Understanding the drug and alcohol addiction treatment medical modelApril 11, 2016
There are a number of methods of treatment or treatment modalities used by doctors and other health professionals. This term is often used when describing psychological or psychiatric concerns. Drug and alcohol addiction is no different, and one of these approaches is known as the medical model of addiction.
What Is the Medical Model of Addiction?
The medical model of drug and alcohol addiction categorizes it as a disease. The American Society of Addictive Medicine defines it as follows:
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”
This treatment model means that drug and alcohol addiction is something that can be diagnosed based on the affected person’s behaviors. The course of the disease can be observed by physicians and other experts and its physical causes can be understood.
Addiction, often referred to as a brain disease, is a chronic illness that is often characterized by one or more relapses. Over time, a person who abuses drugs or alcohol will experience changes to the brain that make it difficult for them to think clearly and make decisions in the same manner as a person who is not addicted.
How Does the Medical Model of Addiction Treatment Assist Patients?
For a number of people who struggle with drug and alcohol addiction, the first contact they have with the medical model of treatment is when they visit the emergency room. The Drug Abuse Warning Network (U.S. Department of Health and Human Services) gathered statistics on national estimates of drug-related emergency department visits in 2011 and found the following:
Since this way of approaching drug and alcohol addiction treatment sees addicts as people who have a disease, doctors in the ED treat their symptoms to ensure they are medically stable. This part of the health care system is meant to deal with acute symptoms, and is not set up to cope with people who are living with a chronic illness.
How the Medical Model Works
The medical model of addiction recognizes that once the crisis that brought a person to the ED for help has passed, the client is still living with a drug and alcohol addiction. The drug use — and alcohol is considered to be a drug — is a symptom of the brain disease. Without appropriate treatment at a rehabilitation center, the person who leaves the ED will likely start using their drug of choice again relapsing back into active addiction.
Use of Medications
This treatment approach may include the use of medications at times when deemed appropriate. During the detoxification or detox stage of treatment, which is supervised by medical personnel at a treatment facility, clients undergo the process of becoming free from the influence of chemicals.
During this time, they will likely experience withdrawal symptoms. Symptoms of withdrawal can range from ones that resemble the flu — nausea, stomach upset, body aches, sweating, insomnia — to more serious ones including— anxiety, depression, seizures and suicidal thoughts.
Clients who are going through detox must be monitored closely. When appropriate, medications can be administered to treat the physical withdrawal symptoms and help a client feel more comfortable throughout this process. Medically supervised detox also helps to ensure that clients are safe during this process. In rare instances where clients experience severe withdrawal symptoms, medical personnel are available to intervene and arrange transportation to a hospital.
Medication is also used to treat clients with co-occurring mental health challenges and drug and alcohol addiction. It’s not uncommon for people living with a mental illness to also have a substance abuse problem and vice versa. Some disorders that are commonly associated with addiction are:
Our treatment facilities conduct detailed evaluations of all clients on arrival. This assessment evaluates their condition and assists in developing a detailed treatment plan. When a dual diagnosis is identified is it essential to treat both conditions concurrently. This is the way to get the best possible outcome. Medication can be prescribed to treat the mental health challenge while the client is receiving holistic treatment for drug and alcohol addiction designed to address their physical, emotional and spiritual needs.
Benefits of the Medical Model
The medical model of treating drug and alcohol addiction provides a number of benefits to clients and their families. This approach puts addiction squarely in the category of health concerns and focuses on helping clients move toward recovery.
Learn More Now
Helps to Remove Stigma About Drug and Alcohol Addiction
There is still a stigma around drug and alcohol addiction that is not present when discussing diabetes, heart disease or cancer. All of these health challenges have a lifestyle component attached to them in the same manner that addiction does. It is much less likely that a client who is diagnosed with one of them will be told they are responsible for their health concern or that it is the result of a “bad habit” and not a real disease, as some people living with an addiction have heard from friends and family members.
