Failings of the disease model of addiction

Colloquially, addiction ranges in meaning from addiction to good deeds to addiction to substances of abuse. Especially during the last four decades, ‘addiction’ in this extreme pejorative meaning has been portrayed alternatively as a disease or a sin, and has been subject to social and moral sanctions. In an open society of free individuals such a coercion cannot be justified unless the condition is defined precisely by the simultaneous attributes of severe psychotoxicity, severe withdrawal symptoms, and recurrence tied to the loss of self‐control and individual volition. Still, these attributes are open‐ended, and an explicit metric of severity at which they may trigger social objection has not been clarified. As a consequence, ‘addiction’ allegations are left to elicit emotional, subjective, and value‐laden responses ready to be exploited. A clamorous example is the claim by US officials that cigarette smoking is equal to the abuse of heroin or cocaine. An unequivocal definition of ‘addiction’ may restore some sense of proportion to official normative intervention. © 1996 John Wiley & Sons, Ltd.