Historical Context: The Disease Model

For the past 75+ years, the Disease or Medical Model prevailed as the sole and primary source of education about addiction and treatment.

When alcoholism was deemed a disease by the American Medical Association in the early 1950s, the impact was tremendous. This designation significantly reduced the stigma attached to alcoholism and to being an alcoholic. Previously, alcoholics were shunned and shamed by society, seen as weak and defective. As society began embracing the disease concept, alcoholics felt safer to come out of hiding and seek help because most people—significant others, as well as practitioners—were responding more compassionately and intelligently.

The AMA defined the disease of alcoholism as a "pathological dependence" that caused loss of control and uncharacteristic behavior, viewing the phenomenon strictly as a medical problem and using medical terminology to describe it. Research indicated correlations between alcoholism and biochemistry and genetic factors, which led to assumptions linking these factors with predisposing conditions and causation. The problem was that numerous exceptions suggested other factors to consider.

The disease designation was tremendously helpful in treatment planning by establishing that achieving a sustained period of sobriety or abstinence must be the first priority before any cooccurring conditions can be effectively treated.

However, after 65 years, sustained stabilization seems to have become confused with recovery and growth. We may have boxed ourselves into a mindset that suggests you're okay as long as you're sober. TRMA™ and the Three Stages of Recovery go far beyond sobriety.

The disease concept also implies progression, meaning that over time, there is a steady diminishment of functioning on all levels—it only gets worse, never stays the same or improves. 

Disease also meant permanence: "Once an addict, always an addict," with alcoholism viewed as a life sentence, incurable.

Treatment planning generally consisted of entering a program to achieve and maintain sobriety, with mandated ongoing and lifelong participation in a 12-Step program. While this standard of treatment has helped millions of people, untold numbers seeking recovery do not resonate with 12-Step programs and their philosophy, particularly the reliance on an externalized Higher Power or God.

The Relationship Model of Addiction™

TRMA™ picks up where the Disease Model left off. It attempts to humanize addiction by examining it outside a medical context, highlighting the emotional, psychological, experiential, and relationship aspects in a way that applies to everyone and everyone can relate to.

TRMA™ is based on two key premises:

1. The need for love and connection (inclusive of other emotional needs) are basic human needs, and when these needs are denied, pain results.

2. The need to relieve pain is also a basic human need.

Newton's Law—for every action, there is an equal and opposite reaction—may apply here. The more pain present, the greater the need to relieve it. The more relief derived from a particular means, the greater the attachment to and dependency on it will be. The need for relief from emotional pain is a precursor to addiction.

TRMA™ defines addiction as a relationship with a means of relieving pain from unmet emotional needs—one that becomes all-consuming, very much like carrying on a "secret love affair" with that means of relief. The need to relieve pain (from unmet motional needs) is the underlying driving force of addiction.

Predisposing conditions are explained in terms of the level of pain that has built up from a lifetime of deprivation. Again, Newton's Law applies: the more pain, the more susceptible or predisposed one is to addiction. The less pain, the less susceptibility (regardless of the presence of genetic or biochemical factors).

TRMA™ attributes the cause of addiction to relationships, past and present, that fail to provide adequate emotional nourishment, leaving a backlog of pain that traps the addict in a vicious cycle of relief-seeking.

The Three Stages of Recovery

Within the TRMA™ framework, recovery is a transitional journey out of unhealthy relationships and into healthy ones. There are Three Stages of Recovery:


1-Stage I: "Breaking Up" - Ending the relationship with the addictive substance, activity or relationship

2- Stage II: Developing the Relationship with Self – Discovering and begin developing the relationship with your Self

3- Stage III: Creating Emotionally Nourishing Relationships – (relationship training)


Progressing from Stage I to Stage II is, essentially, saying "goodbye" to a harmful relationship and "hello" to your new best friend; one replaces the other. This newly developing relationship gives you access to internally based resources that provide guidance, creative inspiration, and nourishment from within—resources which, until that point, hadn't been utilized or known to exist.

Having a relationship with your Self and increased Self-awareness are prerequisites for crossing the threshold into Stage III: Creating Emotionally Nourishing Relationships. Stage III focuses on gaining the know-how to transform all your relationships and "relating encounters" to make deeper connections, and to develop emotionally nourishing relationships.

When you establish emotionally nourishing relationships, the addiction—the relationship with the means of relief—naturally extinguishes itself. When your need for love and connection is being met (through your relationship with yourself and with others), "secret love affairs" will no longer hold the allure they once did when there was far more pain and desperation for relief.

Key Themes of TRMA™

The following overarching themes of TRMA™ have powerful implications for professionals and those on a path of recovery:

• Addiction is a relationship with a means of relieving pain from unmet emotional needs.

• The need for love and connection are basic human needs, and when denied, pain results. The need to relieve pain is another basic human need. The need for love encompasses other basic emotional needs: connection, understanding, being seen, heard, accepted, and embraced.

• We can consider the cause of addiction to be the same as the cure—relationships. If the cause is unhealthy relationships that fail to provide adequate emotional nourishment, then the cure must be healthy relationships that provide adequate emotional nourishment, in which the need for love and connection are met, resulting in a reduction of pain from unmet emotional needs.

• The Self is the Highest Power; the relationship with Self is the most important relationship. The quality of our lives and relationships reflects the quality of our relationship with Self.

• Recovery is a lifelong and ongoing process and practice of developing the relationship with Self and relationships with others.

Summary:

The Relationship Model of Addiction™ (TRMA™) offers a humanistic alternative to the traditional Disease Model by reframing addiction as a maladaptive relationship formed to cope with the pain of unmet emotional needs, particularly the need for love and connection. TRMA™

emphasizes that the root cause of addiction lies in relational deficits, and recovery is a process of building healthy relationships, starting with the self, and extending to others. By focusing on emotional nourishment and connection, TRMA™ provides a framework for understanding addiction and recovery that goes beyond mere sobriety, highlighting the transformative power of healthy relationships in achieving lasting well-being.

For further insights into TRMA™, addiction, and recovery, visit the RelationshipVision ​website, a free and accessible resource for professionals and individuals alike.