The medical model explains that not everyone who experiments with drugs and alcohol becomes addicted. Similarly, not everyone with the same risk factors will develop diabetes, heart disease or cancer. There are a number of factors determining who will ultimately become symptomatic. Some of these factors are present in a person’s genetic makeup, while others have to do with their upbringing and the types of experiences they had while growing up.
Another factor that must be included is each person’s personal makeup, which includes their ability to deal with stressors in their environment. Some people develop different coping methods that do not involve turning to chemicals, or they try them and for whatever reason don’t find them effective. Others will use chemicals and be attracted to this method of dealing with stressors and continue using it to the point where they become addicted.
Calling Addiction a Disease Opens Door to Treatment
When addiction is referred to as a disease, it allows doctors and counselors to address it as an illness to be treated. By the time a client gets to the point where they are getting detoxification services or going to a drug and alcohol treatment center, several years may have passed. During this time, the addiction has had time to take hold and develop into something the affected person no longer has control over. Unless they get professional treatment, they are unable to stop drinking or using drugs on their own.
With Treatment Comes Hope for Controlling the Disease
Part of the disease of addiction is denial about how their actions affect others. Treatment assists clients as they learn to take responsibility for their actions when they were actively using. The goal of treatment is not to punish an addict, but rather to help them understand they need to adopt a new way of thinking and living in recovery.
Addiction affects many different types of people. These are not bad people who are so deeply flawed that they are beyond hope, but people who have a disease that can be treated.
The medical model of addiction stresses that addiction is a chronic disease that can be controlled in recovery, but that addicts can never say that they are “cured.” Recovery is described as a journey, not a destination.
Other Addiction Treatment Models
There are a number of other treatment models of addiction and recovery used to explain why certain people develop substance abuse challenges.
Education Model of Addiction
The education model of addiction puts forward the idea that the lack of information about the possible dangers that could be caused by ingesting harmful substances is behind the number of people who become addicts. If more people had this knowledge, they would make better choices about their personal behavior and their health.
While this model of addiction does address the important subject of education as a deterrent to trying harmful substances before they can become a problem, it doesn’t say anything about what happens after a person starts using. The medical model explains why some people become addicts and offers them hope that recovery is possible.
Developmental Model of Addiction
The developmental model states that immaturity is the underlying cause of addiction. Humans continue to develop throughout life. However, their most important segment of development happens during childhood and adolescence. As they move through these stages, they develop the skills they need to:
- Delay acting for immediate gratification of impulses
- Learn to think about situations rationally to make wise decisions
- Consider their actions in terms of their relationships with others and the impact on society
For some people, a lack of development results in a failure to mature and rise above the level of pursuing selfish desires. They focus on achieving immediate pleasure, which is the payoff that results from addictive behavior. Another concern with this type of person is that they often fail to consider the consequences of their choices on themselves or the people around them.
This lack of “big picture” thinking indicates the person’s lack of maturity or development and needs to be addressed in treatment.
The developmental model of addiction assumes that if an addict can somehow accelerate their emotional maturity, or “grow up,” they can learn to make better choices and the addiction will not be a problem any longer, while the medical model states that the addiction is a chronic brain disease the addict has no control over.
Sociocultural Model of Addiction and Recovery
The sociocultural model of addiction looks at the cultural standards of a society to get clues to the way it may cause addiction. The U.S. tends to tolerate entertainment featuring performers portraying people under the influence of drugs and alcohol in popular culture. Someone can be arrested several times for DUI or DWI in several states before the penalties become very serious.
One of the risk factors for addiction is poverty. In communities where people have fewer chances to advance in life, they are more likely to be bored and frustrated at their personal situation. Daily living is a stressful experience that does not ever end, and a person caught up in a constant struggle to survive is more likely to be looking for some type of “escape,” which can be in the form of checking out by using drugs or alcohol.
