Psychoanalytic and Disease Model of Addition
Addiction treatment uses several models to treat and interpretive addictive behavior. Two models of addiction are classical psychoanalytic model and the disease model of addiction. The contemporary psychoanalytic model is loosely based on the theories of Freud, and the disease model of addiction is an attempt to push for the recoding of addiction as a disease. Both the models have a perspective on addiction that is polarized. Ultimately this article hopes to assert the effectively of psychoanalytic model of addiction.
The classic psychoanalytic models of addiction are loosely based on the works of Freud. Loosely, because most of the concepts have been either overemphasized or diluted. So for instance when Craig argues "[f]reud viewed addiction as a substitute for masturbation and considered the impulse to drink -"dipsomania- a substitute for sexual impulsive(Craig, 2004)" yet fails to cit his source. The assumption to be made is that Craig understands Freud to be linking addiction to the phallic stage, when drinking (as far as Freud is concerned) would be linked to the oral phase. Unless Craig is arguing that masturbation is an oral fixation. What Craig in all likelihood is citing is letter between Freud and Wilhelm Fleiss where in 1897 "Freud wrote, "It has occurred to me that masturbation is the one great habit that is a 'primary addiction,' and that the other addictions, for alcohol, morphine, etc., only enter into life as a substitute and replacement for it(Levin, 1995)." Due to the fact that Craig is citing private correspondence early into Freud's career, the concept that "addiction is a substitute for masturbation" is hardly a definite representation of Freud's seminal work. The fact is that substance addiction was not a main focus of Freud's, mostly because addiction per say did not exist in the same way for us that it did during his lifetime. Craig's text's focus on absurd concept that Freud over-sexualized everything serve two purposes; first, purpose to discredit Freud to generations of students confronted with the obligatory text, secondly a spread a misinterpretation of what Freud actually said about sexuality.
So, what is the classic psychoanalytic model of addiction? Put simple it is a fraud, that has very little to do with psychoanalytics qua Freud. If Freud wrote about addiction he would have started out from the perspective of the death drive (death instinct). The death drive is not the compulsion towards self obliteration, but the compulsion to repeat thoughts, behaviors or actions that are contrary to self preservation. When Freud was revering to the death drive he was speaking in general about a whole slew of activities; from compulsive behaviors like washing your hands repetitively after touching any surface to alcohol addiction. Freud's belief was that repetitive behaviors which served to survival purpose shared a common theme. He called that theme the death drive. Freud argued the death drives
"operate against the purpose of the other instincts, which leads, by reason of their function, to death; and this fact indicates that there opposition between them and the other instincts, an opposition whose importance was long ago recognized by the theory of the neuroses. It is as though the life of the organism moved with a vacillating rhythm. One group of instincts rushes forward so as to reach the final aim of life as swiftly as possible; but when a particular stage in the advance has been reached, the other group jerks back to a certain point to make a fresh started and so prolong the journey(Freud, 1961)."
Freud saw repetitive compulsive behaviors as the result of several causes which lead to several symptomologies. What Freud was attempting to describe was the process in which addictions took in the structure of how he viewed human pathology.
The disease model of addiction is a ideological-political argument. In Counseling the Drug Dependant Client, Craig argues to justify the disease model for three pages, while none of the other addiction models receive such positive support (Craig, 2004). Craig betrays objectivity by not playing a neutral party. The disease model's crux is the argument for the redefining of the terms "addiction" and "disease" in order to pursue the access to funding that disease's have. But is calling addiction a disease accurate? Yes, if you follow Craig's post-modernist argument where disease becomes redefined to include symptoms caused by unnatural yet "naturalized" behavior. In other words, in order to accept the conclusion that addiction is a disease one must also accept the conclusion that the access to substances which facilitate the behaviors inducing addiction and creating disease as a natural inevitable factor in the environment. Craig also argues that loss of total freewill is also an essential factor in defining a disease as a disease. But can we even talk about freewill in the case of cancer (cancer being a definitive case of disease)? While there has been some linkage to behavioral factors such as smoking. Activities such as smoking do not institute a direct universal causal chain to cancer. In order for addiction to take the label of a disease it must share some definitive traits with established diseases.
The disease model of addiction essentially argues that addiction is a disease and that helping profession should seek to treat the effects of the disease and instead of the causal environmental factors. The disease model classifies alcoholics into four categories; beta alcoholics, gamma alcoholics, delta alcoholics, epsilon alcoholics(Craig, 2004). The categories rate the frequency and symptoms of alcohol use from severe (beta) to mild (epsilon)(Craig, 2004).
What Works Best?
In my opinion I think that we need to step away from an empirically based practice criteria grounded in economic profit generation. The criteria in which we use to judge what works needs to be solely based on the people that model or a perspective actually helps in the really-existing-world.
The model I prefer is Lacanian Psychoanalysis which is based upon the works of Jacques Lacan. Lacan sought to redeploy Freudian psychoanalysis in the 1960s, and is arguably the most popular method of therapy globally, with a growing influence in North America(Fink, 1997). One of the difficulties Lacanian psychoanalysis shares with most forms of psychoanalysis is that it was designed to be an empirical based method of treatment. Secondly, Lacanian psychoanalysis does not put the primary focus of therapy on happiness but identification with ones symptom (I know this sounds abstract, but it is outside the scope of this paper to describe the complexities that are required to make "enjoying ones symptom" make sense). I prefer Lacanian psychoanalysis because I feel it better describes the human condition, and options in which to address human problems. Currently I have not studied Lacan's thoughts specifically in regards to addiction, but from I have came across Lacan sides with Freud that substance addiction shares similar structure other behaviors via the death drive.
There are several modalities in setting ones perspective in regards to addiction. Classical Psychoanalysis and Disease models are two of those modalities. Ultimately I have developed an argument for my preference for Lacanian Psychoanalytics a model of human behavior and treatment.