The Role of Psychiatry in the Treatment of Alcoholism

This paper is a revised transcript of a talk Tiebout gave before the American Psychiatric Association in May, 1949. 1

Tiebout tells his fellow psychiatrists there are two reasons why the profession has failed to have success with alcoholics. First, he says psychiatrists tend to be discouraged by alcoholics because they are often difficult patients that don’t respond to conventional treatment. The second and most important reason psychiatrists fail is that they treat alcoholism as the symptom of underlying mental disorder, rather than a disease in itself. He offers evidence for the disease nature of alcoholism in the fact that alcoholic patients can never drink again normally, no matter how much deep analysis they undergo. He points to the success of Alcoholics Anonymous in addressing drinking as the problem, rather than a symptom. Tiebout is looking primarily at step one and AA’s success in getting drunks to “put the plug in the jug.” He notes that the rest of the steps deal with maintaining sobriety, but he’s looking at stopping drinking as an outstanding clinical success that conventional psychiatry has been unable to achieve.

In the rest of these papers, Tiebout is going to lay out his own deep analysis of the alcoholic mind, but with a difference. He’s not looking for the psychiatric causes of alcoholism, he’s trying to find out what prevents alcoholics from benefitting from therapy. What’s standing in the way of alcoholics accepting the truth about their condition?

TIEBOUT H. The role of psychiatry in the field of alcoholism; with comment on the concept of alcoholism as symptom and as disease. Q J Stud Alcohol. 1951;12(1):52-57. [PubMed]