‘Why I believe addiction is not a disease’

Misguided? A US campaign uses the disease model in an attempt to combat addiction stigma.
by Marc Lewis

A neuroscientist and the author of The Biology of Desire: Why Addiction Is Not A Disease, who frequently writes for The Guardian about drugs and “addictions”.

Does the term “addiction” have any real meaning? This neuroscientist argues that calling addiction a disease is both scientifically incorrect and unlikely to help those affected.

Is addiction a disease? Most people think so. The idea has become entrenched in our news media, our treatment facilities, our courts, and in the hearts and minds of addicts themselves.

It is a potent concept: if you are an alcoholic or a drug addict, then you are ill. And you are going to remain ill. According to Nora Volkow, head of the UK National Institute on Drug Abuse, “addiction is a chronic, relapsing brain disease”. That definition has been adopted by medical researchers and policy makers everywhere.

Two huge benefits of the disease concept are frequently touted by Volkow and others. First, addicts need treatment, and if we do not define addiction as a disease, they will not get the help they require. Second, addicts do not deserve to be scorned or denigrated: they have a disease, and we don’t put people down for being sick.

Once addicts recover, it becomes confusing and debilitating to be told they are chronically ill.

There is good reason to ask whether addiction actually is a disease. If it is, then we might expect it to have a specific cause or set of causes, an agreed-on repertoire of treatment strategies, and a likely time course.

We might wonder how the disease of addiction could be overcome as a result of willpower, changing perspectives, changing environments or emotional growth. There is evidence that each of these factors can be crucial in beating addiction, yet none of them is likely to work on cancer, pneumonia, diabetes or malaria.

Neuroscience is a young discipline, and the distinction between brain development and brain pathology remains muddy (think ADHD, autism, depression) — ideal terrain for drawing arbitrary lines in the sand.

For example, the brain changes observed in long-term substance abusers are nearly identical to those seen in people struggling with obesity, gamblers, and simply those involved in intense romantic relationships. They involve overactivation of a part of the brain that directs goal pursuit (the striatum) in response to cues predicting their preferred rewards.

I have been challenging the disease model for years. One result has been a volley of counter-attacks: how dare I pull the rug out from under the feet of addicts who rely on the disease label to get help and avoid stigmatisation? On the contrary, I think it increases their burden.

I have heard from hundreds of addicts who recoil at the notion that they have a life-long disease. Especially addicts who are determined — and successful — in galvanising their willpower and rejigging their habits, their personal goals, and their capacity for self-control.

Once addicts recover, as most eventually do, it becomes confusing and debilitating to be told they are chronically ill. Recovered addicts want to feel that they have developed beyond their addiction and become better people as a result. Many would prefer respect for that achievement over the pity bequeathed by the disease definition.

I don’t expect this debate to be resolved any time soon. But until it is, I urge anyone who has struggled with addiction, or who loves or cares for someone who has, to keep an open mind. Calling addiction a disease has had its benefits (like the discovery of new drugs that help a subset of addicts). And the disease label continues to simplify our conceptualisation of an extremely messy issue, making it appear easier to understand and resolve.

But the net value of the disease definition needs to be questioned. It may be time to move on.

This is an extract from an article published by The Guardian. You can find the full version under Become An Expert.

You Decide

  1. Is addiction a disease?

Activities

  1. Write down your own definition of addiction. Then see how your definition compares with those of your classmates.

Word Watch

Pathology
The science of the causes and effects of diseases, especially the branch of medicine that deals with the examination of samples of body tissue for diagnostic or forensic purposes.
ADHD
Attention deficit hyperactivity disorder is a chronic condition marked by persistent inattention, hyperactivity, and sometimes impulsivity.
Striatum
Located in the centre of the brain, the striatum coordinates aspects of planning, decision-making, motivation, reinforcement and reward perception.

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