The addiction concept: How the language of sin was replaced by that of disease

The disease model of addiction is barely over two centuries old. The product of a secular mindset which medicalized behaviors and states that had been deemed sinful, this conception of chronic substance abuse first appeared during the late eighteenth and early nineteenth centuries in the wake of a larger shift in the way Westerners viewed deviancy as well as other fields ranging from medicine to history. Whether one chooses industrialization, capitalism, scientific awareness or another cause, our perception of the world and of ourselves changed drastically.

Addiction's key feature, the loss of control over a substance, became increasingly problematic as Enlightenment ideas of free will gained ascendancy. Since some “loss of control” was also the key feature of madness and other psycho-behavioral ailments, addiction, which directly targets volitional issues, is the purest rendition of a larger development. Most successful in North America, the disease conception was first aimed at alcohol and only later at other substances. Preindustrial preachers and medical authorities did not consider drunkenness more enticing than other sins such as swearing and fornication—there was no substance-specific conception of compulsive behavior. As well, the chronic and progressive nature of what today is called alcoholism was understood but not considered iron-clad (in the eighteenth century the very notion of disease etiology was still controversial). Further, holistic conceptions of sin and redemption made moderation rather than abstinence the favored solution to chronic drunkenness.

Pertinent themes such as the propensity of addicts to “deny” their condition, and a drunkard's effect on family and friends (today called “codependency”) were well formulated by the nineteenth century Temperance movement which was in step with other social, scientific and philosophical trends. The “denial” practiced by alcoholics, for example, was (and is) similar to the resistance to awareness which purportedly haunts neurotics. In either case deviancy is masked by the suppression of inner truths—entailing a uniquely modern excursion into the recesses of the soul. This “Foucauldian shift” in perception can be identified wherever modernity confronts behaviors and states of mind considered morbid or strange. It also presents unprecedented conceptual paradoxes.