So she took me into her little white walled office with florescent lights. I sat down and after telling her all of my drunk truths, which I never admitted to anyone, let alone myself, she pulled out this huge book, which I now know as the DSM (Diagnostic and Statistics Manual of Mental Health). She lists off the a slew of “symptoms,” and in a nut shell she came to the conclusion – “you are an alcoholic.”
The most beautiful thing about the disease of alcoholism/addiction is that sometimes it can be “beat” or in remission. It is like having cancer, where some are lucky and “fight” the disease, some can only “fight” it for so long, and sometimes the disease wins completely. E. M. Jellinek developed the Disease Model of alcoholism in the 50’s. Jellinek (as cited in Fisher & Harrison 2013, p. 42-43) described addiction as a progress of stages starting with a few drinks, then increased use and dependence, and then conflict within one’s life functions (family, friends, or work) arises. The Disease Model also notes that this progression does not revert to earlier stages even with sobriety. In other words, if an individual goes back to drinking after sobriety they will start back in the stage they left off in. Therefore, addiction is a continuous battle, but not a battle of will, a battle of a disease.
The Merriam-Webster medical definition of disease is “impairment of normal state of the living animal…manifested by distinguished symptoms… and is a response to environmental factors, specific infective agents, to inherent defect of the organism.” Nowhere in this definition is there “will of a person.” Furthermore, when our society talk about cancer and “someone beating the disease” we aren’t talking about an individual’s will to live, we are talking about their body’s ability to fight and withstand surgery, chemotherapy, radiation. If alcoholism/addiction is also a disease why does our society think that that it is based on someone’s will and power of control?
Well this common way of thinking is called the Moral Model, which looks at alcoholism/addiction as a personal choice. In our society it can be easier to place blame on the individual rather than taking a macro perspective, change policies, and build supports from those suffering. This blaming of the individual removes someone from having to feel empathy for the suffering and protects them from the truths of this world. To be honest with you, I don’t think it’s fine to believe in this model. Believing in this model keeps individual oppressed and provides less opportunity for all individuals.
I call my next patient into my little white walled office with florescent lights and have them sit down. They disclose to me their struggles with substances and the pain they are feeling, the guilt, the shame, the difficulty, and the ambivalence to stop. I give them a space to express their pain. I provide to them information and resources about the disease. We discuss the ambivalence to change and challenges in accepting their truths. In order to maintain a therapeutic relationship and to provide them with appropriate supports I don’t disclose that I have the same disease.
Due to the Moral Model and the way that this society looks at alcoholism and addiction I ironically maintain my anonymity here too. To give you more contexts…I am an emerging social worker and I feel that I should not let certain people know about my disease or they may think I am not fit for the job, that I might relapse, or that I am not “strong” enough. This is the problem in itself, the society forces people to remain silent and sit with their struggle all on their own. One day if we are all able to speak honestly about this disease there may arise real change and help. My hope is that we can begin to break the stigmatic Moral Model mold from which society views my disease.
– Leah the Barber
Fisher, G. L. & Harrison, T.C. (2013). Models of addiction. In Substance abuse:
Information for school counselors, social workers, therapists, and counselors (5th ed., pp. 36-50). Boston: Pearson.