Addiction Is A Serious Condition But It Is Not A Disease
(Part 1 of 2)
Addiction is the result of moral failure — at least, that’s what Attorney General Jeff Sessions hopes you will believe. Luckily, many such unscientific, shaming beliefs about addiction are losing traction. An updated and more humane theory of addiction is that it is a chronic brain disease. This belief is now widely accepted, especially among liberals, due to the fact that it helps avoid unfounded, Jeff Sessions-esque, stigma.
However, there is a sensible third premise based on ample evidence: Addiction is compulsive behavior that satisfies immediate and otherwise unmet needs, and continues despite destructive consequences.
This definition resonates with me, someone who studies addiction and has lived through a destructive relationship with opioid drugs. And while it is logically incompatible with both of the two very marketable theories previously mentioned — “addiction is a moral failing” versus “addiction is a chronic brain disease” — it incorporates the most reasonable qualities of both camps: a) addiction is not a disease, but it has disease-like qualities b) addiction is not a choice, but has many qualities of conscious choice-making.
It will help to clearly explain the current and most dominant addiction theory, the disease model.
The Disease Model
The National Institute on Drug Abuse (NIDA) defines addiction as “A chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works.” But this definition describes no more than a normal developmental process. And the more intensely motivated the developmental process — especially when in response to a repeated experience — the more extensive the brain changes.
The desire to continue immediately rewarding behavior — be it gambling, sex, or drugs — is a salient feature of addiction. The experience of desire and reward repeats and as it recurs, several brain changes transpire, none of which are inherently destructive.
Addiction presents many disease-like qualities but is a problem of learning and development, not a disease. Ignoring this has influenced destructive policy decisions, despite altruistic intentions. Below are three truths about the disease model you must understand if you plan to take community action.
- It is an attractive point of view
Americans once suffered from a terrible allergy to people with addiction. Junkies, as they were labeled, were considered amoral, pathetic, and as having severe defects of character. Today, the overall image of drug addiction has changed in a dramatic and positive way, thanks to a widespread cultural enthusiasm for the disease theory. No longer are people with addiction evil villains. Instead, they are sick with a chronic, progressive medical illness and deserve our sympathy.
This idea quickly helped lessen public criticism while allowing people with addictions a slightly more positive self-image. Although it is not empowering to think of oneself as diseased, it outshines the “moral failure” premise. All things considered, of course the disease model would stimulate such robust emotional support.
2) It Is Incorrect
While analyzing the disease theory, it was helpful to consider my own addiction experience. I was addicted to opioid drugs — including heroin — for years. One day, while in the throes of addiction, I decided I needed a change, then I walked away from my harmful habits and never looked back; that doesn’t seem disease-like. If my addiction could be explained within a disease framework, it means it was a disease I could take control of and walk away from. The question becomes, are there other diseases with these characteristics?
My addiction was not a pathological, biological process like the flu. Being a pathological disease would also mean doctors could test for it and find it. To date, nobody has located an “addiction center” in the brain or body.
It was not an infectious disease like strep throat or the middle-ear infection I had last week; there is no parasite, bacteria, or virus to blame for my addiction experience. I wish there were, then perhaps addiction could end with a zpack.
My addiction was also not a biologically degenerative process like coronary disease or ALS. I’m sure my grandfather — who struggles to breathe at times — wishes his condition could be as rosy as my addiction to heroin; he is unable to decide to stop having COPD.
The answer is no, there is no category for addiction in epidemiology. The whole notion that addiction is a medical sickness is unfounded.
I’ll concede there are characteristics of addiction that may share symptoms of various diseases. For instance, when people avoid changing addictive behavior, their lives usually become more destructive. But this does not get to the nature of the complex. That ignoring a problem will make it worse is true in many areas of life that have nothing to do with diseases, like when I don’t do the dishes (ask my wife).
It is also noteworthy that neuroscientists have made progress in charting the neural mechanisms and changes correlated with addiction. When they take brain scans of people with addiction, they find changes involved in pleasure, reward, and impulse inhibition. And i’m sure if I could have observed the chemistry of my brain while I was addicted to heroin, I would notice that as I set my focus on getting high — and the less I focused on everything else — these areas of my brain would change accordingly.
While this is fascinating technical work, it is largely irrelevant. Brain changes occur in non-addicted people all the time. In an interview with Marc Lewis, the best selling author of Biology Of Desire: Why Addiction Is Not A Disease, he told me, “The same brain changes are involved in reading a new book, forming a relationship, or in developing a new passion. Any time there are changes in behavior and thought patterns, the brain will change; synapses (connections) will grow in some areas and become less active in other areas.”
This uniformity creates dissonance for proponents of the disease model and begs a critical question: Why do brain changes prove addiction with regard to heroin or tobacco, but the same brain changes mean something different with regard to regular habits?
3) It matters that it is incorrect
People develop addictions to a range of things, including drugs. However, drugs themselves contain no ineluctable chemical draw. Instead, addiction happens when a) a person becomes involved in a thing or an activity b) the involvement provides some form of pleasure or relief compensatory for lack of such sensations in other areas of life.
When people with addiction find healthy alternatives to compulsive (addictive) behavior, they can begin to develop new patterns and move away from addiction. Nothing about this process implies that addiction is forever or that it cannot be escaped. The disease model tells us the opposite is true. Yet we continue to follow the disease blueprint, despite compelling research to suggest the disease notion is often self-fulfilling.
Which brings us back to my claim: “Addiction is an involvement that satisfies an immediate — and otherwise unmet — need while causing destruction in other areas of life.” This is the most realistic description we have, and by following its premise, we will improve and save lives.
In my next post, I will explain how.
