Co-Principal Investigators     Nigel Turner, PhD., Peter Ferentzy, PhD. & Wayne Skinner, MSW, RSW
Completion Date/Term          Fall 2010                   
Funding Source                     OPGRC
Contact Information               nigel_turner@camh.net

Over the past 200 years, society has gradually come to accept the idea that addictions are a type of disease. The disease notion can be traced back to sermons and medical documents from the late eighteenth and early nineteenth centuries. This perspective was a great step forward as it alleviated some of the guilt, reduced stigma, and encouraged afflicted individuals to seek help. More recently, though, the disease (or medical) conception has been challenged by many experts. While there are several disease models, they are often treated as a unified entity and a few criticisms stand out: 1. it is overly rooted in clinical perspectives; 2. it focuses unduly on the hardest cases; 3. it inhibits harm reduction and moderation therapy approaches; 4. it does not fit well with sociological inquiries; 5. it paints pathology in black and white terms, without allowing for degrees; 6. it still has too much in common with the moral model it supplanted. A major challenge involves viewing addictions along a “continuum” of harm as opposed to a strict focus on pure pathology. This last criticism relates to issues ranging from the appropriateness of harm reduction and prevention initiatives to debates over whether abstinence is the only solution.
   We intend to trace the evolution of these ideas from a PG perspective. Though addressing the earliest manifestations of the disease conception, our main emphasis will be on the middle twentieth century to the present. We wish to provide a systematic rendition of the medical conception and the many emerging alternative perspectives, with an eye on how the situation is likely to evolve. Behavioral learning theory, systems theory, and discussions involving “public health” and sociology have all presented challenges to a dominant “medical” conceptualization of gambling problems arguably beholden to a disease conception that Gamblers Anonymous (GA) and many in the treatment field adapted from Alcoholics Anonymous (AA). Despite the existence of many medical models, the “disease” or “medical” model is often taken as synonymous with the one put forward by GA. Confusing the issue is that many of these models – for example the DSM description of pathological gambling as a “disorder of impulse control” – share traits with the GA model. Yet the public health model, rooted in epidemiology and clearly a “disease” model of sorts, is often presented as a challenge to the more popular GA-disease conception. We wish to unravel the many definitions of disease currently in use, and to provide some historical background for a better grasp of how the current situation has taken shape. Special attention will be given to whether addictions are literally diseases, or only metaphorically so. We also intend to identify future possibilities by determining where certain terms, concepts, beliefs and practices are potentially compatible or even complementary, and where others are – for either practical or logical reasons – mutually exclusive.