Traditional biases in defining addictive illness have blurred our understanding, and magnified the artificial boundaries between mental health, substance abuse, and medical treatment, making service delivery systems ineffective and inefficient.
The philosophical underpinnings of traditional interventions for addictive illness have produced institutionalized systems, over the past seventy-five years, that are limited in their homogeneity. Treatment protocols for the misuse of alcohol and other drugs have been developed, in diverse branches of medical, psychiatric, public health, and criminal justice theory, though the monoculture of the “Twelve Steps” remains pervasive.
The legitimization of addictions treatment was established by the 1956 declaration of the American Medical Association that “alcoholism is a disease,” followed by E.M. Jellinek’s 1960 publication of “The Disease Concept of Alcoholism.” Individuals suffering from addiction began receiving treatment specific to their “disease”, deviating from the historical norms of incarceration or long-term commitment to sanitariums and asylums. Health insurance plans eventually covered inpatient treatment, and the “28-day rehab” became the industry standard, dramatically expanding the numbers of public and private facilities available to those seeking services, increasing their profitability.
Nevertheless, the antiquated legacy of addictions theory and practice, reflected in the drug-enforcement policies of the United States, which remain irrationally-constructed and inconsistently-enforced, remains disconnected from the framework of scientific inquiry that has relatively-recently emerged.
The Diagnostic and Statistical Manual, the incarnation of the American Psychiatric Association’s authority in the diagnosis of mental disorders, has skirted rational consistency in its placement of diagnostic categories within “Substance Use Disorders.” While the much-anticipated revisions of the DSM V offer a more integrated diagnostic compendium of addictive illness (replacing substance “abuse and dependence” with “addiction and related disorders”, the taxonomy has retained much of its arbitrary nature.