In the news media the typical expert describes addiction as a disease. Often these experts work at addiction treatment facilities. It would be easy to conclude that experts agree that addiction is hereditary, incurable and lifelong. In the addiction field this view is referred to as the "disease model." In fact there is significant disagreement about the disease model, but the scientists and professionals who view addiction in other ways do not receive the same media coverage. Why alternatives to the disease model (there are several) do not get more publicity is a story in itself. However, this article will focus on two reasons not to understand addiction as a disease.

The first disadvantage of the disease model is that, for individuals with addiction problems, it is distracting. If I drink too much alcohol, my attention would best be focused on what I need to do about this behavior. By focusing on reducing or stopping my drinking, perhaps I can be successful on my own, or realize that I need to get outside help. However, if instead I spend my time wondering about whether I am an "alcoholic," I am not doing anything constructive to address my problems. Wondering whether I am an alcoholic distracts me from actually resolving my drinking problems. Although it may seem foolish (if you don't have drinking problems) to spend your time wondering about this issue, many individuals who drink too much do so. Unfortunately, the conclusion reached is something like this: "Even though I drink too much, I'm not really an alcoholic, so I don't need to worry about it. Only alcoholics actually need to make changes. I'm just someone who drinks too much."

This perspective does not make any sense, but it is very common. The heavy drinker can hide behind the conclusion of "not being a real alcoholic," and avoid change. It seems that no matter how heavy my drinking, there are others who drink more or have more problems from alcohol. I can think of them as alcoholics, but not me! In reality, whatever amount I drink might cause problems, depending on circumstances. I would do better to address my drinking directly, and not be concerned about whether the label alcoholic (or addict) is the right one for me.

A second disadvantage of the disease model is that it can be depressing and de-motivating: "I have this disease that I can never get rid of." The idea itself is enough to drive me to drink! Rather than motivating me to improve my behavior, the disease model could lead me to feel hopeless. If someone believes in the disease model, and starts drinking, it is easy (and common) to think "I can't help this, I have a disease." Rather than moderating (drinking at a low level that does not cause problems) or reducing (drinking too much but less than a binge), a full-blown binge (of alcohol, drugs, or both) can occur. Once the binge occurs it can be taken as more evidence that I really am hopeless, so what is the point of even trying to change? It would be better for me to think that I need to stay focused on my drinking, and not expect complete improvement immediately. I could learn to moderate or stop my drinking, just as I have learned many other things.

Although the experts quoted in the media are likely for a long time to continue to describe addiction as a disease, we each still have the freedom to understand addiction any way we want to. For many of us, not using the labels addict or alcoholic, and having a hopeful perspective on change, will be more helpful.

About the Author

A. Tom Horvath, Ph.D., ABPP, is a board certified clinical psychologist and president of Practical Recovery non-12-step alcohol addiction treatment, an addiction treatment facility in La Jolla (San Diego), CA, focusing on collaborative care and self-empowerment.