This frames an important distinction. The medical model of addiction has evolved significantly - we now understand that addiction involves changes in reward processing, decision-making, and impulse control in the brain. But that neurobiological reality doesn't negate personal agency or responsibility.

The key insight is that understanding addiction as a condition with biological components doesn't excuse behavior, it contextualizes it. Someone with dopamine dysregulation faces genuine difficulty resisting compulsive use, but that difficulty isn't an absence of choice - it's a choice being made under neurobiological duress.

What's most productive is combining understanding with accountability. Shame and stigma are counterproductive when they prevent people from seeking treatment. But enabling without consequences is also ineffective. The best outcomes come from treatment approaches that acknowledge the biology while preserving the framework that people bear responsibility for their recovery.

Having been a methadone dispenser and alcohol group worker in the NHS for many years people seem to forget, that prior to 2004, addiction, whether alcohol or drugs was treated under the medical model.

A heroin user could be fast tracked to methadone maintenance or reduction precribing service, detox, rehab and full support, using the cycle of change as a base.

I found this model to be quite good at moving clients from addiction to living life as fully functioning members of society.

However, around 2005, the Labour government decided that addiction was no longer deemed a medical problem but a criminal justice matter.

So, 8 minor criminal offences were chosen as a way to enforce drug and alcohol assessments while addicts were in custody at police stations.

The outcome of this useless government intervention!

The revolvoing door of the prison service, which accounts for todays prisons being full to the brim with short sentences of drug users.

It starts like this:

initially they might get a 28 day prison sentence for shoplifting a bottle of Whiskey. They get released from prison and have to attend the probation service with strict protocols.

but being a drug user, the first thing they do is go to the off-licence and buy a bottle of booze. get totally drunk. do not attend probation, the terms of prison release are broken and they are arrested and returned to prison.

the next time they get arrested for stealing a bottle of booze, they get 6 months, the next time they get a year in prison, and so it continues. there is no escape once they become part of the criminal justice system. There is no justice!

round and round they go for years and years. never ever adressing the addiction. for the last 20 years this is what being an addict is like in the UK.

back in 2005 it used to cost £400 per week to keep a man in prison, It cost £500 per week to send a man to rehab. yet successive governments choose to put them in prison.

Who’s we, what’re they thinking, and how is it wrong?

I fundamentally agree with the angle of the author(s).

The drug rat thing is a red herring that keeps being used as an anchor to analogise complex and varied behaviours.

The disease model is absolute dogshit, but, it creates the perfect environment for medicalisation and treatment.

And now you have a market.

Nobody needs an explainer on how markets can deviate to create feedback loops, likewise nobody wants to hear that despite plenty of organisations/operations doing great work there are others creating immense harm, misery, and wealth.

My main point is I don’t get the collective we, because the average person has little interaction with models of addiction, I’d argue that most people would struggle to define it, and then the nuance between addiction colloquially (I’m addicted to matcha lattes) vs addiction medically (I’m addicted to opioids) creates even more problems.

No solutions here, just thoughts.