Let's look a bit deeper into the history and new developments in the addictions field, especially since addiction may be the most controversial topic that has been addressed in the public health and medical communities over the years. The addictions field has evolved through several phases over the past 100 years. What follows is a brief overview of some of the changes in belief regarding the basic nature of "addiction" or substance dependence, how to prevent its occurrence and how to intervene once dependence has become apparent. As shown above, addiction has been viewed as an individual moral problem, a medical disease and a behavioral disorder and now there's an emerging holistic model.
The Moral Model is the belief based on a moral theory. According to this theory, people are individually responsible for the behavioral choices they make, good or bad. Those who choose good behavior should be praised, while those who choose bad behavior need punishment. This leads to people with addiction problems to be stigmatized, labeling anyone with a "bad habit" as a "bad person." The downside of this model has become increasingly clear over the years. People with addiction problems are stigmatized and are therefore often demoralized by feelings of self-blame, guilt and shame to the extent that they are unwilling or unable to seek any help or treatment.
In the 1930's, the new Disease Model began to be formulated. This new view was that addiction was a disease caused by genetic and biological factors. The addict was then no longer held personally responsible for their 'bad behaviors" since these behaviors were now caused by biogenetic factors beyond their control. A strong argument could be made that addicts were patients deserving treatment, rather than criminals deserving punishment. The 12-step recovery movement with its accompanying treatment system enthusiastically accepted this model. Now, officially, addiction was a progressive disease for which there was no cure, and the only way to put the disease "in remission" was by a lifelong commitment to total abstinence. Any use of alcohol or other mind altering substances was considered a relapse, regardless if it resulted in any harmful consequences. So whether it was one drink or 100, it was treated the same.
Despite the wide acceptance and appeal of this disease model (over 90% of U.S. alcohol and drug treatment programs adhere to it), a number of shortcomings and limitations have emerged through years of research. Although these programs do work for some people, there are certain contradictions and paradoxes that prevent others from finding them helpful. The notion that the 12-step way of recovery is superior to all others is not at all backed by the research. People can recover without AA or any other 12-step program and be just as healthy as those who find them helpful. Within traditional treatment, there was a tendency toward a "one-size-fits-all" approach to recovery, which contributed to high dropout rates. And by defining addiction as an incurable, progressive disease, many people will find it difficult to change their addictive behaviors or decide to give up alcohol or drug use on their own.
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