While mankind has been using substances for millennia, recently society has begun to ask the question: is addiction a disease? Since man first discovered substances like alcohol, marijuana and opiates there have been some people who find themselves addicted. While for most of that history these individuals have been written off as “bad” people who lack discipline and proper morals, this view has been brought into question in the past few decades as the medical and recovery communities have begun to wonder if addiction is a disease.
The argument over whether addiction is a disease or a choice is one which has implications in many areas of society which range from healthcare and treatment to law enforcement. While recent scientific research has pointed to clear signs that addiction meets the criteria of a disease, the fact that it has some characteristics which don’t clearly line up with other diseases has made it difficult for society as a whole to embrace the addiction disease model. This has led to a somewhat disjointed and nebulous effort to address the issue of addiction within our society, creating difficulties in creating highly effective treatment models.
While addiction may not behave like other diseases, there is little doubt that the development of the disease model of addiction has played an important role in the development of more effective treatment methods for those who struggle with substance abuse. As scientific research in to the brain and other systems of human biology continue to move forward, the hope is that the current question of whether or not addiction is a disease will be answered with more certainty.
Is addiction a disease?
The disease model of addiction is still relatively new. Until recently, those who struggle with substance abuse were derided for their lack of will power and selfish desire to make bad decisions. However in the past few decades, the medical community has begun to answer the question of is addiction a disease? While the concept of addiction as a disease has been around for at least a couple centuries, it first gained widespread prominence with the advent of Alcoholics Anonymous in the 1930s. This program, which is still widely considered among the most effective forms of treatment for substance abuse, is based partially on the medical opinion of Dr. William Silkworth. Dr. Silkworth worked for many years with patients who struggled with alcohol abuse and throughout his career came to the conclusion that alcoholism, a form of addiction, was indeed a brain disease which fundamentally altered the thought process in individuals who were afflicted with it.
This disease model is based on the thought that drugs and/or alcohol fundamentally change the way some people’s brains function, allowing the desire to use the substance to override other more rational parts of the brain’s decision making process. This change compromises the idea of choice, making it either difficult or impossible for an untreated addict to resists the biological temptation to use. This now outdated idea of choice, which is at the core of the moral argument against addiction as a disease, is pushing the conversation about the nature of addiction forward.
A few decades later when medical science began to advance to the point where the functions of the brain were beginning to be understood, this disease model became more established. Today, most medical associations classify addiction as a disease due to this continued research. Like many other serious illnesses like diabetes and cancer, addiction is caused by a combination of behavioral, environmental, biological and hereditary factors. In fact, some studies suggest that genetic factors account for as much as half of the possibility that someone will develop addiction. This is one of the strongest facts for the argument of the disease model of addiction because these characteristics mirror those of other more understood diseases quite closely.
Another strong factor which points towards addiction being a disease is its typically progressive nature. Just like most other diseases, if addiction is left untreated it often times results in worsening physical and mental health disorders some of which can potentially be fatal. Also, just like many other chronic conditions addiction cannot be cured but only treated and controlled. All of these similarities, which addiction parallels with other chronic diseases are some of the main points that the medical and treatment communities point to when attempting to answer the question of is addiction a disease?
The moral argument of addiction
While the disease model for addiction is currently accepted throughout much of the medical and addiction treatment communities, there are still significant pockets of these communities as well as society as a whole which answer a resounding no when asked is addiction a disease? There are a few reasons for this, all of which tend to stem from our still evolving understanding of the process of addiction.
The first thing that people point to when arguing against the disease model of addiction is that addiction involves choice or free will. It is often argued that addicts choose to use drugs and ruin their lives, unlike a diabetic or a cancer patient who does not choose to become afflicted with their disease. This however is a bit of a simplification of the actual facts. Both addiction and diseases like diabetes or cancer are caused by a constellation of influences which include mostly uncontrollable things like genetics and biology, as well as things which are influenced by the choices and actions of the individual. For example, a lung cancer patient may be genetically predisposed to the disease but choices like smoking or working in a coal mine allow those genetic predispositions to manifest themselves into an actual diagnosis of cancer. Likewise, for an addict they are often time genetically predisposed to addiction but their choices such as drinking alcohol or using drugs allows this genetic predisposition to addiction to manifest itself into the actual disease.