This model relies on the environment and the culture as the reason for the addiction, as opposed to something in the addict’s makeup. It doesn’t fully explain why someone who comes from a “good” area or neighborhood would become addicted, since we know that addiction affects people from all socioeconomic groups and not just those from areas where money may be a problem. The medical model is one that could be applied to people from all backgrounds, since it does not rely on a person’s background or income level to come into play.
Find a Treatment Center for Yourself or a Loved One
If you are looking for addiction treatment for yourself or a loved one, ask plenty of questions before you make your choice. One of the things you should not be hesitant to ask about is the center’s approach to treatment. You’ll want to understand the facility’s philosophy about how addiction services are provided in order to make an educated decision. To find out more about JourneyPure Emerald Coast’s programs, contact us today.
Learn More Now
My first experience working in a clinical setting was in a Therapeutic Community for people with personality disorder and complex needs. Therapeutic Communities are very distinctive environments. They work by requiring genuine and sustained personal albeit professional relationships between clinicians and patients13 and between patients themselves. In more conventional healthcare contexts, the doctor-patient relationship is both formal and hierarchical; and there is no peer-to-peer engagement. The patient has a problem they cannot resolve on their own, and comes to the doctor for the cure. Both the doctor’s expertise, relative to the patient, and the medical nature of the clinical setting, serve to create a divide between them which can help protect doctors from personal involvement with their patients. There is both a power imbalance and a kind of emotional distance that structures the nature of the relationship and is maintained by the norms governing standard healthcare contexts. Therapeutic communities, by contrast, are informal, communal, egalitarian environments, that are committed to flattened hierarchies between clinicians and patients – all of whom are equally referred to as “community members” – where decision-making and responsibility for treatment is shared. Authenticity and emotional intimacy are central to the relationships between patients and between clinicians and patients. A great deal of time is spent together, not only in various forms of group therapy sessions, but also on everyday social activities and chores, such as cooking, eating, cleaning, gardening, or going on outings together as a community. “Community” really is the catch-word here – there is no retreat to “professional distance”.
As well as having personality disorder, many of our Community members also suffered from related conditions, such as addictions and eating disorders. Broadly speaking, these conditions are all what we might call “disorders of agency”. Core diagnostic symptoms or maintaining factors of disorders of agency are actions and omissions: patterns of behaviour central to the nature or maintenance of the condition. For instance, borderline personality disorder is diagnosed in part via deliberate self-harm and attempted suicide, reckless and impulsive behaviour, substance misuse, violence, and outbursts of anger; addiction is diagnosed via maladaptive patterns of drug consumption; eating disorders involve eating too much or too little. If a service user is to improve let alone recover from these disorders, they must change the diagnostic or maintaining pattern of behaviour . For instance, service users with borderline personality disorder must stop self-harming; addicts need to quit using drugs or alcohol; anorexics must eat. There are, no doubt, equally central and important cognitive and affective components to all these disorders. Borderline personality disorder involves instability of self-image and emotional volatility; addicts may use drugs and alcohol to deal with negative emotions and psychological distress; anorexics may have over-valued ideas about low body weight and express anger and achieve a sense of control by refusing to eat. Nonetheless, actions and omissions are diagnostically central to disorders of agency: effective treatment must address these core patterns of behaviour, even if outcome is improved by an integrative approach that engages with behaviour alongside cognition and affect.
Patients with personality disorder are notoriously difficult to treat. Within psychiatry they have long been stigmatized as the patients “no one likes”. But quite generally, people who behave in ways which harm themselves or others – as addicts and those with eating disorders also do – are often very challenging for clinicians to work with effectively, as the behaviour can provoke intense emotions and reactions. Within the clinic where I worked, addictions were regularly conceptualised as forms of self-harm: unhealthy ways of coping with negative emotions and psychological distress, offering relief in the short-term, but at the cost – often itself recognised or indeed even desired by the patient – of causing long-term damage and making things worse. It is extremely difficult to see people you care for treat themselves with brutal disregard.14 It is also extremely difficult to see them act in ways which have a terrible impact on others, especially those who may be dependent on them and particularly vulnerable, such as their children. Clinical work requires a good therapeutic relationship. But what is the right therapeutic attitude to take when patients directly harm themselves and indirectly harm others, whether through cutting, drugs, or other means?
