By Molly Nichols
The subject of addiction is a hotly contested, highly polarized debate. There are two main schools of thought: the disease model (genetics and biochemical factors) versus the moral model (character flaws and lack of willpower). I think student pharmacists might side with the disease model; personally, I believe that addiction is a legitimate medical illness. However, I recognize that not everyone shares my feelings, especially outside of the clinical setting, and I have come to learn that sharing an impassioned rhetoric about why I am right and my “opponent” is wrong does not bring the two sides of any debate closer together.
So, instead, I want to confess something: I haven’t always believed that addiction is a disease. A few years ago, I was a silent but strong supporter of the moral model of addiction. I considered myself an expert on the subject—I had watched my parent* struggle with alcoholism my entire life. I believed that drinking was under my parent’s control, and that they* were choosing to drink alcohol over taking care of me. I did not understand how someone could continue to make such a horrible decision when they knew it had horrible consequences.
In the briefest of all possible explanations, trying to make sense of my parent’s addiction was a never-ending cycle of me angrily asking why: Why were they addicted? Why didn’t they stop? Why did I have to suffer?
The moral model of addiction did not provide any satisfying answers to these questions, only variations of “because they’re bad” or “because they’re weak.” Neither one of those felt quite right. My parent was very loving when they weren’t drinking and consistently showed strength when faced with difficult life circumstances. It wasn’t until I got into pharmacy school that I was introduced to the disease model of addiction and finally, thankfully, received logical answers to my questions.
Why do only some people develop addiction?
Not everyone who uses substances will develop an addiction, and the moral model uses this as evidence for its willpower ideology. The moral model claims that some people simply have more discipline than others when it comes to saying “no.” However, the disease model contends that this discrepancy is due to differences in brain chemistry rather than differences in self-control. A complex relationship exists between a person’s environment, genes, and biochemical factors, and each individual has a unique mix of these components that influences his or her susceptibility to addiction.
Why don’t, or can’t, people stop using?
The moral model asserts that a person makes a conscious decision each and every time he or she uses a substance, while the disease model argues that after the first use, the following uses are likely out of a person’s control. To ensure survival, the brain is wired to reinforce pleasurable behaviors like eating and procreating by releasing powerful neurotransmitters. When a person uses an addictive substance, it triggers a supercharged release of those same chemicals. With continued use, the levels of neurotransmitters and their receptors shift, and reward-seeking behavior to maintain a feeling of “normalcy” becomes a person’s dominant motivator. Even when a person with an addiction acknowledges problematic behaviors, it is enormously difficult to fight the body’s signals to keep using.
Why do other people get hurt?
The disease model of addiction, of course, has no answer for this question. While it may provide an alternative explanation to “because they’re bad” for why harmful behaviors occur, the disease model does not justify or condone the consequences of those behaviors. A lot of people get hurt in addiction. For me, the hardest part of accepting the disease model was thinking that it somehow invalidated the pain inflicted on me by my parent’s conduct. Addiction is complicated: it is a disease, but the disease elicits certain behavioral elements. Denying the legitimacy of the disease model does not help validate the harm caused by addictive behaviors, it only limits access to therapies that increase a person’s chance of recovery.
The next time you come across a supporter of the moral model, I encourage you to ask why that person supports it. Open a dialogue and have a conversation to understand, not an argument to win. At the end of the day, supporting a person with addiction through his or her recovery is what’s most important. But if you really want to change someone’s perspective, take it from me—a little empathy goes a long way!
*Author’s note: All nouns and pronouns have been de-identified to protect the privacy of my parent (who is now, happily, in recovery!).