Moving Beyond The Disease Model Of Addiction

Moving Beyond The Disease Model Of Addiction

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Is addiction a disease? In recent years, especially amid the opioid epidemic, more people are saying yes, addiction is a disease that needs to be treated like any other medical ailment. But that view is limited, says Geoff Thompson, PhD., program director at Sunshine Coast Health Centre, a non-12-step treatment center in British Columbia. 

“The disease model is neat and tidy. That’s its appeal but also its limitation. It leaves no room for any messy human thoughts and behaviors,” Thompson says.

At Sunshine Coast Health Centre, treatment is based not on the disease model, but on the belief that addiction is a response to a life that is lacking meaning. Here’s what that means for treatment, and recovery.

What is the Disease Model?

The disease model professes that drug or alcohol use is a compulsion. People who are addicted have no control over their actions, the model says. 

“Regardless of what a person wants to do, the person has no choice,” Thompson says.

The disease model is widely accepted by the medical establishment and by 12-step traditions. However, it hasn’t been fully accepted, Thompson points out. 

“The public does not accept it, and the courts are clearly not convinced,” he says. 

There’s lots of evidence that counteracts the narrative that people with addiction are powerless over their disease, Thompson says.

“We have real life examples showing that those who are severely addicted to heroin often choose not to use the drug when it is put in front of them—a situation that contradicts the idea that these heroin users have no choice,” he says. 

An Alternative Model

Rather than viewing addiction as a disease, the staff at Sunshine Coast Health Centre sees addiction as a consequence of a life without meaning. This approach is rooted in the work of neurologist and psychiatrist Viktor Frankl, author of Man’s Search for Meaning.

“There is genius in this definition. Interpreting addiction as a problem of meaning does not deny it has a physical substrate in the brain,” Thompson says. 

Frankl’s writing, and subsequent work in this vein, has showed that addiction is complex and multifaceted. 

“If we really want to understand addiction, we have to recognize that it is far more than merely the drugs’ effects on the brain; addiction operates at the level of a fundamental motivation to make sense of ourselves and pursue a meaningful life,” Thompson says. 

Building a Meaningful Life

With this in mind, Sunshine Coast Health Centre has a scientifically-based program that emphasizes creating a meaningful life. Clients are empowered to build a life that is meaningful for them, rather than told that they are powerless over a disease. For many people, this switch is positive, Thompson says. 

“Clients resonate with addiction as a problem of meaning far more than they do with the idea of addiction as a disease over which they have no control,” Thompson says. 

Therapy at Sunshine Coast focuses on building meaning. This has three components: self-awareness, positive relationships and intrinsic motivations. 

When clients pursue meaning in their life — however they define that — they have a reason to do the work required for recovery. 

“We partner with clients to help them develop their own recovery,” Thompson says. “The basic idea is that contented people have a reasonable understanding of what is important to them; they understand their limitations as well as their strengths; they know what they want or desire. They are anchored within themselves and a realistic appraisal of the world around them. From this internal anchor, they reach out into the world making choices that reflect their values and beliefs.”  

This extends into all areas of the client’s life, just as addiction did. 

“Through the lens of meaning, addiction affects people holistically,” Thompson says. “It’s not surprising that regardless of what addiction researchers study—effects of drugs on the brain, cognitions, affect, family, workplace—we’ve discovered that addiction stamps itself into every aspect of the person’s life.” 

Sunshine Coast Health Centre is a non-12-step drug and alcohol rehabilitation center in British Columbia. Learn more here.

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