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What is the Disease Concept of Addiction

The disease concept of addiction has two powerful allies-Alcoholics Anonymous ( AA and subsequent 12-step movements such as Narcotics Anonymous and Gamblers Anonymous), and the American Medical Association (AMA). The first step of AA says the addict “is powerless over (whatever the addiction is) and life has become unmanageable.” Powerless in this sense means an inability to stop on one’s own. Unmanageability means the person continues their addictive thoughts and behaviors despite the suffering of numerous negative consequences. Therefore, according to Step 1 of the 12 AA steps, addiction as a disease means that the person’s addictive condition is beyond the will power of the user to cure.

The AMA as well as the World Health Organization define a disease as a condition that is primary, progressive and ultimately fatal. Primary means that addiction is in itself the disorder, not a symptom or result of some other disorder. Thus the addiction itself is the number one life threatening problem. Progressive means that the addiction usually exacerbates over time. Fatal means that addiction can kill a person either directly or indirectly.

There are some advantages to the disease concept. If the person (and their family) view addiction as a disease, it will likely reduce the shame and stigma of the situation. It also removes any trace of the addiction being the result of moral weakness, or character flaw. Disease assumes it can be properly diagnosed and their is a treatment for it. Thus the addict and their family can learn about it and receive specific interventions designed to arrest it.

Recent research on the brain seems to corroborate the idea that addiction is not so much about choices as brain dysfunction that has a genetic component.

Not everyone buys into the disease concept. Conservative Christians claim that the disease model minimizes the role of “sin” (that is, human have an inherited moral depravity) and personal responsibility. Although they don’t discount genetic and other psychosocial/emotional factors, conservative Christians argue that addiction is really a form of idol worship, that is the addict “worships” their drug of choice instead of worshiping and seeking to please God.

Others emphasize the “bio-psychosocial-spiritual” model. This model says that addiction is caused by a combination of factors: genetics, environment, repressed emotions, poor coping skills, relationship breakdowns, and shame. This model would agree that, while the addiction is primary, the other factors must be addressed if the person is to be successfully treated.