the disease concept

excellent view from Psychology Today
by Lance Dodes M.D.


For many decades it's been widely accepted that alcoholism (or addiction) is a disease.  The "disease concept" is taught in addiction training programs and told to patients in treatment programs.  It is unquestioned by public figures and the media.  But is it true?  And if it is not true, is there a better and more helpful way to define addiction?


Widespread enthusiasm for the disease model, however, has led to willingness to overlook the facts.  Addiction has very little in common with diseases.  It is a group of behaviors, not an illness on its own.  It cannot be explained by any disease process.  Perhaps worst of all, calling addiction a "disease" interferes with exploring or accepting new understandings of the nature of addiction.


But if we are to scrap the disease concept and replace it with something valid, our new explanation must retain all the beneficial aspects of the old disease idea.  It must not allow moralizing or any other negative attributions to people suffering with addictions.  In fact, we'd hope an alternative explanation would have more value than the disease label, by giving people with addictions something the disease concept lacks: an understanding that is useful for treating the problem.

Despite all its past helpfulness, then, we are better off today without the disease idea of addiction.  For too long it has served as a kind of "black box" description that explains nothing, offers no help in treatment, and interferes with recognizing newer ways to understand and treat the problem.
And there is one more advantage.  If we can eliminate the empty "disease" label, then people who suffer with an addiction can finally stop thinking of themselves as "diseased."