Stanton reviews the entire scope of psychological theorizing in the field of alcoholism. He finds that these theories are robust and disprove many assumptions about the pharmacological determinants of alcoholism and the disease nature of alcoholic behavior. But he also notes (along with the volume's editors!) how the theories ignore the major determinants of alcoholic behavior--e.g., alternative opportunities, values, and associations in people's lives. Moreover, he is stunned that the one larger theoretical model of addiction presented in the volume--opponent-process--consists entirely of stories from AA, omits any reference to data, and breezily espouses an abstinence only approach--contrary to the gist and substance of most of the rest of the volume! It is fascinating to see how this watershed volume, and the limitations it underlines, are exactly as true today as they were when the volume first appeared.

Psychology of Addictive Behaviors, 1:120-134, 1987

Reviewed by Stanton Peele

Howard T. Blane is director of the Research Institute on Alcoholism (RIA) and professor of psychology at State University of New York at Buffalo. Kenneth Leonard is a senior scientist at RIA. Stanton Peele has theorized about addiction and alcoholism in Love and Addiction and The Meaning of Addiction.

The appearance of Psychological Theories of Drinking and Alcoholism is an important event. Perhaps as recently as 10 years ago, there were not psychological theories of alcoholism so much as there was an idea that alcoholism was an outcropping of one or another personality type or psychological conflict. This volume presents different psychological elements in alcoholism and theories underlining a variety of sources of the motivation to drink. The volume is thus a sign of the maturing of psychology's view of alcoholism and of the creation of real bodies of data and a firm foundation for understanding alcoholism from a psychological perspective.

The editors, Blane and Leonard, arrange nine bodies of psychological theory and research about drinking and alcoholism into two sections: Traditional Approaches and Recent Theoretical Models. The chapters do not deal with equivalent kinds of theories; the theories differ not only in their scope but in their level of analysis. Nonetheless, given the differences in the material and the amount to be reviewed, the volume accomplishes very well what it sets out to do. The presentations are inclusive and generally well written. They organize largely distinct areas of psychological knowledge into accessible chapters. The contributors give attention not only to theory and data but also to clinical applications of the theories. In nearly all cases, the chapters serve as perhaps the best available surveys of the topics, making this an invaluable teaching tool and reference book.

Cappell and Greeley review the data on alcohol and tension reduction. As Cappell has indicated in earlier reviews, empirical support for the tension-reduction model of drinking is ambiguous and complicated. The complexities include the drinker's expectations about alcohol's efficacy in reducing tension and other individual variations in responses to alcohol. While tension reduction is more apparent in alcoholic and problem drinking than in normal drinking, overall the tension-reduction model does not explain much that we want to know about drinking in any form. Instead, this first chapter on a psychological theory discounts a very popular and widespread notion of the tension-reducing benefits of drinking and the role of tension reduction in alcoholism.

Cox updates the status of personality theory. Although the importance of personality constructs has diminished both in the alcoholism field and in psychology generally, Cox indicates that several dimensions of personality have repeatedly appeared to underlie problem drinking. For example, antisocial impulsivity has been strongly implicated in problem drinking and alcoholism among men. Palliation of negative emotional states is somewhat less clearly tied to alcoholism, although it is more important for women's drinking than men's. Overall, the concept of personality that emerges in this chapter is more indebted to social learning theory than to Freud: "people are motivated to drink alcohol in order to control their positive and negative affective states."

Sadava reviews interactional theory (meaning models that incorporate both personality and social setting) through the work of Jessor, Huba and Bentler, and Zucker. All these models "conceive of problem drinking within a larger context of functionally equivalent behavioral patterns and thus are not specific theories of drinking. All focus on adolescence, and on precursors, sequelae, and developmental stages." Sadava's accomplishment in summarizing this complex work is formidable. At the same time, he offers guidelines for evaluating statistical causal modeling techniques such as LISREL. Although developmental models have produced powerful predictive coefficients "accounting for up to 50% of the variance over time in adolescent problem behavior"—these models sometimes contradict one another and are often so complex as to be unassimilable.

Much of the theorizing in this book is indebted to a broader psychological approach: social learning theory. Abrams and Niaura outline Bandura's social learning model and its expansion of traditional learning theory to include social and cognitive elements. Such a model fits well with the expectations and environmental and social effects shown conclusively to play a role in drinking and alcoholism. Reciprocal determinism describes how problematic drinking, despite its negative consequences, paradoxically exacerbates the motivation to drink. This dynamic explains loss-of-control drinking without positing an insupportable underlying biological process. Recovery involves "both general coping skills required for everyday life, and the specific self-control skills necessary to manage drinking." This chapter is full of rich material; unfortunately, it is not well written and does not synthesize its seminal material in a powerful way.

Social learning theory has by now been classified as a "traditional approach," and ends the first section of the book. Beginning the next section is Goldman, Brown, and Christiansen's chapter on expectancy theory. Just as social learning theory has become a universal background for the models in this book, expectancy theory has become the central psychological mechanism to explain alcoholic behavior: Cognitive variables "play an integral role in determining drug effects and in an individual's choice to use or not use a drug." Happily, given the centrality of this chapter's topic, it is a model of strong writing, explication of theory and research, and application. It also melds survey and epidemiological data with laboratory experimentation.

The accomplishments of expectancy research to date are impressive; according to the authors:

The predictive power of these expectancies is at least as good, and perhaps better than, the best demographic and drinking history variables used in earlier work.(p. 210)

The repeated observation of a relationship between the strength of positive alcohol expectancies and the degree of drinking among diverse types of adult drinkers indicates the robustness of the alcohol expectancy approach. (p. 209)

One-year follow-up of treatment outcome showed that the strength of the alcoholic's expectation for relaxation and tension reduction better predicted treatment outcome than traditional variables such as participation in aftercare programs.... (p. 210)

The task now is for clinical researchers to develop treatment strategies designed to modify those expectancies. (p. 219)

Reinforcing the value of Goldman et al.'s work is the frequent reference to it by other contributors.