Throughout the history of medicine, there have been various theories of addiction. Historically, addiction was thought to be a form of spiritual possession, and this provided the origin of referring to alcohol as “spirits.” Sometimes the behavior of addicted persons seems more animal than human. This is typified by the aggressive behavior and lack of attention to hygiene and other basic forms of self-care frequently associated with active addiction. At various times, addiction has been considered a moral failing, an indication of personal weakness, or a lack of willpower, especially in the western hemisphere and the United States where historically we tend to demonize addicts. There are many people, even in the twenty-first century, who continue to hold this archaic view. The inability to handle stress except with the aid of alcohol or other drugs has become a popular explanation for addiction. Fortunately, perspectives on addiction have become more enlightened, evolving into its current conception as a disease and chronic health condition. Interestingly, the disease model of addiction was actually endorsed by AA as early as the 1930s. In 1956, both the American Osteopathic Association and the American Medical Association released formal statements reporting the definition of alcoholism as a disease. The current understanding of addiction is that there exists a reward pathway in the brain that is activated by pleasurable and survival activities such as eating food, imbibing water, and having sex, but is turned on to a much greater degree by mind- and mood- altering drugs. Other things that can stimulate this reward pathway include positive things like nurturing and caring for others, as well as less-healthy activities such as gambling, and thrill-based activities such as hang gliding and riding roller coasters. Ultimately, if we didn’t have this reward pathway we could neglect to eat and forget to reproduce, but the fact that these substances and activities give us pleasure causes us to repeat the behaviors associated with them. This blog post is an excerpt from The therapist’s Guide to Addiction Medicine – A Handbook for Addiction Counselors and Therapists – by Barry Solof, MD, FASAM; Published by Central Recovery Press (CRP).