Addiction, Models of

The Medical Model

The medical model of addictive behaviors, often called the disease model, proposes that addictions are a disease like any other disease and are not a symptom or manifestation of any other underlying psychological or physical process. The model points out that addictions have many similarities to other diseases. They have a predictable course, which is chronic, progressive, and may lead to death if untreated. There is no cure for the disease, but it can be managed safely much as diabetes and other chronic illnesses are managed. Jellinek outlined four discrete stages in the development of alcoholism: prealcoholic, prodromal, crucial, and chronic.

Given that addiction is a disease, any problems associated with it are a result of the addiction and not a cause of it. These would include issues like depression, anger management, failed relationships, lost jobs, and many other maladaptive effects of chemical dependency. There is a presumed genetic or biological cause for the disease, although the evidence for this is inconclusive as yet. For example, monozygotic twins have the identical genetic code, yet they share the disease of addiction from 40% to 80% of the time depending on the study. However, addictions do seem to run in families. The child of an alcoholic has a probability of developing the disease that is about 10 times as strong as someone with nonalcoholic parents. The uncontrollable urges to use a drink or a drug are often seen as evidence of biological factors. However, some researchers have shown that addicts and alcoholics can control their urges to use through a program of positive reinforcements or rewards.

Recent research into the effects of drugs and alcohol on the brain has shown that there are measurable differences in the parts of the brain that regulate pleasure. This includes the way certain neurotransmitters in the brain, like dopamine, are depleted through excessive substance abuse. Such biological indicators are seen as supporting a medical model of addiction.

The Psychoanalytic Model

Many of the models for addiction parallel the historic and prevailing models that try to explain other psychological disorders. The psychoanalytic tradition and its branches have attempted to explain addictions through analytic concepts and structures. This model avers that addictions are the result of some unconscious psychic conflict or tension. As such, an addiction is the symptom of deeper psychological issues and not a disease unto itself.

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