| MEDICAL CONDITIONS | JUNE 27, 2018
It has become a sign of legitimacy to call a personal problem “medical.” This aims to distinguish the problem from those of morality or character. It implies both that the problem is serious, and that it is unbidden and largely out of the sufferer’s control. Unfortunately, it isn’t clear what exactly qualifies as “medical,” so this label serves more as a rhetorical device than a scientific finding.
Alcoholism is the paradigm and perhaps least controversial example. Through the 19th Century, alcoholism was variously declared a disease, or a matter of will and character. The disease model gained prominence in the 1930s and 40s with the “powerlessness” identified in the 12 Steps of Alcoholics Anonymous, as well as researcher E.M. Jellinek’s descriptions of progressive stages and subtypes of alcoholism. The American Medical Association declared alcoholism an illness in 1956 and has endorsed the disease model ever since, partly as a strategy to ensure insurance reimbursement for treatment.
The model expanded to include other abused substances with the formation of Narcotics Anonymous in the 1950s, and as a result of widespread recreational drug use in the late 1960s and early 1970s. The specialty of addiction medicine was first established in 1973 in California. The American Society of Addiction Medicine now states: “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Proponents of the disease model of addiction cite many documented brain changes and a plausible neuropathology, as well as the presence of genetic risk factors, cognitive and emotional changes, impaired executive functioning, and disability and premature death. The model purportedly destigmatizes addicts — they are no longer “bad” or “weak” people — thereby making it more acceptable for them to seek treatment.
Nonetheless, the disease model of addiction remains controversial. In addition to the existence of alternative models, the disease model itself has been criticized. Some believe it removes personal choice and responsibility, and actually contributes to the problem of addiction. Others cite surveys of American physicians who consider alcoholism more a social or psychological problem — even a “human weakness” — than a disease. Critics note that about 75 percent of those who recover from alcohol dependence do so without seeking any kind of help, and that the most popular and recommended treatment, Alcoholics Anonymous, is a fellowship and spiritual path, not a medical treatment.