A new standard for understanding addiction by expanding the diesease concept to include the relationship aspect.
The application of the disease concept to alcoholism, chemical dependency and addiction by the American Medical Association in 1956 marked a turning point in how addicts are viewed, by treatment practitioners, significant others, the addicts themselves, as well the population at large. This turning point served to lessen the impact of stigma. There is less shame and secrecy associated now with being an addict, making it easier to seek professional help. The shift in perception allowed for a more objective understanding of the disease and had a humanizing effect, not just on the concept of addiction, but also on everything that goes along with it. Application of the disease concept streamlined the process of assessment, diagnosis and treatment. We now understand that addiction meets the medical model criteria necessary to be labeled a “disease,” as it is a deviation from health that has identifiable, specific concomitants. The disease of chemical dependency is commonly referred to as a pathological dependence, one that is overpowering, that is, becomes a primary relationship in the addict’s life, and evidenced by overtly out of control behavior, also seen as obsessive/compulsive.
The disease concept of addiction presumes a primary condition, which means it is always the first order of treatment. Stabilizing the debilitating out of control behavior is always the first step in treatment planning, and must be achieved before other stressors, issues or symptoms can be adequately treated, and which are considered to be secondary. Treatment must begin with abstinence, and is predicated on continued abstinence. “Disease” also presumes that the condition is progressive; that is, if the addiction is left untreated, a steady course of deterioration will eventually manifest in all facets of life (family, physical, occupational, legal and financial), the severity and speed of which depends on the specific substances involved.
Permanence is presumed as well. “Once an addict, always an addict,” goes the saying, implying that anyone in recovery will always be susceptible to relapse. There is no way to undo the substance or activity as need-gratifying agents. Medical conditions are also generally assumed to be involved; withdrawal
and tolerance must be factored into the equation, as they often pose complications and risks.
While it’s true that the medical establishment helped develop a more compassionate and enlightened approach to addiction, the disease concept still doesn’t adequately explain how the disease works. In applying the disease concept, a medical label was placed on a human phenomenon, dependency, the complexities of which far exceed traditional scientific wisdom.
Despite its reliance on objective, measurable data and tried and proven research, and beyond meeting the necessary criteria to be labeled a disease, we actually know little else about the emotional and psychological aspects of addiction.An inherent limitation of a strictly medical approach is ignoring the fact that pathological dependence implies that there is a relationship: One that is human, emotional and psychological in nature that has formed with the pain relieving substance or activity (porn, sex, gambling, etc.) The concept of relationship never enters the picture because it is perceived as too subjective, immeasurable and not provable scientifically. Yet as we will see, a very strong emotional attachment exists nevertheless.
Copyright 2008 Daniel Linder, MFT. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.
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