There are a number of different types of addictions; some cause individuals to compulsively abuse a certain drug or another type of substance while others make someone repeat dangerous and unhealthy behaviors or repeat acceptable behaviors to the point where they become unhealthy. It is well understood that the success of drug addiction treatment depends on the individual and whether or not the specific method works for them. However, two major schools of thought on what kind of problem addiction truly is causes more controversy in the subject as well as a difficulty to accurately decide, once and for all, how the problem should be defined.
Scientists, doctors, counselors, and even addicts themselves disagree on the issue of whether or not addiction is a disease that must be maintained or if it can be cured through treatment and force of will.
“Addiction is a Disease.”
People who believe that addiction is a disease often site one of the most important issues many addicts face as the main reason for their assertion: the high relapse rate and the extreme difficulty of quitting once a person is already addicted. According to the National Institute on Drug Abuse, “Relapse rates for addiction resemble those of other chronic diseases such as diabetes, hypertension, and asthma.” It is for this reason that the problem is often considered to be a relapsing disease for which a person must consistently monitor themselves in order to avoid regression.
Addiction is often considered to be caused by a number of factors in a person’s life in this school of thought as well, the factors including:
- Comorbid mental disorders
- Developmental issues
- Past trauma
- Stressful lifestyle
- Socioeconomic status
Many believe that these factors will cause some people to become addicted while others who abuse drugs in the same way or amount will not. This discrepancy does occur, so it lends credence to the belief that certain individuals are more at risk of experiencing the disease while others might abuse drugs with less severe effects.
But one of the strongest concepts behind the theory of addiction as a disease is that individuals who become addicted sometimes clearly state that they want to stop and try to do so over and over while still experiencing relapse and other issues. The belief is that addiction takes away a person’s ability to choose because of the way substance abuse changes the brain. As stated by the NIDA, “Addiction changes the brain, disturbing the normal hierarchy of needs and desires… The resulting compulsive behaviors that override the ability to control impulses despite the consequences are similar to hallmarks of other mental disorders.” Because most mental disorders are considered to be diseases in that they take control away from the individual, addiction is often considered to be similar and placed in the same category of mental illness.
This theory ascribes to the ideas that:
- Addiction is a disease “that affects both brain and behavior” (National Library of Medicine).
- Individuals suffering from addiction syndromes must receive treatment in order to recover.
- While the condition is treatable, there is no one moment where an individual is free of their addiction, and there is no cure. Instead, the problem is something that they must carry with them and maintain over a long period of time, often for their whole lives.
- Punishing people for abusing drugs is counterintuitive to recovery. Addicts must understand that it is not their fault they are addicted, and it is not through sheer willpower alone that they must fight their condition.
“Addiction is Not a Disease.”
While many individuals in the medical community (as well as the scientific community) view addiction as a type of disease, there are strong arguments that favor the opposite. One of the reasons why many individuals feel the problem cannot be classified as a disease is that it is caused by learned behavior. This behavior, while it has been shown to cause significant changes in the way the brain works, is repeated as the brain learns to rely on the way the drug affects it. As the brain will often change as it learns new behavior and develops over time, it is believed that addiction cannot be a disease if it is learned.
In addition, many believe that addiction is a choice and the actions one takes to either continue to follow dangerous patterns or to make a change are the responsibility of the individual. According to paper written by psychiatrist Tim Holden, “There has been a steady erosion of individual responsibility and loss of any concept of personal blame for bad choices” (NCBI). The idea that addiction is a disease that individuals have no control over can sometimes be comforting, but it may be keeping people from working hard to quit abusing substances and make a positive change in their lives.
This concept also stresses that addiction is caused by “a maladaptive response to an underlying condition,” something others who ascribe to the first theory believe as well but still see them as two separate conditions that must be treated together. People who believe addiction is not a disease are convinced that once this underlying issue is treated, the compulsive behavior itself and desire to abuse the substance will begin to dissipate.
Those who believe addiction is not a disease site individuals who spontaneously recover, those who decide suddenly never to drink or abuse drugs again and adhere to this decision, as an example. This happens much more often with the issue of addiction than with other relapsing diseases, so it does lend credibility to the concept that the problem may need its own category, or at least that it must not be lumped in with heart, metabolic, and mental diseases or illnesses.
Which is Right?
There is not conclusive answer as to which concept is correct. While there has been extensive research on addiction and how it can be successfully treated, the problem is so broad and can occur so differently in separate individuals that it is hard to know for sure if it is truly a disease or not. However, over time, we will likely become more familiar with the issue and learn to treat it more effectively in a larger part of the population, possibly even leading to a solution to this long-standing debate.