Being-with-drug to Being-in-the-World; Sartre or medication? – A comparison of the Existential and Medical Models of Addiction

Author: Dr. Giovanni Grech

This research seeks to investigate the boundary between the existential and medical models of addiction and the contributions which each model makes towards this topic. A literature review for both models is presented, delving into the areas of addiction best described by each model. Through the existential definition being-with-drug, addiction is conceptualised in terms of a relationship with the drug and the impact on one’s self. On the other hand, the medical model focuses on diagnostic criteria, genetic and environmental risk and protective factors, and an underlying neurobiological explanation. Phenomenological research supporting existential psychotherapy in addiction is contrasted with the quantitative medical research which forms the basis for current guidelines for the management of addiction. A comparison of both models is presented focusing on the issues of coping, choice, responsibility, disease, mandatory treatment, medication, psychotherapy and the therapeutic relationship. In contrast to the prevalent disease model, the existential view maintains that drug addiction is a coping mechanism used to mitigate existential and neurotic anxiety which results from facing the existential givens. The biopsychosocial model used by doctors is compared to van Deurzen’s model of existence, which provides the basis for existential psychotherapeutic interventions. Furthermore, existential literature was examined to determine whether an individual can authentically choose to live a life of addiction. In conclusion, this paper serves as a basis for future research of the boundary presented. Furthermore, both models seem to develop the arguments they provide beautifully but fail to give a holistic view of addiction. Hence, a combination of both models is necessary to address the diversity of issues clients/ patients present with. Finally, the existential model goes beyond abstinence, being- without-drug, and aims for a life long project of authentic living.