Ending the Disease Model Controversy
by Phillip Ziegler, MFCC
A number of writers in the addiction field have challenged the disease model of 
addiction. Most notable are Stanton Peele and Herbert Fingarette. Both of these 
writers refer to numerous scientific studies which refute or seriously dispute 
many of the claims and theories attributed to AA and the medical treatment 
community. Their most vitriolic criticisms of the AA/medical treatment of 
alcoholism and other addictions is their objection to the disease concept. What 
is this disease concept and is it accurate to say AA bases its program of 
recovery on it?
According to the disease model, alcoholics have a bio-chemical predisposition 
toward alcoholism. Once the individual reaches the stage where he can no longer 
control his drinking the disease has taken over his mind and body. Once this 
condition becomes manifest the alcoholic can never drink with the assurance than 
he or she can stop at will. It is true that AA is quite clear that total 
abstinence is the only solution. The reason for total abstinence is that the 
alcoholic's reaction to alcohol is so powerful that it's effect cannot be 
predicted. This does not mean that he has a disease, it simply means that he has 
formed an unhealthy relationship with a substance that produces powerful 
negative effects on him. And that reason, self knowledge and will power are 
insufficient to keep his from taking the first drink. Following the 12 Step path 
of recovery does not require adopting the disease concept. It does require 
understanding that compulsive drinking is merely a symptom of a deeper 
psycho-spiritual problem, a breach in the inner relationship between the ego and 
a Higher Self.
It is almost universally believed that the Big Book described alcoholism as a 
disease. This is simply not the case. Bill W. apparently was not comfortable 
with the word. He chose to refer to alcoholism as many things, but not a 
disease. He called it a malady, an illness, and a hopeless state of mind and 
body. It is often suggested that Dr. Silkworth, whose medical opinion appears in 
the beginning of the Big Book, is the source of disease concept. However, a 
close reading of his opinion in the Big Book makes clear that he alcoholic's 
problem was not his inability to hold his liquor, but his inability to stay away 
from it even in the face of incontrovertible evidence that he had lost the power 
to control his drinking once he took the first drink.
Dr. Silkworth's comments include his theory that alcoholism is both an obsession 
to drink and an allergic reaction to alcohol which drives the alcoholic to 
continue drinking once he starts. This allergy theory, which has been argued 
over ever since, was not the heart of his comments or the reason for their 
inclusion in the Big Book. His opinion was that alcoholism was a 
psycho-spiritual malady which could be relieved only by a profound psychic shift 
in consciousness capable of relieving the alcoholic of his obsession to take the 
first drink and that the AA 12 Steps and participating in the AA fellowship 
could bring about such a transformation.
When AAs and those who criticize the disease model debate this issue, the common 
ground between them is lost in a sea of hysteria and fanaticism. When critics of 
the disease model, like Stan Peele, define addiction as a "habitual response and 
a source of gratification or security" they are challenging the disease model, 
but they are missing the underlying commonality between his approach and that 
set forth in the Big Book. When Peele continues to say in The Truth about 
Addiction and Recovery that addiction, "is a way of coping with internal 
feelings and external pressures that provides the addict with predictable 
gratifications, but that has concomitant costs," he is mirroring, not 
contradicting the Big Book. And all of us who are recovering through 12 Step 
programs need to listen carefully when Peele says, "when a person becomes 
addicted, it is not to a chemical but to an experience."
Compulsive behavior is a maladapted method for producing temporary comfort, 
relieving stress and producing a sense of well-being. Alcoholics and other 
addicts have found something that can easy the distress of living. The problem 
is in the living, not the means of temporary relief. AA and those critical of 
the disease model agree, whether they know it or not, that the long-term 
solution to the alcoholic's problems lie in changing personal values, beliefs 
and attitudes about himself, others and life in general, and an ongoing 
commitment to replacing unhealthy behaviors with healthy ones.
While there is much talk in the recovery field about alcoholism being a genetic 
disease this was not suggested in the Big Book. There it is said repeatedly that 
the alcoholic's problem is a disconnection to his inner psychic spiritual core, 
not a genetic predisposition to excessive alcohol consumption. If alcoholism is 
labelled a disease, the Big Book makes in clear that the dis-ease is not 
bio-chemical, but rather a dis-ease at the level of the soul. Recovery is not 
medical, but soul work leading to a spiritual transformation.
Spiritual transformation does not refer to becoming a saint or seeing God. It is 
a process of awakening to the great mystery of life and to discovering and 
drawing upon inner sources of guidance, strength and wisdom found in the depths 
of every human psyche. Once we are able to tap these resources our lives take on 
a new meaning and our ability to handle life's challenges grows. Our self esteem 
expands along with our capacity for intimacy, compassion and love. And we no 
longer feel compelled to seek experiences which provide temporary relief while, 
in the long run, compounding our problems in living.


Phillip Ziegler is a licensed Marriage, Family and Child Therapist in private 
practice in Oakland, California, where he specializes in working with recovering 
men and women. He is author of A Skeptic's Guide to the 12 Steps, published by 
Hazelden/Harper.