Substance Problems is it a Disease?
diagnosis or improper diagnosis.
Stigma is ever present in the diagnosis, a person typically is given one of two designations upon arrival, mostly using an all or nothing thinking, all drinking problems turn into alcoholics and all illicit drugs are drug addicts are traditional schools of thought, however false statements. Obviously not true, but typically “the” treatment received by most seeking help with substance problems. This happens in outpatient treatment, inpatient treatment and a requirement in the self help or mutual self help groups, to be a “member” one has to announce their status, as one or the other.
The biggest and longest “influence” in treatment is the twelve step model. It is taught in 90% of treatment centers in the United States it is called the Minnesota model. The steps have been creating “anonymous” sub groups, mutual self help groups, for 75 years. All promote the “powerless model” calling for a faith power, required recovery. That separates it from all other models. “Religion and science, the medical models” typically are like mixing oil and water. This oil and water analogy is another of the reasons integrated treatment is being developed. There is not a system that allows for each to exist. Domain or loyalty to a system creates a feeling of being disloyal if a person practices two or three different models. Choice is missing; if someone is convinced or taught, this is an “outside issue.” Creating feelings of “disloyalty” are felt or enforced or implied. This has a lot to do with “memberships,” can you feel a part of something, if others point their suspicions at other existing methods? Or that since it was not the groups “focus” or purpose or idea, it was not allowed as a topic or relative to the group’s core beliefs.
Peer pressure in mutual self help groups does produce a feeling superiority or certainty, even if it is wrong or uninformed by other’s standards, when it compares itself, to the other offers, but if you are one of the “others” and wanted to belong to more than one offer, it turns ‘underground’ since peer pressures may see that as being disloyal or impure to the core, absolute, pure, ideals of the original group. What happens most often, someone is forced to “pick sides.” While the other “side” may have something you need, it becomes a matter of pride, or taboo, “stick with the winners” is a losing proposition for anyone that is not allowed to partake in multiple solutions.
The problem of matching treatments and medical or non medical concepts needs answers, the main question for decades is, “Is substance dependence a disease? Yes, but the answer took many years of technical advances to show what “dependence” is, in layman’s terms it is a brain disease, neurotransmitter dysregulation proven by the science community.
Prior to this discovery, three concepts exist and dominate the thinking in the recovery industry, until the science discovery becomes accepted as the medical fact, people will remain subject to “opinions”.
The Moral (spiritual) Disease Model:
Since all step models start with Alcoholics Anonymous the wording of “allergy” is the only medical opine offered in it, solely based on one doctor’s opinion, observation based.
The oldest model (non disease model, in current use) describes alcoholism as a physical allergy to alcohol in a book titled Alcoholics Anonymous (AA). The author of Alcoholics Anonymous, Bill Wilson, however, described alcoholism as a fatal malady, an illness and spiritual malady, of which only a spiritual experience will conquer (thus the moral disease).What few know is the “term” disease only appears once in Bill’s writing describing the “number one problem” as a spiritual disease, “Resentment is the “number one” offender. It destroys more alcoholics than anything else. From it stem all forms of spiritual disease, for we have been not only mentally and physically ill, we have been spiritually sick. When the spiritual malady is overcome, we straighten out mentally and physically.” Bill Wilson codified the Twelve Steps in 1938 from its origin, a Christian Evangelical movement called the Oxford Groups. He intentionally avoided the concept of alcoholism as a disease, since he did not have any medical evidence to support it, and that would remove the needed spiritual experience which is its core, the substance alcohol is not the problem, and the “malady” is spiritual. In 1938, the position of the text has never changed, since its first printing. While the current “members” of Alcoholics Anonymous speak openly of a disease concept its origins is not from Bill Wilson or his works, Alcoholics Anonymous, the book is not the current membership and the membership is not the book. Most of the “membership” currently