Most of us have grown up valuing self-control, sober judgment, and self-reliance. We look at addiction as a disgrace - something to be ashamed of. It represents lack of character and moral failure. We look at addicts as people who are untrustworthy, unreliable, irresponsible, and self-centered.
Many religions view alcoholism and drug addiction as sinful.

Ridding yourself of addiction, according to this line of thinking, involves realizing that you have a problem, repenting, and moving on in your life with renewed self-determination and responsibility.

On the other hand, addiction treatment centers teach addicts and their families the disease concept of addiction, which views alcoholism and addiction as a complex physical and psychological disorder. Addicts and alcoholics are felt to be sick and in need of treatment and understanding.

Addiction is viewed as a chronic, relapsing, and potentially fatal disorder that can be treated if the proper conditions are met. Addiction professionals employ therapeutic techniques to deal with denial, research is done on medications that reduce cravings, and various therapeutic models such as cognitive-behavioral therapy are put forth as solutions.

These two positions - the moral model and the disease concept - are fairly divergent. But once again, like most things that have to do with addiction, both positions are too simplistic to capture the entire nature of addiction. Neither position is wrong, but neither is completely right.

Addiction is a brain disorder that some people are more prone to develop because of genetic, psychological, or environmental risk factors. But it does take an act of will - many acts of will, in fact - to get down the road far enough for the brain disorder of addiction to develop. Does this mean that people who develop addiction have only themselves to blame?

No, I don’t believe so. Life is so complex and has so many unforeseen risks that it makes no sense to place blame on the alcoholic or addict.

On the other hand, if you have an addiction it is still your responsibility to do something about it. It is around this issue of responsibility that the moral model of addiction and the disease concept of addiction come together. As I have lamented in many a treatment team meeting, “You can lead a horse to water, but you can’t make him not drink.”

Another way of looking at addiction is to think of it as a disorder of will. When the addiction sets in, your will is taken over by the need to use the drug - sometimes not completely, but enough so that you end up drinking or using a drug more often or in a greater quantity than you expected to.

And as a result, your priorities change. The need to drink or use drugs takes precedence and leads to all kinds of dishonest, self-centered, and irresponsible behaviors. All too often the end result is incarceration, brain damage, or death. But if you take even the smallest step in the direction of sobriety and recovery, then you can take advantage of the therapies and treatments offered for the disease of addiction. This idea - taking the responsibility for one small step towards sobriety - is basic to recovery, and is reflected in the Alcoholics Anonymous slogan “Just for today.”

In my opinion, the best way to approach addiction is to look at it as a brain disorder that can’t be separated from morality and personal responsibility. You may not have asked for the addiction, but you must ask for help to recover, and you must be willing to accept responsibility for your choices.

Elizabeth Connell Henderson, M.D.

Glossary

Appendix A: Regulation of Addictive Substances

Appendix B: Sources of Additional Information