Models of Addiction Treatment

Why would survivors and their families care about the different ways addiction is viewed and treated?

Most importantly: Many survivors have relied on alcohol or drugs to cope with pain. Understanding views – and biases – helps identify your best options when you are ready to choose a path toward change.

Also importantly: It takes courage for every survivor to begin to seek long-term professional support at all, let alone to make a list of questions and interview potential therapists about training, views, and approaches.

Four long-lasting views of addiction were summarized in a series published by the Recovery Systems Institute and entitled Models of Alcoholism and Drug Addiction, by C. Scott McMillion. No one view had the “magic bullet,” and each was defined by limits.

The Psychoanalytical Model of Addiction has contributed to an important aspect of understanding addiction. This model focuses on the causes of addiction, seeing unresolved issues from the past in the interplay among Id, Ego, and Superego. Originally, the focus was on addressing only the past unresolved issues as the sole answer — delivering minimal results. The important influence of this model continues; for example, when we hear addiction attributed to “underlying emotional problems” we’re hearing the influence of psychoanalysis on recovery therapy. One problem with this model, according to McMillion, is that addictive personality traits can be the cause of an addiction, but they can also be the result of an addition. Figuring out the causal emotional issues for focused treatment can prove impossible.

The Medical Model of Addiction is crucial but has limits, too. Noting that people generally assume health care treats addiction as a disease, McMillion explains that medical science has indeed advanced greatly in treating the acute illnesses associated with addiction, e.g., detox. It has also acknowledged and begun, as have many (not all) psychotherapists, treating addiction as a chronic illness requiring more than a short-term medical intervention, however.

The Temperance Model is presented as historical—and moralistic—and failed. It is presented as linked to the Temperance Movement and Prohibition. Addiction is treated as a moral failure. The addict has weak character and, for his sin, needs to offer a sincere apology and even penance. However, its influence remains in bias toward addicts and toward survivors of trauma. McMillion explains that this model first introduced the lasting idea that spouses, families, and friends can somehow be responsible for intervening, convincing, even forcing an addict to repent (or a survivor to “get over it”); this view persists as social pressure even today.

The Moderation Model is presented as socially dominant now, with an estimated 90 million drinkers in America wondering what’s wrong with the addictive behaviors exhibited by another 10 million friends, family members, and colleagues. This model assumes that a drinker makes a conscious choice whether or not to drink, and that a failure to drink in moderation it due to a lack will power. The problem is that addiction overrides the power to choose. It is marked by a loss of control, in particular a loss of impulse control.

My closing note is that many therapists working with addiction are eclectic, taking the best from different schools of thought and working with an emphasis on each person’s unique needs. Many approach therapy as a partnership, not an authoritative relationship. The same is true of therapists who work with those who have suffered abuse. Yet, it’s important to understand how a therapist views addiction or abuse. Since the end of the 20th century, over 60 different schools of thought interpret abuse, its causes, and its treatment in different ways. That’s why it is important to talk with your therapist about their view of both trauma and your faith. You will find such conversations fruitful before or after making your long-term commitment.


SOURCE: Scott McMillion. Models of Alcoholism and Drug Addiction. Recovery Systems Institute. July 15, July 25, August 15, September 1, 2013. Accessed 12/9.20. Other resources from the RSI may be found here. @RecoveryInst

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