Using the language of “disease” or “sickness” as a metaphor for moral turpitude and/or depravity is an ancient practice. It makes sense.
But that doesn’t mean that vices are really diseases. I am not guilty for being sick but I am guilty when I commit immoral acts.
One of the main proponents of the “disease model” for alcoholism (or the vice of heavy drinking—just to give it a more neutral name) has been Alcoholics Anonymous. Interestingly, after dominating the field of recovering from habitual drunkenness, many are starting to push back. Thus Maia Szalavitz writes in Pacific Standard,
Contrary to popular belief, most people recover from their addictions without any treatment—professional or self-help—regardless of whether the drug involved is alcohol, crack, methamphetamine, heroin, or cigarettes. One of the largest studies of recovery ever conducted found that, of those who had qualified for a diagnosis of alcoholism in the past year, only 25 percent still met the criteria for the disorder a year later. Despite this 75 percent recovery rate, only a quarter had gotten any type of help, including AA, and as many were now drinking in a low-risk manner as were abstinent.
Szalavitz gives us an idea of how this works:
Unfortunately, compared to the rehab narrative, the stories of people who get better without treatment are rarely as compelling. They tend to consist of people leaving college and realizing they can’t binge drink or take drugs and hold a job and care for a family. And since most people who straighten out on their own never show up in treatment, the worst cases congregate in rehab and make addiction recovery seem quite rare.
So far so good. It corresponds well to other things I have seen, like the discovery that Oreos are as addictive as cocaine. But then Szalavitz completely reverses herself without seeming to understand what she is saying.
One effect of this 12-step dominance is that addiction continues to be seen by many people as a moral failing rather than a disease. This is somewhat ironic, because many 12-step advocates firmly consider addiction to be a disease, as do government agencies like the National Institute on Drug Abuse. But it is awkward to posit addiction as a disease while simultaneously promoting AA’s non-medical and moralistic course of treatment. For what other medical condition does 90 percent of the treatment consist of meetings and prayer?
Excuse me? Can’t we also ask, what other medical condition do many simply end by deciding they need to “hold a job and care for a family”? Szalavitz doesn’t make sense. She has described people assessing their values and changing their behavior by making decisions according to those values. What about the man who refuses to change his behavior so that he can hold a job and take care of his family? How is that not a moral failing?
The medical model for alcoholism and drug abuse has never made sense. It needs to be rethought.