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Is addiction a disease? Do the kids I work with at CASTLE have a pathological response to drugs and alcohol? The disease model of addiction is compelling, and has served its purpose in bringing needed attention of healthcare professionals and legislators. My concern about the model is that it continues to stigmatize my patients, and the millions of people struggling with addictions, suggesting they are sick.

Many years ago we used the word invalid to describe people with illness, in particular a person who is incapacitated by a chronic infirmity or disability. Addiction is thought to be chronic, accounting for the potential lifelong vigilance against relapse. The model supports the idea that people who have addictions have a medical condition, and should not be blamed or seen as the modern pariahs and lepers of our society. Addiction is a disease, not a moral issue.

But the word invalid can also be broken down to its constituent parts; in-valid. “Invalid” is defined as flawed, illegal, without validity. This belies the very efforts made to validate my patients who struggle with addictions. It is the dark side of attributing the medical model of disease to the condition of addiction.

Like any disease, a person is held responsible perhaps not for the disease itself, but for the treatment of the condition. A diabetic may not be at fault for diabetes, but is held responsible for taking insulin, managing their blood sugar, being aware of their diet. Addiction is no different. Whether my patients are using heroin or alcohol or marijuana they are held accountable and responsible for their actions. Having a disease is not a tacit nod to enabling. Dis-ease implies that the condition itself is a disruption of equilibrium, causing a discomfort and recruiting the rest of the body to respond to this discomfort. The risk is that the disease model itself becomes the crutch, perpetuating the myth of a crippled and in-valid individual.

But addictions not only impact the person who has the “disease”, it impacts the people around that person. The disease model falls down in this regard, as no disease happens in a vacuum. It is in the relationships that the addict also suffers, as those relationships become increasingly subverted, leaving the person with addictions at peril of being as isolated as a person with leprosy used to be. As with any disease model, the impression of the people who share the community may perpetuate the myth that people with addictions are contagious, dangerous, and not to be trusted. Whether they have a disease or not.

So how do we maintain the idea that a drug addict or alcoholic is not a person without morality, nor a person with a weakness of will, in-valid. How do we bridge the disease model with the potential of hope and sobriety, if not “cure”. One way is to redefine the way we not only see people with addictions, but with people in general. What happens if we remove the overlay of judgment? Instead of saying, “That person should be doing better. What’s wrong with them?”, why not begin viewing people as simply doing the best they can at that moment in time, with the potential to change and make different choices at the next or future moment in time? This leads to the model I have created and been developing at CASTLE, called the Imax approach. Seeing people at an Imax: a current maximum potential.

The Imax suggests that people are doing the best they can at every moment in time. It is controversial, but potentially changes the lens with which we view each other. And if a person is truly at an Imax, simply doing the best they can, what happens to pathology, to disease, as the brain and body respond the best they can to the conditions they face? The Imax becomes a lens of respect: you don’t have to like what a person does. You don’t have to condone it. The person will be held responsible for their actions. But you have to respect it, respect that given the influences of their lives, which I will explore next week, this is the best they can do at this moment, at this moment in time. What happens when we change the way we see people, and how does that have an impact on their brain?