An overview of addiction treatment models, including a brief history of the Moral Model and the development of the Twelve-Step methodology through Alcoholics Anonymous, emphasizes the need for a Biblical approach to addiction treatment focused on Christ. By developing numerous addiction treatment models, man desperately tried to do what only the Healer of Hearts can do. Knowledge of the different models can empower the addiction counselor with relevant truth to enhance the application of a Christ-centered approach to addiction treatment.
Moral Model
During the eighteenth and early nineteenth centuries, many viewed addictions as a sin. Most thought of addiction as a moral problem correctable as one chose a genuine relationship with Jesus Christ. Many individuals have been empowered through saving faith in Christ to leave substance addictions behind. Many who place faith in Christ as their savior continue in substance addictions. I’ve counseled many who developed substance addiction after salvation.
The problem with the Moral Model of addiction is that it is short-sighted. Addiction has its roots in the total human depravity brought about by sin and death. Adam’s original sin brought separation between God and man. Man’s depravity resulted from the separation and dysfunction of spiritual death. The One who came to set the captives free did far more than give the captives a new moral standard. In order to deal with spiritual death, Christ gave the fullness of His life to all who believe. Only the indwelling life of God can pull addiction out of the heart of a man by its roots.
Historically, legalistic, law-based attempts to disciple the addicted resulted in shame-based attempts to change. Alcohol or drug-dependent people were considered morally weak. The church saw addiction as a character fault that could only exist in disobedience to God. Under the moral model’s limitations, the church and society punished the addicted one with whippings, public beatings, stocks, and fines. Public ridicule of one considered to be an “addict” was relatively common.[1]
Without a realization of grace, truth, and the fullness of God’s salvation, shame will always increase addictive behaviors by fostering a sense of identity deficit. The church’s general failure to communicate grace-focused, victorious life truths, including identification with Christ in His work, grace-gifted righteousness, identity, and union with Christ, played into the enemy’s hands by fostering addiction through shame and the emptiness that shame peddles.
Hebrews 12:2, “fixing our eyes on Jesus, the author, and perfecter of faith, who for the joy set before Him endured the cross, despising the shame, and has sat down at the right hand of the throne of God.”[2]
The church’s failure to communicate the dynamics of addiction and equip those struggling to live from the fullness of Christ’s life within influenced the origin of other treatment models. Ignorance, or willful denial, of the daily relevancy of the redemptive work of Christ, led man to resort to his wisdom in an attempt to help those who are hurting.
1 Corinthians 3:19a, “For the wisdom of this world is foolishness before God. —.”
Disease Model
The disease model of addiction views addiction as an incurable condition that can only be managed. The current theory concerning the disease’s essential nature focuses on brain neurology which changes with the repetitive use of some substances or repetitive behaviors. The neurological change is believed to be permanent in some cases, such as opioid use.
I recently a seminar presented by the Association of Christian Counselors on the church’s response to the opioid epidemic, which promoted the medical model of addiction. The seminar’s presenters categorically and emphatically stated that addiction was a disease. The consensus was that adhering to any other addiction treatment model amounted to malpractice. At the seminar, the central medical authority was a Christian medical doctor with years of experience treating addiction. The individual was the head of substance abuse treatment for a major American sports league. This doctor strongly advocated using medication in treatment to counteract some of the behavioral effects of what he claimed was “permanent neurological damage.” In response to his beliefs and assertions, I asked, “Is there any clinical evidence that changes in brain neurology as a result of opioid use are permanent? Or, is this a conclusion based on observing many patients’ continuing use and the propensity for relapse?” His answer was surprisingly contradictory. He stated, “No. It’s not an opinion. I wish there was. But there is no clinical evidence.” Speculation is being labeled as science by many leading the church’s response to addiction. Sadly, a room full of Christian counselors, pastors, and church leaders were placing more faith in what represented as scientific than in the word of God. Science is not infallible. Only God is!
