Morals, medicine, metaphors, and the history of the disease model of problem gambling

Abstract

Over the past 200 years, society has come to accept the idea that addictions such as alcoholism and pathological gambling (PG) are a type of disease that is chronic, progressive, and somewhat mysterious in terms of etiology. This conception has been most strongly associated with organizations such as Alcoholics Anonymous and Gamblers Anonymous. The chronic disease model alleviated stigma and encouraged many to seek help, but has been challenged by some experts. Confusing the issue is that the public health model, often presented as the main alternative to the disease model, is rooted in epidemiology and clearly a disease model itself. In this paper, we trace the history of ideas about PG as a disease and examine some of the assumptions and metaphors that underlie these models. In the final section, we examine what aspects of addiction in general, and PG in particular, are either revealed or hidden by these models.