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Robert Todd Carroll

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substance abuse treatment, ġ

"The now tenacious attachment of the disease model and 12-step philosophy to caring behavior, commonly known as codependency, represents to me the most confusing, and iatrogenic ideas in the realm of clinical psychology." ----Robert Westermeyer, Ph.D.

( : Substance abuse , ๰ 뺸 ų, ź Ϲ 뵵 ǰ ̿ Ѵ.)

ġ(Substance abuse treatment) ̳ ๰ ϴ ̳ Ȥ ׿ ؾ߸ ϴ ؼ ̷ ̳ ๰ ġ ġϴ ̴.

ſ , , , ׸ ڵ 츮 ȸ Ƴ Ϳ ̶ Ѵ. ׵̳ ٸ Ȥ ؼ Ѵ. (substance abuse)"" ֱ ؼ õ " ִ" ٸ ִ. ׷, ׵ ڵΰ? Ȥ ġ(substance abuse treatment, SAT) ȯ ǰ̳ ȳ翡 ̳ Ȥ Ϻ ̱ ؼ ΰ? Ǵ, ȴٰ ܾϴ ó SAT ȥյ ΰ?

ڸ شٰ ϴ ϴ ȸ Ű ൿ̶ ϴ ̳, ׵ Ȥ ϴ ̳ ݷ ıǾٰ ϴ 鿡Դ ȯ Ͱ. и, ɸ, ź, (interventionist) ġü ̵̳, ̷ ü ֳ ڵ ̷ ȯ ̴. ׷ ұϰ, 迡 ܼ ׵ ǵ ִٴ ʴ ̴. ֱٿ Charles Dederich SAT ó(Synanon) ϶. 50 80 20 ⵿, ó(Synanon) 3õ ҿ 5õ Ʈ Ǿ. ũ (Sacramento Bee) Dederich SAT Ѿ ׵ ֱ⺸ٴ ׵ ıߴٰ ߴ. ٴ ؼ Ҽ ɾ.  Dederich Ʈ ־ڴ°? ʿ, ״ ߵڵ ȸ Ͻ(dirty business) ϰ ־. ϴ ̳ ϴ ൿ ̰ Ϲ Ī ̴. , ̷ 츮 鿡 д(abuse)ϴ Ϳ ؼ ǥ ϱ⵵ Ѵ.


ǵ Ǿ ִ.



SAT ſ ̷ ̷  ̶ ȭ Ǵ ƴϴ. ùα Ǵ ׳ ΰ Ǹ ϴ ġḦ ϴ 볳Ǿ ȴ. ǽɽ ġϴ 볳ؼ ȴ. ȿ Ȯ Ű ų Ȥ ƿ ġ 볳Ǿ ȵȴ. ׸ ȯ ⺻ ޸ӴƼ ϴ SAT α׷ ϰ ϱ⵵ , ٸ α׷  Ե ʰ ̰ ٸ ܱ Ͼٸ Ƹ ΰ Ǹ ħض Ҹ ̴. Ѱ ʸ ڴ.

1994 2, ĵ(Tim Scanlon) "(intervention)" ߴ. Ƴ, ̿, ٸ ֿ , ó, θ Ƴ е, , ī, ׸ (interventionist) ѱ׷ ׸ ̿ ݰ ߴ. ״ װ ̶ ߴ. ׷ ׵ ƹ͵ ʾҴ. ׵ ȵǴ ߵ̸ ޱ ؼ ع ʿϴٴ ϱ ؼ ־ ̴.  ֺ ٶ󺸰 װ ΰ ִٴ ˾Ҵ. Ѱ Ƴ ų, Ѱ ġ ü  ϴ ̴. ״ ڽ ִٰ ʾ, ڸ ߴ. ״ ڽ ߵ ƴ϶ "ߴ". ״ ȸ DZ⿡ ռ ̷ غؾ߸ ̴.

ġ ̴ ƴ . ׷ ״ ڽ  ƿ԰ų, ڽſ ź ȸ ߴ. ̾߱⸦ ִ . ǻ ״ ڽ ̾߱⸦  ؾ ð ߴ. ̰ ̴. ֳϸ װ µ ߴٸ װ װ in denial ¶ Ű DZ ̴. , ġ , ٸ 鿡 , ̷  , Ȳ ո ľ Ѵ. 縦 ϱ ؼ  Ǵ ؼ ̸ ࿬ ߴ. ࿡ ڱ ߴٸ, ״ 鿡 ׺ ؾ ̴. Ѱ ɾ ٽ ƿ ʴ ̾. ״ SAT ü ""ߴ. ׷ ¿ ̾.

