Why The Disease Model Of Addiction is So Vitally Important To The American Economy
- 7 hours ago
- 5 min read
For nearly 14 years, I've helped individuals navigate the complex landscape of addiction in order to achieve recovery. Nicknamed "The Casual Counselor", my approach is unconventional but undeniably effective.
The disease model of addiction defines substance use disorder as “a chronic, progressive, relapsing, and fatal brain disease”. Chronic, as in forever. Relapsing, as in similar to cancer or diabetes, the symptoms of the disease will inevitably return. Progressive, as in the illness only increases and persists, even when the individual is abstaining from use. Fatal, as in, if you do not or cannot find a model of constant, forever care to prevent it from flaring up again, then, well, it’s been nice knowing you.
By the way, the model also teaches us that there is no cure. Never has been and never will be. For the individual with the disease, their best hope at living a good enough life is a chance for a daily reprieve, a 24-hour period of remission from use. It’s a simple model. Easy to understand. I’ll give it credit for that. So why is it so difficult to follow? Why does it lack such effective, positive outcomes for people?
Well, for as much as we like to believe we understand the human brain in relation to drug and alcohol abuse, we don’t really know shit. Each human brain is not identically wired or designed to function identically in comparison to any other. We’re just scratching the tip of the iceberg in respect to the neuroscience of truly understanding “addiction”.
While getting the AMA’s seal of approval for “addiction as a disease”, framing it as such has helped open doors for medical intervention and treatment. Simultaneously, it has also greased the skids for the model to serve as a highly lucrative pillar of America’s privatized healthcare system and our economy in general.
“How lucrative are we talking, Josh?”, you may be asking. Most conservative estimates put the disease model of treatment somewhere in the neighborhood of generating between $141 and $143 billion annually, on average. That’s a lot of money by any measure.
By transforming a complex psychosocial issue into a treatable, yet somehow incurable, medical condition, the disease model perfectly dovetails with the commercial interests of private healthcare providers and the insurance industry.
In deeming it a disease, we have legitimized a reliable and high-volume market for private rehabilitation facilities. Inpatient facilities, outpatient aftercare, medical detoxification, recovery housing, individual and group therapy, recovery coaching, transportation services, myriad pharmacological interventions, the list is long, and literally millions of customers to serve those markets.
No matter who you are, no matter what factors are compelling you to self-medicate and seek relief from the unique factors that provoke the use of pleasurable pills, potions, powders, or pipes, you’re now bound within the shackles of the life sentence of the “disease”. You are then relegated to systems of never-ending containment for a shot at brief remission, forever and ever, amen.
Because, remember, it’s chronic. When addiction is viewed as an individual pathology requiring expert clinical care, it justifies expensive, specialized interventions and creates customers for life. Those customers? It also incurs within them feelings of hopelessness, helplessness, and treatment fatigue, often leading them right back to what the disease framework told them to expect: a return to using again.
“Told you so!” It’s actually a very clever model that seems to have validity when the outcome is always relapse. It’s what the user was told at first contact with nearly every treater they first spoke with when seeking help. “You’re sick, you’ve always been sick, you always will be, but we can help!” Yeah.
Private rehabilitation centers can command tens of thousands of dollars per client for standard 30-day inpatient residential programs. Residential facilities routinely administer urinalysis testing to confirm whether or not their “patients” are abstaining from use while under their care.
If I told you that each single cup of urine, shipped to the laboratory for confirmation of the results, costs in the neighborhood of $1,500 per sample, would you believe me? You should, because it’s true.
Many of those residential programs have upwards of 40 to 50 clients on any given day, often being tested upwards of two to three times weekly. You don’t need a finance degree to realize what a cash cow that single service provides to these programs, and in America? There are thousands of these programs and they provide many more services than urine testing.
Because “chronic diseases” are, by definition, “managed” rather than cured, high rates of relapse inherent to problematic drug use or drinking do not signify product failure. Instead, they ensure repeat business.
Those residential programs? They absolutely love it when a former client comes back for care for the 10th time in two years. Their system profits from a revolving door phenomenon, where patients cycle through detox, inpatient residential rehab, and returning to use, because not much stabilization happens in a month for anyone, generating a white water river of rapid revenue for these private operators.
It’s great for their bottom line. A rock-solid business model. It’s reprehensible when viewed through an actual lens of the human toll that it manifests, and the destruction and death that are ancillary to the design of the system.
Treatment trauma. Try sitting with a family whose 20-something-year-old son or daughter just died from an overdose following a dozen attempts at “getting help”. I’ve done it. I’ve had that session too many times. It’s heartbreaking beyond description.
Additionally, the medicalization of addiction shifts the financial burden onto private insurance companies, which in turn benefits the pharmaceutical industry. Think of these entities as “besties”. They pass and share the massive profits between themselves in a symbiotic relationship, shifting blame and accountability to the “diseased person” when the outcomes are not favorable, or even fatal, based on the administered care for which they charged five or six figures.
Under the disease model, medications like buprenorphine, naltrexone, SSRIs, SNRIs, mood stabilizers, methadone, anxiolytics, and many other Rx meds require ongoing, long-term prescriptions. Privatized healthcare systems thrive on this model because it prioritizes high-margin, scalable treatments.
Dispensing a pill or an injection over and over, instead of providing complex systemic solutions like affordable housing, community integration, mutual aid, nutritional support, and economic support, benefits the conglomerate of “Big Pharma” in a big time way.
Finally, by isolating addiction within the individual’s biology, the disease model absolves the broader socioeconomic system of responsibility. A privatized healthcare framework is ill-equipped to treat systemic poverty, corporate and social exploitation, or community trauma, including the rabid stigma of people who use drugs.
None of these have medical billing codes by which to generate a bill to be paid. They actually do help people, those social resources, but they cost. They don’t earn.
By focusing exclusively on “changing a patient’s brain chemistry”, private healthcare entities can ignore the myriad societal failures that drive substance abuse to begin with, while positioning themselves as the only primary, indispensable, and, most importantly, profitable solution.
In short, while the disease model offers individual patients a path to medical care, it simultaneously provides the privatized American healthcare apparatus, a behemoth of our nation’s economy and GDP, with a self-sustaining, highly profitable economic engine.
Like a Rolex watch that keeps perfect time by virtue of its automatic machinations, the hands of the dial moving in perpetuity at the cost of hundreds of thousands of lives lost to this epidemic and the unspeakable devastation of how that reshapes a family into ruin, our neighbors, our friends, when they receive that horrifying call in the middle of the night that their loved one has passed away. But who cares, right?
Read more from Joshua Bennett-Johnson
Joshua Bennett-Johnson, Licensed Counselor & Owner of JBJ Counseling
After working for 7 years in an amazing clinic, I launched into private practice in 2018. I love my job. I can say that without reservation. Watching people rebuild their lives is something that is worth more than any dollar amount.
