Within the depth-psychology corpus, Addiction Medicine names not a settled clinical speciality but a contested site where biomedical authority, humanistic critique, and psychospiritual insight converge and collide. The corpus registers the field primarily through three registers of tension. First, the disease-model debate: Lewis, Dennett, and Alexander interrogate whether the medicalisation of addiction — institutionally consolidated by bodies such as the American Society of Addiction Medicine (ASAM) and the National Institutes of Health — generates genuinely therapeutic frameworks or merely translates moral condemnation into neurological idiom. Second, the pharmacological turn: Avery, Timko, Maté, Addenbrooke, and Hari document and evaluate medication-assisted treatment (MAT) — methadone, buprenorphine, naltrexone — as both evidence-based harm-reduction and as an arena of unresolved ethical and relational conflict between patient autonomy, clinical authority, and institutional inertia. Third, the spiritual dimension: Galanter and colleagues, writing for the International Society of Addiction Medicine itself, argue from within the medical establishment that spirituality constitutes measurable recovery capital and must be formally integrated into clinical protocols. Across these registers, the corpus consistently reveals Addiction Medicine as a field whose explanatory framework shapes treatment outcome, ethical posture, and the very humanity extended to the addicted person.
Spirituality is a construct that is reflected in a diversity of strongly felt personal commitments in different cultural and national groups. For persons with substance use disorders (SUDs), it can serve as a component of the recovery capital available to them.
A formal position statement from the International Society of Addiction Medicine argues that spirituality constitutes an evidence-supported dimension of recovery capital that the clinical field must integrate.
The American Society of Addiction Medicine’s (ASAM) patient placement criteria attempt to match patients to five levels: (1) early intervention, (2) outpatient treatment, (3) intensive outpatient or partial hospitalization treatment, (4) residential or inpatient treatment, and (5) medically managed intensive inpatient treatment.
Avery outlines the ASAM’s formal treatment hierarchy as the structural scaffold of contemporary Addiction Medicine, emphasizing multi-dimensional patient assessment as the basis for level-of-care decisions.
, The Opioid Epidemic and the Therapeutic Community Model: An Essential Guide, 2019thesis
Doctors, medical researchers, and health policy makers assume that addiction is a disease because, for one thing, that’s how medicine defines human problems… the multimillion-dollar price tags of sophisticated research programs are funded by mainstream medical institutions, like the National Institutes of Health.
Lewis exposes the institutional and economic logic underpinning the disease model, arguing that Addiction Medicine’s paradigm reflects funding structures and professional incentives as much as empirical evidence.
, The Biology of Desire: Why Addiction Is Not a Disease, 2015thesis
CARA’s implementation has emphasized increasing access to currently underutilized medication-assisted treatment (or MAT, including methadone, buprenorphine, and naltrexone formulations) alongside naloxone-based and other harm-reduction measures against overdose deaths.
Avery frames federal legislative response to the opioid crisis as an attempt to close the gap between evidence-based MAT protocols and their historically low uptake within American Addiction Medicine.
, The Opioid Epidemic and the Therapeutic Community Model: An Essential Guide, 2019thesis
That spiritually oriented community-based resources that are appropriate for a given patient (such as culturally oriented facilities, religious institutions, and peer support groups, like Twelve Step fellowships) be considered for referral.
The ISAM position statement translates the spirituality argument into clinical protocol, recommending that practitioners assess and mobilise community spiritual resources as part of standard addiction care.
, The role of spirituality in addiction medicine: a position statement from the spirituality interest group of the international society of addiction medicine, 2021supporting
The volume provides an overwhelming body of theoretically informed and evidence-based empirical research, demonstrating the effectiveness of A.A. and its original spirituality-based 12-step approach as well as spirituality’s general role in addiction recovery.
Grim cites the ASAM-affiliated research volume establishing AA’s effectiveness as evidence that Addiction Medicine’s empirical apparatus has begun to legitimate spirituality-based interventions.
, Belief, Behavior, and Belonging: How Faith is Indispensable in Preventing and Recovering from Substance Abuse, 2019supporting
If you give hard-core addicts the option of a safe legal prescription and allow them to control the dose, the vast majority will stabilize and then slowly reduce their drug consumption over time. Prescription isn’t an alternative to stopping your drug use. It is—for many people—a path to it.
Hari’s reportage on the Swiss heroin prescription model challenges prohibition-era Addiction Medicine by demonstrating that medically supervised prescribing can function as a genuine pathway to recovery rather than mere maintenance.
