Disease Model Of Addiction
An Article By Terence T. Gorski
Presented At The
10th Annual Dual Disorder Conference
Friday, October 04, 1996, Las Vegas, NE
GORSKI-CENAPS Web Publications
Published On: October 4,
1996 Updated On: August 07, 2001
© Terence T. Gorski, 2001
These Books & Manuals On Relapse
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My name is Terry Gorski.
I’m the President of the CENAPS Corporation, a training and
consultation firm that specializes in chemical dependency and related
behavioral health problems. I
am pleased to have this opportunity to discuss with Dr. Marlatt the issue
of whether Alcoholism does or does not meet the criteria of being a
The way that we conceptualize alcoholism and other drug
dependencies is critical to the development of effective policy for its
treatment. Effective policy
is necessary to secure the adequate resources needed for its treatment.
If alcoholism is defined as a disease, it will be
treated as a healthcare problem. As
a result, alcoholics will be assured the right to receive appropriate
medical treatment for this disease. The
treatment of Alcoholism will be covered by health insurance and other
health care financing plans in both the public and private sectors.
The appropriate health care groups will be mobilized to support its
treatment. And, most
importantly, ongoing biomedical research which relates alcoholism to other
diseases will be funded.
If alcoholism is not defined as a disease, we will
be making the decision that it does not rightfully belong within
healthcare. Alcoholics, then,
will be denied access to vital healthcare services.
Insurance and other health care financing plans will exclude
alcoholism. Alcoholism, which
is responsible for 30% of all inpatient hospital days and nearly 50% of
emergency room visits, will be divorced from the medical field.
As a result it will never be fully integrated into our health care
If Alcoholism is not a disease, then what is it and how
should society deal with it?
The answer to this questions is vital. If alcoholism is not a disease, then it is not a healthcare
problem. If it is not a
healthcare problem then the healthcare system that is devoted to the
prevention, early identification, and treatment of disease should not
become involved with those afflicted with alcoholism.
If this is the case, where should the alcoholic go to receive
To say that Alcoholism is an “addiction”, an
“affliction”, or “an appetite habit disorder” is to avoid the key
question: “Does Alcoholism
meet the criteria of a disease?” If
we call alcoholism by another name, we must still apply the same question. If we call it an addiction, we must ask the question
“Does an addiction meet the criteria of a disease?”
If we call it an affliction, we must ask the questions
“Does an affliction meet the criteria of a disease?”
If we call it an appetite habit disorder, we must ask the
question “Does an appetite habit disorder meet the criteria of a
To answer the key question of whether or not alcoholism
(or whatever we choose to call it, is a disease, we must look to the
technical definition of “disease” and then look at the phenomena of
alcoholism and see if it meets that criteria.
What is a “Disease”?
To intelligently discuss the issue of whether or not
alcoholism is a disease, we must first define the term “disease”.
To do this I turned to the 24th Edition of the Stedman’s Medical
Dictionary which provided the following definitions.
A disease is a morbus, an illness, a sickness that causes an
interruption, cessation, or disorder of bodily functions, systems, or
A disease is an entity characterized by at least two of these
a recognized etiologic agent (or agents);
an identifiable group of signs and symptoms;
consistent anatomical alterations of known body systems.
To determine if alcoholism is a disease, we must see if
it meets this definition.
My position is that alcoholism is a disease.
This position is shared by many prestigious organizations including
the World Health Organization (WHO), the American Medical Association
(AMA), and the American Psychiatric Association (APA).
The Congress of the United States of America formally acknowledged
that Alcoholism was a disease with the passage of the Hughes Act in 1970.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) was
created to promote research on the nature of this disease.
A major thrust of NIAAA has been on the biomedical aspects of this
disease and much progress has been made in understanding its etiology,
symptoms, and treatment.
There is a good reason for taking the position that
alcoholism is a disease - alcoholism meets all of the criteria of a
disease as defined by any medical dictionary or text book.
Let’s go back to the Stedman’s Medical dictionary’s
definition of a disease as see if these criteria accurately describe the
phenomena of alcoholism. To
do this we will need to systematically answer two questions:
Is alcoholism “an illness or a sickness?
