Tuesday, 25 September 2007

The Disease model of addiction

The Disease model of addiction is probably the most controversial and debated topic in the entire field of substance abuse/addiction. One would have to be well informed on the subject to even attempt to understand the controversy intelligently. This site will not claim to know for sure one way or the other (disease/not disease) but will present a little of both sides of the on going debate with in the professional circles.
First, we must accurately define Disease, since when the word disease is mentioned most think of something like cancer, aids, heart, etc., something which can be isolated in part and extracted from the body and visibly viewed and observed by the eye under a microscope or other apparatus. This is not the case with the "disease of alcoholism/addiction" or at least not at this time.
According to Webster's Dictionary disease is defined as follows:
"Disease: Any departure from health presenting marked symptoms; malady; illness; disorder." Then we must go on to define concept as well, which according to Webster's is: "Concept: A notion, thought, or idea."

This popular model of addiction is credited to E.M. Jellinek who presented a comprehensive disease model of alcoholism in 1960. The World Health Organization acknowledged alcoholism as a serious medical problem in 1951, and the American Medical Association declared alcoholism as a treatable illness in 1956. Following Jellinek's work, the American Psychiatric Association began to use the term disease to describe alcoholism in 1965, and the American Medical Association followed in 1966.
As with many concepts and theoretical models in the addiction field, the disease concept was originally applied to alcoholism and has been generalized to addiction to other drugs as well. The "disease of addiction" is viewed as a primary disease. That is, it exists in and of itself and is not secondary to some other condition. This is in contrast to the psychological model of Dual Diagnosis , which addictive behavior is seen as secondary to some psychological condition.

Arguments Against the Validity of the Disease Concept
As earlier stated, the disease concept is controversial and not without critics. Two well-known critics are Stanton Peele and Herbert Fingarette, both of whom have written books, as well as articles disputing the disease concept of addiction.

Since the disease concept is attributed to Jellinek, a lot of criticism has been directed at his research, which was the basis for his conclusions about the disease concept. Jellinek's data were gathered from questionnaires that were distributed to AA members through its newsletter, "The Grapevine". Of 158 questionnaires returned, 60 were discarded because members had pooled and averaged their responses, and no questionnaires from women were used.
Jellinek himself acknowledged that his data was limited. Therefore, one might wonder why Jellinek's concept of the disease of alcoholism received such widespread acceptance. One reason is that the disease concept is consistent with the philosophy of AA, which is by far the largest organized group dedicated to help for alcoholics. Secondly, as Peele noted:
"The disease model has been so profitable and politically successful that it has spread to include problems of eating, child abuse, gambling, shopping, premenstrual tension, compulsive love affairs, and almost every other form of self-destructive behavior... From this perspective, nearly every American can be said to have a disease of addiction."
Herbert Fingarette goes on to state that the alcohol industry itself contributes to forming a public perception of alcoholism as a disease, as a marketing ploy:
"By acknowledging that a small minority of the drinking population is susceptible to the disease of alcoholism, the industry can implicitly assure consumers that the vast majority of people who drink are not at risk.
This compromise is far preferable to both the old temperance commitment to prohibition, which criminalized the entire liquor industry, and to newer approaches that look beyond the small group diagnosable as alcoholics to focus on the much larger group of heavy drinkers who develop serious physical, emotional, and social problems."
There are many other criticisms of the disease concept, however we will not go in to them at this time. Instead we will review some of the evidence to support the disease concept.
Arguments Endorsing the Disease Concept
Since the introduction of the disease concept research studies have examined a possible genetic link in alcoholism/addiction. One such study demonstrates that the offspring of alcoholics are approximately three to five times more likely to develop alcoholism than offspring of non-alcoholics .
However, the genetic influence on other drug addiction has received less research attention. Also, in 1983, there was a popular theory of alcohol addiction expressed by D.L. Ohlms in his book "The Disease Concept of Alcoholism" that proposed that alcoholics produced a highly addictive substance called THIQ during the metabolism of alcohol.

is normally produced when the body metabolizes heroin and is supposedly not metabolized by non-alcoholics when they drink. According to Ohlms, animal studies have shown that a small amount of THIQ injected into the brains of rats will produce alcoholic rats and that THIQ remains in the brain long after an animal has been injected. Therefore, the theory is that alcoholics are genetically predisposed to produce THIQ in response to alcohol, that the THIQ creates a craving for alcohol, and that the THIQ remains in the brain of the alcoholic long after the use of alcohol is discontinued.
This would provide a physiological explanation for the fact that recovering alcoholics who relapse quickly return to their previous use patterns. More recent research on genetic causes of alcoholism has focused on some abnormality in a dopamine receptor gene and deficiencies in the neurotransmitter serotonin or in serotonin receptors.

As you can see from the above information there is still room for debate and the controversy continues.