ġḦ ޴ ߿ ״ ׵ ȥ ϱ ؼ װ Ե ٸ ־. ״ ڵ ϴٰ 鵵 . "(interventionist) ޴ ̴. Ȥ ׳ װ ޴ ƴ϶ ׵ ⿡ ϴ 밡 ޴´. ׵ ī ſ ǰ ȣ(deliverer) Ѵ. ׷ ̷ ȭ ־°? ڰ ִ ΰ? ׵, ϴ ġḦ ޾ƾ Ѵٰ ϴ ´. ׵, ϴ ġޱ⸦ ϴ 鿡 ֱ ؼ ű⿡ ִ ̴. ׷ ̹οԼ, ׵ ϴ ġḦ ޾ƾ ȴٴ ϴµ ޾ƾ ϴ°? ڰ Ư ü Ҽӵ , ̰ ̱ Ե ̶ ׷ ϴ ΰ? ׷ٸ, ׷ ϴ ߸̴. ֳϸ ڵ ƴϸ, ׵ ġ ü ν ޴ ̱ ̴.

ġ ü ̻ ü ̴. Ǽ ġ ߾ ̱⵵ ϸ "Happy Valley" ̴. "Happy Valley" In Love with Daylight) ̸ ̴. ٸ SAT α׷ ̰ ߵ ȯ ڰ ޴ ̶ 信 ٰϰ ִ. ġ Alcoholic's Anonymous 12-step program̴. AA ˰ ִ Ǹ (satanic booze) ִ ʿ ̶ 𵨰 ȴٴ ִ. ̷ ڿ ̶ ︮ ʴ ⺻δ ݴǴ ̴. Ѱ ڸ ϸ abuser ؼ å ٴ ̸ ٸ ϳ ߵ å ִ. ׷, åӰ ũ ʴ. ֳϸ, ٽ ޾ƾ Ȥ ׳డ ؾ ϰ ׸ ׵ ڽŵ ϴԿ ñ ȴ. ׷, ̶ и ƴϴ.  AA α׷ ߵ ""̶ 𵨿 ̱⵵ Ѵ. ̰ (theodicy, : 縦 )ڵ ̸ ̴. Ϻ ߵ ǵ ϴ ڸ ɾҴ°? ׸Ͽ ״ 12-step α׷ ϰ Ϸ ΰ?

ߵ ̶, Ƹ ̻ ̴.  ٸ ִٰ ȮŽŰ ʿϰڴ°? , ΰ ִٸ, ΰ ִٴ  ŷ ȮεDZ⸦ ٶ ̴. ణ Ÿ ϴ. ΰ ִٴ ڰ Ե װ ʿ ̴.

̶ ϴ ¡Ĵ ü ΰ? 켱, Ĵ ô ̴. ̱ պ Ŵٸ Ƹ ̷ ʾ ̴. պ Ŵٸ Ƹ ߵ ̴. ( Ͽ 3ȸ ̻ Ŵٸ Ҽ Ѵ. 27% ׷ Ŵ. [Self-scoring Alcohol Check-up] )

ٸ Ĵ ô ñ̴. Ʈ ޾Ұų Ȥ ų, ȥִٰ , Ȥ , ο , Ǵ , ׽Ʈϰų Ȥ Ŵٸ Ƹ ߵ ̴. ߵ ̰ ſ ̻ ̴. 󸶳 ׸ 󸶳 ô° ޷ִ. ̰Ͱ ٸ ִ°? ô ̳ ô Ȳ ƴ϶, ̷ ͵ ߵ̴.

ٸ ִ Ư¡ ȿ ΰ ִ ƴ ٸ Լ ٴ ̴. ٸ  ̿ ? κ ȯڰ ٰ . ȯڰ ٰ ٸ  ٰ ʴ´. ٸ Ӱ ϸ鼭 ó DZ Ѵٴ ſ Ư ִ. , ߵڸ װ 谡 ų Ȥ ̶ ϰ ִٰ ߵ ް ִ ִٰ ʴ´. ġ ü ߵ ̱ ٶ ִ. ׵ װ ̴.

