ALCOHOL AND SUBSTANCE ABUSE
Edward A. Dreyfus, Ph.D.

Conclusions

Our typical image of an addict is someone in a back alley shooting up or a drunk tottering on the street. This depiction is grossly misleading. Addicts are often professionals in high-powered positions. They are surgeons, judges, lawyers, dentists, CEOs, business owners. They are making decisions that affect the lives of thousands of individuals and costs millions of dollars in lost productivity and through faulty decisions. Too often, these people are in denial about their abuse and do not recognize the extent to which they are cognitively impaired.

There is no one cause for substance abuse and no one treatment. Substance abuse is a bio-social-psychological problem. Genetic predisposition may be more of a factor in one individual than another. The role of brain chemistry and genetics is different from person to person. Social and psychological influences likewise vary. Hence, treatment must be tailored to each person.

The first priority in treatment should be harm reduction with eventual sobriety. When the individual is “clean and sober,” s/he can collaborate in his or her treatment with full mental acuity. A treatment plan can then be devised and a determination can be made as to what factors are influencing the abuse. Then a decision can be made as to whether moderate drinking, in the case of the problem drinker, is possible. Some approaches, however, such as AA, believe that abstinence must be a lifetime commitment. Other approaches suggest that moderate drinking is possible for some alcoholics. In either case, a thorough evaluation is necessary and sober brain is required to make that decision.

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