The Disease view again seats the nature of problematic use with the individual drug user. The person is not blamed for having the disease but at least partially responsible for managing it.
The disease model holds that the ‘loss of control’ experienced by ‘addicts’ or users in relation to drugs is the manifestation of an underlying disease state. The disease model has two relatively distinct strands:
- Enlightenment model
- Medical disease model
Explained that through the prism of the enlightenment model addiction is considered a disease that is lifelong and progressive. The dominant proponents of this model are twelve step fellowships such as Alcoholics Anonymous and Narcotics Anonymous. Their belief is that:
“Every addict, including the potential addict, suffers from an incurable disease of mind, body and spirit (Marlatt and Fromme, 1988; p7)”.
From this perspective the answer for the addict is to desist from substance use or any other behaviours fueled by the addiction. To change the “addict” must become enlightened, by realising that change is possible only by relinquishing personal control to a ‘higher power’. This begins a process is called “Recovery” (see article on Recovery Capital attached).
Twelve Step programs provide with framework for people to manage their addiction and a fellowship of others in recovery who offer ongoing support, including sponsors (experienced in managing their own addiction) who provide mentorship.
The person who is considered to have an addiction that continues to use drugs is thought of as being in “denial” about their disease and denial of the inevitable consequences. Because the disease is thought of only as manageable, not curable, people who have once had a drug problem and been a part of a 12 step fellowship who has moved on to a place in their life where they are able to use a drug (say one that is legal like alcohol), in an unproblematic way are often considered to be in denial. This implies that no amount of personal change can be enough to beat addiction.
There is also potential for a moral link in terms of a ‘fall from grace’ analogy is clear. Peele (1988) suggests that:
“This model conceives of addicts as being incapable of self control, while at the same time holds them morally responsible should they give into the temptation of a slip (e.g. having a drink). The disease model deprives addicts of the sense of self mastery necessary to both plan their lives in the face of their addictions and to over come individual lapses in their overall journey to freedom from the enslavement of an addiction' (Peele, 1988, pg 11).
There is evidence (ref) disease model informed peer support enables people to arrest the downward personal spiral so often associated with problematic substance use and to experience personal growth and positive change. Many believe that they owe their life to peer support programs. However, if all programs and assistance for young people with drug related problems were based on this model, it would be very restrictive for those who choose to reject its premise.
The medical disease model assumes that change is impossible unless one submits to some kind of treatment program (presumably geared towards the alleviation of the underlying disease (Marlatt & Fromme, 1988). The disease is considered to be a discreet and well-defined entity and not seen as a symptom of another disease. There is however debate over the etiology of this disease.
There are two sides of this argument, each with many levels and variations.
The dominant view is that there is a genetic make-up or physiology that predisposes some people to dependency on a particular substance or substances. This model places a great deal of emphasis on both heredity and neural reward pathways and little on personality.
The alternative view holds that there are certain traits and dimensions of personality that, if existent in a person, cause the person to be more prone to developing addictions throughout their life. This kind of character is often described as an ‘addictive personality’. Perrine (1996), after examining the available evidence found that careful studies of the psychological profiles of alcoholics and addicts have shown that they do not differ from the ordinary population. He concluded that there is little evidence for an addictive personality but the idea still has considerable traction
Regardless of whether the notion of an ‘addictive personality has validity or if the burgeoning field of genetic and neuroscientific research can explain addiction it is essential that health professionals, policy makers and academics are not too deterministic.
The disease model, like the aforementioned moral and pharmacological models, relegates to the background the vast range of pycho-social, developmental and structural factors that have been found to contribute to and reinforce drug problems.