ATTUD Journal Club Postings

Does the Addiction/Brain Disease Model Help or Hinder Tobacco Treatment

I and others have often tried to decrease “cessation fatigue” by decreasing self-blame of those who have failed to quit on multiple occasions (e.g. via having smokers believe that their inability to quit may not derive from poor willpower but due to a surplus of the addiction “disease”. But is this an evidence-based strategy?

The alcohol and illicit drug abuse treatment and research community has mostly believed that the “disease model” has been helpful. However, recent reviews suggest this may not be the case (Social Science and Medicine 96:95;Larkings JS, Int J Ment Hlth Nursing in press; Barnett AI, Drug Alcohol Reviews, in press). These and older reviews (Clinical Psychol Rev 33:782; Angermeyer 199:367) state the data do not support that the acceptance of the disease model is not associated with greater tolerance or less stigma and may undermine attempts to change. However, two of my studies of smokers (Addict Behav 34:1005; Addict Behav 61:58) and a recent analysis of treatment providers (Barnett AI, Drug Alcohol Rev, in press) indicate that both groups do not see the disease model and the willpower model as mutually exclusive. For example, in my studies endorsement of willpower vs addiction as most important should be negatively correlated but the correlation coefficients were very small < 0.3. It appears that smokers do not see addiction and willpower as mutually exclusive. Almost all current smokers (>70%) have tried to quit in the past and failed. I am less and less discussing the addiction concept because I am unclear how it will be perceived by the smoker. I am continuing to downplay the notion that willpower itself should be sufficient. Instead, if the smoker has assumed that willpower in itself is sufficient. I am saying, well, relying on just willpower doesn’t seem to be working, so let’s try something different; i.e. join an internet cessation site, call the quitline, design a plan to avoid relapsing, use medication, etc.