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

[Chris]

New developments in how to view addiction.

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

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. You might wonder: what are we waiting for?

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. Despite consistently low success rates, that's not likely to stop because it pulls in the cash. Second, as long as addiction is labeled a disease, medical insurance providers can be required to pay for it.

...My own role in the controversy has been to keep up a spate of arguments against the disease model of addiction, in books, the press and online, mostly on scientific grounds. 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. Both arguments are presented in some detail here.

...It is important to recognize that drug dependence is a medical matter, as emphasized by Maia Szalavitz in Scientific American and elsewhere. But most addictions do not induce drug dependence, while many prescribed medications do. Thus, withdrawal from (or maintenance on) antidepressants, beta blockers and opiates requires medical attention. Quitting cocaine, meth, porn, gambling, and overeating does not.

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.

[Mister D]

This isn't new. The disease model has been receiving criticism for a long time. It's unscientific and was formulated more to combat the stigma of addiction than to help us better understand it.

[Chris]

I guess I'm out of tough. A few years ago I read some of the most insightful information on how addition changes the neurobiology of the brain, by a leading scientist in the area, Carlton K. Erickson at the University of Texas at Austin, but he too called it a disease, a brain disease.

I agree, the disease model does more harm than good.

[Mister D]

I guess I'm out of tough. A few years ago I read some of the most insightful information on how addition changes the neurobiology of the brain, by a leading scientist in the area, Carlton K. Erickson at the University of Texas at Austin, but he too called it a disease, a brain disease.

I agree, the disease model does more harm than good.

It's not a subject I have a strong background in by any means. It's just one of those feel good claims I suspected was progressive ideology masquerading as science so I looked into it a bit. The theory has received a great deal of criticism. Like I said, I understand why it was promoted but I find it a little disturbing by how wedded former addicts become to this concept. We have gone from attaching a stigma to drug abuse to denying any individual responsibility for risky behavior.