ߵ ߰ Ǵ ƴ϶ ǰ ̴. ġغ ִٰ ϴ ؼ ɷȴٰ Ǿ ɸ ̴. ϴ "ġ" Ѵٸ ״ ü 󸶳 ڴ°! δ ׵ "cure" ʴ´. ġ(remedy) ̴. ߸ڴ ġ Ѵ. ѹ ߵڸ, ߵ̴. 50 ʾҴٰ 𸥴. ׷ ̰ ̻ ߵڰ ƴ϶ Ű ʴ´. ġ Ǿٴ ġᰡ ̻ ʿٴ ̴. ġ SAT ϴ ̴.

쿡 °ġ, ġ Ͽ 3ȸ ġῡ $14,000 ⿡ ڿ 880 ޷ ߰ؾ Ѵ. ȯڷμ ״ ؼ 켱 ù ܰ谡 " ߵ̴" ϴ ̶ ݺؼ . ޾ƾ μ, װ ̶ ؾ߸ Ѵ. ̰ źϴ "in denial" ̸ ں . in denial ʴ´ٴ ϴ ߵڶ ϴ ̴. ̰ ̴. ܰ, (public confession)̴. ̰ 걹 ġ Ҹ Ѵ. ̰ ڵ ٸ տ ؼ ׵  ׵ ڽ ŸŰ, ׵ ΰ ߴ ؾ Ѵ. ⿡ ߿ ๰ ڵ鿡 Ȥ ׳డ ߵ Ǿְų Ȥ ͽ (Ȥ Ѵ) ̰ ڱ ڽ ϴ Ǵ ٸ ߸ ִٰ ϰ ϴ ̴. ü ̷ ٰΰ?

A.A. SAT п ٰŸ ƴ Ӹ ƴ϶,  ġ ȿ ִ Ȯ ִ  ʴ . ʿ, ״ ġḦ ޱ ؼ ٽ ƿ; ұϰ ״ ġῡ ""ٰ̾ ֵǾ. ׸ A.A. A.A. ȿ ִٴ ˰ Ƿ ׵ α׷ ȿ ϱ ؼ ʿ䰡 . ׷ ٸ 󸶳 ׳ ϰ α׷ ƴ ñϴ. 󸶳 , ׳ ȴ ñϴ. 츮 ʵ鸸 Ѵ. װ ʴ ʰ ͵ . ׸ 츮 AA ƴ ٸ α׷ ڷᵵ , 츮  ġᵵ ʰ ֿ ڿ ؼ . ׵ װ͵ ؼ ϴ ʿ䰡 ų Ȥ ʿ.  ̰ Ѵ? ߵ ġᰡ ʵǴ ̰, ̺ ɸ ڵ ϴԿ ڽ ؾ߸ Ѵٸ ü  Ϻ ݰ 뿡 ׵  ִ°? AA ⺻ ö Ǵ ̷ ´ٸ ̷ ͵̴.

ߵ ƴ϶, װ ġ Ѵٴ  ̴. ׸ "ߵ ޴" ȯڵ ġἾ͸ ͵  ̴. SAT α׷ ڸ "" Ѵ. ̷ Ư¡ ߸̰ų ƴϸ ̴. ̰ ڴ ๰ 뿡 å ,  ź ʴ´ٴ ǹѴٸ ̰ ߸̴. , ġǾ ź̸ ߵ̳ Űȭ ְ ൿ , ⵵ ϴ ġδ ʴ ʹٰ ȴ. ߵ "׵ ߸ " ǹ̿ٸ װ ϴ ̴. ׵ ߸ ߴ°? ΰ ʿ ๰ ڸ "" ϴ ٸ 鿡 ׿ ׳࿡ ؼ ҽ ⵵ ϰ "" ׳ ׳ ൿ ȭ ʿϴٰ ϱ ٴ ġᰡ ʿϴٴ ϰѴ. ̷ ġᰡ ߵ̳ ๰ ƴ϶ ̷ Ȥ ٸ ڱ ı ൿ ̴ ź ġϴ ̶ Ǹ ̴. ̷ ź ȣ ๰ ġᰡ ʿ ⵵ ׵ ִٴ ǰ ʿ ƴϴ.

, ߵ ƴ϶ ˾̰, Ѵٰ ص, ߵڸ AA 12-step α׷  ΰģٴ  ̴. AA ϸ ߵڴ ϰ, ׵ ٽ ſԼ ʿ䰡 ִٰ Ѵ.  ſԼ ִ°? μ ̴. ο ׸ζ. ׸ζ. ڽ . ׸ žӿ ض. ü 쵵 ض. ϰ ض. ̶ ϶. 󸶳 ϰ, ҽ ϶. ſ ޶ ûϰ ׷ ̶ Ͼ. ٸ 鿡 ˸ 뼭 ޶ ûϰ, ٸ ġ϶. ſ ޶ ⵵϶. !