Does alcoholism causes an interruption, cessation, or disorder of
bodily functions, systems, or organs?”
Is alcoholism “an entity characterized by a recognized etiologic
agent (or agents);
Is alcoholism “an entity characterized by an identifiable group
of signs and symptoms?”
Is alcoholism “an entity characterized by consistent anatomical
alterations of known body systems?”
Do all people who experience alcohol problems have the disease of
Let’s systematically answer these six questions.
Question #1: Is
alcoholism “an illness, or “a sickness”?
The answer to this question is yes. Alcoholism is a leading cause of death in the United States.
Alcoholism is a major factor in rapidly growing healthcare care
costs. Nearly 30% of all
inpatient hospital days and 50% of all emergency room visits are devoted
to the treatment of medical problems related to alcoholism.
Anyone who has known an actively drinking alcoholic will attest to
the fact that they get physically sick.
This is evidence by the fact that known alcoholics have
significantly higher utilization of medical treatment than non-alcoholic
Even Dr. Marlatt will concede that Alcoholism is “an
affliction”. There seems to
be universal agreement that alcoholics become ill or sick in the medical
sense of the word and seek treatment in large numbers that illness or
Question #2: Does
alcoholism cause an interruption, cessation, or disorder of bodily
functions, systems, or organs?”
Again the answer is yes.
There is a definite profile of alcohol-related damage to body
systems and organs that usually does not occur in people who do not have
alcoholism. The major organ
system that is affected is the brain.
There is clear evidence from neuropsychological studies that
alcoholics have cognitive impairments related to the organic damage caused
by chronic alcohol poisoning to the brain.
The DSM IV clearly identifies and differentiates “substance
related organic mental disorders” and describes their direct correlation
Many other organ systems are also affected.
There is a specific profile of alcoholism related damage to other
organ systems. The liver, the
pancreas, the heart, the endocrine systems among others are all affected.
Alcoholism can be a fatal disease. Many alcoholics die from their alcoholism each year.
Why? Because if the
alcoholic continues to drink heavily and regularly the organ system
problems will become fatal. The
NIAAA informs us that alcoholism is the third most common cause of death
next to cancer and heart disease among adult Americans.
Questions #3: Is
alcoholism “an entity characterized by an identifiable group of signs
Again, the answer is yes.
But here we must be careful to make careful distinctions between
alcohol use, alcohol-related problems, and alcoholism.
About 70% of all Americans use alcoholic beverages on a
regular enough basis to be defined as “drinkers”.
About 60% of these drinkers (40% of all Americans) consume alcohol
in moderation and experience no problems.
These people experience alcohol use, which definitely is not a
disease. About 40% of these
drinkers (30% of all Americans) consume large amounts of alcohol and
experience some problems as a result of their use. These people experience alcohol-related problems which DSM-IV
defines as alcohol abuse.
Since these alcohol abusers do not develop biomedical
conditions related to their alcohol abuse, this group does not technically
meet our definition of disease. Alcohol
abusers, however, are engaging in high risk behaviors that can lead to
About 10% of these drinkers (7% of all Americans) develop
biomedical complications as a result of their alcohol abuse.
These people definitely meet the criteria of having a disease.
For the moment, let’s restrict our attention to this 10% of
people with alcohol-related biomedical conditions.
There are clearly described signs and symptoms that are
associated with alcoholism. These
signs and symptoms were originally identified at the turn of the century
and have been studied and clarified since.
Many researchers and leading professional organizations including
the American Medical Association and the American Psychiatric Associate
recognize these signs and symptoms. With
that in mind let’s briefly review the history of the discovery and
refinement of the signs and symptoms of alcoholism.
The IOM Report to Congress based its reasoning upon a
model that describes alcoholism as existing on a continuum of
alcohol-related problems. Let’s
look at how we can use this model to correctly reason to the conclusion
that there are a large numbers of individuals that have a profile of
alcohol related problems (i.e. signs and symptoms) that meet the criteria
of having a disease.
