The disease model and the moral model have merged their component tenets with emergent models. For example, while both the moral and disease models are usually viewed as distinct from each other, Marlatt (1998, p. 57) notes that the two models have formed an “alliance” which can be seen in Alcoholics Anonymous as it incorporates aspects of both models. For example, the organization views alcoholism as an illness but also emphasizes “a power greater than ourselves,” “a searching and fearless moral inventory of ourselves,” and “defects of character,” as written in the 12 steps of A.
A. (Tatarsky, 2002, p. 34-36). Less well-known is the addictive behavior model, which draws from social learning theory, cognitive psychology, and experimental psychology and views addictive behaviors on a continuum as opposed to falling into fixed categories (Marlatt, 1998, p. 59). Miller and Rollnick (2002) also provide a review of “evolving models of treatment. ” They discusses the medical model as one which grew out of earlier conceptions of the disease model yet takes a more biopsychosocial view.
While less prominent in mainstream discourse, Miller and Rollnick(2002) provide a discussion of the spiritual model, the psychological model, the sociocultural model, and the composite biopscyhosocial-spiritual model. According to Gordis, in the early days of the field, “counselors were credentialed by their own recovery experience. ” Constructed as an issue of moral failing, the field fell into the realms of religion and law enforcement (Gordis, 1997, p. vii). In 1935, Bill Wilson wrote the Alcoholics Anonymous (A. A. ) “big book” which became highly influential in the treatment field.
At that time, it was believed that those in recovery could provide treatment to other alcoholics. However, Gordis (1997) notes that even Wilson did not intend for A. A. to be all there was available for treatment and recognized it as one piece of a larger whole. In the late A. A. began publishing surveys showing its attrition rates, symbolizing a willingness to self-critique absent in the past. This set of ideas, couched in moral failure and/or disease, led to a treatment system in which a majority of programs are based on the disease model and twelve-step approach; ” .
97% of all substance abuse programs in the United States use twelve-step practices and groups as the primary vehicle for treatment… ” (Denning et al. , 2004, p. 17). Thus, the majority of those in a recovery program are in a program based to some extent on 12-step based principles (Marlatt & Donovan, 2005). The most widely available treatment interventions for substance abuse are derived from the 12-step disease model treatment approach, as exemplified by the Minnesota Model (Marlatt & Donovan, 2005).
Ninety-three percent of all drug and alcohol treatment centers in the United States base their programs on the 12-step model of treatment (McKellar, Stewart, & Humphreys, 2003). The Minnesota Model of substance abuse treatment is based on a conceptualization of substance abuse and dependence as a chronic and progressive disease that negatively affects a person physically, mentally and spiritually. The model’s foundation is based on the 12 steps of Alcoholics Anonymous (AA), which is the most well known and widely available mutual support group worldwide (McKellar, Stewart, & Humphreys, 2003).
Twelve-step-based treatments are primarily focused on abstinence from any use of alcohol and drugs, becoming part of a fellowship of individuals in recovery, experiencing a spiritual awakening, acceptance of alcoholism and drug addiction as a progressive and fatal disease, and reliance on “God” or a “higher power’ to cope with the disease of substance use and maintain sobriety. There is a growing body of empirical research showing support for the effectiveness of AA and related 12-step group affiliation (McKellar, Stewart, & Humphreys, 2003).
Although treatments for substance abuse based on the Minnesota Model approaches are effective, 90% of individuals who could benefit from this form of treatment are not utilizing it. It has been proposed that untreated individuals may resist seeking treatment because of the abstinence-only approach proffered by traditional 12-step-based drug and alcohol treatment programs and AA, the stigma associated with accepting the label of alcoholic or addict, and the belief that individuals who have problems with drinking alcohol and using drugs are either immoral or diseased (Marlatt & Donovan, 2005).
The 12-step program originated as a grass roots organization. It is technically not considered treatment or psychotherapy “eschewing psychiatric and behavioral science research, intervention techniques, and concepts” (Hartel & Glantz, 1999, p. 252). Twelve step groups are support groups that provide a framework for recovery, utilizing the 12 traditions and the 12 steps. Meetings are of three types: speaker meetings, open discussion meetings, and meetings which focus on one step in particular. Members are also encouraged to get a sponsor (a member who has experienced recovery) (Hartel & Glantz, 1999, p. 253).