Social factors in the treatment of alcoholism: a comparative study of three organisations and their clients

Abstract

A comparison is amde of the organisational structure and clientele of three agencies offering long-term, inpatient treatment for alcoholism within one New Zealamd city. They are: the Bridge Programme of the Salvation Army, the Wellington clinic of the National Society on Alcoholism and Drug Dependence, and Porirua psychiatric hospital. Two main questions are posed: a) to what extent is the sort of organisation that people go to for the treatment of their alcoholism related to their social class, independently of the nature or severity of their drinking problem? and b) can the differences in the clientele of the three agencies be plausibly explained in terms of the activity and characteristics of these agencies themselves? An answer to the first question is offered through a comparison of the treatment programmes of the agencies and a survey of their clientele to see the extent to which these are correlated. The agencies are ranked along a rough continuum according to the extent to which their treatment programme is elaborately structured and the degree of coercion present in the staff/client relationship, and measures are taken of the social class of the clients and the severity of their drinking problems. Both of these client characteristics are found to be partially and independently related to agency type. The concepts and ideas of writers in the field of organisational sociology are used to present an explanation for the distribution of clients in terms of the past and present activity of the treatment agencies - specifically: the referral links they have established with other organisations; the procedures they use to select clients from among the people approaching them for help; and those aspects, such as publicity, that serve to attract clients to approach them of their own accord. In an historical analysis of the development of the three agencies, their present-day organisational structure is shown to reflect both the social attitudes prevalent at the time of their founding concerning the nature of problem drinking and the best way of changing it, and also the changes that have occurred in these attitudes. Emphasis is laid on the inter-relationships between the goals, organisational structure and environment of the agencies to show how their primary goals tended to change over time to cope with changes in the wider society that presented new problems of survival for the organisations, and how the structure created to fulfill earlier goals often acted as a constraint on the attainment of new goals. It is suggested that the analysis of the development of the agencies over time can offer not only an explanation for the differences in their typical clientele, but also an insight into the characteristic problems facing them in the present day.