Continuum of Alcohol Problems Model
According to the Institute of Medicine Report to
Congress, alcohol problems exist on a continuum of severity from mild to
severe. The following is one
set of criteria that can be used to place different profile of alcohol
related problems on this continuum.
Mild problems create
subjective distress and interpersonal conflict but do not result in social
or occupational impairments.
Moderate problems create
periodic or persistent social and occupational impairments and minor
health problems but do not result in incapacitation.
Severe problem result in
periodic or persistent incapacitation as a result of severe physical,
psychological, or social problems.
Mild Alcohol Problems:
People with mild alcohol problems (i.e. those who have
experienced only subjective distress or mild interpersonal
conflicts related to alcohol or drug use) do not, at that moment, meet the
criteria of having the disease of alcoholism because: there is not a full
and complete profile of signs and symptoms and there is not sufficient
evidence of a disorder marked by structural or functional impairment.
Some individuals who experience mild problems with
alcohol or other drugs will progress to more severe problems. Others will not. In
those who experience a progression from mild to severe problems, the rate
of progression will vary from gradual to rapid.
This variance in the rate of progression, as we will see latter,
can form the basis of developing subtypes of alcoholism.
There is currently no absolutely reliable way to predict
which individuals will experience progression and which will not, although
risk of progression increases with evidence of genetic, prenatal, and
familial risk factors, an d early age onset of initial problems.
It is reasonable to assume that the mild alcohol-related
problems in individuals who eventual progress to severe problems may, in
fact, be the early stage symptoms of alcoholism.
Since, however, reliable predictions cannot yet be made as to who
will and will not experience progressive problems, definitive diagnosis
based upon mild alcohol problems cannot yet be made.
As a result it is best to describe such individuals as being in
high risk of developing alcoholism rather than conferring the definite
diagnosis of alcoholism. As
can be seen,, as of this presentation it is not appropriate to describe
the mild alcohol-related problems as a disease.
Severe Alcohol Problems
People who have developed severe problems with alcohol
and drugs have a consistent profile of alcohol and drug related problems
that can appropriately be classified as a disease.
Most individual who develop severe problems with alcohol and drugs
share the following signs and symptoms:
(1) Severe subjective distress;
(2) severe interpersonal conflicts; (3) severe social and
occupational problems; and (4) incapacitation as a result of severe
physical, psychological or social problems.
The profiles of the symptoms of patients with severe
alcohol problems have been well mapped and constitute the basis of many
well accepted diagnostic typologies that meet the criteria of a disease.
Let’s review some of the most notable.
Moderate Alcohol Problems - The Borderline Cases
It is clear that people with mild alcohol problems do not
meet the criteria of having a disease.
It is also clear that people who have severe alcohol problems do,
for the most part, meet the criteria of having a disease.
Where Do We Draw The Line?
Now we must turn to a critical issue. Where do we draw the line between having the disease of
alcoholism and not having it? How
do we correctly classify the people with moderate alcohol problems?
As of this presentation there are no definitive answers.
It is important however to point out that in clinical practice
these distinction are being made on a daily basis.
Some clinicians operate according to a set of decisions
rules that in essence say, if in doubt, declare the client an abuser and
attempt moderation training until that approach fails.
Other clinicians operate according to a set of decision
rules that say: “Since no
one has ever died from abstinence, and many alcoholics who attempt
controlled drinking and fail suffer serious problems up to and including
death, if in doubt declare the person as having a disease and treat it
Here we confront the link between diagnosis (Is it a
disease or not) and treatment (Does recovery it require total abstinence
or not). I will return to
this issue latter. For now,
let’s simply point out that we are not addressing the issue of effective
treatment (i.e. abstinence vs. controlled drinking).
We are addressing the issue of whether or not alcoholism or certain
of its subtypes are appropriately classified as a disease.
Most people who have severe alcohol problems as described
above meet the criteria for Substance
Dependence as presented in the DSM-IV.
These criteria include:
A Pattern of Compulsive Use marked
by a loss of control over the ability to regulate use or to abstain.
Tolerance marked by both
the need for larger amounts of alcohol to achieve the desired effect and a
diminished perceived effect with the same amount.
