Substance Problems is it a Disease?
active is influenced by the treatment industry, with parts of treatment education being repeated amongst the members. A hybrid of more modern information leaks into the membership, but is not supported by the outdated texts.
The Medical Disease Model:
In 1960 Dr. Jellinek’s alcohol disease model (in current use) was accepted by the American Medical Association (AMA) in 1966; Jellinek described alcoholism as dependence, with two stages preceding “alcoholism” in five different stages, alpha, beta, were used to describe “heavy use” therefore not alcoholic, Delta, Gamma and Epsilon were different stages or symptoms of dependence thus creating his disease symptoms, basically built on two conditions being met simultaneously or separately, loss of control, or increase tolerance to alcohol exposure, the controversy remains, surrounding Dr. Jellinek’s research since it was based solely from Alcoholics Anonymous volunteers, selected and funded by Marty Mann, the first female to achieve abstinence via Alcoholics Anonymous in 1940, with intermittent lapses until her death, with strong ties to Bill Wilson, she founded the National Council on Alcoholism (NCA) which is now the National Council of Alcoholism and Drug Dependence (NCADD). What happens here is a national bias, and the argument of disease, has only recently been proven, scientifically in the past ten or fifteen years.
The good news bad news, depending on who is telling the story, that came from the AMA disease recognition was the creation of a “payer system,” government funding, research, and insurance policies could then pay the doctors for their time and energy, and treatment to alcohol and later, drug problems giving birth to a new recovery industry, the drug and alcohol treatment facility. Since the step model was the only formal treatment in that era and the Jellinek research funded by an AA member (Marty Mann), the Minnesota model was adopted in 90% of the treatment facilities. By forming this national treatment alliance, treatment facilities had AA meetings to send their clients to, after they completed their inpatient or outpatient treatment. This alliance created the largest sector called the self help group, run by non professionals called AA meetings. Now, some treatment facilities offer “after care” programs where professionals are present, but this may not be the case, untrained clinicians are often hired to run aftercare meetings, with the criterion of having a substance problem also, making them, sound or feel similar to the mutual self help groups. Most cannot tell the difference from one to the other.
The Behavioral Model(s)
In the same time period 50’s and 60’s, the American Psychiatric Association (APA) using the terms mental disorders to describe maladaptive behaviors produced the criterion adopted in most medical treatments for substance abuse versus substance dependence. Two controversies start to develop, is substance dependence a mental disorder or a disease? This was also controversial since some saw insurance as the reason to classify substance problems as medical problems, the same issue the AMA continues to battle. The difference being the AMA is a physical disease, the APA sees it as a mental disorder. During this same time period two forms of behavioral therapy were being developed and introduced one being Rational Emotive Therapy (REBT) by Albert Ellis Ph.D., the other Cognitive Behavioral Therapy by Aaron Beck M.D.
We start to see the confusion; we have three very different “medical” opinions base on symptoms, without evidence to prove the opinion. And terminology shifts depending on the group. One is a moral matter, one is a disease and the next is a behavioral problem.
As time goes by, we learn more and know more. Until now, we have spanned seventy five years of medical opinions.
The Neuroscience Model Cracks the Code
Neuroscience: a scientific study of the nerve system, at a molecular and cellular level the nervous system within the brain, behaviors produced by the brain.
In the past ten to fifteen years, neuroscience has produced “the” disease model, the difference here; it is actually based on scientific research, which has not possible with all the preexisting methods. By using Positron Emission Tomography (PET) scans and Magnetic Resonance Imaging (MRI) neurotransmitter dysregulation (brain damage) is being seen, in substance dependence. Where neuroplasticity or neuroadaptive states are being discovered or proven which opens research into genetics or predisposed conditions or long term exposure to a substance. The same progress made with uptake inhibitor drugs with Federal Drug Administration (FDA) approvals, such as