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52 Fed. Probation 28 (1988)
All-or-Nothing Thinking and Alocholism: A Cognitive Approach

handle is hein.journals/fedpro52 and id is 128 raw text is: All-or-Nothing Thinking and Alcoholism: A Cognitive Approach By KATHERINE VAN WORMER, M.S.S.W., PH.D. Marymount Hospital, Garfield Heights, Ohio QUIT! Forget It! When I drink it's to the point of oblivion. Otherwise why drink at all? It is a fact much cited in the literature that al- coholics tend to have been reared in families of al- coholics and teetotalers alike (Peele, 1987). It is a fact not much cited in the literature but known by alcoholism counselors that all-or-nothing thinking is characteristic of alcoholic clients. These two seem- ingly unrelated pieces of information may, in fact, be united by a common theme-an extremeness in thought and behavior. And this common theme may have important implications in the treatment of al- coholism and in its prevention. Stinking thinking is the term used by Alcoholics Anonymous (AA) members to characterize the type of irrational mindset with which they are so very familiar. Alcoholism counselors find that, because of the addict's inclination toward emotions and behav- iors of excess, treatment for the disease must nec- essarily be a lengthy process. Stopping the drinking is not the half of it. Today, observers needlessly debate the point-is alcoholism a moral or a physical defect? What has apparently not occurred to writers in the press or attorneys-at-law caught up in the debate is that the moral side may indeed by a physical ramification. The contention of this article, consistent with the latest compelling scientific research, is that there is no either/or in alcoholism, that the alcoholic think- ing and the alcoholic drinking stem from the same indistinguishable psychoneurological source. The tendency to be addictive and addictive thinking are one and the same. Although all the scientific proof is yet forthcom- ing, recent research clearly points in the direction of some sort of cognitive-perceptual deficit in alco- holics, a deficit which manifests itself in early child- hood long before the onset of problem drinking. Hyperactivity, poor impulse control, and antisocial conduct are cited as precursors of alcoholism in sev- eral neurologically-based studies (Goodwin, 1976; Gorenstein, 1987; von Knorring et al.). Gorenstein (1987) speculates that alcoholism, hyperactivity, and antisocial behavior may be somehow derived from the same predisposing factor. He presents empirical data to substantiate the hypothesis. Depression, sim- ilarly, has been widely cited as antecedent to drug abuse, a finding consistent with the self medica- tion explanation of alcohol use (Deyken et al., 1987; Royce, 1981). The cognitive component in alcoholism is an in- tegral part of the disease itself. At the heart of the problem of alcoholism (and of drug abuse and buli- mea) are underlying thinking and belief disturban- ces conducive to self-defeating behavior. Self-defeating thinking, in short, leads to self-defeating behavior. The thinking shapes the course of the drinking: The thinking determines the when, where, why, how much. If I wanted to explore the relationship between a certain cognitive style and drinking behavior, I would first briefly review some of the pertinent, highly em- pirical research being done on alcoholism and the brain. Then I would want to examine all-or-nothing thinking in some depth, giving attention to its many ramifications. And then I would want to look at other cultures to explore the relationship between alco- holic thinking and alcoholic drinking and follow this with a penetrating look at the AA philosophy and thought control. Finally, and above all, I would want to study treatment implications and strategies for prevention. These, then, will be the basic tasks for this article. Research Findings Twin studies, adoption studies, brain chemistry studies-these all suggest a strong biochemical/he- reditary component in alcoholism. Twin studies in- dicate a likelihood that if one of a set of identical twins is alcoholic, the other is likely to be alcoholic also; the congruence in fraternal twins is consis- tently less (Begleiter, 1984). Carefully documented studies from Denmark indicate that the biological children of alcoholics are more likely to have alcohol problems, even though reared in non-alcoholic homes, than are the children of non-alcoholics (Goodwin, 1976). Evidence of EEG anomalies in children at

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