The Disease and Adaptive Models of Addiction: A Framework Evaluation

Abstract

Underlying a vast proliferation of theory, there are two fundamentally different views of addiction. The first conceptualizes addiction as an illness (disease model) and the second as a way of coping (adaptive model). From the vantage point of the modern history and philosophy of science, both models are better evaluated as “frameworks” than as empirically testable hypotheses. A “framework evaluation” reveals that both models provide a comprehensive, coherent analysis of addiction and both can claim some empirical support, but that they differ sharply in their utility for formulating promising and humane policy. The disease model provides a major part of the justification for excessive, ineffective drug control policies and supports values that are repellent outside the drug field. The adaptive model, on the other hand, implies more humane and potentially more effective policy. This article argues the necessity of a framework evaluation and the superiority of the adaptive model over the disease model and over combinations of the two models.