Despite the Surgeon General’s announcement last year that addiction IS a disease, there is still plenty of backlash from those who contend that addiction is a choice.
Moreover, apparently certain people would rather avoid spending money on addiction and other mental health conditions – in essence, they are labeling behaviors that evolve based on functional brain changes and structure as a “choice,” wipe their hands of it, and move on.
Alternatively, as in this case, they incorrectly infer that treating addiction as a disease is a mostly political issue, when in fact, many scientists, researchers, physicians, and institutions who study addiction agree that it should be treated as a chronic disease.
What Exactly Is A “Disease?”
Unfortunately, there is not a standard scientific consensus as to how “disease” should be defined. However, Google’s definition is as good as any:
“…a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.”
Let’s break this down:
1. Addiction alters the brain’s function AND structure. There is more than one reason why addiction is also known as “substance use disorders.”
I offer the following excerpt from Harvard Health Publications:
“Today we recognize addiction as a chronic disease that changes both brain structure and function. Just as cardiovascular disease damages the heart and diabetes impairs the pancreas, addiction hijacks the brain.”
2. Addiction produces specific signs and symptoms, including:
- Feeling frequent urges to use the drug
- Tolerance (more of the drug needed to achieve the desired effect)
- Spending money on the drug better afforded for other things, stealing to earn money to afford the drug
- Failure to meet obligations including school and work responsibilities
- Engaging in risky activities under the influence, such as driving
- Finding it difficult to cut back or quit use of the drug
- Withdrawal symptoms upon cessation, including anxiety, depression, shakiness, lethargy, etc.
3. Addiction affects specific locations in the brain.
According to the National Institute on Drug Abuse, substance abuse affects the brain stem, the cerebral cortex, and the limbic system. Addiction also affects neurons, neurotransmitters, receptors, and transporters.
4. Chemical changes occur, but no physical injury is required.
Moreover, if addiction is a choice so just about every other mental disorder. We should all learn to moderate our behavior. Somebody should have told Robin Williams.
Why Treat Addiction As A Disease?
Definition specifics aside, I want the reader to consider why treating a mental health condition as a disease is so important.
Jackie Leach Scully, Senior Research Fellow at the University of Basel, Switzerland, and the Centre for Life, Newcastle, England:
“Why is it important to know what a disease or disability is?…because today’s medicine has an unprecedented ability to actually do things, it matters a great deal what we decide to tackle. The ability to make powerful, effective interventions into people’s health brings with it new ethical responsibilities.”
“If we want to ensure that limited healthcare resources are appropriately distributed, for example, we must have a reasonably clear idea, first what a disease is….”
Certainly, evidence has shown that some people and families are genetically predisposed to both mental illness and addiction – not just cancer and high blood pressure.
Yes, there are risk factors involved, but there are also other risk factors for other diseases that may increase or decrease the chance they will occur.
According to NIDA:
“Why do some people become addicted while others don’t? Family studies…suggest that as much as half of a person’s risk of becoming addicted to nicotine, alcohol, or other drugs depends on his or her genetic makeup. Pinning down the biological basis for this risk is an important avenue of research for scientists…”
Consider this – should we stop treating heart disease and Type II diabetes due to obesity, as being overweight could be viewed as a choice, a food addiction no different than a substance addiction? Should we stop treating lung cancer in smokers, or injuries that people incur from an auto accident, because it was their choice to ride in a vehicle?
No one asks for addiction any more than someone asks for diabetes type II by being overweight. If as a society, we choose to treat addiction as a choice, let’s also throw in every other mental and physical illness that is influenced by factors within our control and see how well that goes over.
Treating addiction as a mere choice is, for lack of a better word, lazy. Like every mental illness and health condition, addiction is complicated. It may not be the exactly the same as say, cancer, but it is not a matter of picking and choosing your next outfit.
It is not a moral flaw. It is a condition that is based firmly in our biology.
It is true some people can stop using without treatment. But that doesn’t mean they are free of addiction. There is a reason why people in recovery can’t use the same or similar drugs or alcohol in a responsible manner – they are addicts. Quitting a substance is no different than losing weight to rid yourself of type II diabetes. If you gain weight, it will probably come back.
Until we can come up with a consensus on what exactly a disease is, and if indeed addiction is a disease, I contend that we as humans have an ethical obligation to treat it as such. I’m not saying there isn’t a good deal of decision-making issues involved in substance abuse, but rather, that addiction is complex.
In fact, one of the very cornerstones of evidence-based treatment is to teach people how to cope and employ improved decision-making skills. Moreover, addiction is multi-faceted and a result of many factors – let’s approach it from all angles.
Perhaps determining if addiction is a disease in the truest sense should not be among our top priorities. Our #1 goal should be to study addiction and find treatments that are based on empirical evidence.
We also need to consider that when an addict asks for help, he or she is making a choice to seek recovery.
Let’s honor that choice by allowing them access to the same healthcare options that people with physical health conditions and disorders are afforded.
~ G. Nathalee Serrels, M.A., Psychology