How Psychology Changed the Way We See Addiction

A deeper dive behind the ‘Exploring Addiction’ series

What rationalism did for witches, psychology has done for alcoholics — saved many souls from the baying crowd.

We’ve been drinking for as long as we’ve been human. Alcohol predates recorded history, woven into ritual, celebration, and everyday life across every culture. But for most of that history, the person who couldn’t stop drinking was met not with compassion, but with contempt. They were weak. Sinful. A drain on society. Choosing destruction over decency.

It took the slow, determined work of psychological research to dismantle that story — and replace it with something far more honest, and far more human.

This article traces that journey: from moral condemnation to a rich, multi-layered understanding of addiction that encompasses biology, psychology, trauma, and even spirituality. It’s a story that matters — because the way we explain addiction shapes the way we treat the people who suffer from it.

The Moral Model: When Willpower Was the Only Answer

Left to common sense alone, most of us would probably explain addiction as a failure of willpower. Nobody is forcing the alcoholic to drink. So why don’t they just stop?

Add to that a cultural backdrop of religious teaching — drunkenness is condemned in most traditions — and you have the conditions for what historians call the “moral model” of addiction. The idea that excessive drinking was a moral failing, plain and simple.

In 19th and early 20th century America, this thinking gave rise to the temperance movement, which operated on a compelling but ultimately flawed logic: if anyone could become addicted through overindulgence, then the answer was to remove alcohol altogether. It was this reasoning that drove Prohibition in 1920.

And initially, it worked — somewhat. Alcohol-related problems did fall. But prohibition proved impossible to enforce, and by 1933 it had been repealed, driven out by political and economic pressures. The moral model had failed. The question was: what would replace it?

The Disease Model: A Revolution in Understanding

The shift began in earnest with a physiologist named E. M. Jellinek, who in the late 1930s was given a mandate to conduct a rigorous, unbiased scientific investigation into alcoholism. Working through the newly formed Research Council on Problems of Alcohol, Jellinek brought the tools of empirical science to bear on a problem that had previously been left to moralists and clergy.

His findings were significant. In 1941, his epidemiological research established a measurable connection between a physical disease — cirrhosis of the liver — and the mental experience of alcoholism, characterised by craving and loss of control. He went on to identify distinct sub-groups of “problem drinkers,” distinguishing those with physiological dependence as the true alcoholics.

The culmination of this work was his 1960 book The Disease Concept of Alcoholism, in which he argued that alcoholism had a biological basis — cellular adaptation, physical tolerance, withdrawal symptoms. It was a disease, not a decision.

The impact was enormous. Both the World Health Organisation and the American Medical Association formally reclassified alcoholism as a disease. For the first time, the condition had institutional legitimacy — and with that came research funding, treatment programmes, and a shift in public attitude.

Some critics have argued that Jellinek’s approach was more pragmatic than purely scientific — that framing alcoholism as a biological disease was a deliberate strategy to build public support. And there may be truth in that. But the outcome was real. As a later US Surgeon General put it, for stigma to be reduced, people needed to understand that addiction was a genuine brain disorder, not a volitional behaviour.

The message that began to take hold was simple but powerful: it’s not his fault — he has a disease.

The Neuroscience: What’s Actually Happening in the Brain

Modern neuroscience has built considerably on Jellinek’s foundations, offering increasingly detailed explanations for why the alcoholic can’t simply choose to stop.

Research in the 1960s established that genetics plays a contributory role — alcoholism runs in families in ways that can’t be explained by environment alone. But it’s the neuroscience of reward that offers perhaps the most illuminating picture.

A key piece of the puzzle is something called Reward Deficiency Syndrome. The brain’s reward system relies heavily on dopamine — the neurotransmitter associated with pleasure, motivation, and wellbeing. In some people, that system is less sensitive than normal. They experience less of the natural reward that most of us take for granted from food, connection, and achievement.

For someone with this neurological profile, psychoactive substances like alcohol offer something powerful: a reliable, immediate hit of dopamine that the brain’s own systems fail to provide. What looks like hedonism or recklessness from the outside is, from the inside, the pursuit of something that feels necessary for normal functioning.

This doesn’t mean that neurobiology tells the whole story — there are researchers who argue that the neurological disease model overstates its case. But the evidence of abnormal brain circuitry in addiction continues to accumulate, and continues to do important work in humanising a condition that was, for so long, simply condemned.

The Wound Beneath the Drinking: Trauma and the Unconscious

Biology, however compelling, doesn’t explain everything. And as the disease model gained ground, a parallel tradition was developing its own answers — rooted not in the brain, but in the mind.

Psychoanalysis, the “talking cure” pioneered by Freud in the early 20th century, brought a different set of questions to addiction. Not what is wrong with the brain? but what happened to this person?

Freud’s core insight was that psychological suffering often originates in the unconscious — in feelings and experiences that have been buried rather than processed. The analyst’s job was to bring those buried contents into the light, through conversation, interpretation, and the therapeutic relationship.

