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