My stance on the matter of the 'disease model' is that it implies for the part of professionals the attitude of professional detachment, which means in practice that the addiction professionals are not judgmental but simply practical. True, the wider society is judgmental towards addicts and Chavez will perhaps tell us if an addict cares about the attitude of the wider society; does an addict feel lonely and isolated as an addict and want to join the non-drug-abusing majority?
There are those addicts who have become fatalistic and given up, but in most cases there is a desire to become a normal person. Addiction is a love/hate-relationship with a pleasurable substance or activity, so there are two competing mindsets present within the addict. In the hate mindset, the addict desperately wants to change and in the love mindset he cannot see why life without the fix would be worth it. One of the bad sides of treatment is that it gives the option of never resolving this conflict. Addicts can stay sober when they feel like it, and go back to using as long as they call it a relapse (implying that it is a sign of a disease) or a slip (implying that they used by accident). It's a way of having your cake and eating it too. What's worse, to the outside world and the addict himself, this cycle seems to confirm just how bad his disease is, since even treatment hasn't completely prevented him from using.
If not, then there is not much use in any professional's taking that line with her.
Here lies the difference between our views: you seem to think that how addicts should be treated is determined solely by what helps the addict
the most. While I feel that taking a hard stance on addiction is also the most effective way, there is another way of defending it. Society has two options: it can either accommodate the addiction or expect the reverse, i.e. the addict has to accommodate to the needs of the people around him. Maybe it will help addicts if their families believe themselves partially responsible for using, seeing themselves as "triggering" the use. What this means in both theory and practice, is that some responsibility has been shifted away from the addict and on to someone else. In the deterministic view this makes sense, because there's no logical inconsistency about holding others partially responsible for the addicts use. But let's be clear. If abstinence is not required from the addict, others have to accommodate the addiction. Often this happens in families of addicts, where their whole lives revolve around the addiction of one family member. This isn't right, because it punishes others, forcing the family to live in constant doubt and fear, while the addict has to make no commitment to abstinence, and as I pointed out above, reserves the right to use again.
My support for, let's call it the 'disability model' , of substance abuse is entirely about the need for professionals working in that field to be non-judgmental. This contention between Chavez and I started in a thread about determinism. I, as a determinist, claimed and claim that in order to be non-judgmental the professional needs to believe that assuming responsibility for oneself depends upon whether or not the addict has strength of character. Character strength does not arise newly formed but is caused either by life experience or genetic inheritance, and if the professional were to believe that the addict can simply choose according to something called 'Free Will' then the professional would be justified in blaming the addict.
I'm sure you agree that addicts aren't any more or any less determined than anyone else, so the truth or falsity of determinism is irrelevant for the purpose of this discussion. The question is whether addicts deserve to be treated differently than any person who engages in harmful behavior. You seemed to get fixated on the question of blame. The question can be re-phrased like this: are the people around the addict justified if they demand him to either quit or get out of their lives? Under the disease model, it seems not; the person is sick and cutting contact because of this is not just cruel, but based on a lack of understanding. Under the moral model I promote, zero-tolerance is completely logical. Not necessarily because it makes the addict quit, but at least no one else has to live under the reign of terror of the addict.
I fear that the disability model is just a new word for the disease model. It seems to accept at face value the claim that the addict cannot behave himself or at least requires a period of "working on the problem" before doing so. This seems dubious since addicts cling to this supposed lack of control precisely because of the way it justifies using. It's interesting that addicts rarely apply this lack of control to other areas of life: even the Big Book of AA states that addicts can have quite a lot of self-discipline, patience and willpower in other areas of life. It's an interesting coincidence that the one thing they can't control is the one thing they enjoy the most.
This is really the essence of my argument: nobody should accept and accommodate the claim of being unable to quit, or at the very least the burden should be on the addict to prove that this is the case. Your view seems thoroughly addict-centered; the decision of whether to adopt a hard stance is based on how the addict
feels about this. I think that if the ethical code of professionals prevents them from making moral judgments, then those people shouldn't deal with addiction at all, or deal only with the medical consequences of addiction. My argument is that addiction is a moral issue, that medical professionals aren't meant to deal with moral issues and therefore addiction is not treatable.