For many years, the primary school of thought surrounding addiction has been the brain disease model. While the debate still continues over if addiction is really a disease, there may never be a definitive answer, so we will take a practical approach and look at what works about the model and what doesn’t.
What is the Brain Disease Model of Addiction
Let’s start with a definition: The Brain Disease Model of Addiction describes addiction as a disease, rather than a disorder, syndrome, or purely behavioral issue. The most basic qualification of a disease is a condition that impairs normal functioning, however, the Brain Disease Model acknowledges the possibility of biological, psychological, and sociological causes.
According to The Center on Addiction, “Choice does not determine whether something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices.”
The alternative to the Disease Model is the Life Process Model, which claims that biological causes of addiction are not proven, and thus, not support use of the term disease. The emphasis of healing is therefore focused on repairing relationships and personal strength of will.
Why the Brain Disease Model Works
Understanding the nature of addiction guides the treatment. The brain disease model is powerful for two reasons: (1) it recognizes that individuals may need professional medical and psychological support, and (2) it adds the important element of compassion. It acknowledges that people with addictions can’t just stop, it’s not as simple as choosing to leave the substance behind. Every person with an addiction has it for a reason, whether by choice or other combination of factors. The Brain Disease Model recognizes that there are physiological changes that occur which make healing much more complicated than exercising of willpower.Understanding the disease nature of addiction is particularly helpful in encouraging family and loved ones to stop blaming the person with the addiction. Addiction needs to be treated regardless of whether or not it is a disease, or if there were choices that led to it. The person struggling with addiction needs compassionate help, not judgement or shame.
Why the Brain Disease Model Doesn’t Always Work
For many in the psychology field, the notion of addiction as a disease coupled with the notion of powerlessness that is foundational in the 12 step approach, leads some to become stuck in a perpetually dependent state. The 12 steps promotes the idea that one has a disease that can’t be cured. Once an alcoholic, always an alcoholic. It would be common to hear someone with 20 years of sobriety say, “I’m John, and I’m powerless over alcohol.”
If I suddenly was diagnosed with a terminal cancer, there wouldn’t be anything I could do about that. With addiction, there are definitely things I can do. When we see ourselves as powerless, we can close ourselves off from the latest evidence-based therapies and counseling methods, as well as powerful self counseling techniques.
This doesn’t mean that anyone who decides they are powerful should be able to drink casually. For many, ongoing recovery includes abstinence. But adopting a mantra where I self-identify as an addict, or as a powerless individual, is called a negative affirmation. What we need instead are empowering, positive affirmations.
The fact is, we are powerful. There are many things I can do. Substance abuse doesn’t happen because of genetics alone, it happens because of underlying issues such as anxiety, depression, trauma, and pain. And by dealing with these underlying issues, we can take control and beat addiction.
Finding the Right Approach
Patients struggling with addiction all need to be given compassionate support, and be empowered to take control of their lives. But beyond that, the approach to treating addiction should always be to address the underlying mental and emotional issues. This varies for each individual and is essential for long term recovery.
For example, some mood disorders (such as anxiety, depression, and self-loathing) and trauma can be treated with counseling. For other underlying issues, counseling isn’t enough by itself. Bipolar and schizophrenia are often causes of substance abuse, and both require a treatment plan that includes medication as well as counseling. Medication provides a safer and more effective means of dealing with the symptoms, while counseling helps you build effective coping tools.
In the past couple decades, the field of neuroscience has widely expanded our understanding of how addiction works in the brain. And it turns out, there is a lot that we can do to reprogram the addicted brain. Read more on that here.
In the end, the most important question isn’t “is addiction a disease?” Rather, it’s, “why do I use and what can I do to treat not just the physical, but also the mental, emotional, and spiritual issues that underlie the behavior?”
To do this, we must remain committed to personalized, compassion-based care.