The Disease Model of Mental Illness and Addiction + New Healthcare Coverage

The Disease Model of Mental Illness and Addiction – New healthcare laws to cover both the same as physical disease

shutterstock_86828707Yes, you read that correctly…mental illness and substance use issues are now supposed to be covered the same as any other type of physical disease. What this message is saying is that mental illness is just like any other disease. This is a topic I’ve written about in some shape or form before. And much of the talk about this issue has been spurred as a result of the recent gun violence (i.e. Sandy Hook, Aurora, etc.).

The disease model debate is a difficult one to tackle.  On one end many people feel it exonerates the individual to accept the disease model. It feels as though the individual has no control over their disease. If we were to think of this in terms of substance use, some feel that if we accept the disease model as true, then these “addicts” don’t have any control over their decisions and it takes choice away from them.

Now let’s look at it from the other perspective. From a medical perspective, someone either has a disease or they don’t. Some people are more vulnerable to certain disease than others – some carry certain genes or live unhealthy lifestyles that may make them more vulnerable to certain health conditions. For example, BRCA1 and BRCA2 genes make individuals more vulnerable to Breast Cancer and Ovarian Cancer. A bad diet is a big factor may make you more vulnerable to a number of conditions, including high blood pressure, high cholesterol, which can lead to more serious diseases. Then there are people who may have both genetic risk factors that make them more vulnerable and environmental issues, such as bad diet and lack of exercise that jointly contribute.

Those who accept the disease model often view mental illness and addictions the same way as a physical disease. There are both environmental and biological components contributing to any one outcome. And each outcome has a different proportion of genes and environment contributing to it. Where does choice come into all of this though? Well, it’s hard to say. Someone can choose to pick up a drink for the first time. Someone can choose to continue to drink, but there are differences in how people respond. You and I can pick up a drink and feel completely different things. I may feel quite a strong effect from that drink compared to someone who biologically does not feel the effects as much. Click here for the clip of Matthew Perry on CNN talking about this in relation to his own struggles with addiction. In research, these differential effects are called one’s subjective response to alcohol. It’s been shown that those with a lower level of response are at greater risk for alcoholism (see work by Dr. Marc Schuckit). So it may be true that one has the choice to pick up a drink, but the cycle that they can get into is much different than your cycle and my cycle. We each carry our own set of risk factors.

Let’s be clear though, it’s not all genes and biology. There are environmental influences, contextual influences, and free will. Someone may have grown up with addicted parents (although this would also carry a biological influence); someone may have a substance using peer group; someone may work in an industry that reinforces substance use. College is often a time that people engage in more substance use. It doesn’t mean that all these people are addicted though. None of these create direct cause-effect chains. It’s often hard to say what is exactly driving an addiction or mental illness. It could be that those who are addicted seek out peers or contexts that are reinforcing of their substance use or it could be that among those who are vulnerable to addiction, they have a common personality trait that may seek out substance using peers. They may be more impulsive or sensation seeking that lead them to create certain social groups, which may lead them to using. These mechanisms aren’t yet clear though.

This isn’t all about addiction though…you could apply this idea to any mental illness. It could be that those who are depressed isolate themselves, but it could also be that those who have depressive tendencies (possibly through biology) seek out solitary activities, which fuels the fire (so to speak). It’s not always clear what the mechanism is and it could be different for each individual, but I think it would be naive to say that any one factor is contributing to any one outcome. Even with the BRCA1 and BRCA2 gene there is still a possibility that an individual will not develop cancer.

So do we exonerate those with mental illness and/or addiction and say that this is a disease and it’s all out of their control? Or do we punish them asking them why they choose to drink, stay home by themselves, have hallucinations, delusions, etc? What if we took a middle ground and said that perhaps there was a choice somewhere on that individual’s journey and perhaps there were poor decisions, but what if there were certain factors (i.e. genes, family environments) that were out of their hands that contributed to their decisions more than they might contribute to yours? Can we accept that there might be a little bit of both going on? After all, isn’t that what happens in medical diseases anyways?

Related links:

Rubin Khoddam, PhD Clinical Psychology student at University of Southern California, founder of Psych Connection.

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Categories: Addiction Connection, Articles, Blogs by Rubin

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7 replies


  1. Don’t judge someone else’s experience based off of your own experience! | Psych Connection
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