The Problem with the Disease Model of Addiction-Related Disorders
In my recent course titled “Issues in Forensic Psychology”, two former students discussed the inaccuracy of the Disease Model. This made me think of how I literally saw a billboard last week stating that substance abuse is a disease with a number for a hotline. I never realized that there was a problem in calling these disorders a disease because that is what we all have been taught for so long. It sounds like there is no biological marker for substance use disorders in the literature which I plan to explore here along with the costs and benefits of the model.
Some “strengths” of the disease model may be debated, but they
still reap some benefits. By claiming these disorders are biological, clients
are more likely to be rehabilitated rather than incarcerated. This also shifts
some of the blame off the client when the cause is attributed to something
“they cannot help.” Some believe that this framework helps to remove the stigma
around these disorders which would promote those suffering to seek help. Health
insurance is more likely to cover the cost of treatment and rehabilitation as
well with the disorder being labeled as a disease. Additionally, this model
argues that the drugs an individual takes changes the chemical makeup of the
brain, thus creating the “disease” while altering the brain.
An argument from the other side is that it is not the drugs
that are altering the state of the brain, rather it is the brain’s
neuroplasticity and its ability to adapt to new situations. This is part of
what the disease model fails to address: the environment of the individual. I
think this relates to the point that Thea made when she said so many people use
substances and do not get addicted, so there must be another factor that is not
being accounted for. Neuroscientist Marc Lewis argues that addiction is the
result of “deep learning” formed by stress and isolation. This form of learning
can be reversed by forming healthier habits to reroute the synaptic pathways.
The disease model depicts those in recovery as being in remission with the
constant risk of relapse, but some argue that creating goals and new habits can
override the need for substances. Research has shown through brain scans that when
use of a substance declines, so do the synaptic pathways which eventually
redevelop when new habits are formed. This explains how the brain adapts to new
environments and substances (or the lack thereof). As for the genetic and
hereditary component of addiction, no genes have been linked to these
disorders. Rather, there are other features which may contribute to substance
abuse such as impulsiveness, frustration, and sensitivity. Lewis claims that
even IQ can have an effect because it leads to different reactions to
environmental stress. Additionally, anxiety, ADHD, and OCD are linked to
substance dependence because of their traits which are associated with
environmental stressors. Focusing on the biology can distract from the
historical and social factors which influence the disposition to addiction.
Another issue with this model is that it severely limits the
options one has for recovery. Most treatments include other drugs and
medications, but therapy is viewed as not being useful because therapy is not a
solution to a biological issue. However, even the DSM-5 lists criteria for
these disorders as behavioral ones rather than biological. Additionally,
research has shown that when it comes to coping with cravings, the disease
model misses the point. Through this model, cravings are resolved through
coping skills which has been proven to not be effective in preventing relapse. Therefore,
relapse programs such as the 12-step program are not as effective as they
should be since they simply promote abstinence. This program as well as
rehabilitation centers have consistently shown that they are not successful
treatment methods, but their continued use may be because of how much money
they bring in. It is possible that the reason the disease model is pushed is
because of the agenda of pharmaceutical agencies. By reinforcing this model,
these agencies earn a large amount of money from the drugs and treatments used
to “cure” these disorders. With criticism of this model, they could potentially
lose a lot of money. However, this is not to say that these programs do not
help anyone. Some clients have succeeded through these programs, but they
should not be a “one-size-fits-all” approach.
Another complaint experts as well as clients have with the
model is the language and tone around the word “disease.” While some argue that
it offers relief and a sense of power for some clients, other say that it has a
negative connotation and impact. Some patients feel that this language makes
their family appear to have “weak” genes and they are looked down upon for
being “diseased.” Others say the language should not be the focus, rather the
stigma and other issues surrounding the diagnosis. Using more neutral words to
describe these disorders would be beneficial, however there are other more
pressing issues surrounding this model.
Overall, the main critiques of the disease model are that it
has a negative connotation, it does not provide effective treatment, and it is
an inaccurate depiction of how the disorder works. There are still some
benefits to the model which should not be overlooked, however the criticisms
should be considered. Eliminating this model would change the entire system of
treating addictive disorders, mostly with treatment. Experts and professionals
should consider these critiques so that those suffering from addiction can
receive more effective treatment that does not simply serve agencies and
companies, rather the well-being of clients.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3969751/