Monday, March 9, 2015

Disease Model of Addiction

     Working right now in drug and alcohol, I hear a lot that drug abuse and dependence is a disease. I have to say that I am very conflicted with that statement. Perhaps in the past I was more conflicted, but I still get negative twitches when someone calls their substance abuse condition a disease. I plan on talk about: 1) When the disease emerges after the behavior; 2) Why I didn't like the word disease; 3) Why behavior or disease might be better than the other; and 4) What I've heard from clients recently on the subject.
     I think that it is difficult to pinpoint a moment when the behavior of drinking/doing drugs turns into a disease. A behavior is something that involves thoughts, feelings, beliefs, etc. There is some level of choice involved and, as such, there is some level of control over the circumstance. A disease is different in that choice or motivation has nothing to do with it. Instead, a disease progresses seemingly without the consent of the victim and proceeds, sometimes, to rob that person of any further ability to stop it, through the destruction of relationships, communication, logical thought patterns, and positive expression of feelings. But the question still stands: When does the behavior turn into the disease?
     I guess that the logical answer, given the definitions, is that behavior develops into a disease when there is no more control over the action. When there is real chemical dependence, meaning that withdrawal symptoms are either bad enough to kill or distressful enough to inhibit normal or safe functioning, the person must continue or risk such consequences. Of course, there is no clean delineation between behavior and dependence here; in fact, it is possible that there is a middle stage where chemical dependence is starting to take root, but a strong enough verbal or psychic burst (whether coming from inside or external, though certainly an intrinsic shock would yield better results) might allow the person to kick the habit.
     There is some power in semantics, using certain words can either preclude or assist a client in gaining active recovery status. I think that words like "behavior" and "disease" themselves have power. Each one has positives and negatives. Behavior is positive in that it denotes a changeable variable, as most, if not all, behavior can at some point be altered for good or ill. Behavior can be a negative word here if we paralyze the client for not changing or for "mis-diagnosing" a disease as a behavior. Disease, likewise, has both positives and negatives assigned to it. Disease is positive if diagnosed correctly because it correctly describes the inability of change by choice. Disease is negative in that it can easily be seen as a crutch - a way to eschew responsibility off of the self and on to something out of their control.
     It is very much this last example that pushes me away from the word disease. At one point in the life of the addiction, there wasn't a disease. There was a repeated behavior. The person chose, for whatever reason, to continue the negative action until the consequences were so deeply embedded that a change in action was either impossible or inconsequential. I think that part of my issue with the word disease comes from the belief that these people deserve their predicament. This belief, of course, is shameful and without evidence. Logically, could we say that the first behavior was their fault? Logically . . . yes. But do they deserve to suffer? No, they do not. 
     I know that a lot of my current clients mention that they have a disease. For them, as long as they are no using the word as an excuse, its use is fine with me. I think that a happy medium, perhaps, between the two terms could be "condition." A condition has the dual meaning of being treatable and a little easier on the ears than the word disease. It's different from behavior in that it shows a certain amount of seriousness or semi-permanence than behavior can inherently imply. I don't think I'll be pushing the work condition in sessions, but I will think it to myself. 
     I think it important to mention that the recovery process from addiction is both behaviorally treated and medically assisted. To treat the "disease" through detox and medically-assisted rehabilitation methods and not to treat the behavioral issues that go along with it doesn't add up. It's kind of like balancing an equation. One side is the behavior and the other is the disease.

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