In the last several decades, a great deal of empirical work in the addiction field has focused on cognitive-behavioral therapy (CBT) for alcohol abuse and dependence. This chapter will review the history of cognitive-behavioral models for treating alcohol problems, describe the extent and impact of alcohol problems, describe current cognitive-behavioral models and empirical support for them, identify unresolved issues and areas most in need of investigation, and suggest strategies to address these issues.

History of classification of alcohol-use disorders

In the nineteenth century, medical writers began discussing alcohol problems in a way that emphasized the concept of addiction or dependence and led to the development of the disease concept of alcoholism (Grant and Dawson, 1999). Kraeplin (1909-15) continued in this approach with his emphasis on organic disorders associated with alcoholism. Jellinek (1960) elaborated the disease model with the focus on the atypical physiological response to alcohol that leads to involuntary loss of control over drinking behavior and an inability to return to normal drinking. The disease model views alcoholism as a progressive syndrome that cannot be cured but can be managed by treatment that helps the alcoholic maintain abstinence. According to Jellinek, an alcoholic progresses through several stages: symptomatic, prodromal, crucial, and chronic phases. The chronic phase is characterized by physical and behavioral deterioration and leads to disability or death unless the alcoholic receives treatment.