First, I think this thread should be addressing: Is ADDICTION a disease or something else? Alcoholism is just one of many kinds of "addictions."
I think there are a number of problems to address, one being the definition of "addiction." Far too often, it seems to me the term "addiction" is thrown around anytime someone becomes habituated to anything, whether or not the individual is habitually moderate or habitually excessive.
"Addiction" has thus become a term largely synonymous with Obsession. Which is a shame, because there certainly are "Real" Physical Addictions which an individual does not have any control over. Their Physiology literally overpowers their "will." I think in such cases, the Disease Model of addiction is very appropriate.
My problem is that the Disease Model of Addiction has become a Blanket Model for all "addictive" behaviours. Another issue for me is that groups like AA have conflated their Sin Model of addiction with the Disease Model of addiction.
Further confusing the issue is the "Behavioural" Model of addiction, which frankly isn't very dissimilar to the Sin Model of you think about it. They both posit "addiction" as a behavioural problem, and are both a means of Behaviour Modification. Though clearly the Behavioural Model is the more empirically based model of the two, in that God is not necessary for behaviour modification.
Yet still nagging at me is the idea that any one particular model is useful in all cases of "addiction."
Some people really
don't have any control over compulsive behaviour, and expecting Behaviourism, CBT, and the like to be effective in these cases seems ridiculous on the face of it, as it requires the individual to make changes that they
can't effect themselves (not to mention that there are certain ethical quandaries that arise when it comes to "behavioural modification" programmes--an issue for another thread perhaps). In such cases chemical intervention may be the only means to break the compulsive behaviour pattern; one could ostensibly consider such cases as falling into the Disease Model of addiction.
Now to back up a bit, I want to address the whole Puritanical Addiction Ideology that suggests that all "addiction" is "bad." I think sometimes self-medicating is a reasonable means of coping with life's misfortunes.
I made some comments on the AA/Religious thread that I don't think I can restate any better than I already have so here they are:
...the CDC and the Medical Community's lumping together of all forms of alcoholism into a disease model is dubious, and politically (rather than medically) based on the Sin/Disease model that has become the de facto model for addiction. It has become more a PC article of Faith, thanks to AA's cultural propaganda. This is probably one of the key reasons why I dislike AA so much.
As I pointed out earlier, the reasons for "addictive" behaviour are varied, and shouldn't all be treated in the same manner. The Medical Community has truncated its own ability to respond empirically by adopting the "Disease" Model of "addiction".
Indeed, it's even debatable that some forms of "addiction" are always "bad" and must always be treated. The Medical Community (particularly in the US), with its strong ties to the Pharmaceutical/Insurance complex make big money off of this dubious classification of "addiction" as "disease".
It's not so easy to separate out the political/economic factors that drive the growth of the Mental Health Industry from ACTUAL biological problems stemming from neurological and psychiatric disorders. Often, people self medicating with relatively safer drugs like Marijuana, are forced by the legal system to buy expensive, dangerous, and barely tested pharmaceuticals.
Chronic Pain sufferers are forced into strict dosage regimens of opiate based drugs when higher doses might actually be more beneficial, because doctors have been constrained by the political ideology of addiction.
AA is directly responsible for creating much of the Puritanical language, and shaping the political debate--particularly in the US, and by extension its allies--surrounding "Addiction", Prohibition, and the Drug War. It is no accident that it was founded by Protestants, and that it continues to promote a Puritan Ideology.
Part of my problem with a lot of Recovery Organizations, is that I think the whole environment has been "corrupted" by the puritan influence of religious temperance movements and their off-shoots like AA.
Society has become so paranoid about "addiction" that it shapes the whole debate and fuels the Drug War. So I don't just question AA because it's religious; I question the whole Anti-Addiction "Industry" because I think it is based on a lot of varying questionable assumptions that all seem rooted in the questionable assumption that "habitual" use of "drugs" is always wrong, even when ostensibly medically necessary.
This has made doctors increasingly paranoid about being prosecuted, and thus they often don't treat chronic pain patients with enough pain-killers to be effective. This has been enumerated by a Chronic pain Specialist I heard on NPR (and anecdotally, by my own doctor when she explained why she couldn't prescribe me enough to control my own chronic pain problems. And my protestations about the situation fell on deaf airs in NA meetings when family members pushed me to try to "kick the habit").
The whole Addiction Ideology also affects the arbitrary drug schedule classifications of rather innocuous, and potentially beneficial, "drugs" like marijuana.
The Commercial imperative of Big Pharma is also a major contributor to the current addiction ideology, as they make a fortune getting people legally hooked on THEIR drugs. So AA and Puritanism isn't the only "bad guy" in this propaganda picture.
But Puritanism seems to be the primary motivator behind Addiction Ideology, and I think a great case can be made that this is due to the internalization of Protestant ideas in society at large, to the point where they don't even seem religious at all.
So whether Recovery Groups posit a Sin/Disease Model as does AA, or a Behavioural Disorder Model of Addiction as does RR, they still subscribe to the notion that all habitual use of "drugs" is always wrong, and that negative outcomes are always the fault of the user rather than occasionally the negative attitudes, and laws of society.
...I think a lot of people with major substance abuse issues can't always "choose not to use" (not through any fault of their own).
Though clearly, many other people can still make choices (but to the extent to which they can make a choice it's not clear to me that such people actually need to stop "using" their drug of choice). It's the people that aren't able to effect change in their lives and are engaging in life-threatening behaviours that need the most help.
And I think this is why almost NO form of therapy currently available is particularly effective (though studies of breaking addiction patterns with psychotropics hold some promise, but these are unfortunately frowned upon in the current political climate). And this is why any program with a "one size fits all" approach is doomed to abysmal recovery rates.
I think that we will eventually find that most effective is treating the underlying problems that cause people to fall into heavy abuse patterns (Schizophrenia, Depression, Anxiety, OCD, Chronic and Severe Pain, Genetic predisposition to addictive behaviour patterns, coping with personal Financial Problems, coping with abuse, coping with living in an oppressed population group, coping with living in a highly demanding society that forces most people to work for less and less and being put out of work and out of house by Fat Cats who control and destroy economies, coping with living in a War Zone...etc, etc.). In some of these cases, helping people to USE drugs more effectively, might actually be better than helping them to stop using.
PS: It's about time society got of its moral high horse regarding the habitual use of drugs
So, in a nutshell, I think all models of "addiction" (except the sin model) have some validity in some cases. But I think the whole concept of "addiction" needs to be completely reworked to begin with, and for that we need a less Puritan political climate.
GB
). 
