The disease model explained

In medical circles, AARC’s view of addiction is known as the disease model. The disease model of alcoholism and drug addiction says the condition is a chronic, progressive illness, similar to Type II diabetes and cardiovascular disease. In other words, once you have the disease it is irreversible. Of course, like Type II diabetes, you might have taken action prior to developing the disease of addiction, which may have allowed you to avoid it. But we are talking about adolescent clients who no longer have that option.

At the heart of this model or theory is the thought that addiction is characterized by a person’s inability to reliably control substance use. This is accompanied by an uncontrollable craving or compulsion to use substances that is derived from a physical change in brain chemistry.

The loss of control can be manifested during either a short or long period of time. In our experience, an adolescent can lose control of substance use in a very short period of time due to their immature brain development.

According to E.M. Jellinek, one of the pioneers of the disease model, the compulsion to use a substance is best described as an “urgent and overpowering desire.” (Jellinek, E. M., The Disease Concept of Alcoholism, Hillhouse, (New Haven), 1960.) It is this feeling that compels the person to do whatever it takes to obtain the object of the addiction, even when there are potential harmful consequences.

The American Society of Addiction Medicine’s (ASAM) definition of addiction (2011):

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors”.

“Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death”.

The disease model emphasizes that the impaired control and craving are irreversible. There is no cure for alcoholism and drug addiction; they can only be arrested.

AARC accepts that the disease model is a theory. Some suggest that the neurological damage can be reversed. Others disagree with the disease model entirely, proposing that addiction is a temporary mental state, a psychological episode or even a lifestyle choice that can be altered by the willpower of the individual or by medication. Our experience contradicts these views; addicted adolescents appear to be permanently susceptible to drugs, and individual willpower alone has never been seen to succeed long-term. Instead, they require a significant change in lifestyle that involves a change in thoughts and feelings facilitated through the 12 Steps of AA as a lifelong recovery tool.

Based on our view that addiction is a chronic illness, AARC’s expected treatment outcome is total and lifelong abstinence from all mood-altering drugs.

Adolescent brains are particularly susceptible to damage by psychoactive drugs, like cannabis and alcohol, as the structure and chemistry of the brain have not yet reached maturity. You can read more about the neuroscience of brain function in substance-abusing adolescents here.

The Canadian Centre on Substance Abuse put it this way:

[T]he scientific literature points to adolescence as a sensitive period with regard to drug reward, comorbidity, motivation and drug taking. Because the cellular adaptations associated with addiction processes occur in the same regions of the brain as those undergoing preferential maturation during adolescence, adolescence should be viewed as a period of particular vulnerability to the effects of rewarding drugs and to the development of future drug-related problems. Substance Abuse in Canada: Youth in Focus, CCSA, 2007