For a long time now, the accepted model of addiction has been that of the disease model. But that may be about to change based on recent research and studies being done.
Scientific America says that “there is also strong scientific evidence that most people recover from addiction on their own and that things are not as simple as the medical model implies.”
The disease model was certainly more accurate than the model that it replaced, which was essentially the “moral model” of addiction. Before we had the disease concept of alcoholism and addiction, people simply believed that alcoholics and drug addicts were selfish, bad, people.
It is important to note that the understanding and the model that is used to understand addiction also correlates with how we attempt to treat it, at least to some degree. The old response to alcoholism and drug addiction was not to send people to AA or to rehab, but to send them to jail or lock them up in a mental institution. The response was different in the past because our understanding was different.
Now the point of any model is to try to represent reality more accurately so that we can make better predictions and also better choices about how we should respond to things.
So the idea here is not to get people upset and say “The disease model is all wrong, and everyone who says otherwise is a fool!” That is not the point of this discussion.
What science attempts to do is to keep testing models and to keep fine tuning it. So a new model or theory of addiction would likely include some of the foundations of the disease model, but it would expand on it in order to accommodate new data that we have found.
For example, there is a large body of data that indicates many people who meet criteria to be diagnosed as “addicted” or have some level of dependency will essentially “grow out” of addiction on their own by age 30 or so. This claim is often disputed by people in traditional recovery programs, saying that “those people were not real addicts and alcoholics, they were just dabbling with drugs or booze, they don't really qualify as hard core addicts.”
That is a fair argument, because really when you get down to it we are arguing about definitions. In other words, how do we define a true addict or alcoholic? The definition within certain recovery programs seem to describe a person who has been completely hopeless in fixing their own problem. They could not overcome their drinking or drug use alone and they needed help–when they sought help, they were able to find sobriety. That is what defines their condition–not the pattern of use, but the fact that they could not fix their problem on their own, and that they needed help.
So it sort of depends on how exactly you want to define addiction and alcoholism, and how precise your definition is. If you simply wave your hand and dismiss those who “spontaneously recover” on their own, claiming that they don't fit criteria to be a real addict, then you can claim that addiction is still a disease of the truly hopeless and out of control.
One thing is for certain, and that is the fact that we still, as a society, have to try to help those who are struggling with addiction and alcoholism. Do the labels really matter if someone is killed by a drunk driver, and we could have prevented that by doing a certain form of treatment or intervention?
Furthermore, the concept of blame comes into this argument. We can blame the addict themselves and their moral standing, or we can blame the addict's disease that they have, but what difference does that make if their condition is tearing up their family and creating chaos and misery for everyone involved?
In other words, at least part of what these models are seeking to do is to assign blame to something or someone. Do we blame the addict, do we blame their disease, who or what do we blame?
The bottom line is: Who cares! What we really need to focus on is not so much what the addiction is where it comes from, but in how we can fix it and treat it most effectively.
It is important to note that one of the things that helped when we moved from the moral model of addiction to the disease model is that it helped to reduce the stigma involved. Why do we care about this? Because reducing the stigma allowed more people to seek treatment based on the level of shame involved. If people are too ashamed of their condition then they will not seek help for it.
Is this a risk in revising the disease model to involve learning and choice? One proposed updated model would be the learning model, in which we argue that the addict learned how to become addicted through the choices that they made, and they can do the same thing in learning how to recover. But will this increase the stigma again and make it less likely for people to seek treatment? Will it cause people to not give themselves permission to seek treatment?
Those who are arguing for the learning model of addiction are saying that just because we label an addiction as a disease does not mean that there are automatically no choices involved any longer.
This is an interesting debate to be sure, because the disease model is arguing that the addict has no choice, that they have to self medicate once they are addicted.
Even within my own experience, I would say that I reached a point in my disease at which time I made a new choice. I decided to ask for help. This happened when I reached a point of what I would call “total and complete surrender.” But the question is, could I force myself to surrender to everything and become willing?
My answer to that is no. No, I could not have just decided to suddenly surrender and become willing to do whatever it took.
That point of surrender came to me when it came to me, and not a moment sooner, and it was based on all of the pain and misery and suffering that I had endured at the hands of my addiction. I tried to force myself, when I was in treatment in the past, to have some sort of spiritual awakening and achieve that surrender moment, and I just couldn't.
But I remember trying. I remember wanting to want recovery, and failing at it.
And then one day I had simply had enough, and that was the day I surrendered, and I have been clean and sober even since that day. So we can call it a disease or we can call it a choice, but the bottom line is that I do not feel like I had any control over when I “chose” to surrender and finally seek help. It just happened one day. And for that I am grateful.
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