craving for alcoholic drinks reduces with time (Hone-Blanchet et al., 2014). The treatment teaches the person about positive ways to cope with managing drinking habits and cues from the environment that will provoke cravings again. The CET treatments help to a great extent to withdraw from alcohol cravings (Mellentin et al., 2017).

Pittance research has proven CET as a long-lived treatment for alcoholism. Stress is the main cause that provokes addiction in a person. CET has proven to treat anxiety disorders like post-traumatic stress disorder, which helps treat alcoholism at a deeper level (Mellentin et al., 2017). CET takes a couple of trials to work and to show positive results in person. There is very little research on CET and minimal knowledge of the topic and its limitations. This makes CET a very limited treatment that is used to treat alcoholism and is considered less effective (Mellentin et al., 2017).

What is operant conditioning (OC) and treatments for alcoholism?

OC was discovered by an American physiologist named B.F. Skinner in 1937 (Staddon & Cerutti, 2003). OC is a learning process in which a behavior is learned, strengthened, or weakened through reinforcement or punishment.

Skinner conducted an experiment known as the Skinner Box experiment, in which he used a rat in a Skinner box with a lever and an electric grid as the base of the box. In Skinner’s experiment, there are two types of reinforcement: positive reinforcement and negative reinforcement (Staddon & Cerutti, 2003). Whenever the rat lowered the lever, the rat was given food as a treat for the rat’s behavior, and it was repeated. The rat was conditioned, and this type of conditioning was known as positive reinforcement. Alternatively, the rat was given electric shocks via the electric grid at the base of the box, and when the rat lowered the lever, the electric shock stopped (Skinner, 1937). Soon the rat learned to lower the lever when the rat got the electric shocks. This type of conditioning is known as negative reinforcement.

Finally, whenever the rat lowered the lever for no reason, the rat was given an electric shock. This stopped the rat from unnecessarily lowering the lever, and this type of conditioning was known as punishment (Skinner, 1937). From this experiment, Skinner concluded that we can condition through reinforcements or punishments (Skinner, 1937). OC explains that alcoholism is caused by our brain producing chemicals that make us feel happy and reduce our stress levels, which reinforces our behavior to become addicted to alcohol (O’Tousa & Nicholas, 2014).

Community Reinforcement Approach and Family Training (CRAFT) is a treatment that is widely used to treat people with alcoholism. It was discovered by Robert J. Meyers and William R. Miller in the 1970s (Kirby et al., 2017). The CRAFT method works on teaching family members and friends how to interact with the person who is addicted to alcoholic drinks since the family members and friends know a lot about the person, like what triggers the person to drink and how he or she reacts when high on alcohol (Hellum et al., 2019). The CRAFT method focuses on reinforcing good behavior and not reinforcing bad behavior.

Family members are instructed to treat well and show more love and affection when the person comes home sober without being drunk on alcohol, and if the person comes home drunk, the family is instructed to avoid the person and let him/her pay the consequences of being intoxicated (Kirby et al., 2017). By doing this, the person will gradually reduce getting drunk often because they get rewards from family and friends, which then promote this behavior of not getting drunk. Additionally, CRAFT focuses on helping the family deal with the person by instructing them to show more love and affection when sober, reducing the stress levels in the person, which helps to reduce the addiction (Kirby et al., 2017).

The CRAFT method is a scientific method that has been studied and proven to show great results with time. The CRAFT method not only helps the person who is dealing with alcoholism but also helps the mental health of the family members and friends who are interacting with the person (Kirby et al., 2017). The CRAFT method instructs the family not to care for the person and instead to let the person pay the consequences of getting drunk, which could lead to harm to the person. Even though CRAFT is a scientific method, its efficacy relies on how well the family and friends understand and participate in the treatment and not on the psychologist (Kirby et al., 2017).

Contingency Management Therapy (CMT) is a treatment that focuses on reinforcing positive behavior through a reward system. CMT was invented by an Austrian psychologist named Fred Edward Fiedler in 1964 (Miguel et al., 2015). CMT is used a lot in rehabilitation as a part of their treatment plans, and it is mainly a one-on-one treatment. There are many types of reward systems in CMT, like voucher-based reinforcement and direct rewards (Witkiewitz & Marlatt, 2011). First, experts in CMT conduct interviews to get to know the person and what the best reward system is for him or her (Miguel et al., 2015).

Afterward, the therapist reinforces positive behavior by telling the person that you would receive a reward if you gave a clear urine sample with no traces of alcohol in it; likewise, the therapist would give more similar tasks to reinforce positive behavior to avoid bad behavior like drinking alcoholic drinks (Miguel et al., 2015). But if there were traces of alcohol or the person was not able to complete the task successfully, the person would not receive the rewards. This makes the person feel bad, and they try to complete the task successfully the next time. With some time, the person quits drinking habits and instead starts to build healthy habits for life (Miguel et al., 2015).

CMT not only reduces drinking habits in a person but also helps the person find ways to control his or her behavior and life. Research conducted on CMT has proven that people undergoing CMT feel happy and motivated to achieve the given task successfully compared to other types of treatments (Witkiewitz & Marlatt, 2011). The effectiveness of the treatment might not last for some people after stopping the reward system. CMT can mentally affect the person after the reward system is stopped (Miguel et al., 2015).

