In working with individuals struggling with alcoholism, I've heard the disease statement many, many times. In some instances it served a positive purpose, providing certainty and direction; in others it served a negative purpose by empowering the addiction and undercutting self-efficacy. There has always been something that doesn't sit well with me regarding the disease approach. For my therapeutic approach to addiction, click here.
The word “disease” has a medical connotation. You have a disease, you see a medical doctor, go to a hospital, have a treatment possibly with medication. That's the association that I make, maybe I'm in the minority. In many cases, a disease suggests that the condition was something out of your control. Diabetes, cancer, multiple sclerosis. In some cases, there is little to no control, in others our choices have made them uncontrollable.
A major hurdle for the field of psychology is feeling inferior to the field of medicine. The former is a social, pseudo-science; the latter a legitimate, biological science. In a grasp for legitimacy, research has rapidly become the norm in psychology. Scientific terms like “evidenced-based”, “empirically-supported”, and “etiology” are commonplace. Research certainly is not a bad thing (even though it can be fallible), many advances have come from research. However, has the drive for legitimacy and respect had a negative impact on psychology?
Why does any of this matter? Great question. A major part of treatment is based on how a condition is conceptualized. In the case of alcoholism, my concern is the use of “disease” takes away from the social and psychological contributing factors. I'm not ignoring decades of research that give credence to genetic and biological factors of alcoholism. However, I believe alcoholism grows out of a combination of social and psychological issues to become a serious condition often requiring medical intervention.
In graduate school, a professor argued feelings weren't social, biological, or emotional. They were chemical. The release of a specific neurotransmitter. It's hard to argue that point, and you can make a parallel argument for the underlying factors of alcoholism (or most any condition, disease, or disorder for that matter). Bias to my training, in most cases I lean psychological. Even when the presentation is medical, I focus on the psychological variables. I am encouraging other clinicians to shift their perspective. If you aren't convinced, then consider conceptualizing alcoholism as a social or brain disease.
To be clear, I'm not advocating that society, clinicians, or friends and family should be more critical and harsh to those struggling with alcoholism. I'm suggesting the term “disease” can minimize personal factors and increase the belief that since it's a disease it is out of a person's control. I'm not saying this is the majority belief, but it does exist. I hope this post has brought a different perspective to a condition that has impacted millions.
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