ſ ϴ ̴. ׸ (sobriety) ( ׵ ų ϱ ؼ) ϱ ؼ ׷ ϰ ִ. ſ ϱ ؼ ϴ ƴ϶ иϴ. ſ ߵǴ ࿡ ߵǴ ͺٴ ü ذ ̴. ׷ ̰ ȥ ش شٴ ƴϴ. 12-ܰ ȹ ϴ ؼ ھƸ ؾ ϴ ƴϴ. ؼ ٽ ϰ, 츮 ߸ ϰ, ̰ ġ ٽô ̷ ʰڴٰ ϴ Ͱ ܰ и 츮 ؾ߸ ϴ ͵̴.  ܰ迡 ؼ ο ̴. ׷, ݰ ȥ ̸ ġᰡ DZؼ ϴ ġ Ǵ ʿϴٰ ϴ ̴. ̷ ŵ ö ų · Ǿ ִ ͵, ϴ Ұ, ȭ ̴.

ٸ δ, ̳ (manic depression) ȯ ΰ ִ ׵ ذų Ȥ ׵ ϱ ؼ ̳ ࿡ Ѵٴ ϴ ŵ ִ. ̷ ΰ ߵ̳ ġϱ ٴ ׵ ź ġѴ. ȭ ̳ ׳ ͼ ׳డ ڽϵ Ųٰ ϴ ⵵ غ. ƹ ȿ ̴. ī庸 ڽ 鼭 ô ο ⵵ Ǵ ȭ õ . ð ̴. ׳డ AA ؼ ƴ϶ ׳ ȯ ϰ ġѴٸ ִ.

, ׵ ڽ Ȥ ٸ λ ıϰų Ű ڵ ִٴ ʴ´. ׵ ִٴ ϴ ڵ ִٴ ͵ ʴ´. ׷ ݿ ϴ δ ݿ ִٴ ޾Ƶ ʴ´. Ƹ κ ڵ ٸ ׵ ൿ ߴ ٴ ʴ´. AA Ȥ ٸ SAT ؼ ũ ޾Ҵٴ ϴ ͵ ƴϴ. ׷ ڵ ׵ ī ׵ ൿ ϰų Ȥ ̷ ൿ ϱ ϴµ ʿ ̻̰ - ν ̹ Ǿٴ 忡 ؼ Ѵ. ׸ ̷ ̻̰ - ν Ǵٰ Ǵµ ģ Ȥ ְ λε ϴٴ Ϳ ؼ ݴѴ.

, ߵڵ ο ؼ ٴ ޾Ƶ ʴ´. ׵ ü ߵ Ǿִ ͵ ƴϴ. ׵ ߵǾ ִ ͵ ƴϴ. ׵ ߵ ͵ ƴϴ. ׵ ڴ ƴϴ. ׵ ɸ ͵ ƴϴ. ׵  µ ¿ ִ ͵ ƴϴ. ׵ ̼ Ȥ ͵ ƴϴ. ׵ ź δ ͵ ƴϴ. ׵ ġ Ǵ ġ ʿ ͵ ƴϴ. ׸ и ߵڿ 𵨷 ""̳ "" ٰŸ ٸ ׸ Ǹ α׷ ̴. ׷ ͵ Ϻδ Ƹ "Happy Valley" ó ʰ ȿ ̴. ٽ ڽ λ ϱ⸦ ٶ ڵ AA Ǵ "chemical dependency" ƴ ٸ α׷ Ȯϴ ̴. ׸ ̷ α׷ ϴ ׵ ãƿų Ȥ 鿡 ؼ Ե ǻ Ư ź ǻ翡 ׵ ̷ ൿ̳ ڱ ı ൿ ϴ Űȭ ƴ ؾ ̴.

See related entry on copendency.


б ڷ

reader comments

Fingarette, Herbert. (1988). Heavy Drinking: The Myth of Alcoholism as a Disease Berkeley: University of California Press.

Torrey, E. Fuller (1992). Freudian fraud : the malignant effect of Freud's theory on American thought and culture. New York, NY : HarperCollins.

Peele, Stanton. (1989). Diseasing of America. Boston: Houghton Mifflin.

Sykes, C.J. (1992). A Nation of Victims: The Decay of the American Character. New York: Saint Martin's Press.

Copyright 2000
Robert Todd Carroll

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