get is a set of behavioral changes that are generally similar without overt pathology The pathologies are a consequence of the substance abuse. 

Let's take a look at alcoholism in which somebody who is considered an alcoholic binges once every three months, or who once a month will go on a two-day binge.  Then there is the alcoholic who drinks a little bit every day.  They feel as though they can't stop.  These people feel like they have got to have a certain amount, but they might not drink nearly as much as the alcoholic who binges. Yet they are drinking every day and are becoming psychologically dependent on the drinking.  Then there are the ones who drink heavily every day.  That is a pretty broad range of behaviors and of consumption to be all lumped into one thing.  So, I think the model developed because in earlier people who drank too much were considered to have a moral defect in their character. So the people who promoted the disease model basically were trying to counteract and replace the character deficit model.  So, they said, "Let's call it a disease.  A disease doesn't have moral implications."  So that is really what they were all about.  They were trying to take the moral stigma out of alcoholism and drug abuse. 

I actually had an interesting experience with someone who was deeply committed to the disease model once.  A therapist who worked in a drug rehab hospital did a presentation at a hypnotherapy association meeting and she spoke about alcoholism disease. I asked her, "Well, what are the advantages and the disadvantages of the disease model, and what other ways do you have of thinking about it?"  And her answer was to basically go blank.  She had no answer at all, because it never occurred to her that "addiction" could be anything other than a disease.  No one ever taught her it was a model.  She thought it was real.  It's not real.  Addiction is not real.  Addiction as a disease is not real.  It is just a way of thinking about things and as a metaphor it has proven to be very powerful and very useful in a great many circumstances.  Next page