Withdrawal marked by the
development of a specific withdrawal syndrome upon the cessation of use or
the use of the same or similar type of drug to relieve or avoid the
Mental Disorders that result from the toxic effects of chronic alcohol
and drug poisoning to the brain.
DSM IV places a heavy weighting upon the pattern of compulsive use as the primary factor distinguishing
between abuse and dependence. This
pattern of compulsive use is marked by the following signs and symptoms:
A strong desire to use the substance.
Loss of control over use:
The tendency to use larger quantities of the substance than
intended and to use the substance for longer periods of time than
Inability to abstain:
The persistent desire to cut down or control accompanied by the
failure to be able to so in spite of past attempts.
Addiction Centered Lifestyle:
The increased amount of time spent in seeking and using alcohol and
other drugs resulting in the centering of major life activities around
alcohol and drug use.
Addictive Lifestyle Losses:
The tendency to give up or reduce the frequency of involvement in
important life activities to accommodate the increased amount of time
spent in drug seeking and using.
Continued Use In spite of
Problems The tendency to
continue to use alcohol and drugs in spite of problems.
It is appropriate to describe people with severe alcohol
problems that meet the DSM IV criteria of substance dependence as having a
disease. In these cases there
is clear evidence of a syndrome (a clearly identifiable pattern of signs
and symptoms) and a disorder (clear evidence that those signs and symptoms
have created both functional and structural impairment.
Question #4: Is
alcoholism (defined as drinkers who develop biomedical complications from
alcohol abuse) “an entity characterized by consistent anatomical
alterations of known body systems?”
The answer to this question is definitely yes.
There is no doubt that alcoholism produces a syndrome marked by
predictable signs and symptoms. There is also no doubt that these signs and symptoms
frequently create functional and structural damage to the brain and other
organ systems. These facts,
however, do not address the question of why a person would voluntarily
keep drinking and using drugs until brain and organ system damage
This question can be answered, in part, by understanding
the relationship of brain reward mechanisms and the behavior of using
alcohol and drugs. This
demonstrates that the tendency toward alcohol seeking behavior is strongly
linked to progressive alterations in the function of the brain, and in
late stages to the development of structural damage to the brain and other
Recent NIAAA Research clearly shows that there are
biomedical processes that occur within the brains of alcoholics that
reinforce the regular and heavy use of alcohol.
These biomedical brain
reinforcement processes are different from the classic alcohol
withdrawal syndrome. Let me
quote the summary of this research reported in the Alcohol Alert from
NIAAA for July of 1996.
People will tend to repeat an action that brings pleasure or
reward. The pleasure or
reward provided by that action is called positive reinforcement.
Certain behaviors, especially those associated with survival needs,
are linked to biochemical processes within the brain that cause powerful biological
reinforcement for these behaviors.
This biological reinforcement is related to the release of specific
brain chemicals when the behavior is performed.
These brain chemical produces a sense of pleasure or reward.
Evidence suggests that Alcohol and Other Drugs of Abuse (AOD’s)
produce chemicals that are surrogates of these naturally occurring brain
chemicals that produce biological reinforcement.
As a result the use of AOD’s cause a rewarding mental state
(euphoria) that functions as a positive reinforcer of the initial use of
AOD’s. This rewarding
mental state is defined as euphoria.
(Euphoria is a state that is separate and distinct from the
symptoms of intoxication).
As a result individuals who receive positive reinforcement for AOD
use as a result of the production of these brain chemicals are more likely
to engage in drug seeking behavior and to use drugs regularly and heavily.
The biochemical reinforcement that results from alcohol and drug
use is more powerful and persistently reinforcing than the biomedical
reinforcement provided by other survival related actions.
As a result, people who experience this are more likely to feel
that the use of alcohol and drugs is more important than engaging in other
vital survival linked behaviors. As
a result they will tend to use AOD’s instead of actively meeting other
This perception that alcohol and drug use is more important than
meeting other needs results in alcohol-seeking behavior.
After alcohol seeking
behavior has been established, the brain undergoes certain adaptive
changes to continue functioning despite the presence of alcohol.