Within the Therapeutic Community where I worked, the clinical staff were very clear about what their attitude should be, and usually, although of course not invariably, succeeded in achieving it. Community members were responsible for their actions and omissions and accountable to the Community for them – self-harm and harm to others was not accepted – but an attitude of compassion and empathy prevailed, and they were not blamed. As a novice clinician, this stance of responsibility without blame, as I was immediately inclined to describe it, struck me forcefully. And, if I am honest, I initially had no idea how this stance was so much as conceptually possible, let alone achievable for myself within my own clinical practice. I could make sense of the idea that, despite appearances, a Community member who was, for example, misusing drugs and seriously damaging their health, their relationships, their life and the lives of those around them, might not be responsible because their addiction excused them, and hence not to be blamed. In other words, I could readily invoke a disease model of addiction, to delegitimize blame by rendering their actions involuntary and so too the possibility of attributing any responsibility to them moot. And I could make sense of the idea that, despite their addiction, they were responsible, and hence to be blamed. In other words, I could readily see how the moral model could be invoked to purportedly legitimize any blame I or others might feel. But the combination of responsibility without blame for actions that caused serious harm – to patients themselves or to others – struck me as a philosophical and clinical conundrum.
What is the source of this conundrum? Both within philosophy and within our culture at large, there is a deep-rooted tendency to link the idea of responsibility fundamentally to morality, by holding that its point or purpose is moral evaluation: the assessment of another and their behaviour as good or bad, right or wrong. In addition, such moral evaluation is sometimes understood as fundamentally affective in form  – embodied and expressed in our feelings towards those whose actions we morally condemn. These feelings can include anger, resentment, hate, indignation, disgust, revulsion, contempt and scorn, and are often accompanied by equally hostile thoughts and actions. At its most radical, the link between responsibility and these sorts of attitudes and expressions might be thought to be constitutive: “to regard oneself or another as responsible just is the proneness to react to them in these kinds of ways” . More modestly, to hold another responsible might be understood to consist in believing that such reactions would be appropriate or fitting, even if one does not actually feel or do anything oneself [50, 51, 52]. But such nuances aside, the idea of responsibility to emerge from this picture links it fundamentally to moral evaluation via our practice of responding to others with what is in effect an affective form of blame – a set of hostile feelings typically accompanied by equally hostile thoughts and actions.15
Clinical practice offers a corrective to this deep-rooted tendency. Effective treatment of disorders of agency – where core symptoms or maintaining factors involve actions and omissions, including those that cause harm to the patient or to others – requires clinicians to engage with patients as responsible agents with regard to their behaviour in order to help them to change [37, 41, 46, 47]. This is because improvement or recovery from disorders of agency requires patients to break the cycle by doing things differently. As Lewis emphasises, the disease model and its corresponding “sick role” do not aid addicts in this process. After all, people will only try to change what they believe lies in their power to change [37, 53, 54]. Hence the clinical task with such patients is not to deny their agency and rescue them from blame by pathologising their behaviour, but to work with them and help them to develop their sense of agency and responsibility – to support and empower people to make different choices. In the clinic, the purpose of employing the concept of responsibility is therefore not fundamentally a form of backwards-looking moral evaluation, whereby a person is judged and potentially condemned for their past behaviour. Rather, the purpose of employing the concept of responsibility is fundamentally forwards-looking, serving to identify where there exists capacity for change thanks to the presence of choice and control, and, through clinical practices of holding responsible and to account, to motivate and encourage people to break the cycle – to develop, learn, and ultimately change what they choose to do and their sense of who they are and can be.
