Thursday, September 29, 2016

How Disease Models Strangle Science

In some quarters substance abuse is rigidly defined as a "disease". Professionals trained from that perspective, as well as many addicts who recovered through 12-step groups, often hold onto this point of view very firmly. Explorations into other perspectives, and their resulting approaches to intervention, are often seen as heresy within those communities. I am personally aware of one facility which only allows medical protocols due to its fidelity to this paradigm. When one whispers "What about harm reduction?" this is met with gasps and even shaming, which is odd given the role of shame in substance abuse.

While disease models do allow sufferers to be unburdened by needless shame, and may help some on the higher end of the abuse spectrum, they cannot help the other 80-90% of those affected. Substance abuse is well-known as a stubborn, intractable problem for many people. For this reason alone we ought to creatively explore as many options as possible for investigating and helping.

Some are proposing that addiction is not a disease at all. They point to a consistent lack of supportive data (except for brain changes that may result from addiction), and argue for approaches focusing on skills like mindfulness and understanding the role of history in the development of abuse behaviours. Others believe that addiction is actually a method of disconnecting from relationships since, by definition, one is not functioning in reality when one escapes it. So, some people turn toward escape as a means of coping with problematic interpersonal patterns. This approach offers many possibilities in terms of program and service development. It is even easy to see how 12-step programs such as AA address addictions through the development of community.

Every field has its sacrosanct positions, sometimes borne of economic or political motives. That rigidity is dangerous in that it may stifle thought, investigation, and creativity. Of all fields one would think that mental health needs this degree of openness most of all.