This essay is designed to critically evaluate two chosen models of addiction and discuss how these might affect the legal status of controlled substances. Firstly, this paper will provide the overview of the topic of addiction and introduce the problematic nature of definition. Secondly, it will critically compare two selected, contrasting models of addiction which are the Disease Model and the Adaptive Model. Thirdly, this essay will discuss how these models might have contributed to the legalisations of controlled substances and treatments of addiction and indicate possible limitations within the drug policy. Finally, it will draw the relevant conclusion based on provided research and raised arguments.
To begin with it is relevant to introduce to the area of addiction study and indicate the problematic nature of definition. A human being can develop a very intense relationship with chemicals and as it has been researched, every person has chemically alerted their mood at some point in their lives whether it was a cup of coffee or bar of chocolate or illicit substance (Hanson et al 2005). However, for many people chemicals become a central quality in their life affecting not only their behaviour but also deciding of their values, regardless of the damage to their health and social well-being.
Many researchers such as Alexander and Schweighofer (1998) have acknowledged the changes within the meaning of the word addiction which occurred over the years. Moreover, various models were designed as an attempt to explain the still growing phenomenon of addiction which nowadays is accepted as a complex disease (DiClimente, 2003). Therefore, according to NIDA (1999) addiction is a compulsive and uncontrollable action, substance carving or particular behaviour seeking that occurs regardless of its health damaging consequences. The critical aspects of addiction are related to the development of the problematic routine within the brain which reinforces particular behaviour. It also involves both; physical and psychological dependence to substance or activity that is difficult to change (DiClemente, 2003). However, it is important to acknowledge that there is no, one, single way of defining addiction and to try understand why some individuals are more likely than others to become substance or behaviour dependent, many aspects need to be taken in to consideration.
The World Health Organisation (WHO) plays a central role in the international drug control system and provides the international definition of drug dependency as follows:
'A state, psychic and sometimes also physical, resulting from the interaction between a living organism and a drug, characterised by behavioural and other response that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence. Tolerance may or may not be present. A person may be dependent on more than one drug'.
(WHO 1969, p.5)
Each of the addictive drugs requires to have its own policy to regulate their use in society. Moreover, each country develops the act to classify addictive substances and laws according to the seriousness of physical and psychological injuries which the usage of them can cause (WHO, 1969). As a result, various types of drugs are prohibited due to the level of harm which they can cause and their addictive tendencies. In the UK all known harmful and addictive drugs are regulated and controlled by the Misuse of Drugs Act (1971) which uses classification categories of A, B and C. Due to the changing conditions in society and new research, some of the substances may be moved from one category to another, therefore, policies need to be flexible enough to adapt these changes (Goldstein, 2001). Therefore, many argue, that some of the drugs needs 'tighter' regulations than they have now and others need a 'relaxation' of prohibitions (Hanson et al 2005).
The following part of this paper will introduce to selected, contrasting models of addiction. Although, both chosen models: disease and adaptive, provide a broad and logically coherent examination of addiction development, they are rarely formally examined (Peele, 1988). In order to critically compare and contrast selected models, a brief introduction to each one will be provided.
The Disease Model
According to this model factors like the genetic predisposition or faulty upbringing lead initially to susceptibility of addiction then alcoholism or/and drug addiction and finally reaches the self-destructive stage which may be family breakdown, self-hate, depression, aggressiveness, selfishness or economic dependence (Peele, 1988). The more contemporary Disease Model clarifies that the susceptibility may well be the outcome of any disease process; however it can also be attributed to the genetic predispositions or psychological damage which could arise due to the childhood traumatic experiences, or both (Hanson et al, 2005). Accordingly, susceptible individuals are recognised as vulnerable to substances in the same way as individuals with other genetic defects are vulnerable to diabetes or individuals with childhood traumatic experiences are vulnerable to psychosis (Goodwin, 1985). Consequently the Disease Model hypothesises that if susceptible individual is exposed to drugs, including alcohol, and/or some form of the environmental tension, it is likely that they develop in to addiction which will then lead to mentioned earlier, self-destructive problems. There are different variations of this model therefore some put more attention to 'genetic predisposition' over the faulty upbringing (Goodwin, 1985). Others put forward the exposure to drugs or alcohol, over other factors (Gold and Rea, 1983). This model was firstly known as the 'exposure orientation' (Alexander and Hathaway, 1982).