Individuals who desperately search for answers often come to conclusions that overlook both evidence and the authority of God’s word. There is much compelling evidence that the medical model is short-sided and errant. To examine clinical evidence that contradicts the medical model, I recommend the book The Biology of Desire: Why Addiction is Not a Disease by Marc Lewis.[3] Mark is a neuroscientist and professor of psychology. The book is not written from a Christian perspective and misses the spiritual foundation of addiction. Never-the-less, it presents strong evidence that the medical model of addiction is not credibly scientific.
I also recommend reading a short journal article, A Map Of The Soul, by neurosurgeon Michael Egnor. The article chronicles Michael’s reflections on man’s immaterial nature due to his surgical experience. Any addiction treatment model that does not consider man’s spiritual disfunction and the fullness of God’s redemptive work is short-sided and will harm. Dr. Egnor’s article is available at www. Firstthings.com.[4]
The medical model ignores evidence instead of accounting for it. As a result, the medical model of addiction can correctly be called unscientific speculation.
The medical model of addiction may well, at least in part, be a response to the legalistic, shame-based moral model of addiction prominent in the early eighteenth and ninetieth centuries. Is addiction a sin? God’s word answers with a resounding, yes! Does the God who despises shame (Heb. 12:2) use shame-based behavioral modification tactics to set captives free? Of course not!
John 1:17, “For the Law was given through Moses; grace and truth were realized through Jesus Christ.”
Satan loves to encourage people to react to either side of the fine line of truth. It doesn’t matter to the enemy which side. The father of lies peddles his wares to steal, kill, and destroy when the truth is missed. A deadly combination of truth mixed with lies is one of his favorite potions!
Psycho-dynamic Model
Sigmund Freud developed the psychodynamic model of addiction. This model links addiction to unresolved childhood issues. Addiction then is a symptom of coping, or not coping, with the impact of childhood events.
Psychology has correctly observed that childhood developmental events can shape behaviors that persist into adulthood and even throughout one’s life. The psychodynamic model’s errant assumption is that formative past events are the root cause of current behavioral problems. The Bible makes a distinction between past events shaping coping strategies and past events “causing” behavior. Man’s primary behavioral problem is not unresolved past issues. Although unresolved past problems often need to be addressed in addiction treatment, they are not primary. The primary foundation of any behavior involves faith and whether or not an individual is relating to God by grace through faith or not relating to God by grace through faith at any moment. Dysfunctional behavior (which is determined by God’s standards) always has spiritual roots. The fundamental issues resulting in sinful behavior in unsaved humanity are spiritual death and unbelief. For Christians, sinful dysfunction is the present expression of unbelief.
2 Corinthians 5:7, “For we walk by faith, not by sight.”
The fact that past events form belief systems that drive specific fleshly coping strategies is an essential part of all victorious life counseling. Understanding the correlation between beliefs chosen in past events and current fleshly strategies helps one see the depravity and bondage of fleshly coping strategies. As long as an individual places faith in self-coping methods, compulsive behavior (addiction) in some form will always be present.
Romans 8:6, “For the mind set on the flesh is death, but the mind set on the Spirit is life and peace.”
Understanding the nature and structure of the flesh (coping strategies) also equips a believer to cooperate with the Spirit of God in the renewing of the mind (Rom. 12:2). Biblically, the renewing of one’s mind involves lie-based memories replaced by Spirit revealed truth even as the old thoughts and emotions of those lie-based beliefs present themselves within the soul.
A Biblically based addiction treatment model will always equip individuals to deal with past events through explicit faith in Christ’s person and presence within the believer.
The Psychodynamic Model of addiction has evolved to include comorbidity in addiction treatment. Comorbidity is the belief that one dysfunctional condition can exacerbate or cause a propensity for another. Comorbidity is never primary. But it is often a secondary factor in addiction.
Social Learning Theory of Addiction
This theory promotes the idea that addiction is a learned social behavior. The addictive process is thought to be more about the individual’s thoughts towards using the substance than the substance itself. Society influences many to use addictive substances. But addiction is much more than programmed social thinking. An individual’s thoughts towards using can strengthen the addictive behavior. But, a truth-based change in thinking occurs when the Spirit of God renews the mind. Only the Spirit of God gives light through His word and witness.
