The seventeenth century and the moral model of addictions

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104 HEALTH PSYCHOLOGY
I What causes someone to start smoking?
I What causes drinking behaviour to become a problem?
I Why can some people just smoke socially whilst others need to smoke first thing in
the morning?
I Is it possible for an alcoholic to return to normal drinking?
I Do addictions run in families?
Questions about the causes of an addiction can be answered according to the different
theoretical perspectives that have been developed over the past 300 years to explain and
predict addictions, including the moral model, the 1st disease concept, the 2nd disease
concept and the social learning theory. These different theories and how they relate to
attitudes to different substances will now be examined.
HISTORICAL CHANGES IN ATTITUDE AND
THEORETICAL APPROACH
Theory is often viewed as independent of changes in social attitudes. However, parallels
can be seen between changes in theoretical perspective over the past 300 years and
contemporary attitudes. These parallels will be discussed in terms of alcohol use.
The seventeenth century and the moral model of addictions
During the seventeenth century, alcohol was generally held in high esteem by society. It
was regarded as safer than water, nutritious and the innkeeper was valued as a central
figure in the community. In addition, at this time humans were considered to be separate
from Nature, in terms of possessing a soul and a will and being responsible for their own
behaviour. Animals’ behaviour was seen as resulting from biological drives, whereas the
behaviour of humans was seen to be a result of their own free choice. Accordingly,
alcohol consumption was considered an acceptable behaviour, but excessive alcohol use
was regarded as a result of free choice and personal responsibility. Alcoholism was
therefore seen as a behaviour that deserved punishment, not treatment; alcoholics were
regarded as choosing to behave excessively. This model of addiction was called the moral
model. This perspective is similar to the arguments espoused by Thomas Szasz in the
1960s concerning the treatment versus punishment of mentally ill individuals and his
distinction between being ‘mad’ or ‘bad’. Szasz (1961) suggested that to label someone
‘mad’ and to treat them, removed the central facet of humanity, namely personal
responsibility. He suggested that holding individuals responsible for their behaviour gave
them back their sense of responsibility even if this resulted in them being seen as
‘bad’. Similarly, the moral model of addictions considered alcoholics to have chosen to
behave excessively and therefore deserving of punishment (acknowledging their
responsibility) not treatment (denying them their responsibility). In effect, contemporary
social attitudes were reflected in contemporary theory.
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