The Adaptive Model
This model, although, also represents an organised set of casual relationships, differs from the previous one. The process of addiction begins with the involvement of three factors: faulty upbringing, inadequate environmental support and 'genetic unfitness' (inborn, physical or psychological disability) (Goldstein, 2001). Due to these and the way the individual perceive these factors, it may result in the failure to achieve the crucial expectations of society which are self-reliance, self-confidence, competence and social acceptance what causes those individuals 'never grow up' and consequently leads to failure to maintain adult integration (Peele, 1988).
Accordingly, due to the lack of this 'adult mixing' individuals become physically and mentally isolated and depressed which can result even in suicide (Hanson et al, 2005). Moreover, there is an urgent need to replace what the individual misses and to provide mining, organisation and support. Therefore, from the Adaptive Model viewpoint, drug or behaviour addiction is seen as adaptive as the other option is worse so it is about choosing the less evil (Goldstein, 2001).
Contrast Between The Models
Although both models are consisted of mostly the same components, they differ in many ways. Firstly, a major assumption within the Disease Model is the hypothesis that addicted people are sick. The Adaptive Model, however, does not recognise addiction as a disease; it assumes that addicted individuals are responding adaptively to the limitations within themselves (DiClimente, 2003). Secondly, the cause and effect process is reversed in both models as in Disease Model, addiction and alcoholism are recognised as the cause of further problems (self-destruction), the Adaptive Model demonstrates that those behaviours are the result of the same problems (Peele, 2001). Thirdly, although both models are using similar components, they are constructed differently. For example 'genetic predisposition' in the Disease Model is called a 'genetic unfitness' in the Adaptive Model and both of them, although, sound similar, have a different meanings (Peele, 2005).
Although, many researches have challenged the idea and attempted to combine the components of two models, others strongly disagreed with that (Reich and Filstead, 1986). The reason for it is logically understandable as the Adaptive Model is not a form of drug experimentation, instead it is a model of the addictive process itself, and therefore by combining both models it would be approval of the Disease Model (Goodwin, 1985).
By combining different components of two models illogical results may be reached. For example, the individual who is acting adaptively does not require the treatment because he/she is not recognised as a patient. Moreover, 'adaptation can not be maladaptive' and therefore addict's environments can not involve both, caring and insufficient, and similarly about the behaviour; it can not be 'mechanically determined and purposive' (Peele 1988, p. 53). Therefore it is essential to acknowledge that both; the Disease and Adaptive Models, although, are designed to serve the same purpose and help people, theirs components are only logically coherent if considered as a whole.
Overall, the Disease Model is a representation of the instrumental and determined way which is followed by the individual in the process of drug involvement. It suggests that factors like genes, metabolism and family experiences make the individual 'susceptible' to become addicted. Then the availability of drug/alcohol and exposure to environmental stress lead to illness and epidemic disease - addiction (Peele, 1988).
The Adaptive Model, however, demonstrates a differing argument. It, illustrates that, although everyone is 'fighting' to be self-reliant and be acceptable in society, not everyone manages to achieve that. Therefore, those who failed begin the search for substitute in order to compensate what they have missed in life and in result, locate the alternative of 'that' in drugs (Peele, 1988).
The next part of this paper will indicate possible limitations within the policy and discuss how the above models of addiction may have contributed to the legalisations of controlled substances and addiction. Therefore, it is relevant to explain what a drug policy is.
According to the WHO (2001) it is a document which is an official government statement which identifies medium and long - term goals and strategies for the government to combat the negative effects of drug addiction is society. As it has been mentioned in the introductory part of this essay, each country develops their own drug policy which 'defines the national goals and objectives for the pharmaceutical sector, and set priorities' (WHO 2001, p. 5).
Analysing statistics, Roe (2005) cited in Reuter and Stevens (2007), found that UK has got the highest rates in illicit drug use in European Union. Moreover, though it is difficult to judge the number of individuals who use illegal drugs in UK, it is estimated that over ten million people in England and Wales have tried illicit drugs (MDA, 1971).
Current drug policy in the UK represents an attempt to move beyond the failures of the past years. The mentioned earlier in this essay Misuse of Drugs Act (1971) is a current legal basis and a tool to control the use and availability of illicit drugs in UK. Although the policy has been used to punish the still increasing number of drug users and dealers, only a small minority of them had been punished. Therefore, many question the effectiveness of the Misuse of Drugs Act. Furthermore, there are limitations within the policy such as the reliance of the research on the British Crime Survey which may exclude the most vulnerable groups from the study. In addition, the disproportional level of attention can be recognised as the main focus has been put towards a crime harm, rather than health harm.
