Disease Definition of Addiction Does More Harm

Why the Disease Definition of Addiction Does Far More Harm Than Good – By Marc Lewis on February 9, 2018

Over the past year and a half, Scientific American has published a number of fine articles arguing that addiction is not a disease, that drugs are not the cause of addiction, and that social and societal factors are fundamental contributors to opioid addiction in general and the overdose crisis in particular.

The dominant view, that addiction is a disease resulting from drug use, is gradually being eroded by these and other incisive critiques.  

Yet the disease model and its corollaries still prevail in the domains of research, policy setting, knowledge dissemination and treatment delivery, more in the United States than in any other country in the developed world.

The disease model remains dominant in the U.S. because of its stakeholders.

First, the rehab industry, worth an estimated $35 billion per year, uses the disease nomenclature in a vast majority of its ads and slogans.

Second, as long as addiction is labeled a disease, medical insurance providers can be required to pay for it.

Of course they do so as cheaply as possible, to the detriment of service quality, but they at least save governments the true costs of dealing with addiction through education, social support, employment initiatives and anti-poverty mechanisms

Third, the National Institute on Drug Abuse (NIDA), a part of the National Institutes of Health (NIH) that funds roughly 90 percent of addiction research worldwide, is a medically oriented funder and policy setter, as are the American Society of Addiction Medicine and other similar bodies.

For these organizations to confess that addiction isn’t really a disease would be tantamount to admitting that they’re in no position to tackle it, which would be a form of institutional suicide.

And finally, there are the families of addicts, many of whom welcome the idea that addiction is a disease because that implies that their loved ones are not bad people after all.

As a neuroscientist, I’m able to show why brain change—either in general or specifically in the striatum, the motivational core—does not equal pathology or disease.

And as a developmental psychologist (my other hat), I highlight the role of learning in brain change (or neuroplasticity) and reinterpret NIDA’s findings in terms of deeply ingrained habits of thought and action.

If addiction is a disease, then we should be looking at cellular mechanisms, MRI scans and other brain-recording techniques, and this is exactly the policy NIDA has followed for years. In fact, it’s the policy the NIH has implemented in its approach to all psychiatric and psychological problems

As recently captured by Eiko Fried, “despite many decades of considerable research efforts into uncovering underlying biological mechanisms, we have not identified specific and reliable markers for many of the most prevalent mental disorders.”

NIDA has consistently promoted the disease definition as a boon to addicts who have historically been depicted as morally deficient. If they have a disease, their addictive behaviors are not their fault and they should not be stigmatized.

If addiction is a disease, then addicts are, by definition, mentally ill. And indeed, scholars of addiction point out that the disease definition promotes a divide between “us” and “them.”

The stigma of having had the disease of addiction implies that you are not to be trusted, now or ever.

Viewing addiction as pathology has other, more direct detriments. If you feel that your addiction results from an underlying pathology… and if that pathology is chronic, as highlighted by both NIDA and the 12-step movement, then you are less likely to believe that you will ever be free of it or that recovery can result from your own efforts.

This characterization of addiction flies in the face of research indicating that a great majority of those addicted to any substance or behavior do in fact recover, and most of those who recover do so without professional care.

As concluded by a recent meta-analysis, “biogenetic explanations for psychological problems induce prognostic pessimism and negative stereotyping regarding dangerousness.” In other words, both addicts’ own faith in their recovery and the confidence of those around them are hampered by the disease definition.

If we stop confusing addiction with pathology, then we can focus much more clearly on the specific needs of specific individuals.

That seems a huge advantage over dumping everyone in a basket that fits almost no one.

Original article: Why the Disease Definition of Addiction Does Far More Harm Than Good


4 thoughts on “Disease Definition of Addiction Does More Harm

  1. Kathy C

    The current “Research’ is essentially looking where the light is better, more funding or media attention. I know people whose lives have been derailed or ruined due to psychiatric labels. They will tell you their condition is ‘Genetic” so they have no desire to improve. This description is reiterated every time they see their clinic Psychologist, where they are reminded how screwed up they are. Their is virtually no research into this kind of stigmatization. The damage the Industry has caused, because they choose to study where the money directs them, is incalculable.
    We can clearly see that whatever they are doing is not improving anything, yet they continue on. Every time i go to town, i see the ragged, blanks stares, sick people living in their cars or homeless, begging for change. Our local Media tell us of a wonderful non profit that got a Grant, for their version of “Treatment.” Most of the young people around here have only soul killing minimum wages jobs available, which require them to enroll in a social services program to eat or maintain a roof over their heads. The haphazard “non profits are above the Law, and appear to be just passing the buck, and fundraising. The people who think this works, are like mindless pod people. No one track show many of these people in these programs, die, end up hospitalized or in the ER, or how many times they have to repeat the program.

    The Media is Gas Lighting the public on this and many other issues. The marketing program was so good, and persuasive, that beliefs outweigh the facts. If you looks at the advertising for everything related to health or Mental health and addiction, it is deceptive. This is a profit making enterprise. They had to conflate Addiction, Mental illness and Pain, in order to dehumanize these groups. That is more profitable than an objective look at why this is happening. The fact that none of this is working, is clearly not informing any decisions. It has not improved outcomes or shown any kind of progress. The descriptions are designed to have 2 interpretations, one for people with resources, and another for the rest of us.
    They deliberately turned cherry picked Science into advertising, because it works. They just leave out the facts.

    Liked by 1 person

      1. Kathy C

        Powerful Companies like Cambridge Analytical, used data from psychological experiments with social media to track how these marketing campaigns worked. Then they doubled down on the popular and effective messages. I just came across this Article, https://www.npr.org/sections/health-shots/2018/02/26/588334959/pediatrians-call-for-universal-depression-screening-for-teens NPR relies on funding from PhRma, and many Foundations with dubious purposes. This “Recommendation” comes on the heels of the School Shootings and the demands for “Mental Health.” It is hard to tell anymore where the facts begin, and the marketing ends. Teens with adequate resources are less likely to be distressed, yet here they are Pathologizing all teens. Low Income kids will be stigmatized, and treated with Pharmaceuticals, even though they might be experiencing Environmental or situational “Depression.” The same conflation is seen in the “Addiction Crisis.” In our culture any tragedy is a Marketing Opportunity.



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