Of course, the exact nature of clinical practices of holding responsible and to account varies between therapeutic modalities. But within Therapeutic Communities, they typically include direct and challenging feedback, so that the negative effects of problematic behaviour on self, others and relationships is made explicit and must be faced, potentially alongside the imposition of consequences if members nonetheless continue to repeatedly engage in it (usually with advance warning and the individual’s agreement). These consequences inevitably involve a reflective component, whereby the history, circumstances, and conscious or unconscious psychological function of the problematic behaviour is explored, in order to develop a person’s own narrative self-understanding so that they can better identify what is stopping them from changing and develop a plan for how to succeed in future.16 But they may also involve measures that can potentially feel punitive, such as withdrawal of privileges, or time-limited suspension from the group.
It is a staple of clinical practice that, because these forms of holding responsible and to account have the potential to feel punitive, they must be effected with an attitude of concern, respect, and compassion, as opposed to being accompanied by or expressive of any of the feelings, thoughts or actions constituting an affective form of blame. For, once again, the point is not to morally evaluate and condemn, but rather to care for patients and help them improve and recover. Affective blame is understood within clinical practice to undermine the capacity of responsibility and accountability to enable change and empower, because of its propensity to make patients feel rejected, worthless, ashamed and uncared for, thereby rupturing the therapeutic relationship as well as damaging any sense of hope for the future they might otherwise have, and, correspondingly, any motivation or belief that they really can overcome their difficulties [37, 39]. The clinic thus offers a corrective to the tendency to understand our concept of responsibility as linked with affective blame, by offering a clear and established practice of attributing responsibility for problematic behaviour and holding to account without affective blame, but instead with positive regard, maintaining attitudes such as concern, respect, and compassion throughout.
Hence reflection on clinical practice brings into sharp relief a distinction between whether the patient has choice and a sufficient degree of control over their behaviour to be appropriately asked to take responsibility and held to account, and how others respond to patients who are responsible for behaviour that causes harm during the process of addressing it and holding them to account. Community members may be responsible and held to account for behaving in ways which are harmful, but without affective blame colouring the attitudes and actions of those engaging with them throughout this process.17
In effect, the clinical stance of responsibility without blame charts a course between the moral and disease models of addiction. On the one hand, like the moral model, it acknowledges the role of choice in addiction, thereby opening the door to the possibility of responsibility. Of course, it is important to recognise that choice and responsibility are not all or nothing, but come in degrees. People can have greater or fewer choices genuinely available to them, and more or less capacity for control. Those, like many addicts, who come from disadvantaged backgrounds typically have fewer available choices; equally, in so far as drug use is a habitual pattern of coping with negative emotions and psychological distress, the desire to use will not only be strong but equally serves an important psychological function. It is therefore extremely difficult to forego drugs unless and until the underlying feelings and difficulties are addressed, alternative healthier coping mechanisms are learned, and more options are available. For these and other reasons, agency may sometimes be diminished compared to the norm, and responsibility correspondingly reduced. But reduction is not extinction: choices may be limited and control hard to achieve, without either being nullified.18
On the other hand, unlike the moral model but like the disease model, the clinical stance of responsibility without blame maintains an attitude towards addicts of care. But it does not achieve this by denying addicts their agency in order to exculpate them from responsibility, thereby making any improvement or recovery dependent on a medical “cure”. Rather it aims to mobilize a sense of agency and empowerment in addicts, avoiding blame not through conceiving of them as helpless victims of disease, but through acknowledging and working with their agency without adopting moralising or stigmatising attitudes and practices. Undeniably, this runs counter to many aspects of the current cultural climate, which both appears to have a near insatiable appetite for self-righteousness and blame, and – as we saw at the opening of this article – severely stigmatises drug users and addicts. But – and this is the key point – just as those we may find ourselves unthinkingly inclined to blame and stigmatise often have a choice over their behaviour, we have a choice over how we respond. There are choices on both sides.