Introduction
In the present day, addictions remain a global problem, with citizens of every country suffering from them. To deal with the problem and to create a universal concept for it, several models of addiction have been created. The (brain) disease model of addiction and the harm minimization (reduction) model of addiction are the most recognized now; they are, however, fundamentally different. The aim of the present paper is to conduct analysis on the two models, and demonstrate the better one based on a comparison. While the disease model is older and is, therefore, more tried and tested, it is now outdated, with its basic theory dehumanizing those addicted.
The Disease Model of Addiction
As mentioned above, the disease model of addiction has been firmly established in medical knowledge. The nurses are educated on it (Kaye et al., 2014, p. 231), including the matter of the lack of Vitamin B as a result of alcohol usage (Kaye et al., 2014, p. 237). In this case, Vitamin B is given in tablets to compensate (Kaye et al., 2014, p. 85). According to the theory, drug users are pathologic and consume drug excessively. While the brain disease model admits the importance of social and environmental studies, it does not include intention to analyse them (Tekin 2018). After a study with the model in conjunction with neuroscience, health care practitioners claimed that addiction took away drug users’ ability to choose, making medical intervention necessary (Szott, 2014). This was caused by drugs affecting the brain’s mesolimbic dopamine system (Tekin 2018). The mesolimbic dopamine system controls individual reactions to food, sex, and sociality.
Studies written in line with the disease model of addiction are numerous and touch upon different types of addiction. For example, Gainsbury et al. (2018) analyse gambling addiction; while their study includes behavioural assistance and increasing awareness, it includes legislation on interventions as well, making the state an actor in the case. Thus, according to the theory, drug users have no responsibility over their actions, and their actions are de-stigmatized; they are represented as a passive category.
The model now tends to attract more and more criticism. Kuorikoski & Uusitalo (2018) claim that the model should not position agency as a property of brain. They state that the decision are not solely made by brain, but by one’s commitments to those around them, changes in environment, and that an impression of medications making a brain healthy is flawed. The authors claim that addiction remains a social phenomenon as well, and understanding it simply as a brain disease creates an opportunity for harmful administrative or medical usage. Another point of their criticism is that the disease model of addiction tends to brand too many drug users as beyond help, denying medications for those could still receive help. Therefore, the disease model faces a lot of criticism, and even those who still use it, such as Gainsbury et al., do it in a combination with the different theory.
The Harm Minimization Model of Addiction
The other model is the harm minimization model of addiction. It pictures drug user as people who are currently at risk, but can improve by themselves if provided with the necessary instruments and information. An American organization called the Harm Reduction Coalition has created eight principles on the matter. Notably, one of them is to accept that drug usage is a part of one’s life and that the task at hand is not to condemn it, but to limit its harmful effects (Szott, 2014). To achieve this, it is advised to encourage people to save funds, including usage of augmented reality for it (Gainsbury et al., 2018). Kaye et al. state the main purposes of the harm minimization model as to “decrease consumption, decrease the hazards of consumption, increase social functioning, increase the potential for abstinence” (Kaye et al., 2014, p. 253). Thus, the model focuses on preventing the harmful effects of drug use through communication instead of judging and forbidding it.
Like the previous model, the harm minimization model is already widely used, despite being newer. For example, a Portuguese project called Kosmicare has gone through many difficulties to earn recognition, but has been functioning since 2000 (Soares 2017). Kosmicare is a harm reduction festival area, and its team is made of medical professionals. It is based on human rights and includes creating drug consumption facilities, education, and methadone maintenance (Soares 2017). While risk evaluation is not compatible with the project’s activity and the harm minimization model in general, the drug users are expected to conduct risk evaluation by themselves. Another case of usage of the harm minimization model deals is smoking. According to Abrams et al. (2018b), the model is effective in that area as it helps to move smokers to less dangerous ways of smoking such as e-cigarettes. The purpose is, therefore, to make tobacco cigarettes completely obsolete (Abrams et al., 2018a). The means to it are to inform people on the comparative influence of different ways of smoking, rather just the fact of smoking.
Comparison
The models, as evident, are notably different from each other. In the disease model, the addiction is characterised as removing autonomy from the drug users, placing responsibility on medical personnel and authorities. In the harm reduction model, the drug takers maintain their autonomy and make their own decisions, with the medical professionals simply providing the options (Szott, 2014). Therefore, they most notably differ in their consideration of the patients.
