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Moral Model

For several hundred years, conceptions of tobacco, alcohol, and drug dependence have been based on incongruent beliefs involving moral judgments and medical considerations. To this day, neither set of beliefs has supplanted the other. As a result, in the general population there is much disagreement and confusion about the nature of addiction and how to best address problems involving substance abuse. These conflicting views are at the center of the ongoing debate about public policies on tobacco, alcohol, and other drug abuse prevention and treatment. The moral model can be considered the philosophical foundation of much of the U.S. federal drug control policy and the so-called War on Drugs.

Features of the Model

In the moral model, addiction represents a refusal to abide by some ethical or moral code of conduct. Excessive drinking or drug use is considered freely chosen behavior that is at best irresponsible and at worst evil. This conception of addiction does not require one to equate addiction with the sinfulness of committing rape, larceny, or murder. Nevertheless, in this view addiction is seen as misbehavior because substance use is thought to be freely chosen conduct. Persons who are dependent upon a substance are not considered to have experienced a loss of control. Instead, they are seen as selfish and hedonistic and personally responsible for creating suffering for themselves and others. Therefore, they are blameworthy and the justified targets of punishment and are thought to deserve the health and medical problems, employment problems, and legal sanctions that they encounter. Furthermore, punishment is perceived to be a viable and credible means of deterring further involvement in substance use and abuse. Relapse is generally considered evidence of lingering evil that needs to be suppressed with the threat of further sanctions.

In American culture, the moral model of addiction has long been the guiding conceptual framework of politically conservative groups, law enforcement organizations, and some zealous religious communities. Also, U.S. politicians have been known to appeal to this sentiment by proposing tougher legal penalties for possession and distribution of illicit drugs, underage drinking, and for alcohol-impaired driving. Unfortunately, U.S. history is marked by failed government efforts to eliminate addiction via criminal legislation and law enforcement actions. The crackdown on Chinese opium smokers in the 1800s and the enactment of Prohibition in the early 20th century stand as two noteworthy examples.

Disease Models

To fully understand the conceptual underpinnings of the moral model, it is necessary to contrast them with those of the disease models of addiction. In the latter view, substance use and abuse is seen through a different lens—it is considered to be a disease process. Persons who are dependent upon a drug are thought to be suffering from an underlying disease process that causes compulsive use. In other words, the high rate and volume of use are merely the manifest symptoms of a latent or less apparent illness. The exact nature of the illness is not fully understood at this point, but many proponents of the disease models believe that it has genetic origins. For these reasons, it is hypothesized that individuals cannot smoke, drink, or drug themselves into addiction. If the disease (possibly arising from a genetic vulnerability) is not present, then a dependency will not usually develop.

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