Like other public health issues, our understanding of addiction has evolved with time. We have cycled through a number of theories, models, and conceptual frameworks to explain addiction and its causes, though this has been met with relatively little success. One of the earliest and widespread theories of addiction was the moral model, which treats addiction as a moral failure rather than a treatable health condition. This framework did little to advance addiction treatment, but rather served as a source of stigma towards people with addiction, justifying ostracism and penal punishment.
As the field of addiction science began to take shape, however, we found consistent patterns through which we could identify individuals who are at a higher risk of experiencing addiction and its consequences. This finding would push the field away from the moral model and towards the disease model–though there was still, and continues to be, a widespread belief in the immorality of addiction. Indeed, these remnants persist even into the modern era where we have come to view addiction as a complex, multifaceted disorder caused by a number of factors. In other words, the disease model treats addiction not as choice, but rather as the outcome of a constellation of life experiences. Some programs such as Alcoholics Anonymous still characterize addiction as a deeply moral issue. One must look no further than The Twelve Steps, a core aspect of the program, to find references to moral shortcomings and wrongdoings.
To address persistent stigma towards those who suffer from addiction, this month, The BASIS will focus on pathways to addiction. In doing so, we hope to illustrate to our readers how one can travel down the path towards addiction through factors that are, to at least some extent, out of one’s control. Throughout this Special Series, we will review recent research on the risk factors for and pathways to addiction. First, ASHES will review an article detailing the role of parental smoking on youth nicotine use. STASH will review a study that explored the importance of initial experiences with drugs. The WAGER will review an article detailing subtypes of gambling and pathways to each. Finally, The DRAM will review a study that assessed the role of education in future drinking. We will interweave editorials from other experts in the field of addiction science to complement these review articles. Dr. Sharon Levy, an expert researcher on adolescent substance use, Maia Szalavitz, an investigative journalist and science writer, and Paul Buck, CEO of EPIC, an independent gambling prevention organization, will provide these editorials.
— John Slabczynski, Research Coordinator, Division on Addiction at Cambridge Health Alliance, a Harvard Medical School teaching hospital
Conflict of Interest Statement
Mr. Slabczynski has no conflicts of interest to disclose of personal, financial, or other benefits that could be seen as influencing the content of this editorial. The Division on Addiction’s funding sources can be found here.
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