Generally speaking, the social learning theory is indicative of secular humanistic philosophy. The secular humanist views truth as a social construct. They do not believe that truth exists outside of human perception. This mindset promotes social influence as the ultimate driving force of humanity. The secular humanist ultimately attributes all of man’s dysfunction to errant social thinking. It’s an evil and dangerous world view that lends itself to all kinds of compulsive, selfish behaviors. In the latter days in which we live, willful suppression of God’s truth leads to obsessive worship of secular humanism.
The Socio-cultural Model
The socio-cultural model is relatively new, gaining popularity in the last fifteen years.[5] This model focuses on society as the first cause of addiction in an individual. The model suggests links between inequality, cultural disadvantage, social injustice, and drug use. Responsibility is taken away from the individual and given to those perceived as victimizing the user. Instead of recognizing God’s authority, false authority is given to the collective mindset to decide what injustice is.
If you are unfamiliar with the secular humanistic mindset, beliefs such as those in the socio-cultural addiction model can seem like irrational foolishness. It is absolute foolishness. But it’s not irrational given their darkened ideas.
Romans 1:21&22, “For even though they knew God, they did not honor Him as God, or give thanks: but they became futile in their speculations, and their foolish heart was darkened. Professing to be wise, they became fools.”
If you understand that secular humanism believes that truth is a social construct, you realize that the socio-cultural model is a futile but rational attempt to explain darkness with darkness. Such attempts increase both darkness and the suffering that results from the darkness.
Spiritual Community and the Beginning of the Twelve-Step Model of A.A.
Bill Wilson and Dr. Bob Smith co-founded Alcoholics Anonymous in 1935. The Oxford Group, founded by Frank Buchman in 1921, previously influenced both Wilson and Smith. Jessie Penn-Lewis influenced Frank Buchman during her speech at the Keswick Convention in Keswick, England (1908). Jesse Penn-Lewis’ speech’s focus was victorious life teaching focused on the personal relevancy of Christ’s work for daily living by grace. All three men, Buchman, Wilson, and Smith, had genuine faith experiences with Jesus Christ, which led to a desire to help others struggling with alcoholism.
The Oxford Group had six foundational principles:
1. A Complete deflation (humility).
2. Dependence on God.
3. A Moral inventory.
4. Confession.
5. Restitution.
6. Continued work with others in need.
Bill Wilson, Alcoholics Anonymous co-founder, was struggling with alcoholism in November of 1934. Ebby Wilson, an old friend, freed from alcohol use through The Oxford Group, visited Bill Wilson’s home. Bill later testified that he struggled to understand the undeniable change witnessed in Ebby. While pondering Ebby’s difference and struggling against the Holy Spirit’s conviction, Wilson rejected faith in Christ. Bill Wilson told Ebby that the failures of many Christians were why he rejected faith in Christ. Ebby’s response to Bill would later influence the formation of A.A.’s twelve steps. Ebby replied, “Why don’t you choose your own conception of God?” Ebby most likely intended to encourage Bill to put man’s opinions and representations of Christ aside, not to promote any conception of deity outside of Jesus Christ. In response to Ebby Thatcher’s statement (Ultimately, in response to the Holy Spirit), Bill Wilson decided to place faith in Christ. Wilson would later write, “That statement hit me hard. It melted the icy intellectual mountain in whose shadow I had lived and shivered many years. I stood in the sunlight at last.”[6]
After becoming involved with an Oxford group in his area, Bill Wilson reportedly became discouraged because many other men in the group relapsed and did not seem to have the same transformation as him. A friend in the medical field recommended to Bill that he stop preaching and start talking about alcoholism as a disease. This recommendation may well have been a reaction to the shame-inducing Moral Model view. Shortly after that, Bill Wilson again found himself craving a drink. Others then led Bill to contact a different physician, Dr. Robert Smith, who later co-founded A.A. with Bill Wilson.
