In the world of addiction treatment and recovery there is contentious and ceaseless debate between two warring factions - those who believe addiction is a choice and those who believe addiction is a disease.
While each philosophical camp has helped many people recover from drug and alcohol addiction in their own way, this author would like to offer another perspective to add onto the body of clinical intervention and treatment of addiction… and that is addiction is an attachment disorder more than anything else.
A brief overview of the Moral Model (Choice Model) and Disease Model of addiction
The Moral or Choice Model of Addiction
The essence of the Moral (Choice) Model of addiction lies in the belief that addiction is a moral failure of the individual. That it is the individual’s moral weakness and lack of will power that causes them to become addicted to drugs and alcohol.
The Moral Model tends to perceive addicts as criminals and degenerates who lack moral character, often believing addicts are a blight on the community and need to be “locked up” as a form of punishment in hopes that will make them stay sober. Through the Moral Model lens, those suffering from addiction are viewed as the products of poor choices (“they can stop if they really wanted to”), lack willpower, and are unwilling to change their lives.
While the Moral Model of addiction is considered “outdated” by modern research and clinical standards of care, the legal system was (and still is) the most primary way of “treating” the problem of addiction through incarceration. And many 12 Step-based groups such as Alcoholics Anonymous, Narcotics Anonymous, and Al Anon too utilize the Moral Model as their philosophical foundation for addiction recovery.
The Disease Model of Addiction
The more widely accepted Disease Model of addiction used today postulates that once addiction develops, the person suffers from an “illness” that prevents them from choosing to not use drugs or alcohol. When this illness is done in a compulsive manner – regardless of the self-destructive or negative impact on daily functioning – it becomes accepted as a mental illness.
The paradigm of the Disease Model has advanced research into understanding the changes in an addict’s neurotransmitters and brain functioning caused by drug and alcohol use. Neurotransmitters such as dopamine and serotonin, when artificially stimulated or blocked by substance use can drastically alter behavior, influence motivation (aka the “reward center” of the brain), impede impulse control, and hinder judgment; as well as lead to the development of other physical or mental health problems.
Proponents of the Disease Model highly encourage substance abuse treatment (i.e. cognitive behavioral therapy or behavior modification), harm reduction interventions (i.e. needle exchanges and safe use areas), medication management and medication “replacement” therapies (i.e. methadone for opioid replacement or nicotine patches for nicotine replacement) as the primary treatment modalities for treating drug and alcohol abuse.
The Disease Model contends that best practice is to treat the “illness” of addiction by teaching how people change addictive thinking and behavior, avoid relapse triggers, manage cravings, and manage one’s neurochemistry using psychotropic medication to reduce anxiety, depression, or other mental health issues which may contribute to their addiction.
Addiction As an Attachment Disorder
“Attachment can be defined as a deep and enduring emotional bond between two people in which each seeks closeness and feels more secure when in the presence of the attachment figure.”
- Mary Ainsworth
We humans are social animals and attachment forms the essence of our very existence. Attachment, or these intimate social bonds we form throughout our lifespan, are rooted in the survival of our species; forming the foundation of every culture, civilization, and evolutionary behaviors that have allowed humans to survive, thrive… and even perish throughout all our recorded history.
How important are the attachments we form? Well, we have not, cannot, and will not survive without forming attachments to one another and the world around us.
Our foundation for attachment is formed in early infancy, where we are wholly reliant on our caregivers to provide us with the protection, care, and nourishment we need to survive and thrive.
When attachment between parents and child is repeatedly disrupted or when one or both parents are the sources of abuse, neglect, or trauma, young children begin to develop a complex network of psychological defenses to protect themselves from the hurt; as children simply can’t leave or deal with these types of situations on their own.
This is where many children will fall into the trap of addiction later in life.
When children or adolescents are exposed to drugs and alcohol for the first time, they experience how exceedingly effective different substances are in numbing painful thoughts and feelings, while subsequently providing positive feelings like pleasure, joy, and euphoria. One many find certain substance (or other behavioral addictions) work well to numb painful feelings like shame, worthlessness, or fear; while other substances (or other behavioral addictions) are effective at stimulating feelings of power, invincibility, or “love.”
Our innate propensity to avoid pain (re-experiencing the pain, fear, and disappointment of attachment wounding) motivates people to seek certain substances or addictive behaviors as a survival strategy. This is what is suggested by addiction being, more than anything else, an attachment disorder.
A Need for a New Paradigm Shift: Attachment-Focused Addiction Treatment
Our society needs a paradigm shift, a third model of addiction which builds upon the Moral and Disease models. Its philosophy spotlights the relationship between trauma, attachment, and addiction. Its treatment embodies a dynamic and experiential approach addressing the biological (neurological), psychological, and sociological (interpersonal relationships, community support and integration, social belonging) components of addiction recovery.
While aspects of the Disease Model and Moral Model are vital for addressing the initial, more emergent challenges of addiction, an attachment -focused model of addiction appears to be the third pillar of addiction recovery that can genuinely support what addicts need to build a strong and solid foundation for long-term recovery.
By treating the underlying attachment wounding caused by trauma, abuse, and neglect, which are the most common reasons people turn to drugs and alcohol in the first place, the addiction itself no longer becomes a necessary coping strategy to numb those painful thoughts and feelings.
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Contemplation for the Reader (Comment Below)
1. What has been your experience with addiction treatment, either as a client or a clinical provider?
2. What are some strengths or limitations of both the Disease Model and Moral Model of addiction?
3. What changes would you make to how addiction is treated now?
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Weston Zink LPC LAC is the owner of WholeHearted Therapy PLLC and Clinical Director at Breakthrough Recovery of Colorado. He has over 10 years of clinical experience working with trauma and addiction. Weston is an EMDR Certified Therapist and member of EMDRIA who’s working to heal traumatized people and communities at home and abroad.
If you’re “tired of being sick and tired” and ready to take a life-changing next step in your trauma or addiction recovery journey, please contact Breakthrough Recovery of Colorado at: https://breakthroughrecoveryco.com/schedule-contact for a free consultation or to schedule an appointment.
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