This adaptation is called tolerance.
Once this tolerance is established, further abnormalities occur in
the brain when alcohol is removed. In
other words, the brain looses it capacity to function normally when
alcohol is not present.
This low-grade abstinence-based brain dysfunction is distinct and
different from the traditional acute withdrawal syndromes.
This low-grade abstinence-based brain dysfunction is marked by
feelings of discomfort, cravings, and difficulty finding gratification
from other behaviors.
This creates a desire to avoid the unpleasant sensations that occur
in abstinence. This desire to avoid painful stimuli is called negative
People who experience biological reinforcement (both positive and
negative) are more likely to use alcohol and drugs regularly and heavily.
People who use alcohol and drugs regularly and heavily are more
likely to develop physical dependence syndromes marked by tolerance
and classic withdrawal symptoms, and biomedical complications
resulting from alcohol and drug use.
There is evidence that people who are genetically and prenatally
exposed to addiction may have pathological brain reward mechanisms.
This pathological brain reward mechanism is marked by a below
average release of packets of brain reward chemicals when not using the
drug of choice. When the drug
of choice is used the brain releases abnormally large amounts of brain
reward chemicals. When not
using, the person experiences a low grade agitated depression and a sense
of anhedonia (the inability to experience pleasure or find satisfaction in
any activity). This feeling
creates a craving for something, anything that will relive the feeling.
When the person finds the drug of choice that releases large
amounts of brain reward chemicals, the person experience a powerful sense
of pleasure or euphoria. The
experience feels so good that the client begins seeking that experienced.
Progressive Symptoms of
Addictive Brain Reward Mechanisms
Let’s explore the progression of symptoms that may be
related to this pathological brain reward mechanism.
Chronic Low Grade Agitated
Depression: Due to
abnormally low release of brain reward chemicals the person experience a
chronic state of low grade agitated depression. This state is dysphoric and creates an urge to find
something, anything that will relieve this state.
The person experiments with a drug of choice that activates the
release of brain reward chemicals. This
results in an intense feeling of euphoria and personal well being.
For the first time the person’s mood normalizes and they feel
good. They can experience
pleasure. Whatever feelings
they are experiencing prior to use becomes normalized.
As a result the drug of choice can be used as a psychoactive
Obsession, Compulsion, and
Craving: The biological
reinforcement creates a positive experience.
The person trains themselves in the process of euphoric recall.
they remember how good the experience was and exaggerate the memory
of the good feelings. This
thinking about the euphoria stimulates the limbic system to develop and
emotional urge to repeat the experience.
This emotional urge, as it grows strong, can activate a primitive
tissue hunger for the drug.
The person is able to use large amounts of the drug of choice
without becoming intoxicated or impaired.
As a result they can use heavily without apparent adverse
The person experiences minimal sickness on the morning after using
alcohol and drugs. This rapid
recovery allows the person to resume use rapidly and to use the drug of
As a result of the experiences created by the biological
reinforcement, high tolerance, and hangover resistance the person comes to
believe that the drug of choice is good for them and will magically fix
them or make them better. They
come view people who support their alcohol and drug use as friends and
people who fail to support it as their enemies.
The person attracts and is attracted to other individuals who
share strong positive attitudes toward the use of alcohol and other drugs.
They become immersed in an addiction centered subculture.
Addictive Lifestyle Losses:
The person distances people who support sobriety and surround
themselves with people who support alcohol and drug use.
A Pattern of Heavy and
Regular Use: The pattern
of biological reinforcement has motivated the person to build a belief
system and lifestyle that supports heavy and regular use.
he person is now in a position where they will voluntarily use
larger amounts with greater frequency until progressive addiction and
physical, psychological and social degeneration occur.
Progressive Neurological and
Neuropsychological Impairments: the progressive damage of alcohol and drugs to the brain
create growing problems with judgment and impulse control.
As a result behavior begins to spiral out of control.
The cognitive capacities needed to think abstractly about the
problem have also been impaired and the person is locked into a pattern
marked by denial and circular systems of reasoning.
