Addiction seems to be quite the hot topic at the moment, and many people have their own views when it comes to whether or not it is a ‘disease.’ While you might not think it is a ‘choice’ calling it a disease is not as cut and dry as you might want it to be.
Addiction can and does destroy people and families. It is a damning thing for anyone to go through, be it firsthand or having to watch a loved one go through it. That being said, it does not necessarily meet the requirements of a ‘disease’ at all.
I recently came across a paper published in CMAJ that went over how addiction is not a disease, and it really put things into perspective for me. Addiction begins with a choice, a choice of whether or not you will take a substance put in front of you. Once you make the decision to give that drug a try, you are creating your own prison.
You could actually even go so far as to say addiction is more so a ‘self-inflicted mental illness.’ The paper mentioned above wrote as follows in regards to addiction not being a disease:
Addiction does not meet the criteria specified for a core disease entity, namely the presence of a primary measurable deviation from physiologic or anatomical norm.2 Addiction is self acquired and is not transmissible, contagious, autoimmune, hereditary, degenerative or traumatic. Treatment consists of little more than stopping a given behavior. True diseases worsen if left untreated. A patient with cancer is not cured if locked in a cell, whereas an alcoholic is automatically cured. No access to alcohol means no alcoholism. A person with schizophrenia will not remit if secluded. Sepsis will spread, and Parkinson disease will worsen if left untreated. Criminal courts do not hand down verdicts of “not guilty by virtue of mental illness” to drunk drivers who kill pedestrians.
At best, addiction is a maladaptive response to an underlying condition, such as depression or a nonspecific inability to cope with the world.
The study on the neurobiology of addiction3 referred to in the CMAJ editorial1 looked at the brains of people with addiction after they had damaged them by their behavior — brains were not examined in their premorbid state. This is analogous to saying that the sequelae of a traumatic brain injury were themselves the cause of said brain injury. Ironically, the title of the referenced article uses the term “disorders” not “diseases.”
Medicalizing addiction has not led to any management advances at the individual level. The need for helping or treating people with addictions is not in doubt, but a social problem requires social interventions.
When we allow people to refer to addiction as a disease, we are placing it alongside things like cancer, and that is not fair at all. When people with cancer decide they want to be free of ‘disease,’ they can’t just detox their cancer away. No, getting off of drugs is not as easy as those who have never used may think, but at the end of the day it is not comparable to any kind of ‘disease.’
Yes, depending on the drug, the physical withdrawals might be hell, but that still doesn’t put it on the same level. What do you think addiction is? Do you agree?