The Medical Case for Addiction as a Disease
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The Medical Case for Addiction as a Disease
People often disagree with the idea of calling addiction a disease in the same way
we call conditions like diabetes a disease. The behavior of addicts is frustrating, ugly -
even criminal. How can driving drunk be a symptom of a disease?
The best argument against calling addiction a disease states that addicts make the
choice to use drugs and that their inability to stop is simply immature and irresponsible
behavior. Diabetics, for instance, do not have a choice about whether or not to have a
high blood sugar. These arguments make sense, and are often embraced for their intuitive
appeal alone.
When doctors use the Disease Model of Illness to think about a disease, they think
of a specific physical defect in some organ or physiologic system of the body. That
defect, once discovered, provides a causal explanation for the patient’s symptoms and
points the way to treatment. With diseases like diabetes, the defect is easy to understand.
With brain disorders however, it is not that simple.
Our understanding of brain disorders has not kept pace with our understanding of
other diseases - like diabetes. A big part of our difficulty in calling addiction a “disease”
stems from the fact that no one could ever find the defect in the brain that caused
addiction. Without a physical brain defect to point to, addiction never earned the status of
“disease” like diabetes did. The addict’s symptoms were assumed to be due to their
intrinsic badness – their immaturity, their irresponsibility, or worse.
But guess what? In the last ten years we have learned a lot more about the brain.
We know what the physical defect of addiction is and where in the brain it is. Addiction
is a defect in the hedonic system, or the system that perceives pleasure, which is deep in
the part of the brain that handles basic survival. Because of this defect, the addict
unconsciously thinks of the drug as life itself. A beer is not just a beer anymore – the
addict needs the beer to get through life and when the beer is unavailable they crave it.
While it is true that the addict may have a choice in whether or not to use drugs,
they do not have the choice over whether or not to crave. If craving gets bad enough,
even the strongest-willed, most mature and most responsible person will return to using
drugs. No brain can ignore that survival imperative. One of the big reasons we have
difficulty calling addiction a disease is our inability to grasp the true nature of craving.
Craving is a very real mental suffering the addict endures when they come to the point in
their addiction when they are using drugs even when they do not want to.
If you are in medical school and you write, “addiction is not a disease” on one of
your exams – you will flunk. In medicine, we now know that the addict’s brain really is
different than normal brains, and from a physiologic standpoint we now know how it is
different. This explains a lot of the symptoms we see in full-blown addiction and helps us
develop better, more effective treatments to help the addict recover. It also means that
addiction fits the Disease Model of illness as well - if not better - than many other
diseases.
Like say, diabetes.
we call conditions like diabetes a disease. The behavior of addicts is frustrating, ugly -
even criminal. How can driving drunk be a symptom of a disease?
The best argument against calling addiction a disease states that addicts make the
choice to use drugs and that their inability to stop is simply immature and irresponsible
behavior. Diabetics, for instance, do not have a choice about whether or not to have a
high blood sugar. These arguments make sense, and are often embraced for their intuitive
appeal alone.
When doctors use the Disease Model of Illness to think about a disease, they think
of a specific physical defect in some organ or physiologic system of the body. That
defect, once discovered, provides a causal explanation for the patient’s symptoms and
points the way to treatment. With diseases like diabetes, the defect is easy to understand.
With brain disorders however, it is not that simple.
Our understanding of brain disorders has not kept pace with our understanding of
other diseases - like diabetes. A big part of our difficulty in calling addiction a “disease”
stems from the fact that no one could ever find the defect in the brain that caused
addiction. Without a physical brain defect to point to, addiction never earned the status of
“disease” like diabetes did. The addict’s symptoms were assumed to be due to their
intrinsic badness – their immaturity, their irresponsibility, or worse.
But guess what? In the last ten years we have learned a lot more about the brain.
We know what the physical defect of addiction is and where in the brain it is. Addiction
is a defect in the hedonic system, or the system that perceives pleasure, which is deep in
the part of the brain that handles basic survival. Because of this defect, the addict
unconsciously thinks of the drug as life itself. A beer is not just a beer anymore – the
addict needs the beer to get through life and when the beer is unavailable they crave it.
While it is true that the addict may have a choice in whether or not to use drugs,
they do not have the choice over whether or not to crave. If craving gets bad enough,
even the strongest-willed, most mature and most responsible person will return to using
drugs. No brain can ignore that survival imperative. One of the big reasons we have
difficulty calling addiction a disease is our inability to grasp the true nature of craving.
Craving is a very real mental suffering the addict endures when they come to the point in
their addiction when they are using drugs even when they do not want to.
If you are in medical school and you write, “addiction is not a disease” on one of
your exams – you will flunk. In medicine, we now know that the addict’s brain really is
different than normal brains, and from a physiologic standpoint we now know how it is
different. This explains a lot of the symptoms we see in full-blown addiction and helps us
develop better, more effective treatments to help the addict recover. It also means that
addiction fits the Disease Model of illness as well - if not better - than many other
diseases.
Like say, diabetes.
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Join Date: Feb 2008
Posts: 2,433
Interesting read.. thanks. The article doesn't mention that the "defect" in the brain is apparently caused by the intake of alcohol in the first place, though. But it does seem to describe the nature of cravings pretty well.
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Join Date: Sep 2008
Location: San Francisco, CA
Posts: 679
I just watched a video about this in a class last night. It was really interesting even though it was made 10 years ago and in the interim I am sure the body of knowledge has been greatly expanded. However, the distinction that mattcake makes is important. I did ask in class if that is something that has been determined over the last decade— is there a difference in brain chemistry before substances are introduced between an addict brain and a non-addict and the science is just not there to confirm in either direction.
The film was part of the PBS series Moyer on Addiction:
Close to Home - About the Series
It was Part 2: The Hijacked Brain. I have no idea if they have this for rent on Netflix or something but if they do and this sort of thing interests you it might be worth checking out.
The film was part of the PBS series Moyer on Addiction:
Close to Home - About the Series
It was Part 2: The Hijacked Brain. I have no idea if they have this for rent on Netflix or something but if they do and this sort of thing interests you it might be worth checking out.
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