Disease Concept

Characteristics of the Disease Concept

The disease of addiction is viewed as a primary disease. That is, it exists in and of itself and is not secondary to some other condition. This is in contrast to psychological models of addiction in which addictive behavior is seen as secondary to some psychological condition. Jellinek also described the progressive stages of the disease of alcoholism and the symptoms that characterize each stage. The early stage, or prodromal phase, is characterized by an increasing tolerance to alcohol, blackouts, sneaking and gulping drinks, and guilt feelings about drinking and related behaviors. The next stage, the middle or crucial phase, is defined by a loss of control over drinking, personality changes, a loss of friends and jobs, and a preoccupation with protecting the supply of alcohol. The issue of "loss of control" has come to be a central defining characteristic of alcoholism and one of the more controversial aspects of the disease concept. The late stage, or chronic phase, is characterized by morning drinking, violations of ethical standards, tremors, and hallucinations.

It is important to conceptualize these stages as progressive. In other words, the stages proceed in sequence and, in the disease model of addiction, are not reversible. Therefore, an individual does not go from the middle stage back to the early stage of alcoholism. The rate at which this progression occurs depends upon factors such as age, drug of choice, gender, and physiological predisposition. For example, adolescents progress more rapidly than adults, females faster than males, and users of stimulants more quickly than alcohol users. Proponents of the disease concept also do not believe that the progression of addiction disease is affected by a period of [Page 293]sobriety, no matter how long the period of sobriety lasts. Consistent with this concept is the notion that addictive disease is chronic and incurable. That is, if an individual has this disease, it never goes away, and there is no drug or other treatment method that will allow the alcoholic or addict to use again without the danger of a return to problematic use. One implication of this notion is that the only justifiable goal for the alcoholic or addict is abstinence. Furthermore, the idea that addiction is chronic and incurable is the underlying rationale for alcoholics and addicts who are maintaining sobriety for referring to themselves as "recovering" as opposed to "recovered" or "cured."

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