Understanding the Disease Model of Addiction

For hundreds of years, addiction was considered a moral failure or lack of willpower. Only recently has society reshaped its opinion of this condition. Today, most medical associations recognize substance use disorder as a disease of the brain. While this is the most popular interpretation – and one with significant scientific backing – it may not be the entire story. Today, we’d like to discuss the finer points of the disease model of addiction. 

A Nuanced Interpretation of the Disease Model of Addiction

When medical professionals call addiction a disease, this is what they mean:

Addiction is a chronic, relapsing condition, just like diabetes or hypertension. Like these disorders, substance use disorder can be brought on by psychological, genetic, behavioral, and environmental factors. It also affects the way the body operates. If left untreated, it can have life-threatening consequences. Since addiction shares many qualities with other chronic conditions, it is essentially a disease. 

For Dr. Carl Fisher, an addiction physician and author of The Urge: Our History of Addiction, this concept did not reflect his experience. “Thinking of addiction as a disease might simply imply that medicine can help, but disease language also oversimplifies the story… Addiction becomes an individual problem, reduced to the level of biology alone. This narrows the view of a complex problem that requires community support and healing.”

Dr. Fisher asserts that in addition to viewing substance use disorder through the lens of Western medicine – as a problem to be diagnosed and medicated away – it is crucial to remember that a holistic approach is necessary for recovery.  

Seeking Comprehensive Treatment for the Disease of Addiction

Those responsible for running treatment programs understand the myriad factors that contribute to substance use disorder. To ensure long-term recovery, each area of one’s life should be addressed. An example would be:

• Mental health – Treating any anxiety, depression, or trauma that may contribute to substance abuse.
• Physical health – Helping the client to restore their strength through proper nutrition, exercise, and medication-assisted treatment.
• Financial health – Learning life skills that will help the client to retain employment, pay bills, and get out of debt.
• Social health – Opening up to others about their condition, forming new bonds, and establishing a sober support network.

However, the layperson may not believe all of this is necessary. If they perceive the disease model of addiction as a simple issue solved by medication, they are unlikely to attend a residential program or dedicate much time to getting well. While outpatient programs can be effective, they must include the elements listed above to have real staying power. This is the concern expressed by Dr. Fisher. To correct the public’s understanding, a nuanced explanation of the disease model of addiction must be made widely known.

The Complexity of Substance Use Disorder

In his article for The New York Times, Dr. Fisher cautions providers against embracing a simplified explanation for addiction. “Not all drug problems are problems of addiction,” he writes, “and drug problems are strongly influenced by health inequities and injustice… The disease notion obscures those facts.”

The research aligns with his claims. In an article published in the Annals of the New York Academy of Sciences, Mary Jeanne Kreek describes the “extreme marginalization” faced by those dealing with addiction and other mental health disorders. She explains that most well-defined medical problems may be attributed to a negative social environment that fosters these conditions. This is because each person responds to stressors differently, and those living in certain situations face a great deal more stress than the average American. As a result, individuals in these positions are much more likely to develop a substance use disorder. They’re also more likely to be blamed for it and deal with prejudice as a result.

It is important to note that the disease model of addiction does include some acknowledgment of the environmental factors that contribute to substance use disorder. However, providers, policymakers, and experts should go out of their way to include this information when discussing the prevalence of addiction. This explanation can positively impact legislation and public programs designed to address the spread of substance use disorder.

Finding the Motivation to Overcome Addiction

Finally, Dr. Fisher expresses his concerns about the disease model sapping motivation from those in active addiction… and increasing the stigma they face. 

If substance use disorder is framed as a physical problem, Fisher argues, people may doubt their own ability to overcome it. Indeed, self-efficacy is a crucial component of any treatment program. It is called for in the famous Serenity Prayer: “God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.” When someone believes they have an incurable, lifelong illness, they may not have the motivation to fight back against addiction. Treatment providers must instill in participants the knowledge that this disease can be addressed and lived with.

Additionally, research indicates that biological explanations for mental illnesses can worsen public perception of those with these conditions. If the general population can cast blame on someone for developing a dependency, they may view them with more hostility and less compassion. Advocates, then, should be sure to shape their messaging to address this potential bias.

Addiction is Treatable. We Can Help.

Substance use disorder is a complex condition. While some people drink or use drugs without incident for years, others develop a strong dependency after a short time. Still others may depend on drugs and alcohol to manage their emotions, but do not meet the diagnostic criteria for addiction. This vast spectrum of possibilities, coupled with the myriad factors that contribute to substance abuse, means that each person’s situation is truly unique. Therefore, fully individualized care is necessary for people to recover. When it comes to addiction, one size does not fit all.

At R&A Therapeutic Partners, we understand the nuance required for in-depth mental health treatment. Our comprehensive array of services helps you to address unhealthy coping mechanisms, break free from addiction, and live a full, happy life. To learn more about our approach to counseling for substance use disorder, contact our office today. We look forward to speaking with you.

At R&A Therapeutic Partners Raymond Estefania and Ana Moreno specialize in substance use and mental health disorder evaluations, treatment, intervention and therapeutic/educational consulting for clients throughout the greater South Florida area, as well as nationally and internationally. For more resources and information please visit Therapeutic-Partners.com or on Facebook.