Applied to addiction, this framework produced some remarkable insights. The psychiatrist Ed Khantzian, in work developed through the 1970s and beyond, proposed what he called the “self-medication hypothesis.” The alcoholic, he argued, is not drinking for pleasure. They are drinking to make unbearable feelings bearable. Beneath the addiction lies unprocessed pain — and drinking is the only solution the person has found to a problem they may not even be able to name.

Khantzian captured it precisely: actively suffering with addiction and its consequences feels better than passively suffering with an unknowable internal world.

He also pointed to developmental failures — a lack of adequate self-care developed in early life, often due to trauma or neglect — as central to addiction. The addict doesn’t just have a physical dependency. They have a wound. And until that wound is addressed, no amount of willpower will be sufficient.

This work did something important culturally. It gave people a way to understand aberrant behaviour as the consequence of experience rather than character. The shift in perception might be captured simply as: you’d drink too, if you’d been through what they’ve been through.

AA, Jung, and the Spiritual Hole

No account of alcoholism is complete without Alcoholics Anonymous — the peer-led mutual support organisation founded in 1935 by Bill Wilson and Dr Robert Smith, whose 12-step programme has helped millions of people achieve long-term sobriety.

AA’s relationship to psychology is more intimate than it might appear. The 12 steps draw heavily on psychoanalytic principles — creating what the therapist Philip Flores calls a “therapeutic holding environment,” and working systematically to bring unconscious fears, resentments, and defensive patterns into conscious awareness.

But AA also has a spiritual dimension — and its origins here are surprising. Bill Wilson, in correspondence discovered after his death, attributed the founding inspiration for AA to none other than Carl Jung.

Jung, one of the most influential figures in the history of psychology, held a view of addiction that went beyond both biology and psychology. He believed that at its core, addiction represented a spiritual search — a quest for transcendence, for wholeness, for connection to something larger than the individual ego. Alcohol, in Latin, is spiritus — and the craving for alcohol, Jung suggested, was in some sense a misdirected craving for spirit.

Jung was cautious about publicising these ideas during his lifetime. Spirituality was considered unscientific, and he feared it would damage the credibility of psychology. But his influence persisted underground — finding its way, eventually, into one of the most effective addiction recovery programmes the world has ever seen.

The Hero’s Journey: Addiction as Transformation

If Jung provided the spiritual seed for AA, transpersonal psychology — which emerged more fully from the 1960s onward — developed those ideas into a more complete framework.

Transpersonal psychology extends the scope of psychological enquiry beyond individual pathology to include the full range of human experience: self-realisation, transformation, and the evolution of consciousness. Within this framework, addiction takes on a different meaning.

The psychotherapist Stanislav Grof proposed that addiction stems from a deep craving to return to a state of wholeness — what he called the “divine self.” All human beings, he suggested, generate attachments designed to escape the existential anxiety of separateness. Most of us muddle through. The addict goes to an extreme — pursuing through substance use a transcendence that ultimately destroys everything it touches.

In this reading, addiction is not simply a disease, or a symptom of trauma, or a neurological malfunction. It is the darkest point on what the mythologist Joseph Campbell called the hero’s journey — the descent into the abyss without which no real transformation is possible.

This might sound abstract. But in practice, it offers something that neither the disease model nor the psychoanalytic model fully provides: a way of making meaning from the experience. Not just “what went wrong” but “where this might lead.” Recovery, in this frame, is not merely the absence of drinking — it is the beginning of a genuine confrontation with the self.

The practical implications include the growing mainstream acceptance of meditation, yoga, and other contemplative practices as tools in addiction recovery. And more broadly, a cultural shift toward seeing the recovering addict not as a damaged person managing a chronic condition, but as someone engaged in a profound and courageous process of self-discovery.

The Full Picture: Why Complexity Is the Only Honest Answer

What emerges from this journey through psychological research is not a single theory of addiction, but a layered one.

The biological dimension tells us that some people are more neurologically vulnerable than others — that for them, alcohol hijacks reward systems in ways that make choice a far more complicated matter than it appears from the outside.

The psychological dimension tells us that people drink to survive — that beneath almost every addiction lies unprocessed pain, and that treating the addiction without addressing the wound is likely to fail.

The spiritual dimension tells us that the craving for transcendence is a fundamental feature of human consciousness — and that addiction, however destructively, is in some sense an answer to a genuine need.

Together, these perspectives form what researchers now call the biopsychosocial-spiritual model of addiction. It is not a tidy framework. But it is an honest one — and its most important practical consequence is compassion.

When we understand addiction as a complex condition with biological, psychological, and existential dimensions, we no longer need to choose between holding someone responsible and holding them with care. We no longer need to exonerate the addict of all agency in order to extend them basic human dignity.

The moral model said: they are weak, and they should stop. The biopsychosocial-spiritual model says something quite different: they are suffering, and they deserve our understanding.

That shift — from judgment to understanding — is perhaps the most important thing psychology has given us.

*This article accompanies the ‘Exploring Addiction’ series on Facebook. Follow along each week for a deeper look at each dimension of addiction — biological, psychological, spiritual, and beyond.*