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The Disease Model

October 10, 2009
by Lynn Sucher
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I’ve been reading the recent articles on the new cocaine vaccine and was stuck by a comment by Dr. Nora Volkow. Dr. Volkow, the director of the National Institute on Drug Abuse, said “the research exemplifies a transformative perspective on drug addiction. By targeting it (drug addiction) as a medical disease as opposed to a moral dilemma, we’re likely to come up with solutions that have a much longer impact”. This quote made me realize an actual paradigm shift is taking place not only in the way we treat addiction, but how the public perceives this disease. However, to hear that pharmaceutical companies may not be interested in producing this or other “addiction” vaccines is disheartening.

My husband, an addiction medicine physician, and I have talked endlessly about the disease model. He works with impaired professionals who are often enrolled in monitored aftercare programs. When his patients are drug tested, he does so because he wants to know if they are still in remission from their disease. If not, what type of treatment do they need? What will best help them recover? He has been open to trying new drug treatments and has found them very helpful.

Change is often hard and I think it’s important to keep an open mind when it comes to treating addiction. If the pharmaceutical companies believe the professional addiction community is going to be supportive of new medication or vaccines, then maybe they will consider producing them.

If there are new advances in medicine that help our clients, that’s wonderful. It doesn’t mean that 12 Step programs and psychotherapy aren’t valuable therapeutic modalities. If the psychotherapists, addiction specialists and the medical field can find a way to dialogue on a regular basis, the research and development of new treatment options will benefit everyone. Is there a way to start a forum of some sort, so those of us on the front lines can communicate better with medical researchers and show our support for new vaccines and medications? If you have any thoughts, please feel free to comment.



I didn't read the full text of Dr. Volkow's speech, but it was strange to read that she considers the disease model a recent innovation in addictions treatmtent field. E.M. Jellinek wrote the book a half-century ago. and it's been mainstream for decades. But we need to reflect on the components of the disease model. Do we still subscribe to the notion that addiction is an inevitably progressing disease, as did Jellinek, NCA, and AA in those days? Jellinek studied a small sample of "low bottom" alcoholics in AA, excluding those who stabilize or fluctuate at a higher level, recover naturally, etc. Early on, I had colleagues who claimed that the disease progressed WHILE THEY WERE SOBER. I seldom hear this anymore, showing that there is some sort of dilution of the original paradigm among hard-core adherents.

Peter L. Myers, Ph.D.

I have been fighting alcoholism since the age of twelve, and heroin addiction from the age of twenty-eight. I am 50 years old and have been in recovery for almost 8 years. I am a Certified Alcohol and Drug Counselor, and 5 months away from a masters degree in Addiction Studies. I always looked at addiction as a disease progressive, primary, and fatal that is up until two years ago. Although I believe that one does indeed have some genetic predisposition, it remains dormant until activated, activated by choice. The choices we make are ultimately ours, regardless of how they were presented. I am a firm Trantheoretical Model proponent. It is grounded in the belief that there are many factors that contribute to addiction, and that there are also many factors that contribute to its demise. The field of addiction counseling is finally making headway in treating the 'disease'. I, as a counselor, pride myself in being skillful at integrating many psychotherapy theories, just as TTM does. The bottom line is that if we 'treat' addiction as a behavior, then we can 'treat' recovery as such too. The path to addiction is paved with a series of choices, that eventually become set behaviors, ones that demand pacification. Okay, now let us work the path backwards, another series of choices, that become behaviors, again, only these behaviors are not as 'demanding' as the problematic ones. These choices, result in behavior changes that are healthy for all of society. Instead of looking at addicts as a whole, as the scourge of the earth, let us look at them as individuals, asking silently for help and guidance in making the right decisions. In reality, not everyone makes the right choices everytime. If we stop persecuting those who persecute themselves, they might actually ask for help. It is all about change, global change, change in our attitudes, discriminations, prejudices, and stigmas. Society, as a whole needs to step down, from our pedestals, and individually, will see that we are not above change.

I'm so heartened to read your open view about embracing alternative treatment methods in addition to the twelve steps and psychotherapy. Yes - let us dialogue on a regular basis.

I am a holistic chiropractic physician and board eligible diplomate of the American College of Addictionology & Compulsive Disorders, being trained by Dr. Jay Holder, M.D., Ph.D., D.C.

I am also a recovery compulsive overeater and daughter of alcoholic. As both doctors of medicine, psychology, chiropractic and oriental medicine begin to share valuable information all patients will benefit and we will be able to eventually remove the stigma addiction has had for so very long.

I just today found your website and am very gratified. Don't know how to subscribe to your RSS feed because I don't know what type of RSS "reader" I have but I will visit and signed up for your newsletter.

I shared your link with Dr. Holder. I am unable to write a webinar proposal for your upcoming series by 10/15 but perhaps he will.

Thanks for your thoughts,
Dr. Christina Winsey-Rudd

Follow up on Dr. Myers comment: I agree with your point. However, Jellinek actually proposed five types of alcoholics with various degrees of progression and chronicity. He did not subscribe to a unitary disease model however, the addiction profession has generally taken that view. The DSM uses the word "disorder" instead of disease. This seems to me to be a more neutral term that leaves the debate about classification of addictions open.

In responce to Dr, Myers, that he seldon hears that the disease is progressive. I have never heard anyone who has relapsed state that it was not worse. The progression we are talking about is the emotional deterioration, such as the reappearance of guilt, denial, and shame, which usually is more intense

Its my perception that a lot of the reluctance to use of the disease model has been that it traditionally it 'categorized' patients into 'boxes' with treatment protocols then limited to what options are in the 'box',

There are two interesting trends that have changed this attitude 1) a focus on wellness where diseases can be viewed as 'episodes' along a broad patient care pathway and 2) new workflow automation technology that accommodates patient and provider centric input at decision points along what no longer need to be 'disease-specific' workflows.

I believe in the disease model of addcition, and yes still hold to the notion that addiction is an inevitably progressing disease. I also believe that it take a whole treatment facility and more working together to treat an addiction in or out of a treatment center. So yes getting together and having open dialoge about ways of addressing addiction will alway bring on positive change.

Lynn Sucher

Lynn Sucher, MC,...

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