Such models include: moral model (cause of alcoholism is a moral deficiency), learning theory (we learn to drink from others such as family and friends and this becomes a social norm), sociological causes (the environmental and cultural influences such as poverty, peer pressure, lack of education, and using alcohol as a social construct), educational (alcohol misuse is because of a lack of knowledge about the harmful aspects of drinking), and psychological (using alcohol to cope with stress, anxiety, depression, etc.).
The disease model was developed by the American Medical Association in 1956 with the premise that there are four reasons that it is a chronic, progressive, irreversible, and relapsing disease. These include: tolerance, loss of control, withdrawal, and social and/or physical impairment. The DSM-5, the bible of psychological disorders, reveals the disease process with diagnostic criteria including cravings, using even when causing physical or psychological problems, tolerance, and withdrawal. Research is included in this model, as Dr.George Koob, in the NIH Medline Plus, relates that,
“This expanding research knowledge will aid the development of new evidence-based prevention and treatment strategies for alcohol problems across the lifespan, including the diverse alcohol-related diseases that occur throughout the body, and help find better ways to deliver health service for alcohol problems.”
Some people have argued that using the disease model could give excuses to people suffering from substance use disorder and increase the stigma, but the reality is people often feel relieved to know that there’s a reason they suffer and can’t stop. Here are 9 reasons using the disease model for SUD (addiction) will benefit everyone.
- By examining alcoholism as a disease, the medical community is able to embrace the diagnosis and can more effectively monitor and treat the individual by utilizing medical care either through inpatient, intensive outpatient, and/or outpatient treatment. It allows hospitals and outpatient health clinics and community mental health treatment facilities to also examine the illness and treat as needed. Significant physical health problems arise from alcoholism as it affects numerous organs within the body, causes numerous illnesses, and can lead to death. Illnesses include heart, liver, brain, and pancreatic problems, including cirrhosis of the liver and Wernicke-Korsakoff Syndrome.
- Because it is a disease, medical intervention is a primary goal with treatment by medication to aid in the recovery process such as thiamine for vitamin deficiencies, psychotropic medications for withdrawal, and medication to help with cravings (such as Antabuse, Naltrexone, or Suboxone). Also, the health status of alcoholics is often poor and medical intervention is needed for related illnesses.
- Utilizing the medical model embraces therapy as a treatment mode, for mental health issues are related to physiological issues. Counseling techniques, recovery management, relapse prevention, and exploring other mental health concerns allows for treating the illness in a comprehensive manner.
- The disease model decreases the stigma of alcoholism by embracing it as an illness, not a weakness. While there is still stigma attached to alcoholism, by accepting the illness, just as one needs to accept other diseases such as diabetes, the stigma is lessened. People are more likely to buy in to a program that stresses it as a disease that can be treated instead of a personal failing or criminal misconduct.
- As a disease model, families are included in the treatment by exploring their own processes such as enabling behaviors and codependency.
- The recovery community, by embracing the illness, offers treatment, recovery groups, aftercare programs, sponsors, and Alcoholics Anonymous as well as other self-help groups such as the 16 Steps of Empowerment, Rational Recovery, and Secular Sobriety.
- A medical diagnosis allows for insurance coverage. With the enactment of the Mental Health Parity and Addiction Equality Act of 2008, insurance companies are required to treat alcoholism as a disease and must provide for such coverage.
- Studies are continually funded to examine addiction as a disease process, the science providing increased knowledge of the disease, brain dysfunction, prevention, treatment, and pharmacology treatment, as well as monitoring and other methods of healing from the illness.
- Public health policies can continue to be examined and funded to examine the disease as one of the community and not just the individual. This can lead not only to primary treatment, but also to prevention through education.
The disease model, while not perfect, allows many opportunities to help in the recovery of the illness. SAMHSA delineates four major dimensions regarding recovery from this disease: health, home, purpose, and community. By expanding the definition of disease and recovery, people are more apt to work towards healing and growth.
Reach Out Recovery Exclusive by Carol Anderson D.Min., ACSW, LMSW