Disease Model of Use

Origins and Evolution

The concept of the disease model of use can be traced to the 18th century when Benjamin Rush, the father of psychiatry, observed alcohol consumption as a problem and made medical conclusions about how to treat it. During Prohibition, which outlawed the sale, manufacture, and transportation of alcohol in the United States from 1920 to 1933, support for the disease concept waned. In the 1940s, the disease concept re-emerged as an organizing construct for the treatment of alcoholism through the work of three organizations: the Research Council for Education on Alcoholism, the Yale Center for Alcohol Studies, and the [Page 200]National Committee for Education on Alcoholism. The disease concept continued to evolve over time and shape the treatment of alcoholism in the United States; it was also extended to the treatment of drug abuse and dependence.

From 1970 to 2000, there was growing public and professional support for the view of addiction as a disease. During this time period, there was a dramatic increase in the number of treatment programs in the United States that used the disease concept as the guiding principle for treatment. In 1972 the Feighner Criteria, a set of new diagnostic criteria for major depression, antisocial personality disorder, and alcoholism, were published. These criteria established a research base for the disease concept of alcoholism and influenced the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III. The DSM-III, published in 1980, marked a significant change in the conception of alcoholism. For the first time, alcohol abuse and dependence were included as a category of substance use disorders rather than a subset of personality disorders. Federal support for the medical view of substance abuse grew as well, evidenced by the founding of the National Institute on Drug Abuse (NIDA) in 1974, whose mission was to “lead the Nation in bringing the power of science to bear on drug abuse and addiction.” Further, as part of a federal mandate to expand the availability of effective treatment and recovery services for alcohol and drug problems (i.e., ADAMHA Reorganizational Act of 1992), the Center for Substance Abuse Treatment (CSAT) was established as part of the Substance Abuse and Mental Health Services Administration (SAMHSA). NIDA and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) were also integrated into the National Institutes of Health (NIH).

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