Are There Downsides To Thinking About Addiction As A Disease?

When professionals began advocating for addiction to be thought of as a disease, most of them had the best of intentions, especially since the other prevailing view of addiction at the time was a moralistic one that held addicts entirely personally responsible for their choice to continue using drugs despite their drug use’s profound negative consequences.

So, a shift to the idea that people addicted to drugs were suffering from a biological illness they could not control as opposed to simply making bad decisions seemed like a good starting point in reducing the stigma that surrounds addiction.

However, in the years since the disease paradigm of addiction became dominant, other researchers and experts have suggested that it may not actually be the most helpful or the most accurate way of conceptualizing such a complex condition. 

Before we examine the reasoning behind this viewpoint, it might prove helpful to take a look at the definitional difference between a “disease” and a “disorder.” While a disease is a “particular distinctive process in the body with a specific cause and characteristic symptoms,” a disorder is an “irregularity, disturbance, or interruption of normal functions.”

Addiction, which is itself defined as compulsive substance use that continues despite harmful consequences, is clearly an irregularity that interrupts normal functions. But while it can probably be said to have a set of characteristic psychological symptoms that hold true across addictions to different substances and even to non-substances, whether those symptoms have a specific biological cause is a far murkier matter. 

There certainly exist biological predispositions to addiction, with studies having shown the disorder to be approximately 50 percent heritable. But there are many different genes that predispose one to addiction, and not everyone with those predispositions goes on to become “addicted.” Nor can even the most addictive substance be considered a true biological “cause” of addiction, since not all or even most people who experiment with any given drug go on to become addicted. 

And though studies have found measurable differences between the brains of addicts and the brains of non-addicts, such as lower activity in the areas associated with self-control, what most of these studies do not do is illustrate whether these changes were caused by addiction or one of the factors that predisposed people to it.

So, as Marc Grifell and Carl L. Hart argue in a comprehensive American Scientist article, one harmful effect that the brain disease paradigm of addiction might have is to perpetuate the idea that someone who has a substance abuse disorder has irrevocably damaged their brain with excessive drug use, when in actuality that is likely only true for a small percentage of long-term users of certain substances. 

Hart and Grifell also found that the brain and cognitive differences that have been found to exist between addicts and controls were “insufficient to determine true cognitive dysfunctions,” with any small differences found still indicating that the addicted subjects were in the normal range for their age and education-matched counterparts. 

Another danger that they find in this approach is that the intense focus on biological causes of addiction that comes with the disease paradigm takes focus, funding, and energy away from the potentially more important—and potentially easier to address—psychosocial causes of addiction. 

In another article in the journal Nature, Hart reflects on his realization that drug addiction in the “resource-poor” community in which he grew up was not the cause of the poverty and crime there so much as an effect of it and of other socioeconomic factors like societal racism, coming to the conclusion that the “neuro-exaggerations” of the disease paradigm of drug addiction actually promoted social injustice. 

Some evidence suggests that the disease paradigm could be damaging to the self-conceptions of people struggling with addiction as well. One study found that alcoholics who were prompted to internalize statements promoting a disease model of addiction “tended to have weaker perceptions of drinking self-efficacy” and “increased….feelings of stigma and shame relative to the control condition.”

Professor Tim Holden also criticizes the disease paradigm of addiction for downplaying the role of personal responsibility even while stating that “the need for helping or treating people with addictions is not in doubt.”

In other words, the idea that someone who is abusing drugs simply “has a disease” seems as if it could foster a dangerous determinism. People with a substance abuse disorder may start to think of themselves as having an intractable “disease,” and thus somehow irrevocably damaged, suffering from a condition that they have no power over rather than from a condition they can choose to pursue and commit to treatment for. 

Considering addiction as a “disorder” rather than a “disease” also does not have to mean blaming or shaming those suffering from addiction for that disorder. Another analysis by Neil Levy posits that since the “deficits” associated with drug addiction only actually result in that addiction in specific social contexts, they do not in and of themselves constitute a disease. And since those contexts are predominantly ones that the person suffering from addiction did not create, they still should not be blamed for their condition and thus still deserve compassion.

“If we are to understand addiction and respond appropriately to it, we must not focus on just the addicted individual herself, much less her brain. Our focus must be on her, in her social setting. Inevitably, that entails that we must ourselves come under scrutiny; perhaps we need to change as much as she does,” he writes.

In the end, though, all of this might come down to semantics. Whether thinking about addiction as a disease is helpful to you or not, it might be a better idea to reflect on the fact that the human brain is remarkably plastic and adaptable, and that the human spirit is incredibly resilient. 

Most people who suffer from addiction do eventually go on to recover, and even though someone in the midst of a severe addiction might feel as if they have no choice to keep using, they still do have the choice to seek help. 

If you’re ready to seek that help now, it might be time to reach out to Reco Intensive. Our personalized and comprehensive bio-psycho-social approach will take into consideration the unique context of your addiction, and our experienced alumni can help you establish the support system you need to stay solid in your recovery. Call RECO Intensive at (561) 464-6533 today. Let’s get back to a brighter future.

SOURCES:

https://www.americanscientist.org/article/is-drug-addiction-a-brain-disease

https://www.frontiersin.org/articles/10.3389/fpsyt.2013.00024/full

https://www.nature.com/articles/s41562-017-0055