Is Addiction a Disease?
Many people reject the disease model of addiction. In their view, the disease model gives addicts and alcoholics a free pass: “I can’t help it! I’ve got a disease! I don’t have to take responsibility!”
This is a misinterpretation of the disease model. In response to this reaction, I like to quote something I heard in the rooms of Recovery: “We are not responsible for our disease, but we are responsible for our Recovery.” Usually, a look of relief comes over the skeptic’s face once he/she understands that we (the alcoholics/addicts) don’t hold a “get-out-of-jail-free” card.
My mother was a devout Catholic and she believed in “free will.” She did not like the notion of powerlessness and the disease model. But when I quoted the above saying, she started to accept the disease concept.
A diabetic may not be responsible for his/her disease but he/she sure has to monitor their daily blood sugar and is ultimately responsible for his/her own treatment.
My mother’s initial reluctance in accepting the disease model of addiction is, amazingly enough, shared by many, if not a majority, of health care professionals even today. The disease model remains a controversial subject.
Background on the Disease Model
It is important to remember that not until the beginning of the twentieth century did mental illness in general become characterized as a disease. It would take even longer for alcohol/substance dependency to be officially recognized as a disease or a subcategory of mental illness.
The disease model was espoused by Alcoholics Anonymous some twenty years before the American Medical Association officially (and belatedly) recognized alcoholism as an illness in 1956.
Loss of control (powerlessness) is the most fundamental characteristic of the disease.
Here are just a couple of scientific developments that support the disease concept:
- There is now substantial evidence that alcoholism is a genetically transmitted disease; some people have a vulnerability that is triggered when they are exposed to alcohol.
- Scientific studies also suggest that ingested alcohol is converted into a chemical compound that acts at the same brain receptors as morphine or heroin. Thus a mechanistic/ medical explanation for alcoholism and addiction is emerging.
But Where’s the Free Will?
This purely mechanistic viewpoint, which seems to discount “free will,” makes many people uncomfortable.
Perhaps another way of looking at the free will vs. disease concept is to consider this analogy: a person has a choice (free will) to stand by the deep end of a swimming pool or to jump in. Once in the pool (and if the person can swim), the choice is gone: the person will instinctively/involuntarily swim. She/he cannot help herself/himself. If the person CAN’T swim, there is equally no choice: the person will drown. FREE WILL ONLY EXISTS OUT OF THE POOL.
In the same way, free will exists for the drug addict/alcoholic as long as abstinence and Recovery are achieved. Free will no longer exists (the disease is activated/reactivated) when a significant relapse occurs.
The disease (and responsibility-for-one’s-disease) concepts are extremely useful in paving the way for therapeutic modalities. More on this in future blogs.
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