This moral argument against the question of is addiction a disease is mostly rooted in the historical ignorance of how the brain works. Until recently almost nothing was known about the actual chemical and electrical processes which govern our thought and actions as humans. This unfamiliarity led to the assumption that all actions that people make are governed completely by a person’s morals and values. Therefore, a person who was thought to be unwilling to stop drinking or using drugs in spite of mounting consequences for both themselves and their families was considered an immoral person because they were assumed to have the ability to stop their addiction, they simply chose not to. While the argument here is by no means settled, the modern scientific understanding of the brain’s mechanisms as well as the biological implications of addiction point to the assumption of choice in the matter to be a bit more complicated.
The disease model: how addiction affects the brain
In the early years of the disease model of addiction, proponents of the model had a difficult time pointing to concrete evidence when answering the question is addiction a disease? Their arguments were based mostly on anecdotal evidence and experience, however as breakthroughs in the understanding of the brain began to occur in the decades to follow substantial evidence began to appear. The single largest and most complete piece of the disease model of addiction has to do with the way that the brain works in its response to substances like drugs and alcohol.
The brains of all humans are a result of millions of years of evolution which have allowed it to become the center of all thought, action and survival. Because humans need things like water and food to survive, over time the brain developed a specific mechanism for pleasure which makes necessary behaviors like eating and drinking enjoyable to humans. When humans take part in these certain behaviors, neurotransmitters like dopamine are released into a part of the brain called the nucleus accumbens, often times referred to as the pleasure center, which trigger the feeling of pleasure. This pleasure reinforces the specific behavior and the memory of that pleasure encourages the individual to perform this behavior again and again.
This mechanism for reinforcing behavior is crucial to the survival of humans, however the brain is not infallible and this reward system can sometimes become “hijacked.” This can occur due to the fact that substances like alcohol and other drugs trigger the release of considerably larger amounts of dopamine in the brain than things like eating, drinking or even sex. Because the brain is constructed to respond to these levels of dopamine with pleasure, the use of these substances can become reinforced the same way that these other behaviors which are necessary for survival. Continued reinforcement of this mechanism with the use of drugs and/or alcohol can fundamentally alter the brains natural process to the point where the individual afflicted with addiction essentially acts as if the drug they are addicted to is necessary for their survival.
This particular understanding of the way motivation for specific behaviors work within the brain has shed a bright light onto the question of is addiction a disease? Just as a person is internally driven to do things like drink water for hydration and consume food for nourishment, those who have developed the disease of addiction are driven to use drugs and/or alcohol as if it was fundamentally necessary for their survival.
The impact on addiction treatment
While this recent revelation about the way addiction impacts people has brought the disease model of addiction into the mainstream, there are still those out there that insist addiction is not a disease but a choice. These two differing thoughts about the nature of addiction have led to a significantly disjointed and often times ineffective model for treatment in not only the addiction recovery field but in society as a whole.
Because confronting the issue of addiction requires two vastly different approaches depending on the particular understanding or belief about it, those who find themselves struggling with addiction are getting caught in this social argument. Those who believe that addiction is a choice made by “weak” individuals have pushed for things like stricter legal enforcement and harsher punishments for those who use drugs. On the other side of the argument, those who answer yes to the question of is addiction a disease tend to argue for more accessible and effective treatment options for addicts. While the moral issue of choice for an addict or an alcoholic may be a more difficult ethical belief to tackle, the question of how to deal with those struggling with addiction is becoming more straightforward even for those who are staunchly opposed to the disease model.
Yet another enlightening fact in this argument is that while neither punishment nor treatment for addicts can claim extraordinary success rates, the addicts who find themselves undergoing treatment as opposed to punishments like jail time tend to have a considerably higher chance of success. This fact alone should move society towards a stronger insistence on the treatment of addiction as a disease rather than a choice. Regardless of the side of the argument, is addiction a disease, you find yourself, it is difficult to overlook the fact that more addicts are changing their lives when they are able to get the proper substance abuse treatment.