Discussion 1: Exploring Historical Views of Addiction


History of Addiction Treatment
The history of addiction treatment in the United States has been
shaped by how the country responded to the prevalence of heavy alcohol
use in the colonial period (Stolberg, 2006) through modern challenges
related to the range of substances of abuse and expansions of what is
considered an addiction (Karim & Chaudhri, 2012). The history of
treatment is complicated by how we define addiction. For the purposes
of this course, addiction will be limited to the disorders defined in
the fifth edition of the Diagnostic and Statistical Manual of Mental
Disorders (or DSM-5) published by the American Psychiatric
Association. While this excludes many behavioral addictions as
outlined by Karim and Chaudhri (2012), it does offer a common frame of
reference that is relevant for the practicing counseling professional.
The models of addiction that will be introduced in this unit and
explored in more detail in Unit 2 reflect the tension between
understanding addiction as a moral failing or a choice (Heyman, 2013)
and conceptualizing addiction as a disease (Miller, 1993). Variations
on each side of that dichotomy are explored in our readings, and the
underlying assumptions for both polarizing viewpoints are challenged.
Exploring the relative strengths and limitations of adopting either
side of the debate will help set the stage for how treatment
approaches are evaluated throughout the course.


The historical view on addiction has continued to evolve over time. The moral model, which is one of the earliest models of addiction posit  that addiction results from individual indulging in  substance abuse and addiction comes because they are morally weak. However, this model conflicts with the disease model that considers individuals as victims of forces beyond their control. According to Miller (1993) the disease model considers addiction as a single, incurable, all-or-none disorder that is caused by biological abnormalities, thereby limiting the treatment adopted. Miller (1993) proposes a new disease model that takes into consideration the moral and diseases aspect of it.