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Disease Model
Chemical Dependency includes alcoholism and any other drug dependency. Chemical dependency is also called addiction. In order for a chemical to be addictive, it must possess three properties: it must 1) be mind-altering/mood changing, 2) produce intense pleasure, and 3) be reinforcing, that is, taking the chemical stimulates taking more of the chemical. Psychoactive chemicals that are addictive fall into six drug categories:
Each day in this country, about 10 people die from illegal drug use such as heroin and cocaine, but there are 300 + alcohol-related deaths, and over 1,000 daily deaths caused by nicotine addiction. In terms of addictive potency, cocaine ranks first, followed by heroin and other opioids, nicotine, alcohol, other stimulants, sedative/hypnotics, perceptual distorters, and marijuana. Less than 5% of the alcohol/addict population "lives under the bridge." Most are quite functional and on-the-job which is precisely why they are so difficult to detect. Their work performance is the last area of life activity to deteriorate. Social isolation, family concern, emotional turmoil, physical damage, financial problems, legal difficulty, and spiritual conflict precede workplace impairment. Dependency, or addiction, is defined by three characteristics that are easily remembered as the 3 C s: Loss of Control, Compulsive Use, and Continued Use Despite Adverse Consequences. Loss of control means loss of predictability, that is, individuals cannot predict three things once faced with a drink or drug: a) whether or not they will use, b) how much they use, and c) what behavior results. A compulsion is an irrational repetitive act that is done despite firm intention not to do it. It arises from an obsession which is an omnipotent thought, so powerful, that takes precedence over all other very powerful thoughts, even survival type thoughts. This dual loss of control plus compulsive use is devastating because it means that alcoholics and addicts don't drink or drug they way they do because they want to; they do so because they have to! Prior to the first drink or drug, and during initial use, alcoholics and addicts, like normal individuals, can choose whether or not to drink or drug. But once chemical dependency takes hold and becomes clinically manifest, free will is no longer operative! They can stop for a while, but they can't stay stopped as evidenced by continued use despite adverse consequences such as social isolation, family concern, emotional turmoil, physical damage, legal difficulty, financial problems, and spiritual deterioration. When someone engages in an activity (alcohol/drug ingestion) that causes problems (multi-system impairment), and that same someone persists in that same activity despite recurring problems, this is simply not normal behavior! Chemically dependent people do so initially because they are ignorant of the cause-and-effect relationship between the drinking/drugging and the problems. This is so because of denial which is a subconscious defense mechanism. Denial is not lying. Lying is conscious distortion of the facts. Denial is the mind's way of playing a little trick on itself by protecting the individual from all the bad news associated with acknowledging the problem. Denial distorts the reality surrounding the individual's relationship with the chemical. It is his or her perception that nothing is really broken, and therefore, there's nothing to fix. Sooner or later, this delusional thinking system is penetrated, yet they persist in the same activity. One must then explain this bizarre behavior as resulting from stupidity, insanity, immorality, or insufficient will power. Careful scrutiny reveals that none of these apparent explanations applies. Alcoholics and addicts do not show lack of intelligence, evidence of underlying psychopathology, absence of moral fiber, or inability to exercise will power compared to their matched cohorts in the general population. Their abnormal behavior is explained by the fact that they are sick, that is, they suffer from an illness! A disease is a dysfunctional state with characteristic form. A dysfunctional state means someone is functioning abnormally, or in medical terminology, "beyond normal limits." Characteristic form refers to the criteria established by the medical community that must be met in order to qualify as a disease state These criteria include:
Let's compare chemical dependency with some other diseases, like Diabetes and Aids. In Diabetes, the cause remains unknown to medical science. This does not make it any less a disease. The defect is an insulin imbalance. It has diagnostic symptoms, signs, and lab abnormalities. Without treatment, certain complications consistently occur such as blindness, kidney failure, and nerve damage. With treatment such as diet, pills, or insulin replacement, a reproducible percentage of those afflicted will improve over time. The cause of Aids is known, namely the Human Immunodeficiency Virus. The defect is the T-4 blood cell which can no longer perform its protective function. Aids has diagnostic symptoms, signs, and lab tests too which differentiate it from other diseases. All who get Aids follow a similar course. There is no curative treatment, so outcomes can't be measured. Like Diabetes, the exact cause of Chemical Dependency is unknown. The defect appears to be a combination of some type of chemical imbalance in the brain and abnormal psychological traits in the mind. The chemical imbalance involves neurotransmitters and their abnormal receptor site physiology. Some normal psychological traits are lacking and others exist in excess. When this combination of brain-mind abnormality is present, and addictive chemicals are added to the equation, the disease becomes clinically manifest, is readily identifiable, and follows a predictable pattern in all the individuals so afflicted. This places its victims at a disadvantage, but it is responsive to therapeutic intervention with a similar outcome time after time. Clearly Chemical Dependency fulfills the medical criteria to qualify as a disease state. Chemical Dependency is a chronic condition meaning that it is permanent and prone to relapse. It is also primary, meaning that it exists independently and is not secondary to some other underlying mental illness. It is most often progressive with four stages: early, middle, late, and too late! Lastly it is "contagious." The insanity of the illness is contagious in that the stress of living with an alcoholic/addict produces dysfunctional coping behavior similar to that seen in post-traumatic stress syndrome.
The answer is clearly, B. You drink too much because you have a disease that produces a different response to alcohol than that experienced by those without this brain-mind abnormality. Your persistent bizarre activity despite adverse negative consequences does not result from ignorance, stupidity, insanity, immorality, or insufficient will power. It occurs because you are sick! Therefore, it should be addressed not morally, but medically, and treated like any other disease with dignity and confidentiality. Lewis, D.C. A Disease Model of Addiction. In N. S. Miller and MC Doot (eds.) Principles of Addiction Medicine (1994). Chevy Chase, Maryland. American Society of Addiction Medicine, Section 1, Chapter 7, Pages 1-8. Hyman, Stephen E. The Addicted Brain. Harvard Medical Alumni Bulletin (Winter 1995). Cambridge, Massachusetts, pp 29-33. |
