In 1955, the American Medical Association declared that alcoholism was a disease. In the early 1970’s the topic was still hotly debated. The Rand Corporation sponsored a major study which indicated that alcoholics could learn to practice “controlled drinking.” Many studies since then determined that controlled use led to relapse and addictive patterns in the majority of cases. Today, the disease model of addiction is widely accepted. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) includes alcohol and drug dependence and abuse. Addiction is generally characterized by tolerance and withdrawal. Tolerance is a need for increased amounts of the substance over time. Withdrawal from the substance results in a variety of physical and psychological symptoms.
However, there continues to be debate about the disease model of addiction. For example, in their recent book Brainwashed: The Seductive Appeal of Mindless Neuroscience, psychiatrist Sally Satel, M.D., and psychologist Scott O. Lilienfeld, Ph.D. report about evidence from neurological studies that show how drugs affect the reward and inhibition mechanisms in the brain – indicating “proof” that addiction is an intractable disease. However, Drs. Satel and Lilienfeld caution that a view of addiction as a “brain disease” over-simplifies the picture. Other factors should also be considered to fully understand the complexities of addiction. For example, social and interpersonal dynamics (influence by others, cultural norms, etc.), specific situational cues for alcohol and drug use, stress and anxiety, among others, contribute to patterns of use, abuse and dependence. They conclude that classifying addiction as a simple brain disease may create false hope for a medical cure.
Chemical dependency counselors and therapists who have dedicated their careers in recovery programs and services have learned that addiction is a complex condition that affects all areas of their client’s lives. Perhaps the “disease model” debate should take a back seat to compassionate understanding and care for people who struggle with addiction. We know that the condition, disorder, or “disease” is caused by a combination of genetic predisposition, personality, childhood developmental factors (especially neglect, abandonment, and/or abuse), relationship dynamics, and chemical, neurological responses to addictive substances. And we know that evidence based treatments, support groups such as AA and NA, and ongoing relapse prevention help hundreds of thousands of people every year. With so many successful stories of recovery, there are good reasons to be hopeful and optimistic – regardless of our terminology or definitions.