by Arielle Reisman, LSPC Family Defense Social Worker • Published May 2025
Because it is National Mental Health Awareness Month, we wanted to take a moment to address a mental health issue impacting millions of people in the United States each year: addiction. The current model of understanding addiction is a disease model. The idea is that a person has a cluster of symptoms that are associated with not being able to control their relationship to something that gives them short-term pleasure such that it negatively, or even catastrophically, affects their long-term goals. If a person has enough of these symptoms related to drugs or alcohol, they can be diagnosed with Substance Use Disorder (SUD), which is the current diagnostic name for this behavior when it is conceived as a mental health disorder.
To be diagnosed with SUD, a person has to meet two or three out of a set of eleven criteria within a specific time frame (usually the past year). The key, though, is that the person has persisted in the use of the substance despite harmful consequences. However, many of the harmful consequences associated with substance use are manufactured by society rather than natural consequences of over-using substances. Incarceration, for example, is an unnecessary consequence of addiction that actually decreases the likelihood of recovery. So, although thinking of addiction as a disease, similar to asthma or diabetes, rather than as a problem of willpower was intended to combat stigma and also allow for medical treatment, this perspective alone does not account for the social, political, and environmental factors that impact outcomes. Instead, the disease model has reinforced the notion that addiction is an individual problem requiring treatment—or, more likely, punishment—of the individual.
However, if we adopt a public health approach—one that considers what the Center for Disease Control (CDC) refers to as Social Determinants of Health, such as access to quality healthcare, education, community support, economic stability, and safe environments—we can begin to address structural obstacles to prevention and recovery. For example, research shows that one way to address the negative addiction outcomes associated with criminal legal system involvement (short of prison abolition) is to do away with discriminative criminal background checks. Instead, directing resources toward facilitating a smoother reentry into society enables individuals who have been incarcerated to obtain jobs and access healthcare.
This is not to say that individuals lack any agency over their own outcomes. While being formerly incarcerated can increase challenges to recovery for a number of reasons (including traumas endured while in custody, estrangement from family and friends, and barriers to accessing stabilizing resources upon release), a person’s chances of recovery can be improved when they seek out and engage with available community supports. Peer support groups, credible re-entry and recovery programs, and skilled mental health professions and recovery counselors, to name a few, can combat isolation and offer valuable encouragement and guidance. These support networks may also provide information and gateways to critical housing and job opportunities. Recovery doesn’t happen in a vacuum. By accessing resources tied to social determinants of health whenever possible, individuals coming home can take meaningful steps toward healing. And, it is equally as important that we, as a society, shift the narrative around both the causes and the effective treatment of addiction and continue advocating to remove structural barriers to recovery.
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