Many medical scholars do not accept any one of the models, instead utilizing them both in one way or another. For example, Wakefield (2020) points out that, while the harsher forms of the disease model, such as the perception of drug users having brain damage, should be omitted, drug use is still a mental disorder. Barnett et al. (2018) argues for it as well, even outright stating that a ‘hybrid approach’ is necessary. A questionnaire by Szott (2014) and a different study by Barnett et al. (2017) demonstrate that many practicing doctors already tend to follow a ‘hybrid approach’, using harm minimizing practices. The latter even included allowing their patients to continue taking the drug in the case of a relapse. However, the same analysis has proved that, while doctors use harm minimizing practices, their purpose and perception of the problem remain in line with the disease model.
Discussion & Conclusion
The ‘hybrid approach’ can be considered to only be temporary. As the models are fundamentally different, they may not be used in conjunction forever. For example, the disease model considers relapse a failure of treatment, while the harm minimization model allows for it on the condition of a safer manner (Bayles, 2014). In addition, the disease model requires significant funding, as the most treatment programs have failed, and new ones need to be invented (Hall et al., 2015). The depiction of drug use as a brain disease creates a negative image as well, provoking hostility and fear. Finally, the disease model fails to acknowledge that multiple factors cause drug use, and can be treated not just with medication, but with behavioural interventions as well (Tekin 2018). All of these factors prove that the disease model is outdated, and its fundamental incompatibility will stop its usage in the future altogether.
References
Abrams, D. B., Glasser, A. M., Pearson, J. L., Villanti, A. C., Collins, L. K., & Niaura, R. S. (2018a). Harm minimization and tobacco control: Reframing societal views of nicotine use to rapidly save lives. Annual Review of Public Health, 39(1), 193–213. Web.
Abrams, D. B., Glasser, A. M., Villanti, A. C., Pearson, J. L., Rose, S., & Niaura, R. S. (2018b). Managing nicotine without smoke to save lives now: Evidence for harm minimization. Preventive Medicine, 117, 88–97. Web.
Barnett, A. I., Hall, W., Fry, C. L., Dilkes-Frayne, E., & Carter, A. (2017). Drug and alcohol treatment providers’ views about the disease model of addiction and its impact on clinical practice: A systematic review. Drug and Alcohol Review, 37(6), 697–720. Web.
Barnett, A. I., Hall, W., Fry, C. L., Dilkes-Frayne, E., & Carter, A. (2018). Implications of treatment providers’ varying conceptions of the disease model of addiction: A response. Drug and Alcohol Review, 37(6), 729–730. Web.
Bayles, C. (2014). Using mindfulness in a harm reduction approach to substance abuse treatment: A literature review. International Journal of Behavioral Consultation and Therapy, 9(2), 22–25. Web.
Gainsbury, S. M., Tobias-Webb, J., & Slonim, R. (2018). Behavioral Economics and gambling: A new paradigm for approaching harm-minimization. Gaming Law Review, 22(10), 608–617. Web.
Hall, W., Carter, A., & Forlini, C. (2015). Brain disease model of addiction: Misplaced priorities?The Lancet Psychiatry, 2(10), 867. Web.
Kaye, A. D., Vadivelu, N., & Urman, R. D. (Eds.). (2014). Substance Abuse: Inpatient and Outpatient Management for Every Clinician (2015th ed.). Springer.
Kuorikoski, J., & Uusitalo, S. (2018). Re-socializing the vulnerable brain: Building an ethically Sustainable brain disease model of addiction. Frontiers in Sociology, 3. Web.
Soares, M., Carvalho, M. C., Valbom, M., & Rodrigues, T. (2017). Tackling harm reduction, human rights and drug uses on recreational environments: Tensions, potentialities and learnings from the KOSMICARE Project (Portugal). Revista Crítica De Ciências Sociais, (112), 3–24. Web.
Szott, K. (2014). Contingencies of the will: Uses of harm reduction and the disease model of addiction among Health Care Practitioners. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 19(5), 507–522. Web.
Tekin, S. (2018). Brain mechanisms and the disease model of addiction: is it the whole story of the addicted self? A philosophical-skeptical perspective. In H. Pickard & S. H. Ahmed (Eds.), The Routledge Handbook of Philosophy and Science of Addiction (pp. 401-410). Taylor & Francis.
Wakefield, J. C. (2020). Addiction from the Harmful Dysfunction Perspective: How there can be a mental disorder in a normal brain. Behavioural Brain Research, 389, 112665. Web.