What is social learning (SL), and what are the treatments for alcoholism?

Social learning is a type of learning process in which we learn from others by observing, imitating, and modeling their behavior (M.A. & Berge, 2012). SL was discovered by a Canadian-American psychologist named Albert Bandura in 1977.

Bandura conducted an experiment known as the Bobo Doll experiment (Johnson et al., 2017). Children were divided into three groups and exposed to two role models. One role model behaved kindly with the Bobo doll, and the other role model behaved aggressively towards the Bobo doll. The third group was not exposed to any role models, making them the control group (Johnson et al., 2017). Later, the children were given Bobo dolls to play with, and the group that was exposed to the aggressive role model behaved aggressively with the Bobo doll, while the other group that was exposed to the role model, behaved kindly with the Bobo doll, behaved kindly with the bobo doll. Bandura concluded through this experiment that people learn through observing, imitating, and modeling other people’s behavior (Johnson et al., 2017). SL explains alcoholism as a behavior that is influenced by environmental factors like the behavior of others around a person, and that behavior becomes an addiction through our cognition (Smith, 2021).

Group therapy (GT), also known as group counseling, is a type of treatment that uses social interaction within a group to treat alcoholism. In GT, there is always an experienced therapist who treats people dealing with alcoholism, and they should be able to observe and study them individually while interacting with the group as a whole. They also need to encourage people who do not interact much within the group (McCarthy, 1946). By doing this, it helps the person improve his or her interactions with people around them and find ways to improve himself or herself to stop being addicted to and dependent on alcohol.

In GT, there are two main types of groups: psychoeducational groups that focus on teaching the members of the group to cope with stress and ways to get rid of their addiction to alcohol (McCarthy, 1946). The other main group is known as process-oriented, which focuses on learning through others’ experiences in the group. Groups can be further divided according to people (McCarthy, 1946). For example, people who are highly addicted to alcohol and want to get out of alcoholism are grouped, and those who do not want to get out of alcoholism but attend therapy because of family are grouped. Likewise, there are more types of groups, and grouping like this helps to make the treatment more effective for the person (McCarthy, 1946).

People start to develop their social skills and build confidence while they attend GT. GT in small groups has been proven to be very effective in treating alcoholism and can be conducted easily (Fox, 1967). Since GT does not last long, the members of the group will disperse after getting treated, which then provokes feelings of loss in some people. Many people who are dealing with severe alcohol addiction and whose lives are dependent on alcohol need individual attention, and they might not speak up about their thoughts within groups (Fox, 1967).

Alcoholics Anonymous (AA) is a type of psychosocial treatment that is conducted by counselors or pastors in groups and is based on 12 steps to deal with alcoholism. AA was founded by Bill Wilson and Dr. Bob Smith in 1935, and both of them were recovering from alcoholism (Huebner & Wolfgang, 2011). AA is a treatment where people dealing with alcoholism are taught to admit and avoid drinking habits by themselves. The 12 steps start with making the person admit that he or she is addicted to alcoholic drinks and is dependent on them, and end by making the person spiritually awaken (Huebner & Wolfgang, 2011).

AA works by helping people surround themselves with people who are fighting against alcoholism and get rid of people who are heavy drinkers. Other people in the group act like role models that help to shape their behavior and learn to deal with alcoholism while being sober. Research that is conducted on AA has proven that AA is an effective treatment to help deal with alcoholism (Huebner & Wolfgang, 2011).

People who participate in AA remain anonymous throughout the treatment and afterward. AA has been able to improve social skills in people, which helps them deal with alcoholism. (Kelly, 2017). AA is a treatment that is more spiritual than scientific in treating alcoholism. AA cannot look into other problems that cause alcoholism in a person (Kelly, 2017).

Credit:Barış  Karagöz 

Conclusion 

The number of people who are dealing with alcoholism is increasing every year because stress levels increase every day, and alcohol is a widely available and legal type of substance that helps to get high and reduce stress levels when high but causes more stress and dysfunction in people’s lives (Denzin & Johnson, 2017). While there are many types of psychological treatments for alcoholism and how to deal with it, research has proven AA to be the most effective treatment for treating alcoholism, and CET is known as the least effective treatment for alcoholism (Miller & Hester, 1986).

Both TAT and CET focus on associating by pairing unconditional stimuli with a conditional response. But TAT and CET are different because TAT is considered unethical since it uses unpleasant stimuli that create discomfort in the person, and CET is not considered unethical (Baker et al., 1978). CRAFT and CMT are similar in that they use reinforcement, but they differ in the reward system and who it focuses on for treatment. CRAFT focuses on helping people around the person who is addicted to alcohol to help treat the person (Kirby et al., 2017). Whereas CMT focuses on treating the person who is addicted to alcohol based on a positive reward system (Miguel et al., 2015).

GT and AA are both based on social learning theory, even though they differ in how they are used to treat people with alcoholism. GT focuses on teaching people ways to cope and get rid of the addiction through new coping strategies and experiences from other members of the group (McCarthy, 1946). AA, on the other hand, is more spiritual and focuses on making people admit that they are dealing with alcoholism and teaching them how to control themselves while being sober (Huebner & Wolfgang, 2011).

Alcoholism is an ongoing major topic across the globe, and therefore, it has made psychological researchers conduct more research on the topic and find new psychological treatments and solutions to improve existing treatments.

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