I’ve given just a few highlights of Bill Wilson’s journey and the founding of Alcoholics Anonymous. The twelve-step methodology is a conglomerate model that has undoubtedly morphed over the years, probably taking on some meaning and direction that the founders never intended. Regardless, the influence of the moral model, the medical model, and genuine experiences of God’s grace shaped the events leading to the founding of the 12 steps. For a cross focused evaluation of Twelve-step methodology, I recommend the July 2020 blog post Pathway vs. Promise: An Evaluation of 12 Step Methodology in Light of the Cross of Christ available on this site (uncommonrecovery.org).
A brief overview of addiction treatment models exposes strengths and exposes the weaknesses in each. The strengths and weaknesses of each model played a role in the development of successive models. The Moral Model’s tunnel-like focus on addiction’s morality and the absence of equipping grace and truth resulted in shame-based attempts at change. The failure of shame-based attempts led many to discard the moral model and define addiction as a disease. As psychology and psychological theory developed, connections between past events and addictive behavior became known. Psychology can be very descriptive of man’s behavior and identify needs and even motives on some level. Psychology may well describe man’s dysfunction, but only Jesus can heal it. Christ is the only foundation of human wholeness.
All of man’s models fall short of God’s truth. The moral model omits almost all of the liberating truths of Christ’s finished work on the cross. In many settings, the twelve-step methodology often omits core redemption truths, though not to the moral model’s degree. The medical model recognizes a physical dimension of addiction but excuses the moral failure present in addiction. The medical model makes the glaring omission of disregarding God and disregarding man as a spiritual being made in the image of God. The Psychodynamic model recognizes the relationship between unresolved past issues and present behavior but fails to address the root of addiction, which is a sense of deficit resulting from failure to receive, or appropriate, the life of God. The Social Learning model and the Socio-cultural model are desperate attempts to find an answer to addiction that ignore both individual responsibility to God and the blood-bought privilege to receive freely from God.
Colossians 2:9&10, “For in Him all the fulness of Deity dwells in bodily form, and in Him you have been made complete, and He is the head over all rule and authority.”
Addiction cannot rule over a child of God without deception! In God’s children, addiction requires a willful investment in a lie.
The purpose of Uncommon Recovery is to allow the word of God to speak to the issue of addiction with uncommon clarity, comprehensiveness, and the power to do just as Jesus promised – to set the captives free (Luke 4:18). Uncommon Recovery is a Christ-focused approach that recognizes the relevancy of the redemptive work of Christ to all daily living. Uncommon Recovery is founded upon Christ’s indwelling life in a believer and the abundant life Christ died to give His children. True freedom is always appropriated by grace through faith in every moment of life. Christ and the daily relevancy of the glorious salvation that He freely gives to all who will receive Him is the only answer to addiction.
Colossians 1:27, “To whom God willed to make known what is the riches of the glory of this mystery among the Gentiles, which is Christ in you, the hope of glory.”
Living in the freedom of His life together,
Don Steve
[1] “3.4 Models that help us understand AOD use in society,” Australian Government: Department of Health, 2004, https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front5-wk-toc~drugtreat-pubs-front5-wk-secb~drugtreat-pubs-front5-wk-secb-3~drugtreat-pubs-front5-wk-secb-3-4.
[2] All Scripture quotations are from the New American Standard Bible unless otherwise noted.
[3] Marc Lewis, “The Biology of Desire: Why Addiction is Not a Disease,” PublicAffairs (A division of PBG Publishing, LLC), 2015.
[4] Michael Egnor, “A Map Of The Soul,” First Things, The Institute on Religion and Public Life, 6/29/17, http://www.firstthings.com.
[5] “3.4 Models that help us understand AOD use in society,” Australian Government: Department of Health, 2004, https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front5-wk-toc~drugtreat-pubs-front5-wk-secb~drugtreat-pubs-front5-wk-secb-3~drugtreat-pubs-front5-wk-secb-3-4.
[6] Quote is from an article entitled A History of the 12 Steps published on www.cornerstoneofrecovery.com. Corne
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