Dirk Hanson has a great post on resistance to the disease model.
I’m a believer in harm reduction as part of the continuum of addiction interventions, but there is often a chasm between the way harm reductionists and treatment providers frame the problem. This can make it difficult to work together. Dirk does a great job illuminating an element of the differences in frames.
For harm reductionists, addiction is sometimes viewed as a learning disorder. This semantic construction seems to hold out the possibility of learning to drink or use drugs moderately after using them addictively. The fact that some non-alcoholics drink too much and ought to cut back, just as some recreational drug users need to ease up, is certainly a public health issue—but one that is distinct in almost every way from the issue of biochemical addiction. By concentrating on the fuzziest part of the spectrum, where problem drinking merges into alcoholism, we’ve introduced fuzzy thinking with regard to at least some of the existing addiction research base. And that doesn’t help anybody find common ground.
He also offers some historian David Courtwright’s perspective on resistance to the disease model.
Historian David Courtwright, writing in BioSocieties, says that the most obvious reason for this conundrum is that “the brain disease model has so far failed to yield much practical therapeutic value.” The disease paradigm has not greatly increased the amount of “actionable etiology” available to medical and public health practitioners. “Clinicians have acquired some drugs, such as Wellbutrin and Chantix for smokers, Campral for alcoholics or buprenorphine for heroin addicts, but no magic bullets.” Physicians and health workers are “stuck in therapeutic limbo,” Courtwright believes.
Interesting. Because medical practitioners have had a difficult time establishing a role for themselves, there’s a lot of resistance to recognizing it as a disease.
When we look at the chronic disease burden, does this lead to bias in favor of pills and procedures, and neglect of lifestyle medicine?
Dirk also gets into the ways addicts benefit from the disease model. Check out the whole post.