Some say that struggling with a substance abuse problem is a sign of bad decision-making and poor moral fiber. Experts disagree with this somewhat flip assessment. Sure, a bad choice might have gotten you started, but biochemical changes make it extremely difficult to stop. So, is addiction a disease, and if so, what is its target?
The Argument against Addiction as a Moral Failure
If a substance abuse problem were little more than a morality issue, most people would quit using during personal hardships. Instead, people struggling with an addiction try to stop repeatedly only to start again within a few hours or days. The compulsion to use is stronger than family ties, financial well-being, the comfort of a home, or personal health.
Because it goes against human nature to self-destruct, this seems to suggest that drug abuse is not a voluntary action.
Is Addiction a Disease? Some Different Perspectives
Perspective #1 - Why Addiction is a Disease
One perspective from the American Society of Addiction Medicine (ASAM) is that addiction is a disease. This group defines substance abuse as a brain disease, and recognizes the chronic nature of the illness that targets the midbrain.
Said a bit differently, ASAM calls addiction “a primary, chronic disease of brain reward, motivation, memory and related circuitry.”
This view holds that both prescription drugs and illicit street products have the potential to rewrite the brain’s chemistry. As a result, they make the workings of the brain depend on the influx of the chemicals.
According to this thinking, this brain chemistry rewrite is the reason why someone caught up in the cycle of drug use has a difficult time stopping. People want to stop, but the brain’s chemistry no longer functions the way it once did. The brain needs a reset in the form of detoxification and rehab. Drug and substance abuse programs help to break the chains of dependency on the physical and mental levels.
Similarly, the National Institutes of Health currently defines addiction as “a chronic and relapsing brain disease.”
Perspective #2 - Why Addiction is Not a Disease
Dr. Sally Satel, an expert psychiatrist, author, and lecturer at the Yale University School of Medicine, argues that addiction is not a disease and should be categorized as a form of behavioral disorder.
According to Dr. Satel, the notion of "addiction is a brain disease" was first introduced in 1995. She recalls Dr. Alan Leshner, then the director of NIDA (National Institute on Drug Abuse), introducing the addiction-is-a-disease model at a meeting that was sponsored by the National Institute of Health (NIH).
She thought that's a very strange way to think about addiction. Her view as a psychiatrist is that certainly drugs affect the brain, why would people take them otherwise? And there's no question that they cause changes in the brain.
But according to Dr. Satel, when you think about that way, it's not very satisfying, because everything changes the brain, including prescription, over-the-counter, and illicit drugs and medicines.
"How could it be healthy to constantly sabotage yourself, and injure your body, and risk overdose? In psychiatry, we can certainly consider [addiction] a disorder of behavior," says Dr. Satel.
However, Dr. Satel objects to the aspects of the addiction-is-a-diesase model that disempower individuals and discourage recovery. She says:
"The disease part ... only bothers me when people invoke it as a reason why they do what they do. In other words, they have no control and they can't do otherwise. And that is not the most constructive use of disease in this context."
For Dr. Satel, the brain disease thing took it into a whole other realm. She asserts that this thinking made addiction essentially interchangeable with schizophrenia, Alzheimer's disease, multiple sclerosis, and other similar brain diseases and conditions.
But there's a big difference between the brain changes of Alzheimer's disease and addiction.
According to Dr. Satel, this is because the changes in the brain that accompany addiction do not prevent the person from responding to meaningful consequences, be they incentives or sanctions.
And that's a key difference in the is-addiction-a-disease debate.
Watch the video, "Is Addiction a Disease? An Interview with Dr. Sally Satel" where she explores the question of whether addiction is a disease or not.
Relapse is Part of the Experience
Far too often, even those who recognize a connection between addiction and brain disease fail to acknowledge the potential of a relapse (or "slip" in our vernacular). Ideally, someone who goes through rehab won’t use again. Practically, we know that's not the case.
Our therapists consider a slip – whether it’s the first or the tenth – a bump in the road. Yes, you need to deal with it, but it’s not a failure. It’s part of the condition.
For this reason, the rehab experience needs to focus on current healing and future relapse prevention.
Read more on why we believe relapse is not a failure.
Is Addiction a Disease? Our Perspective
From our perspective, addiction is a dysfunctional set of behaviors that alters brain chemistry and neurocircuitry. It is a disorder that impacts the individual on all levels: physical, mental, emotional, and spiritual.
That said, we're hesitant to refer to addiction as a disease, because of the associations of powerlessness that term invokes.
Framing addiction as a chronic, relapsing disease negatively impacts individuals in recovery. It implies that people don't have agency in their own lives, that they can't create a new reality for themselves.
Sadly, many of our Participants have discouraging and demeaning experiences in detox and traditional addiction treatment prior to enrolling in our Program.
They know what it's like to be shamed for trying and "failing" at 12 Step programs.
They know how it feels to have authority figures demand that they hand over their personal power and rage at them if they refuse.
While it is true that addiction changes the brain, it's also true that individuals retain their power to choose. Even in the throes of addiction, they can still respond to meaningful consequences.
And treating people with respect and compassion helps much more than guilt and shame.
Addiction Recovery Is Possible
The idea that addiction is a chronic disease implies that long-term, full recovery isn't possible, and we know firsthand that that's not the case.
Under the right conditions recovery is not just possible, it's probable. In fact, we now know that most people who are addicted to drugs do stop using.
As New York Times bestselling author, addiction journalist, and recovered former user Maia Szalavitz noted in our video interview:
"Most people do recover. You just have to stay alive long enough to get there ... There is hope. And the way people recover from addiction is through love and connection and empathy."
We couldn't have said it better.
When individuals get into a space in which they can receive both professional support and wholehearted love, they can heal their underlying core issues and recover from addiction.
The Right Conditions for Recovery
The best substance abuse programs include:
- Assessment of mental health disorders and treatment, as necessary, to regain emotional stability
- Trauma treatment for individuals with addictive tendencies rooted in unresolved traumatic events
- Emphasis on peer group formation for emotional support and future relapse prevention
- Intensive one-on-one counseling that takes up more than 100 hours in the span of a month
- Spiritual, but non-denominational, components that integrate a mind, body, and spirit wellness approach
If you or a loved one needs treatment for one or more addictions, The Clearing can help. Whether you’ve been through rehab before or this is your first time, we'll provide the support you need to recover.
Call 425-275-8600 today for confidential help that can change your life.