6.2 Moral theory

Where does a moral approach to substance use come from?  Wright^[1] suggests our current moral judgments of addiction begin with a Victorian politic, when “modern man begins to worry that any weakness of moral fiber in the exercise of self-restraint could lead him rapidly away from industry and towards indolence and even idiocy, by way of the bottle, the pipe or the syringe”.^[2]  There are examples of the moral model in Canada, including prohibition and the Controlled Drug and Substances Act, as well as the Criminal Code of Canada.  The moral model suggests using a substance is a moral failing which will lead to a path of destruction.  It views people who use substances as having a choice to use substances and judges them for using the substances.  Listen to the short podcast below.^[3]  Note the language used.  Is this podcast stigmatizing?

The stigma associated with substance use is so prevalent, a recent review by the World Health Organization concluded out of all health disorders, substance use and process addiction disorders were the most stigmatized.^[4] Think about the language used to describe substance use disorders and the people who live with them.  Stigma and the moral model go hand in hand. “A large body of research indicates that this stigma is persistent, pervasive, and rooted in the belief that addiction is a personal choice reflecting a lack of willpower and a moral failing”.^[5]  The moral model still exists today when you hear statements like “pull up your bootstraps,” or “get over it,” when talking about a substance use disorder.  It seeks to place blame on the person with the substance use disorder.  This can impact individuals who use substances, who may see themselves as having failed, especially when it comes to treatment and recovery.

The following video may help you understand how some view substance use.^[6]

Treatment methods generally have moved beyond a moral model.  For example, programs that offer a harm reduction approach are a direct challenge to the moral model, as they offer a lack of judgment and support people “where they are,” embracing the stages of change and allowing for engagement at each level of pre-contemplation, contemplation, preparation, action, and relapse.

The field of Social Services is working to move beyond a moral model of substance use disorders.  You can help people make their own decisions (self-efficacy) and advocate for services to improve the lives of people who use substances and live with SUDs.