CONCEPT
Disease Model of Addiction
The dominant medical paradigm treating addiction as a chronic, relapsing brain disease caused by substances hijacking neural reward circuitry—a framework Peele argues is scientifically incorrect and therapeutically harmful despite its humanitarian intentions.
The disease model, institutionalized by the American Medical Association (1956) and codified by NIDA in the 1990s under Alan Leshner, holds that addictive substances produce neurological changes compelling continued use regardless of consequences. Addiction is chronic, progressive, and requires lifelong medical management; the addicted person is sick, not weak-willed. This model reduced moral stigma and justified treatment funding, representing genuine humanitarian progress over prior condemnation frameworks. Peele's critique accepts the humanitarian benefits while rejecting the scientific validity: the model cannot explain natural recovery (most people with substance use disorders recover without treatment), cannot account for environmental determination (Vietnam veterans' heroin use resolved with return to civilian life), and produces harmful therapeutic consequences by teaching powerlessness. Applied to productive addiction, the disease model becomes absurd—it cannot distinguish between a surgeon's residency and pathological gambling, diagnosing intensity itself rather than dysfunction.
In The You On AI Field Guide
The disease model's institutionalization followed a century-long trajectory from moral