The disease concept of chemical dependency is the concept that a disorder (such as chemical dependency) is like a disease and has a characteristic set of signs, symptoms, and natural history (clinical course, or outcome).
The disease concept has long been accepted by the medical community. The concept proposes that a disease is characterized by a specific set of signs and symptoms and that the disease, if left untreated, will progress to some endpoint or outcome (clinical course). However, controversy arises when the medical community is faced with new abnormal conditions, owing mostly to the new technologies in genetic engineering. This controversy becomes especially apparent when examining psychological disorders.
In the past, psychological disorders were thought in general to be due to both psychological and social abnormalities. Although these psychosocial problems are still of utmost importance, researchers have since discovered that many psychological disorders, such as alcoholism, also have genetic causes. Recent studies have identified a genetic area (locus) where a gene is located that can transmit alcoholism from affected father to son. Mental health professionals also know from clinical experience that alcoholics demonstrate a characteristic set of specific signs and symptoms.
Additionally, it is well established that the ultimate clinical course for untreated alcoholism is death.
Therefore alcoholism, once thought to be a disorder of those with a weak will, or "party people" can now be characterized as a disease.
Can it be inferred that other chemical dependencies may also have biological causes? There is compelling evidence that this theory may be correct. It is interesting to note that all psychoactive mood-altering drugs (alcohol, cocaine, marijuana, heroin, etc.) act in specific sites in the brain and on a specific neurotransmitter (a chemical that delivers impulses from one nerve cell to another) called dopamine. These mood-altering substances cause dopamine depletion, inducing an abnormality in nerve cells that "hijacks" the cells into chemical dependence.
In other words, the substance introduced in the body affects the dopamine in a way that makes the affected individual unable to experience everyday pleasures—the individual instead needs that substance to experience pleasure. Thus the individual's driving force is any drug that can provide some kind of transient happiness (euphoria). In fact, the gene for alcoholism is located in the dopamine molecule. This can further suggest that chemical dependencies may have a medical (biological) cause.
The disease concept of chemical dependency is gaining worldwide acceptance, but does have some critics who argue instead that addiction must be understood as a general pattern of behavior, not as a medical problem. Advocates of the disease concept of chemical dependency model maintain that the identification of biological causes or correlations is crucially important for treatment. They argue that if clinicians can understand the intricate details concerning the mechanisms associated with drug effects, then measures to interrupt the effects can be devised. These interventions can be both medical (developing new drugs to chemical block effects of illicit drugs) and psychological.
According to the disease concept model, psychological intervention includes a vital educational component that teaches people with chemical dependency the concept of understanding addiction as disease. As a result of this understanding, affected people then view their dependency as a disease, similar to other diseases with a biological cause (heart disease, cancer, high blood pressure), and with a specific set of signs and symptoms and an outcome in the future (clinical course).
Proponents of this approach believe that this understanding can help affected people to follow treatment recommendations, and can reduce shame and guilt commonly associated with chemical dependence. Alcoholics Anonymous is a prominent example of an organization that embodies the disease concept of chemical dependency.
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Johnson, J., M. K. Leff. "Children of substance abusers: overview of research findings." Pediatrics 103, no. 5 (May 1999).
Laith Farid Gulli, M.D.
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