Moreover, there is a very little evidence which cold confirm that policy can influence the number of drug users. Niether, that tougher law enforcement, more prevention or increased treatment reduced the number of users and addicts in the country. According to statistics, the level of imprisonment in the last two decades has increased for all categories of drugs and 'the claim that increasingly tough enforcement sends a message that will reduce drug use does not appear to be supported by the evidence' (Reuter and Stevens 2007, p. 82).
Therefore, due to these contradictory arguments and frustration with the policy over the lack of control of drug use, many argue that illicit drugs should be legalised. However, there is also an issue there. If the 'drug problem' is defined as a 'crime problem' then some may simply argue to make drugs legal. But, on the other hand if addiction is a brain disease, as proposed by the Disease Model, the legalisation of drugs would be very opposite of the treatment of addiction (Goldstein, 2001).
Although, several limitations of the drug policy can be recognised, it is important to acknowledge the positive products of the Misuse of Drug Act (1971). For example, by providing sterile needles and condoms to all addicts it reduces the further harm to wider society caused by AIDS virus (HIV).
Furthermore, the study suggests that by providing clean needles it does not recruit new users (Goldstein, 2001). Therefore, the involvement in the policy of the Adaptive Model over the Disease Model can be recognised. Accordingly, by providing the clean needles and condoms the process of 'harm reduction' can be visible. An addict is recognised as an individual who adopted drugs in compensation for losses, therefore he/she receives a sterile needle to protect from further harm (AIDS and HIV), and not to cure the illness like it is anticipated in the disease Model.
The Disease Model however, by recognising addiction as an inborn disease may have influenced the drug policy in relation to treatment. Accordingly, if addiction is illness as proposed by the Disease Model, therefore it requires the treatment and cure (Peele, 1988).
Interestingly however is a consumption of tobacco and alcohol which are recognised as legal, recreational drugs within the public. These substances have been used by people for centuries so they have become gradually acceptable in society; however it seems to be forgotten that these are also addictive substances. That may be due to the tax income which is 'earned' from the trade of these and therefore it has become a business for the government - some may say 'immoral business' (Goldstein, 2001).
Therefore the main concern is to do with the availability of the drug 'over the counter' which makes them easily accessible to people and at the set price. Policy restraining the use of cigarettes/alcohol in public places has been noted to contribute to the decrease of consumption of cigarettes (DiClemente, 2003). That may be due to social factors such as the need of leaving the public place like pub or club in order to smoke outside.
The Disease model may have had contributed to policy restraining the use of tobacco/cigarettes in the public sphere. As addiction is an illness which requires treatment and passive smoking is almost as bad as active smoking therefore in order to protect people and their health the restriction of the law was designed so many give up the habit (Peele, 1988).
To sum up, this essay has discussed the problematic nature of the definition of addiction. It has also introduced some statistics in order to understand the growing phenomenon which is addiction. Two contrasting models of addiction have been discussed; the Disease Model and the Adaptive Model. Each one was shortly identified and then they were critically compared in order to acknowledge the different assumptions and discover the reasons for why some people become addicted. The final part of this essay has introduced to the UK drug policy. The Misuse of Drugs Act (1971) has been used to assist with understanding of UK drug legislation and demonstration how chosen models may have contributed in the policy making process. It has been found that both models explain the development of addiction in different way. According to the Disease Model addiction is inborn, 'genetic predisposition', disease which requires cure like any other illness. It has been found that this understanding may have contributed to the policy making process by enforcement of the smoking law in public spaces in order to prevent illness.
According to the Adaptive Model, addiction is a sort of compensation for the loses due to the social exclusion which occurred due to the traumatic childhood experiences. This model however, has been applied in drug policy which presents harm reduction instead of treatment in order to minimise the progression of AIDS and HIV in society.
Overall, although there are many schools of thoughts to uncover what is causing addiction, there is no one single definition or theory which can be applied. It is important to acknowledge the problematic nature of addiction and understand that many factors need to be taken in to consideration before judging the person. It is essential also to recognise the contribution which these theories/models put towards the policy making process.
