Addiction 3 2 1 - Three Models, Two Diseases, One Choice

Which Do You Choose?

A Disease Model that stems from Alcoholics Anonymous (AA) and espoused by many 12-step programs and participants. But, according to Ernest Kurtz, a well-known author and AA historian: “the closest the book Alcoholics Anonymous comes to a definition of alcoholism appears on p. 44, at the conclusion of the first paragraph of the ‘We Agnostics’ chapter, where we are told that alcoholism ‘is an illness which only a spiritual experience will conquer.’”(citation). Kurtz also quotes Bill Wilson (a co-founder of AA): “We have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore, we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. We always called it an illness, or a malady -- a far safer term for us to use.” George Valliant, MD compared alcoholism as a disease to cardiovascular illness as a disease in his acclaimed book “The Natural History of Alcoholism Revisited”. The model suggests addiction is a spiritual problem with a spiritual solution.

B Disease Model that states addiction is a disease that is Brain-Based or Biologically Based (BB). It states that “addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long-lasting, and can lead to the harmful behaviors seen in people who abuse drugs.” (NIDA). This model lends itself to a medical response usually through medications to “fix” permanently damaged neuropathways thought to be responsible for risk, reward, emotions, judgement, and decision-making. With it's emphasis on the repeated use of a chemical that interacts with brain, this definition may or may not be mapped onto addictive processes such as gambling disorder or sexual behaviors that involve repetitive behaviors rather than the repeated ingestion of a drug. Nonetheless, this model of addiction describes a medical problem with a medical solution.

C The Choice model of addiction, a favorite of some psychologists, is perhaps best described in the book by Gene Heyman “Addiction: A Disorder of Choice”. One of the main reasons why the concept of choice in addiction is so compelling is because most people who develop some form of mild, moderate, or severe addictive disorder stop their compulsive use without treatment. This is sometimes called “spontaneous remission” or “natural recovery”. As this article concludes: “Most drug abusers who had started using drugs by their early 20s appeared to gradually achieve remission. Spontaneous remission was the rule rather than the exception.” There is a body of literature that strongly supports the fact that most people stop using alcohol, drugs, nicotine as well as stop addictive behaviors without extensive use of 12-step programs, health providers, or treatment programs. This model of addiction asserts a psychological problem with a psychological solution.

Could it be that all models have something to offer and something lacking? Which do you choose? Perhaps (D) “All of the Above” is the correct answer if this was a multiple choice question! (Like/Comment Below)