A critique of the disease model of addiction

While there is widespread disagreement as to just what addiction is, the two most popular models are the moral model (i.e., addiction is a moral failing) and the disease model (i.e., addiction is a kind of disease). Both of these models have serious problems, for theory and for practice. Furthermore, since competing models for addiction have different implications for treatment, law, social norms, and so on, it is important to find a single model for addiction that works in every arena. We need an account of addiction that avoids the problems of the disease models and the moral models. That is, it must be able to accurately describe the lived human experience of addiction, account for all the major features of addiction, and accord them appropriate weight. Furthermore, it should point us toward treatment options that will work, social policies that make sense, and laws that are fair. Finally, the new model should reflect the complex nature of responsibility, and should avoid overly simplistic attributions of blame. This dissertation presents an alternative definition of addiction, one that is fundamentally different from both disease models and moral models of addiction. Rather than describing addiction as a moral, psychological, or physiological defect of the addict, this proposed model, herein called the existential model, describes addiction as a compulsive, inauthentic habit: a compulsive habit that the individual does not endorse. Compulsion and habit are frequently included in descriptions of addiction, but authenticity and addiction is relatively new. The existential model rests on the idea that addiction is an inauthentic response to the experience of angst, or existential anxiety. These inauthentic responses to angst may begin as compulsions and become entrenched as habits, or begin as habits and become compulsive. In either case, these are addictions. There are implications of this model for theory and practice, as well as indications for further research. Perhaps the most interesting implication of this model concerns the importance of strengthening individuals' authenticity, both to protect against addiction and to recover from addiction.