An integration of three approaches to addiction and methadone maintenance treatment: the self-medication hypothesis,the disease model and social criticism

The two models which have most affected theory and practice of addiction medicine have been the disease model and the self-medication hypothesis. The disease model's fundamental concept is that the addicted individual is sick and suffers from a disease. The self-medication hypothesis proposes that drug and alcohol users are attempting to cope with an underlying psychological or social disorder by means of self-medication. These two viewpoints are presented in the light of a number of specific methadone maintenance treatment and drug abuse related issues such as the question whether drug abuse is an illness of the body, the mind or society; whether the disease model really de-stigmatized drug abuse; what the correct methadone dosing policy should be; the place of psychotherapy in methadone maintenance treatment and drug abuse and how polydrug abuse should be treated. These issues are discussed and an integrated approach is suggested stressing the need for social criticism and a renewed social policy towards drug abuse in general and its treatment in particular.