How well does the disease concept apply to addiction?

The disease concept had a humanizing effect and lessoned the impact of the stigma attached to alcoholism/addiction. This shift in perception ran counter to the prevailing ignorance at a time when alcoholism/addiction problems were associated with a lack of willpower and/or moral character.

However, while the medical model led to a more compassionate and enlightened approach, it left gaping holes in our knowledge base. The disease concept doesn’t adequately explain what an addiction is, how it works (in terms of emotional and psychological dynamics); nor does it adequately account for etiology (why people become addicted.) In terms of treatment implications, it makes for a short-sighted vision as to what treatment and recovery entail.

The relationship aspect and emotional dynamics of the disease were never included by the medical establishment as these issues are not befitting of the scientific method; viewed as subjective in nature and therefore untreatable.

Extending the relationship concept to the disease merely implies that a relationship is established, a pathological relationship – not with another person (although it could be with another person), but rather with an object, a source of relief; in other words, a substance or activity. It may not be a relationship with a person, but it is a real relationship nevertheless.

This relationship takes over the person’s functioning. It is a survival-based attachment, the primary relationship in the addict’s life, more powerful than any other. There is no emotional nourishment provided in this relationship, only relief: relief that is artificially induced and short-lived. It’s a relationship that is emotionally-driven, not physically – especially in the earlier stages, before a physical tolerance develops. It may be likened to falling in love – or, more accurately, to a secret love affair.

Understanding etiology (why people become addicted in the first place) is another area that is not adequately addressed by the traditional medical model. The medical model explains etiology in terms of genetics and chemical imbalances, when these are really only correlates, not causes. The countless number of addicts who don’t necessarily fall into those categories remains unaccounted for. Why do people get into pathological relationships? Why do people get into relationships with sources of relief rather than emotionally nourishing ones?

Addiction can be sourced back to the existence and preponderance of non-emotionally nourishing relationships, both past and present, and to the residue of pain they leave behind. We may describe the psychosocial context of addiction as widespread and pervasive emotional deprivation.

The greater the level of pent-up pain from unmet emotional needs, the greater the need to relieve that pain, and the more susceptible one is to a source of relief, to getting involved in yet another non-emotionally nourishing relationship.

From a relationship perspective, it becomes clear that the need to relieve the backlog of emotional pain from non-emotionally nourishing relationships is the driving force of addiction.

There are treatment and recovery implications when using this relationship model for understanding the emotional dynamics of addiction. Traditional recovery and treatment approaches target restoration of behavioral stability and baseline functioning as primary goals. These approaches also include the need for lifelong participation in a 12-step fellowship, which is integral to any recovery program. It is clear that the fellowship is a vital and indispensable source of sober support, a place to go for a sobering reminder about what it means to be an addict.

However, for many addicts, many questions remain unanswered. What’s next? What is beyond sobriety? Based on this relationship model of addiction, the ability to create emotionally nourishing relationships is key to a quality, sustained recovery. Getting beyond sobriety means gaining the experience and skills necessary for transforming the quality of one’s relationships.

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About Daniel Linder, MFT

Daniel Linder

Relationships. I was born with a keen sense about relationships, was always assessing how close and intimate people are with each other. I had a knack for relationships. The importance of relationships cuts to the core of who I am. The combination of clinical training, 25 years of professional experience treating dysfunctional, non-intimate couples and families, as well as rigorous self analysis has given me a lot to work with. I put what seemed to come naturally to me under a microscope in an effort to break the process of building healthy relationships down to concrete essentials: Understanding of Basic Principles, Communication Skills, Self-realization and Intimacy.

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