The disease concept of addiction is a model that both defines addiction and presents an approach for treatment. It embodies the idea that drug and alcohol dependence is an illness that has an underlying pathology that cannot be attributed solely to environmental factors. By defining it as a disease, it is held to be a condition that, left untreated by the medical community, will progressively deteriorate.
Addiction is not one of the top five pathologies identified by medical science, but its prevalence and chronicity begs the question of why not. The debate over whether drug and alcohol addiction is a primary disease or the result of a pre-existing pathology is a controversial one among researchers and clinicians who treat it. However, the disease concept of addiction is embraced by a number of influential governing bodies within the allied communities of physical and mental health. Their spheres of influence lay the foundation for the most widely used drug and alcohol treatment protocols available today.
The concept of addiction as a disease was first introduced by Dr. Benjamin Rush in 1984 who believed that alcoholics had no control and that the only effective treatment was total abstinence. This disease model was further defined in 1960 by Dr. Elvin Jellinek who maintained that those who still regained control of the ability to choose when and how often to drink were not diseased. He added an additional belief that the pathology of the disease could be influenced by environmental factors.
The modern disease philosophy of addiction is a construct used to explain why addiction occurs. In its purest form, it is a model that looks at addiction as the primary disease, with no underlying pathology. Proponents of the disease concept of addiction share a common philosophy with Alcoholics Anonymous similar to their Twelve Step Program and the belief that total abstinence is the only treatment option that can be completely successful.
The World Health Organization, National Institute of Health, and American Medical Association all substantiate their support of the disease model through research and imaging studies done on the brain. They interpret findings to suggest that substance abuse may trigger latent neurological and biochemical changes in the brains of certain individuals who have a predisposition to abuse and/or addiction. They point out that the disease of addiction is chronic and irreversible and that genetics can play a significant role in determining whether those who drink alcohol or use recreational drugs may eventually become addicted.
Those who oppose the concept that addiction is a disease see it as a moral choice that leads to substance abuse. Psychologists, like Harvard's Gene Heyman, challenge that clients who embrace the disease philosophy take no ownership of their addictions or recovery. These psychologists argue that the inherent risks of consuming alcohol and recreational drugs are well documented. Those individuals who use drugs and alcohol make a personal choice to do so, knowing that their use has more potentially negative outcomes than positive ones. Proponents of the moral choice theory view drugs as the problem, while advocates of the disease model believe that only certain individuals have the genetic propensity to abuse and/or become addicted to drugs or alcohol.
Midway between the disease and moral philosophies of addiction, there is a third model. The Dual Diagnosis philosophy suggests that addiction may coexist with one or more mental health illnesses. Treatment facilities like the Authentic Recovery Center in Los Angeles, approach alcoholism as an illness with potential underlying psychological factors which render an individual more susceptible to addiction because of an overall inability to cope. This model embraces a limited view of the disease philosophy of addiction but suggests that other mental health issues or personality disorders may also predispose an individual to abuse or become addicted.
Future research may ultimately conclude that a balanced perspective on substance and alcohol abuse addiction is called for. This may involve recognition of both the culpability of the individual who chooses to abuse and the organics involved, which can properly be called brain disease. In the meantime, the disease concept of addiction is what drives therapy protocols and assures that the medical community continues to gate-keep treatment models for a majority of abuse and addiction facilities.