The client is unable to recognize the pattern of problems related
to the use of alcohol and drugs. When
problems are experienced and confronted
The person begins to experience physical, psychological and social
deterioration. Unless the
person develops an unexpected insight or is confronted by problems or
people in their life the progressive problems are likely to continue until
serious damage results.
Inability to Abstain:
The person attempts to abstain but is plagued by acute
withdrawal and the longer term withdrawal symptoms associated with chronic
brain toxicity. In addiction the low grade agitated depression and symptoms
of anhedonia return. The
combination of problems impair judgment and and impulse control. When coupled with the addictive belief systems and the deeply
ingrained pattern of obsession, compulsion, and craving the person find
themselves unable to maintain abstinence and relapses.
Question #5: Is
alcoholism “an entity characterized by a recognized etiologic agent (or
The answer again is yes.
The etiology of alcoholism is a complex interaction between genetic
and prenatal factors, impaired neurological development resulting from
impoverished environment in infancy and early childhood, and psychosocial
factors that support the heavy and regular use of alcohol.
Public Health Model:
The World Health Organization Provides an excellent model for
understand the role of environmental factors in the etiology of disease.
According to this model etiological factors interact with
environmental factors to produce disease.
Distinction need to be made between three elements:
The Susceptible Host:
Different people have different biochemical reactions to the
ingestion of alcohol. Some of
these reactions create resistance to alcohol related damage.
Other people have biochemical reactions that make them more
sensitive to damage and hence more vulnerable.
The Toxic Agent:
In this case the toxic agent is alcohol.
The exposure to alcohol is a necessary catalyst for the development
of the disease in a susceptible host.
A Permissive Environment:
The environment will increase or decrease the likelihood of
exposure to the toxic agent (alcohol).
The more a culture reinforces the use of alcohol as necessary or
desirable the greater the likelihood that more members of the culture will
be exposed to the toxic agent.
Genetic and Prenatal Predisposition
There is convincing evidence that there is a genetic and
prenatal factors can create a predisposition alcoholism.
This evidence is reviewed in depth in the series of reports to
congress on alcohol and health submitted by the NIAAA.
The most recent reviews of the genetic research occurs in Alcohol
and Health Research World, Volume 19, Number 3, 1995.
1.Impaired Neurological Development in Childhood:
There is a growing body of evidence that an impoverished
environment during early infancy can impair neurological development and
as a result prevent for genetic and prenatal tendencies.
Impoverished environments create chronic states of pathological
anxiety through abuse. Impoverished
environments also deprive the infant of sufficient sensory stimulation
needed for adequate development of the psycho-sensory system.
This psycho-sensory system is closely related to the production of
reinforcing brain chemical.
There is also convincing evidence that psychological and social
factors can increase the risk of future alcohol and abuse and alcoholism.
There is an interaction between personality style, lifestyle,
culture, and social system. When
these psychosocial variables encourage the following behaviors related to
alcohol and drug use the prevalence of addiction increases.
The factors the increase the incidence of alcoholism appear to be
psychosocial factors that:
Promote the use of alcohol and drugs as safe, normal, and low risk
Support frequent use.
Support heavy use.
Promotes intoxication as normal.
Views intoxication a reason to exempt individuals from personal
responsibility for the consequences of behaviors while intoxicated
Do all people who experience alcohol problems have the disease of
The answer here is no.
Not all people experience alcohol related problems have the disease
of alcoholism. There are
different subtypes of alcohol related problems.
To assume that all subtypes of alcohol related problems are caused
by the same etiology is a serious error. All alcohol problems cannot be accounted for by a single
disorder. The issue of
whether alcoholism is or is not a disease can only be intelligently
discussed in relation to each of its known sub-types.
The judgment as to which subtypes of alcoholism are
appropriately called a disease needs to be based upon the use of standard
criteria which we just reviewed that allows us to distinguish a disease
from a non-disease. There are
specific subtypes of alcoholism that clearly and undeniable meet the
criteria of a disease. There
are other subtypes of alcoholism that do not meet the criteria of a
All subtypes of alcoholism have known etiologies that
result from a complex interaction among physical, psychological, and
social predisposing factors. Not
all sub-types have strong physiological predisposing factors. The etiological factors can be described in one of three
Physiologically Dominant Predisposing
These are factors related to genetic, prenatal and early
childhood experiences that alter or predispose brain function to favor the
development o an addiction to alcohol.
