Depending on who you talk to, addiction is often viewed as a disease from which one can never recover. Unfortunately, this rather pessimistic view has become the dominant explanation for the large range of negative behaviors and health problems resulting from drug and alcohol use. However, not everyone agrees, and addiction rates have only continued to climb, providing an indication, at the very least, that the solution to addiction lies outside the disease-based model.1
If addiction isn’t a disease, then what is it? While there are many opinions, most experts agree that addiction is comprised of at least three common components:
- Addiction is a complex learned negative behavior. Continued use causes increasing consequences both for the user and those around them. While drug use may have seemed to resolve emotional pain, the effect is short-lived, and the consequences of using quickly begin to outweigh any perceived benefits.
- The addiction persists despite attempts to stop. As the substance use is continued, the individual is unable to self-regulate. This inability to stop despite growing consequences creates a chronic pattern of relapse, which, if not handled, often results in incarceration or death.
- Physical dependence and cravings reinforce the negative behavior. With continued use, drugs and alcohol cause the body to become physically dependent on them. This results in a need to increase the amount of the substance being used over time and causes intense cravings when the substance use is stopped.
While not everyone agrees on the exact definition of addiction, most would agree that as a result of physical dependence and reinforced negative behaviors, most addicts are unable to stop without outside help. Unfortunately, the stigma attached to addiction prevents many from ever receiving help. Addressing the negative behaviors associated with addiction is made that much more difficult when those behaviors are viewed as a moral failing or when those who seek help are demoralized and relegated to the criminal justice system without access to effective treatment programs.
Problems with the Disease Model
For a variety of political, religious and social reasons, addiction has historically been perceived by many as a reflection of moral weakness or criminal behavior. To a large degree, the disease model of addiction was introduced to provide an alternate explanation for addictive behaviors. If addiction were to be viewed as a disease, it was thought, society would be more open to providing treatment and encouragement for those suffering from the problem. While the disease model certainly has some advantages in this regard, it still creates more issues than it solves.
Criticisms of the disease model include:
- Addiction includes a wide spectrum of behaviors and circumstances, making consistent diagnosis impossible.
- Not everyone who begins to use substances continues the progression to addiction.
- Labeling someone as a chronic alcoholic or addict may decrease confidence in their own ability to change.
- It may decrease an individual’s personal responsibility for their actions, with the addict instead blaming others.
- Critics argue that the medicalization of addiction is just another form of social construction, creating a new class of individuals who are labeled with a chronic disease and then treated with medications.
Despite the criticisms levied against the disease model, addiction is perhaps the nation’s most neglected preventable health crisis. It is easy to understand why one might believe that more medicine is the answer to a health crisis. However, the past decade has shown that the medicalization of the treatment industry has led to a morass of healthcare policies and the creation of business models focused solely on providing the lowest level of care possible.