The ‘Third Wave’ of Treating Substance Use

~ By Nathalie Baret


Has addiction become a publicly open severe problem only in the last few decades?


If you look at the historical roots of addiction, you will find Emil Jellinek (1890–1963), a biostatistician, physiologist, and an alcoholism researcher who founded the Yale Center of Alcohol Studies, started writing in the 1940s about alcoholism being an illness when his book “The Disease Concept of Alcoholism” went to press in 1960. “The emotional impact of the statement, ‘Alcoholism is a sickness,’ is such that very few people care to stop to think what it actually means,” is stated in Jellinek’s book.


Dr. Debra Rothschild, Ph.D., who is a New York City-based clinical psychologist, psychoanalyst and CASAC, wrote an interesting article on addiction dubbed, “The ‘Third Wave’ of Substance Use Treatment,” which mentions Jellinek’s work and his ushering in the movement of the Disease Model, the second model of addictive disorders that followed the Moral Model.


“Substance use treatment is generally described as having progressed from a ‘Moral Model’ to a ‘Disease Model’ of conceptualizing alcoholism and addiction,” said Rothschild in her article. “Early on, drunkenness and intoxication were considered a sin and addressed through the church. Those who were publicly inebriated were brought into the church through their community, the Salvation Army or other such organizations, and were told to pray for salvation and find moral rightness. In the 1940s, Emil Jellinek changed all this by writing about alcoholism as a progressive disease and speaking about it as such. In fact, Jellinek was referring to ideas from a much earlier time. He quoted Thomas Trotter, a British naval physician, who, in 1804, spoke clearly and eloquently about how alcoholism should be treated as a medical condition and not a moral one. Jellinek quoted Trotter as saying, “I consider drunkenness, strictly speaking, to be a disease.” Jellinek’s articles are often cited as the moment of shift between the Moral Model and the Disease Model of addictive disorders.”





“In the history of treatment, following the Moral Model, then the Disease Model, which is now waning, today, there is a new paradigm gradually replacing the medical disease model. It is a Harm Reduction approach, and I think of it as the “Third Wave”


Although the Disease Model has been widely accepted, endured for years, and continues to dominate, Rothschild suggest there is a third movement—one she coins the “Third Wave”—that focuses on a harm reduction approach and encompasses a biopsychosocial model. The process of delving in more deeply and examining an individual’s medical-biological factors, social-environmental and psychological ones, can reveal a more conscious, and committed, process of staying clean.


“In a psychodynamic approach, the relationship with the therapist matters a lot and what happens in the relationship determines a lot of the therapy. Being cared for, respected and listened to, may be a brand new experience for someone—it is therapeutic in and of itself,” said Rothschild. “Here is an example: I had a client who could not understand why he used cocaine despite all the terrible consequences. After seeing me for a while, he had gone from using a few times a week to only once every few weeks. He was frustrated. Each time he used, he felt awful and regretful, yet about once a month, he would “find” himself calling his dealer and using. It was only during our therapy sessions that his underlying loneliness and depression became clear and only after he identified that he used whenever those feelings were especially powerful that he was able to begin to get a handle on his behavior. He had to become conscious of feeling that way in order to be aware that he was having an urge before automatically calling. Only after that could he begin to use my behavioral suggestions to find alternate ways of soothing himself when he felt bored, sad or lonely at night.”

Read the full article “The ‘Third Wave’ of Substance Use Treatment” HERE


About Dr. Debra Rothschild, Ph.D., is a NYC-based clinical psychologist, psychoanalyst and CASAC offering psychotherapy, psychoanalysis, supervision and consultation; a faculty member at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis; and a member of the Executive Board of the New York State Psychological Association Division on Addictions. She publishes and lectures widely on the integration of psychodynamic concepts and psychotherapy with substance use treatment.


~ Written by Nathalie Baret, CiR Director of Communications and Marketing, email: of PR, Win-Win Publicity House, email:

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