, Chasing the Scream: The Search for the Truth About Addiction, 2015supporting
Leshner’s (1997) angle was that despite some individuals’ compulsion to drink or use drugs, they should still be held accountable for their actions, whether under the influence or not.
Dennett maps the internal medical debate over whether the brain-disease framing of Addiction Medicine extinguishes moral accountability, highlighting the persistent tension between neurological determinism and personal responsibility.
, Individuation in Addiction Recovery: An Archetypal Astrological Perspective, 2025supporting
There is no drug analogous to methadone to help with cocaine addiction… I would like to see long-acting stimulants investigated more vigorously, despite their own addiction potential.
Maté writes from clinical experience to identify the pharmacological limits of current Addiction Medicine, calling for expanded research into substitute prescribing for stimulant disorders.
, In the Realm of Hungry Ghosts: Close Encounters With Addiction, 2008supporting
It would have been instructive to know whether or not the psychiatrist and his faithful scribe at the Globe were willing to extend this principle to other groups, such as, say, smokers with lung cancer or emphysema.
Maté challenges the selective moral withdrawal of medical care from addicted persons, arguing that Addiction Medicine’s ethical obligations must be consistent with its responsibilities to patients of other self-implicating conditions.
, In the Realm of Hungry Ghosts: Close Encounters With Addiction, 2008supporting
While modern psychiatry was moving more and more toward defining mental illness as a biochemical disorder requiring pharmacological intervention, addiction treatment was heading in the other direction. Drugs and medication were not the answer; they were the problem!
Flores traces the historical divergence between mainstream pharmacological psychiatry and addiction treatment, framing the self-help revolution as a direct response to the perceived failure of medical approaches.
, Group Psychotherapy with Addicted Populations An, 1997supporting
Substitute prescribing is a favoured treatment for heroin addiction today, but it should not be valued at the expense of other treatments. If it can alleviate symptoms long enough for patients to reassess their goals, then that is fine.
Addenbrooke critically contextualises substitute prescribing within Addiction Medicine, warning against over-reliance on pharmacological solutions at the cost of relational and psychological treatment modalities.
, Survivors of Addiction: Narratives of Recovery, 2011supporting
Mainstream psychology, like mainstream medicine, is inseparably wedded to the conventional wisdom on addiction. For this reason, it is not particularly useful on this topic.
Alexander indicts Addiction Medicine alongside mainstream psychology for operating within free-market cultural assumptions that preclude an adequate social and dislocation-based understanding of addiction.
, The Globalisation of Addiction: A Study in Poverty of the Spirit, 2008supporting
Historically, addiction was perceived as disease of poor characteristics and was not systematically addressed by the medical and academic societies until 20th century.
Nabipour situates the medicalisation of opiate addiction historically, noting that formal Addiction Medicine emerged only in the twentieth century after centuries of moral rather than clinical framing.
, Burden and Nutritional Deficiencies in Opiate Addiction- Systematic Review Article, 2014supporting
This study focused on medication and behavioral therapy factors related to retention in MAT for opiate addiction, to the exclusion of other factors such as patient determinants.
Timko acknowledges the methodological constraints of MAT retention research, pointing to gaps in Addiction Medicine’s evidence base regarding patient-level determinants of treatment engagement.
, Retention in medication-assisted treatment for opiate dependence: A systematic review, 2016supporting
The United States’ long history of overreliance on pharmacological approaches to pain management, as well as an underestimation about the addictive potential of opioid analgesics, opened the floodgates to the opioid epidemic.
Avery locates the origins of the opioid crisis partly within the structural failures of American Addiction Medicine’s predecessor practices, particularly the pharmaceutical culture of pain management.
, The Opioid Epidemic and the Therapeutic Community Model: An Essential Guide, 2019supporting
Theories based on these hidden causes have failed to generate either a generally believable account of addiction or anything more than marginally effective forms of therapy.
Alexander dismisses the neurobiological and genetic causation models favoured by Addiction Medicine as empirically and therapeutically insufficient, proposing dislocation as the underlying social determinant.
, The Globalisation of Addiction: A Study in Poverty of the Spirit, 2008aside
One aspect of the service was unusual: there was no prescribing of methadone or any other opiate substitute. The psychiatrist in charge of treatment did not believe in its efficacy.
Addenbrooke documents a dissenting clinical practice that deliberately excluded pharmacotherapy in favour of relational and psychological treatment, illustrating internal disagreement within Addiction Medicine’s prescribing culture.
, Survivors of Addiction: Narratives of Recovery, 2011aside