Drug addiction and alcoholism are chronic disease processes that affect the body and mind on cellular, tissue, and organ system levels. They have genetic linkages and are often passed through multiple family generations. They respond well to appropriate medication approaches. They involve components of brain change through neuroplasticity, and these long-term changes actually promote further drinking and drug use behaviors. They need to be managed through a comprehensive health model of care, otherwise can lead to early death and poor life functioning.
The disease model has been studied for the past 60 years and originated through scientific studies of animals. The behavioral patterns and brain changes from substance use within those animals mirrored that of humans quite closely. Prior to these studies, even the medical and psychiatric community defined addiction as issues with morality and poor life choices.
For more discussion on this topic and further learning, we recommend the writings of Nora Volkow, MD and George Koob, MD in their article Neurobiologic Advances from the Brain Disease Model of Addiction, published in the New England Journal of Medicine January 2016. These researchers and speakers are able to explain the process of addiction as broken into 3 phases:
The notion of chronic disease is very important for family systems, as this implies the nature of addiction as a relapsing and remitting health condition. It is very common that a person with alcoholism will be in stable recovery for multiple years and then experience a significant relapse around volatile life circumstances (or sometimes for no great reason at all!). By understanding the possibility of relapses, you as a family member can be more prepared to offer the best support possible.
Families who do not understand the chronic component of this disease become highly dejected, angered, or detached around relapses, and their paths to help often are clouded by these emotions.
Many families will hear something about addiction being a disease from a professional, either through a structured treatment program or from an individual provider. Clinicians always pay attention to how that message is received. This dynamic lets us know what strong emotions are present as part of the family cycle and where to focus our attention. For instance, many parents will feel uncomfortable with the disease model based on it absolving their son or daughter of recent hurtful events. They feel that the child should be held accountable for the relapse instead of offered such ‘warmth’ and nurturing in addiction treatment.
Interestingly, there is fair truth in these beliefs by the family. A chronic disease process is not a passive one. We use the diabetes metaphor to help explain addiction as a condition with a base medical state in which choices and ownership really matter. This would not apply so closely to something like cancer, in which the presentation of the disease is out of the person’s hands (aside from tobacco-based lung cancer…) and the treatment is essentially ‘given’ to the person.
Addiction treatment requires active engagement by the person and quality health decisions to stay stable. It is in this way that we can both hold someone accountable for relapse and harm from the relapse while at the same time empathizing about the suffering of disease.
Not in one’s control while at the same time in one’s control? We use the term dialectic in behavioral health to describe phenomenon such as this. The definition of a dialectic is:
One of the principles we use in education for families is that of choosing to embrace the disease model. Even if you feel a skeptic to this and prefer more of a tough-love approach, the chronic disease model does provide some basic comfort to the struggling and tense family. It provides the addicted individual a framework for understanding behaviors and it provides a path towards health.
Most importantly, it uses the concept of the sick role to ground treatment. The sick role concept is used in multiple forms of talk therapy and emphasizes one being defined as ‘sick’ today with a goal of ‘healthy’ tomorrow. Many of the families we’ve worked with professionally had poor outcomes when there was a breakdown of this concept. The addicted individual did not seem to embrace the sick role and continued to progress further into a toxic disease with a rejection of the healing path.
We can even take this further and embrace the family itself being sick. There are many positive attributes to taking this position as it will require an open-mindedness to learning, an assumption that sickness will not last forever and you can achieve health as a family, and a reminder of the disease components in addiction. Sick families heal. Families who resist the mentality of having a disease carry wounds that fester.