Some Thoughts About the 'Disease Model'

I've posted here before on my discomfort with the standard 'disease model' that is commonly used in professional addiction treatment.

Addiction certainly has a disease-like effect, and I think it can be classed as a disease in the way we think of mental illness, which does not differentiate between organic disorders and those that are strictly thought-based.  In the case of addiction, it is clear that both can come into play.

Organically speaking, addiction not only involves the organic process of stress reaction (some people are naturally wired to have higher anxiety levels), while others have an inordinate response to certain substances that is often referred to by the AA characterization of an 'allergy.'  Then, when the brain begins to reroute neural pathways to accommodate addictive behavior, you indeed have some real organic problems.

However, to classify the organic problems on the same level as organic schizophrenia is ludicrous.  Addicts are not passive victims the way most schizophrenics are.  Addicts make choices to start and to continue.  The non-organic side has the ability to reel in the biochemical side of the disease, because we see people do it all the time.

As I have said before, I consider the 'disease' of addiction to be more about the spiritual disease of the Passions.  Addiction is a symptom.  Sure, when someone asks us if we are sick, we can say, "I have a runny nose" and everyone knows what we are talking about.  The runny nose is a symptom that we identify with the disease.

The addict who thinks that having a disease excuses his behavior is dead wrong.  Too often, counselors, when confronting a pitiful and remorseful addict, try to soften the blow by saying, "Yes, but you were in your disease" as if that excuses his conduct.  The AA Big Book certainly makes no claim, and does not differentiate between conduct inside or outside the disease.

If you want to get sober, you have to own up to all of it.  There are no excuses.

Modern thinkers hate this.  That is because they will say, "But, he was sick, so how can you blame him?"  We look at the mentally ill this way, excusing their mis-behaviors because they don't really have a bad intention when they act out.  The only problem here is that addicts are not mentally ill in the strictest sense of the word.  Addict are and will always be 'voluntarily ill.'  They chose to be sick.

By my book, that means they must own all their own garbage, and so they have to pick it up.  Again, working the Steps does not mean categorizing which of your behaviors are really your fault and which are not.  If you did it, you own it... plus you must own your attitude as well.

If you are looking for excuses, you've come to the wrong place.

If anyone tries to use the disease model to avoid responsibility, then they simply don't understand recovery.  Addicts need to take full responsibility for EVERYTHING that they have done.

The funny thing that most of us have experienced is when we own up to something that, when we finally admit our wrongs and become willing to do what is necessary to make them right, they suddenly become far less embarrassing or fearsome than they once were.  Our minds tend to over-emphasize some events either accidentally or because of the influence of pride.

At the same time, we often see our actions which we minimized turn out to be far more catastrophic.  It is not all chocolate and roses when it comes time to make amends.  When we experience these awakenings, the most harmful thing that can be done is any attempt to minimize the sorrow.  We must mourn.  Only then can we begin to heal.

So, disease is an explanation but it is never, ever an excuse.