A Critique of the Medicalized Recovery Model
Contemporary addiction treatment is dominated by a medicalized framework that defines addiction as a chronic, relapsing brain disorder. According to the U.S. National Institute on Drug Abuse, addiction is characterized by “compulsive drug seeking and use despite harmful consequences,” and recovery is understood primarily as symptom management: abstinence, relapse prevention, medication adherence, and behavioral regulation. Within this model, suffering is treated as pathology, craving as neurochemical dysfunction, and relapse as clinical failure.
This framework is not incorrect. It is, however, radically incomplete.
What the medicalized model cannot explain is why addiction emerges with such intensity in modern, secular, technologically advanced societies, nor why abstinence so often produces a flattened, anhedonic form of life rather than genuine renewal. The model treats addiction as a malfunction within an otherwise intact world. It does not ask whether the world itself has become existentially uninhabitable.
The medical model inherits an Enlightenment assumption that suffering is primarily a technical problem requiring correction. Its implicit promise is that, once stabilized, the individual can return to baseline functioning. Yet this “baseline” is rarely examined. The question of why life is experienced as unbearable without chemical mediation is deferred, pathologized, or excluded.
Carl Jung anticipated this failure in Civilization in Transition, where he warned that modern rationalism exposes the individual to unconscious forces it no longer symbolically contains. When meaning is reduced to function, suffering loses its interpretive depth. Craving becomes noise rather than message. Emptiness is treated as a side effect rather than a structural condition.
As a result, sobriety frequently reveals—not resolves—the underlying nihilism addiction was suppressing. The substance is removed, but the metaphysical vacuum remains.
Jung explicitly rejected the notion that addiction could be understood solely as a biological disorder. In his correspondence with Bill Wilson, co-founder of Alcoholics Anonymous, Jung observed that the Latin spiritus denotes both alcohol and spirit, linking intoxication to a distorted religious function. He wrote that the alcoholic’s craving is “the equivalent, on a low level, of the spiritual thirst of our being for wholeness.”
For Jung, addiction is not meaningless compulsion but misdirected transcendence. The addict seeks an absolute experience in a culture that has dismantled legitimate symbolic forms of encounter with ultimacy. This is why Jung insisted that willpower and technique are insufficient. Neurosis—and addiction as one of its modern forms—is “a substitute for legitimate suffering.”
Medicalized recovery, by contrast, attempts to eliminate the symptom without engaging the existential demand it expresses. It seeks control rather than transformation.
Wolfgang Giegerich radicalizes Jung’s insight by situating addiction within the historical completion of Western metaphysics. In The Soul Always Thinks, Giegerich argues that modern consciousness is defined by the internalization of transcendence. Meaning is no longer given cosmologically; it has collapsed into subjectivity and technological totality.
From this perspective, addiction is not an illness interrupting a healthy life. It is a structurally necessary defense against the unbearable conditions of modern freedom and emptiness. Attempts to “restore” meaning therapeutically merely reproduce the compulsive logic they seek to cure.
For Giegerich, modern suffering cannot be healed in the traditional sense. It must be understood historically and endured consciously. The task of the soul today is not cure, but truth. Recovery models fail insofar as they promise normalization, colluding with the fantasy that life should be livable without sacrifice, contradiction, or loss.
Twentieth-century Christian theology offers a stark counterpoint to both medical optimism and spiritualized recovery. Christianity does not promise relief from suffering; it locates meaning within suffering itself. T. S. Eliot noted that a society ceases to be Christian not when belief weakens, but when Christianity is positively rejected as a cultural form. Addiction arises in the aftermath of this rejection, where neither belief nor disbelief can carry existential weight.
The Cross stands as a direct affront to the logic of cure. It declares that salvation is not achieved through technique, stabilization, or progress, but through endurance of reality without anesthetic. Dietrich Bonhoeffer’s assertion that “only the suffering God can help” inverts the therapeutic promise of recovery culture.
In this framework, recovery is not stabilization but conversion—not to belief, but to truth. It is the relinquishment of the fantasy that life should be painless or coherent.
The medicalized recovery model asks:
How can craving be eliminated and relapse prevented?
Depth psychology and theology ask:
What unbearable truth is the craving attempting to silence?
Medicine treats addiction as a malfunction.
This framework understands it as a false solution to nihilism.
Medicine aims at functioning.
This framework aims at truthful suffering and symbolic transformation.
Addiction persists not because treatment fails, but because it often succeeds at the wrong level. Biological stabilization and behavioral control can preserve life, but they cannot address the metaphysical conditions that made intoxication necessary. The substance is removed, yet the demand for transcendence remains unmet.
Nietzsche diagnosed the coming of nihilism. Jung recognized addiction as its religious shadow. Giegerich insisted that this condition must be endured historically. Christianity incarnated it in the figure of the Cross.
Recovery, then, is not the restoration of health.
It is the capacity to live without substitutes.
And this is something no medical model—on its own—can provide.
Brenton L. Delp MFT
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