The Book Addict and Disease Model

¶ … Addict, Michael Stein uses a case study approach to exhibit, analyze, and discuss addiction in general and how addiction impacts the lives of individuals specifically. The author takes into account psychological trauma, psycho-social issues, and other situational variables but ultimately ascribes to the disease model of addiction. Stein concludes from his case study with Lucy that substance abuse is a disease just as heart disease is but does not provide any substantial evidence backing up this claim.

In fact, Stein (2010) simply calls addiction "the disease of wanting more," which is hardly a scientific assessment of substance abuse (p. 25). If the disease model were supported by the literature, there would be clear outlines of disease etiology and the neurobiological pathways upon which it works. In fact, the disease model has not received unequivocal research support. Although popular and politically effective in terms of freeing up funding for addiction treatment, the disease model is not a scientific model.

"Wanting more" cannot be quantified as a disease in the same way that cancer or Parkinson's can be. Still, most researchers do recognize the potential benefits of the disease model such as potentially opening up funding for addiction programs. Research reveals the evolution of the addiction model, tracing it back to the early twentieth century and the earliest stage of the profession of psychology itself.

According to Parssinen & Kerner (2016), the first formal mention of addiction as a "disease" was recorded in 1878, when physicians first discussed their patients' tendency toward opioid addiction. The use of the term "disease" was similar then as it is now, less a scientific assertion and more an emotional reaction to the pain and suffering exhibited by addicts. Because researchers, physicians, and other conscientious observers noted similar behavioral, emotional, and cognitive characteristics in addicted clients, the disease model seemed like an attractive way to group together cases of substance abuse.

Furthermore, the use of the disease model superseded the far less productive tendency to moralize addiction by claiming that addicts are somehow degenerate or sinful. Given the tremendous push to legitimize psychology as a social science and remove any taint of religion or moral judgment from the field, by1910, the disease model had become entrenched as a paradigm in the field of psychology (Parssinen & Kerner, 2016).

The disease model has allowed substance abuse to be studied as a psychological and sociological phenomenon, and has certainly paved the way for actual neurological and biological research into potential disease etiology. However attractive the disease model is from a theoretical and counseling point-of-view, a biological foundation for the model has yet to be elucidated. Still part of the psychological orthodoxy, as Stein shows, the disease model has nevertheless prevailed.

The disease model parallels the philosophy of one of the most widespread and significant treatment interventions for addiction: the Twelve Step program. The Twelve Step program of recovery relies on the disease model to encourage participants to remain vigilant about their substance abuse tendencies in order to avoid relapse. Furthermore, the disease model has informed research hypotheses and the direction of clinical research for generations. However, clinical research does not substantiate the disease model.

In one study, Hall, Carter & Forlini (2014) find that the disease model is "not supported by animal and neuroimaging evidence to the extent its advocates suggest; it has not helped to deliver more effective treatments for addiction; and its effect on public policies toward drugs and people with addiction has been modest," (Hall, Carter & Forlini, 2014, p. 105). This research highlights studies that do reveal changes in the addicted brain, which themselves cannot point to any "disease," per se but simply a set of related phenomena.

As Hall, Carter & Forlini (2014) and other researchers continually point out, neuroscience has yet to provide clear-cut evidence that addiction has a genetic etiology, or that persons who have chronic substance abuse issues have brain abnormalities not evident in a control group and which clearly differentiate the addicted population. This is not to say that addiction has no biological markers, but that it has no systematic biological basis.

All the stages of substance use and abuse do have some neurological and neurochemical correspondences, but that does not mean that addiction is a disease. The reasons for supporting the disease model vary in the literature, but "many argue that framing addiction as a disease will enhance therapeutic outcomes and allay moral stigma," (Hammer, et al., 2013, p. 27). Most researchers do acknowledge that the addiction paradigm has been helpful for funding purposes and for political reasons, as it reduces the stigma associated with addiction.

In The Addict, Stein (2010) clearly expresses his political reason for promoting the disease model: "Addiction is the only disease it is illegal to have. It is the only disease you can be jailed for," (p. 241). Framing addiction as a disease is a political stance that might be used to alter public policy towards drugs and cease assuming that persons who are addicts simply lack self-control. Consistently, research reveals that addiction is not a self-control problem even if self-control does play into the cognitive-behavioral mechanisms of addiction (Griffiths, 2005).

Although it is important to fund addiction research and to change drug policy, the framing of addiction as disease does not reflect the empirical evidence. The disease model is exactly that: a model. Addiction is not a disease, but is being called such for political and economic expediency. Researchers -- not in clinical psychology but in the more medically oriented fields like neurobiology -- consistently conclude that the disease model "is not necessary, and may be harmful, to frame addiction as a disease," (Hammer, et al., 2013, p. 27).

It has been said in the literature that the disease model can be harmful because it divests the individual of personal responsibility and potentially create self-fulfilling prophesies rather than promote cognitive and behavioral change (Hammer, et al., 2013, p. 27). Clinical psychological research, which is occasionally besieged by methodological problems and pseudoscientific leanings, appreciates the disease model as it provides a seemingly more medical and therefore legitimate means of conceptualizing the phenomenon.

For example, Griffiths (2005) calls addiction "part of a biopsychosocial process," a nebulous phrase that highlights the pseudoscientific and spurious nature of the disease model (p. 191). This is not to say that there are no physical, biological markers of addiction. Addiction does correspond to a biochemical reward system, but that system alone cannot qualify as a disease (Levy, 2013). Heyman (2013) finds that even though addiction.