A key component of the disease theory is the belief in loss of control of one’s behavior. According to this theory, loss of control is an involuntary reaction to the presence of alcohol in the body. It is argued that when alcohol enters in the bloodstream, it produces an irresistible craving for more alcohol. This is said to be an involuntary biological reaction, similar to catching a cold or developing a fever. The sickness label implies that people do not choose to get sick, they are not bad because they are sick, and when they get sick, they need treatment. This concept is summarized in the often heard saying: “You’re not bad, you’re sick!” The disease label is not confined to alcohol, but expanded to include all kinds of behaviors. Today, people who have problems with gambling, sex, eating, shopping, smoking, or any other problematic behavior, can also claim the sickness label.
I counseled with a young man once about his alcohol abuse. He was labeled as an alcoholic by treatment professionals because he fit all the criteria. During rehab in a traditional disease model program, it had been pounded in his head that he had a disease and could never touch alcohol again without losing control. Instead of following their advice, he continued to abuse alcohol. His girlfriend encouraged him to come to me for counseling since nothing else seemed to work. At our first session, he began to tell me about his disease and loss of control. I pointed out that he did not have a disease and that he abused alcohol because that is what he wanted. This was the first time he had been told anything like this and he was shocked that I would say such a thing. As we continued our discussion of the negative consequences often associated with the disease view of addiction, he finally said: “Well, I really never did believe them when they said I had a disease anyway.” His honest reflection on his previous treatment is the initial reaction of most people to the disease model. There is something about it that is illogical and counter intuitive, and yet this is what people are commonly told even to the point of intimidation and brainwashing. It seems that people are forced to accept what they intuitively know to be false!
A few weeks later in a counseling session, this young man confessed to me that he recently went out with some friends for dinner and consumed alcohol. I asked him, “Well, what happened? Did you go crazy? Did you go on another drinking binge?” He said, “No, I had the one drink and that was all.” I asked, “What happened when you denied yourself another drink of alcohol? Did you run down the street screaming because you could not have another drink?” He smiled at this and said, “No, I did not have another drink because I did not want to get drunk. There are other things I want to do right now than drink all of the time.” His response reveals a real danger in the disease model of addiction. The danger is that people who believe they cannot control their behavior continue to behave in keeping with the sickness label assigned to them by treatment professionals, family, and friends. As a result, the disease model establishes an addiction identity that makes it difficult for change to occur.
When I argue that it is legitimate to say people are bad rather than sick when they abuse alcohol, I am not making a moralistic judgment of personal condemnation. From a biblical standpoint, Jesus warned against judging people, “Do not judge, or you too will be judged. For in the same way you judge others, you will be judged, and with the measure you use, it will be measured to you” (Matthew 7:1-2). But in the same chapter, Jesus encouraged people to make righteous judgments regarding people’s behavior, “By their fruit you will recognize them” (v. 16). So, there is a difference between judging or attacking the person and judging a behavior.
According to biblical teaching, drunkenness is a behavior that excludes one from the kingdom of God (1 Corinthians 6:10). For those who take the Bible seriously, this ought to provide a great incentive to change behavior. Those who do not accept biblical morality still recognize that some behaviors are bad in the sense that they are harmful to themselves and others. The goal is not to personally condemn people simply because they hold to unconventional values, but to help them recognize when a behavior is harmful and irresponsible. If people refuse to recognize the harm they bring to themselves and others, and if they continue to prefer the immediate gratification of alcohol abuse over the long-term benefits of either abstaining or controlling their drinking, then there is not much that can be done.
J B Myers