Traditionally physiologically dominant predisposing factors lend
weight to defining a disorder as a disease.
Psychosocially Dominant Predisposing Factors:
These are factors related to psychological predisposition (as
reflected in thoughts, feelings, and behavioral habits that set the stage
for heavy, regular and abusive drinking) and social predisposition (as
reflected in cultural practices and social systems that support the
regular, heavy, and abusive use of alcohol).
Traditionally psychosocially dominate predisposing factors when
presenting in isolation from physiological predisposing factors lend
weight to the argument that a disorder is not a disease.
Mixed Etiological Features:
Most subtypes of alcoholism have mixed etiological features
consistently of differently balanced profiled o physiologically dominant
and psychosocially dominant predisposing factors.
The New Paradigm for Alcoholism
There is clear evidence that a new diagnostic paradigm is
emerging that is reframing the definition of disease from one that is
physiological symptoms only to one that is biopsychosocial in nature.
Therefore the clear distinction between physical and psychosocial
predisposing factors may become less important in future definition of
Hoffman M.; DelBoca, F.K.; Hesselbrock, V.M.; Meyer, R.E.; Dolinsky, Z.S.;
and Rounsaville, B. Types of
Alcoholics I: Evidence for an empirically derived typology based on
indicators of vulnerability and severity.
Archives of General
Psychiatry 49: 599-608, 1992.
C.R. Neurogenetic adaptive mechanisms
in alcoholism. Science 236: 410-416, 1987
The clinical implications of primary diagnostic groups among
of General Psychiatry 42:1043-1049,
Gorski and other member of the GORSKI-CENAPS Team are Available To Train
& Consult On Areas Related To Recovery & Relapse Prevention
Gorski - CENAPS, 17900 Dixie Hwy, Homewood, IL
60430, 708-799-5000 www.tgorski.com, www.cenaps.com,
Terence T. Gorski is internationally
recognized for his contributions to Relapse
Prevention Therapy. The scope of his work, however, extends far beyond
this. A skilled cognitive behavioral therapist with extensive training in
experiential therapies, Gorski has broad-based experience and expertise in
the chemical dependency, behavioral health, and criminal justice fields.
To make his ideas and methods more
available, Gorski opened The CENAPS Corporation, a private training and
consultation firm of founded in 1982. CENAPS is committed to
providing the most advanced training and consultation in the chemical
dependency and behavioral health fields.
Gorski has also developed skills
training workshops and a series of low-cost
book, workbooks, pamphlets, audio and videotapes. He also works with a
team of trainers and
consultants who can assist individuals and programs to utilize his
ideas and methods.
Terry Gorski is available for personal
and program consultation, lecturing,
and clinical skills training workshops. He also routinely schedules
workshops, executive briefings, and personal growth experiences for
clinicians, program managers, and policymakers.
Mr. Gorski holds a B.A.
degree in psychology and sociology from Northeastern Illinois University
and an M.A. degree from Webster's College in St. Louis, Missouri.
He is a Senior Certified Addiction Counselor In Illinois. He
is a prolific author who has published numerous books, pamphlets and
articles. Mr. Gorski routinely makes himself available for
interviews, public presentations, and consultant. He has presented
lectures and conducted workshops in the U.S., Canada, and
books, audio, and video tapes written and recommended by Terry Gorski
contact: Herald House - Independence Press, P.O. Box 390 Independence, MO
64055. Telephone: 816-521-3015 0r 1-800-767-8181. His
publication website is www.relapse.org.
Gorski and Other Members of the GORSKI-CENAPS Team Are Available To Train
& Consult On Areas Related To Addiction, Recovery, & Relapse
Gorski - CENAPS, 17900 Dixie Hwy, Homewood, IL
60430, 708-799-5000 www.tgorski.com, www.cenaps.com,
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