Ideology and the stagnation of AODA treatment modalities in America

The disease model of alcoholism was adopted by the American Medical Assoication in 1956, and the intervening 47 years have seen the development of increasingly varied and sophisticated types of evidence for the biological sources of addiction to Alcohol and other drugs of abuse (AODA). However, a synthesis of 12-step treatment with a confrontational and moralistic version of cognitive psychology remains the modal approach to AODA treatment, despite its inability to even engage many addicts. Simultaneously, the growing evidence for therapies that teach self-regulation of biopsychological processes, which treat clients supportively while encouraging their recognition of the problems and building their desire to change, has been largely ignored by practitioners. The epitome of this self-regulation approach, neurofeedback therapy, has been all but ignored despite reports of high success rates. This paper examines the confluence historical economic and ideological factors that maintain this divergence between knowledge and practice from the perspective of Gusfield's notion of moral passage based on deviant labels.