The phrase “addiction is a disease” has been in common use in the addiction and recovery field for decades. But it doesn’t seem much like many other diseases, where there are clearly defined linear symptoms for diagnosis and universally accepted treatments.
The line between addiction and problematic substance is far blurrier and is a bit different for everyone. Different too are addiction’s specific symptoms and the individual treatment pathways available. All these differences have added up to a situation where many in the addictions field have questioned the logic of labeling addiction as a “disease”, and some have been able to state quite a strong case as to why we shouldn’t.
Let’s take a look at the history of how addiction came to be recognized as a disease, and modern thoughts and developments on the logic and efficacy of the disease model of addiction.
Origins of the Disease Model
A fascinating recent article details the story of Elvin Morton Jellinek, a larger than life character who, together with socialite and journalist Marty Mann, popularized the idea that alcoholism was a disease. In 1960 Jellinek authored the book “The Disease Concept of Alcoholism”, in order to make his case. One of the central difficulties of Jellinek’s quest was reaching a workable definition of the term “disease.” In the end, he appeared to throw his hands in the air and give up. “A disease is what the medical profession recognizes as such” was his conclusion.
But it is exceedingly difficult to find consensus on this issue, even among medical professionals. As the New Yorker notes, the American Psychiatric Association no longer recognizes Asperger’s Syndrome as a disease, but binge-eating disorder is recognized, even though its symptoms are listed as eating “in a two-hour period, an amount of food that is definitely more than most people would eat in a similar period of time under similar circumstances.”
The definition (and public acceptance) of alcoholism and drug addiction as diseases is crucial to the way society deals with these disorders. Are they moral failings which should be dealt with by police and the courts, or legitimate ailments which deserve public funding for treatment and research? Jellinek and Mann were deeply concerned with defining addiction as a disease. In 1942, Jellinek’s journal published an article entitled “Alcohol and Public Opinion” which noted that only by being recognizing addiction “as a disease can the required approvals be gained for changing existing situations, for the creation of new institutions, for the formation of groups to do things.”
Jellinek and Mann were extremely successful in bringing public attention to the plight of alcoholics. Their essential message was that alcoholics were sick people who could be helped by treatment and that alcoholism was, therefore, a public health problem that society should attempt to fix. Together they helped to start the Yale Center for Alcohol Studies and the National Committee for Education on Alcoholism, which later became the National Council on Alcohol and Drug Dependence. Their work was instrumental in de-stigmatizing addiction and helped millions of people.
Evolving Definitions
The definition of addiction as a disease has led many to deal with drug abuse and addiction as a public health issue rather than a criminal matter. However, the definition of addiction recommended treatments, and criteria for diagnosing addiction are constantly evolving. The chemical and structural changes that occur in the brains of addicts have been documented by researchers. Evidence-based treatment practices have evolved, and scientists have been working hard to create “vaccines” which could theoretically eradicate addiction.
Meanwhile, a number of experts in the field are becoming increasingly critical of the disease model of addiction. One opposing theory is the “life-process” theory of addiction. Proponents of this theory feel that addiction is either a habitual response or a source of gratification and security for the addict and that a decision to repair relationships and change one’s life are the true keys to recovery.
Voices of Dissent
Professor and neuroscientist Marc Lewis, author of the book “The Biology of Desire: Why Addiction Is Not A Disease”, argues that rather than a disease, addiction is the result of “deep learning”, usually triggered by trauma, stress or anxiety, which has an effect on the brain’s synaptic pathways. He argues that building different habits of thought and behavior can re-wire the brain and allow addicts to “unlearn” the things that led them to addiction.
Gabor Mate, an influential doctor, writer, and philosopher, believes that the roots of addiction are in past trauma, stress and a sense of shame. He notes that while there are “genetic predispositions to addictions… they don’t cause addiction by themselves; they just increase the risk. In both animal and human studies, subjects don’t become addicted if they receive the proper nurturing, even in the presence of predisposing genes.” Mate feels that addiction is best treated through a combination of mindfulness practice (yoga and meditation, for instance), nutrition, and psychological counseling to deal with feelings of shame and damage from trauma. Mate notes that “The experience of being treated well and with compassion has a huge positive impact on addicts’ sense of well-being and connection to the world, which makes it more likely that they’ll move toward overcoming their addictions.”
Another addictions expert who takes issue with the disease model is the British journalist Johann Hari. He spent 3 years conducting research for his book “Chasing the Scream: The First and Last Days of the War on Drugs” and concluded that addiction was more of a social than a mental or physical illness. Hari claims that “the opposite of addiction is not sobriety. The opposite of addiction is connection.”
One of the examples Hari cites is the famous “Rat Park” study conducted by Canadian psychologist Bruce Alexander in the 1970s. Alexander found that rats who were given drug infused water in an isolated environment became addicted, but when offered the same drugs in an environment with toys, cheese, and other rats, they used 75% less of the drug-infused water and none of them overdosed.
Hari also cites a Portuguese harm reduction program which created jobs and offered micro-loans to addicts who wanted to start businesses. The country also de-criminalized all drug use. In the years since 2001, when these policies were introduced, injection drug use has decreased by 50%.
Hari concluded that addiction wasn’t the result of chemical triggers that cause addicts to crave drugs, but rather the result of isolated lives that deprive individuals of the connection they need to maintain their mental health. Referencing the Rat Park study, he asks “What if addiction isn’t about your chemical hooks? What if addiction is about your cage?”
The disease model has done a great deal to de-stigmatize addiction. Most people now acknowledge that it is not a moral failing and that addicts deserve treatment rather than incarceration and condemnation. And the classification as a disease has brought a great deal of funding to treatment and research, which have given us a broader understanding of substance use disorders. However, at Tabula Rasa Retreat we believe that everyone should be willing to listen to and learn from the arguments of experts who have studied addiction in depth. Any insights that can help us treat addiction should be received with an open mind.
For further information visit www.tabularasaretreat.com or call PT +351 965 751 649 UK +44 7961 355 530