It seems that the general view of addiction, including its underlying causes and mechanisms, has been changing over the past several decades. The so-called disease model of addiction is more widely accepted now than ever, illustrating the increasingly accepted belief that addiction is a mental health condition that requires treatment as such. However, this enlightened perspective is actually quite new. Before we break down how the popular opinion of addiction has changed, we need to have a brief history lesson.
Several decades ago, the general view or opinion of addiction was quite different than it is today. Back in the mid-twentieth century as substance abuse and chemical dependence were getting much attention in the press as well as medical and health fields, society at large was greatly prejudiced against those who suffered from addiction, not unlike prejudices against minority groups, those seen as having “poor breeding” if they had a less-than-privileged socioeconomic status, and so on, which were quite widespread in those days. At the time, addiction was seen as proof that an individual was immoral, weak in will and character, selfish and self-serving, lacking in discipline and self-control, having little regard for others and concerned only with seeking pleasure.
A History of Incarcerating Addicts
Due to these views, substance abuse became heavily criminalized in many societies. If you look back at the statistics, you’ll notice that the increasing rates of chemical dependency and addiction coincided with steadily increasing rates of incarceration. Since addicts were seen as being morally bankrupt and a scourge on society, they were dealt with by simply throwing them into jail. Even though current perceptions are slightly different, there is still a high level of drug-related incarcerations today due to the many lingering residual laws punishing individuals who suffer from addiction; there were an estimated 1.8 million adults involved in the criminal justice system in 1980, which jumped to 7.3 million by 2007. Additionally, it’s estimated that half of all incarcerations are due to drug-related crimes and that the rate of substance abuse is four times higher among criminal offenders than in the general population.
However, despite the prevailing view of the period being that addiction was tantamount to deviance, there were some who proposed handling addicts in some other, more effective way. Responding to the tendency of addicts to simply become incarcerated, in 1939 the Assistant Surgeon General noted that prison is where addicts’ “real needs were neglected.” Although incarceration forces abstinence on addicts whether they want to abstain or not, most addicts will continue with their substance abuse upon release from prison. As such, incarceration has consistently proven ineffective in treating addiction, leading to the emerging view of addiction as being somewhat like an illness rather than merely being indicative of immorality and weakness in character. Even so, high rates of addict incarceration continue today. It’s estimated that two out of three people released from prison for drug-related crimes return to prison within three years. This shows the need for an alternative approach when handling addicts and the criminal behaviors that result from their addiction. Rather than treating substance abuse as a law-enforcement problem, addicts need some other method that helps them to reform from these behaviors.
The Legal System and Views of Addiction
Since history has shown us that it’s most often been the legal system that deals directly with addicts, it follows that reform in the legal system would lead to changes in the public opinion of addiction. A rather illustrative recent example of how the legal system can have a huge impact on views and, consequently, the treatment of addiction is the decriminalization of substance abuse in Portugal. In 2001, a nationwide law in Portugal decriminalized possession of all drugs—including narcotics like cocaine and even heroin—for personal use, making them administrative violations rather than criminal offenses. While this might initially seem like a plan that would result in a spike in addiction rates, it’s now been ten years since Portugal decriminalized substance abuse and the rates of addiction have actually declined. At the time the law went into effect, officials in Portugal estimated that there were 100,000 individuals who were addicted to “hard” drugs; there are currently only 40,000 individuals being treated for drug abuse in Portugal, which is a decrease of more than 60 percent.
In the United States, the changing view of addiction, from being punitive for more rehabilitative, has resulted from the effective and convincing advocation of addiction as a disease. The evidence has proven that incarceration is an ineffective way of treating addicts while at the same time, it’s been difficult for most individuals to receive addiction treatment as addiction treatment has frequently been excluded from coverage by health care providers. However, in the past few years, there have been legal changes—particularly those related to health care reforms—that have had positive implications for individuals who suffer from addiction. Arguably the most important change, making the proceeding changes possible, was addiction being classified by the American Society of Addiction Medicine (ASAM) as a primary psychiatric and neurological disease rather than merely a set of behavioral patterns, creating “distortions in thinking, feelings, and perceptions,” which drive their behaviors. Once addiction became officially recognized as a disease, the disease model of addiction was quickly accepted by health and social services systems, preempting changes in health care laws.
The Patient Protection and Affordable Care Act (PPACA)—commonly referred to as the Affordable Care Act and colloquially known as “ObamaCare”—brought attention to a number of “essential health benefits” that were very infrequently covered by health plans, requiring most providers to expand coverage in 2014 and beyond. Among these essential benefits were “mental health and substance abuse disorder services, including behavioral health treatment.” This meant that addicts would be able to receive treatment for addiction under their insurance plans. Many addicts don’t have health insurance, but the Affordable Care Act also encouraged individuals to enroll in a health plan by making them more affordable and obtaining. Overall, this has been a huge step in the right direction as it brought widespread recognition to addiction treatment with many acknowledging it as the preferred and most effective way to deal with addiction. Despite the progress, there’s still a long ways to go before we can hope to see a significant reduction in national addiction rates. Specifically, there’s a shortage of treatment providers that would make treatment more accessible for addicts who need it. Additionally, the drawback to the disease model of addiction is that it seems to excuse addicts from the role they played in their own addiction, which has prompted a discussion of the necessity of finding an alternative model that acknowledges addiction as a disease while also making individuals accountable for its development and responsible for sustaining their recovery.
Addiction is a lonely, dangerous disease that often leads to death if left untreated. The Palm Beach Institute can help those who suffer from addiction to alcohol and drugs begin the journey of recovery and get onto a path of health and fulfillment. Don’t wait; call us today at 855-534-3574 or contact us online.
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