The nineteenth century and the 1st disease concept
During the nineteenth century, attitudes towards addictions and, in particular alcohol,
changed. The temperance movement was developed and spread the word about the evils
of drink. Alcohol was regarded as a powerful and destructive substance and alcoholics
were regarded as its victims. This perspective is also reflected in prohibition and the
banning of alcohol consumption in the USA. During this time, the 1st disease concept
of addiction was developed. This was the earliest form of a biomedical approach to
addiction and regarded alcoholism as an illness. Within this model, the focus for the
illness was the substance. Alcohol was seen as an addictive substance, and alcoholics
were viewed as passively succumbing to its influence. The 1st disease concept regarded
the substance as the problem and called for the treatment of excessive drinkers. Again,
social attitudes to addiction were reflected in the development of theory.
The twentieth century and the 2nd disease concept
Attitudes towards addiction changed again at the beginning of the twentieth century.
The USA learned quickly that banning alcohol consumption was more problematic
than expected, and governments across the Western world realized that they could
financially benefit from alcohol sales. In parallel, attitudes towards human behaviour
were changing and a more liberal laissez-faire attitude became dominant. Likewise,
theories of addiction reflected these shifts. The 2nd disease model of addiction was
developed, which no longer saw the substance as the problem but pointed the finger
at those individuals who became addicted. Within this perspective, the small minority
of those who consumed alcohol to excess were seen as having a problem, but for the
rest of society alcohol consumption returned to a position of an acceptable social habit.
This perspective legitimized the sale of alcohol, recognized the resulting government
benefits and emphasized the treatment of addicted individuals. Alcoholism was
regarded as an illness developed by certain individuals who therefore needed support and
treatment.
The 1970s and onwards – social learning theory
Over the past few years attitudes towards addictions have changed again. With the
development of behaviourism, learning theory and a belief that behaviour was
shaped by an interaction with both the environment and other individuals, the belief
that excessive behaviour and addictions were illnesses began to be challenged. Since the
1970s, behaviours such as smoking, drinking and drug-taking have been increasingly
described within the context of all other behaviours. In the same way that theories of
aggression shifted from a biological cause (aggression as an instinct) to social causes
(aggression as a response to the environment/upbringing), addictions were also seen
as learned behaviours. Within this perspective, the term addictive behaviour replaced
addictions and such behaviours were regarded as a consequence of learning processes.
This shift challenged the concepts of addictions, addict, illness and disease, however the
theories still emphasized treatment.
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