Of all the subtopics of addiction and recovery, the disease model of addiction is possibly the most debated. Proponents, those opposed and those with mixed emotions alike will likely engage in uncomfortable moments where two minds aren't thinking as one concerning the validity of the disease model of addiction.
Support for the Disease Model
Although addiction is defined as a disease by the American Society of Addiction Medicine and the American Medical Association, anyone wanting to have an informed conversation on the matter will need to understand the reasons why addiction is considered a disease by many.
What helps define addiction as a disease to many is that it is characterized by a combination of environmental, biological and behavioral factors—like other diseases, including cancer and diabetes. In addition, supporters of the disease model generally believe that—based on previous research—addiction is hereditary, and genetic risk may account for up to 50 percent of the likelihood that someone will develop an addiction.
Furthermore, Harvard Health Medical School acknowledges addiction as a chronic disease that alters brain and body function and may be put into motion by risky behavior or may be inherited.
The disease model also recognizes addiction as a progressive disease that worsens over time if left untreated and can cause irreparable damage to the brain and body, resulting in disability or even death.
And Those Opposed
Then, you have those who question the disease model or oppose it altogether. Some feel that medicalizing addiction has its own set of risks and problems.
On the milder side of opposition, a CMAJ article refutes an editorial from the same publication stating that addiction is a disease, stating that the claim is "not supported by the evidence and reads more like a political policy statement than a reasoned intellectual argument."
Still, others take a more radical view that the disease model of addiction has been nothing but damaging to the medical field, as well as to those who suffer from addiction or know a loved one who has. To those who don't consider addiction a disease, the disease model is damaging and causes gratuitous thinking and behavior that enables and perpetuates addiction.
Furthermore, an article published by the Baldwin Research Institute (BRI) goes as far as to say that the disease model of addiction—specifically in regards to alcoholism—was developed and is being executed for corrupt reasons.
The article states, "the disease concept was a panacea for many failing medical institutions and pharmaceutical companies, adding billions of dollars to the industry and leading to a prompt evolution of pop psychology."
Instead, BRI supports the Freedom Model, the self-proclaimed "original non-12 step program." According to BRI's website, "the Freedom Model isn't treatment, as substance use is always a choice, not a disease."
A Brief History
Although some believe that the disease model is merely decades old, the first published acknowledgment of addiction as a disease is credited to the Swedish physician Magnus Huss, for his 1849 essay Alcoholismus Chronicus.
Huss used the word "alcoholism" in his essay, and it is believed that this term did not exist before this written work. He identified and described what he believed to be the determining characteristics of alcoholism and explained how they were disease-like in nature—characterized by damage to organs and body systems that can prove fatal.
Huss also wrote that addiction can sometimes go into remission—like other diseases—and can resurface in the form of relapse.
Another aspect of the disease model is the contribution of increased tolerance on the development of addiction. As the development of addiction progresses, the user's tolerance also increases. This process was first described by the biostatistician E.M. Jellinek, in The Disease Concept of Alcoholism. In his work, Jellinek demonstrates the tolerance phenomenon in a diagram known as the Jellinek Curve, breaking alcoholism into several stages.
The Jellinek Curve is widely used to characterize tolerance as addiction progresses, with the alpha stage being psychological dependence, followed by a beta stage of physical effects. As tolerance increases further, the curve recognizes the delta stage of losing control and ends with the epsilon stage characterized by chronic binging, or the relentless cycle of using to maintain a sense of normalcy and to avoid being ill.
Where Does That Leave Us?
In many ways, it leaves us at the beginning. Probably no one would deny that addiction is an important social and health issue that is ruining and taking lives. We also know that once dependence sets in, it becomes increasingly harder to stave off addiction, and therapeutic and medical care are often needed.
Most detox and treatment facilities support the disease model, and many argue that this positively contributes to rehabilitation, aftercare and ongoing recovery, as research on addiction as a brain disease has led to new therapeutic interventions and medications.
How effectively the disease model aids addiction treatment—and whether it supports the validity of addiction as a medical condition—is impossible to determine. Personally, I've yet to choose one end of the spectrum when it comes to the question of addiction being a disease. In all honesty, it doesn't matter to me whether it's accepted as a disease or not.
For me, I know that I am highly likely to have a strong genetic propensity for alcoholism, and I grew up in a family where drinking was, not just accepted, but celebrated as a badge of honor. Then, I married into a family where everything revolved around alcohol. I had strikes against me, for sure.
All these things I know. Another thing I know is that the rest of the story was and is up to me, and whether or not addiction is a disease really has no power over my future choices. I was dealt a risky hand, but I was the one who chose to keep upping the ante and lose the things that meant the most to me.
Addiction may be a disease. It may not. Either way, I hope I am always too distracted by nurturing my recovery to care.