11_Models of Addiction
Models of Addiction
There are many models that have tried to explain addiction. Here, I will
briefly review five of the main models.

Stress-Reduction/Behavioural

Moral-Volitional Model

Personality Model

Dispositional Disease Model

Alcoholics Anonymous (AA)
Stress-Reduction/Behavioural Model
This is based on the notion that people learn to use alcohol because it
helps them cope with stressors, and reduces emotional stress reactions.
Use might then become abuse, and then dependence, if drinking is a
person’s main coping strategy.
Hence, “Given an individual with no alternative models on which to draw
for effective coping behaviours, drug use becomes a learned response for
dealing with personal and social problems” (Krivanek, 1995, p20).
Suggested Therapy: Learning alternative ways of coping with
stress/emotions.
Moral-Volitional Model
Alcoholism is viewed as volitional, i.e. as a consequence of the exercise of
choice, or free will. An alcoholic is thus, in this model, seen as morally
weak, or degenerate. This perspective was upheld by the US Supreme
11_Models of Addiction
Court in 1988, in Traynor v Turnage, when it defined alcoholism as “wilful
misconduct.”
This model positions alcoholism as caused by a lack of will-power/moral
fibre. This implies that the solution to alcoholism is for the alcoholic to
impose control and drink less.
Personality Model
This is a psychoanalytically informed model, which “views alcoholism as a
symptom of an underlying personality disorder, a disturbance of normal
development” (Miller and Kurtz, 1994, p160).
From this perspective, addiction might be seen as “a habitual response
and a source of gratification and security, so that when a person becomes
addicted, it is not to a chemical, but to an experience” (Peele, S., 1991,
p42).
Recommended treatment: psychotherapy/psychoanalysis.
The Disease Model
The disease model views alcoholism as a disease: “Most physicians,
counsellors, and psychologists view alcoholism according to the disease
model. Alcoholism is seen as a disease, with treatment emphasizing total
abstinence” (Smith and Smith-Stevens, 1998, p272).
The dispositional disease model rests on four assumptions (Milam and
Ketcham, 1983):
11_Models of Addiction
1. Alcoholism is a unitary disease entity that is qualitatively distinct
and discontinuous from normality. As with pregnancy, there are no
grey areas; one either is, or is not, alcoholic.
2. The causes of alcoholism are solely biological, rooted in heredity
and physiology. Behavioural, family, and personality disturbances
are merely symptoms of the underlying physical abnormality in how
the body reacts to alcohol.
3. The definitive symptom of developed alcoholism is an inability to
control consumption after the first drink. This is an inexorable
reaction to the chemical ethanol, resulting from the physical
abnormality.
4. This condition is irreversible and cannot be cured, only palliated
According to this perspective, “Alcohol is an addictive drug only for the
minority of its users who are physically susceptible” (Milan and Ketcham,
1983, p24).
“In this view, alcoholics bear no responsibility for the development of their
problems; they are in fact viewed as incapable of making rational
decisions, warranting social intervention to coerce them into treatment”
(Miller and Kurtz, 1994, p160).
Alcoholics Anonymous
AA views alcoholism as being a bio-spiritu-psycho-social problem; this is
an inclusive model that rules nothing out. “Of necessity, there will have to
be a discussion of matters medical, psychiatric, social, and religious” (AA,
1976, p 19).
11_Models of Addiction
In essence, AA views alcoholism as a spiritual problem. As with the
Disease Model, AA argues that the full-blown alcoholic will never be able
to drink with control again and must abstain from alcohol.