The NIDA considers substance abuse and addiction to be a chronic disease, with similar mechanisms to Type-2 diabetes and hypertension.
However, there’s much contention around that statement. The disease model, as it’s known, isn’t universally accepted. And there’s a lot of debate around whether addiction should be considered a disease, and if that doesn’t somehow absolve some responsibility from addicts for the actions they’ve committed while under the influence of drugs.
It’s a complicated topic – especially because definitions tend to get muddled. There’s a lot of stigma around being called diseased, sick, or suffering from an illness – no one wants to carry a label around stating that they have a medical condition.
But then comes the question – is the disease model even correct? The neurological findings regarding addiction touted by the NIDA have been, by others, cited as like the very same reactions found when falling in love, combatting obesity, or overindulging on the Internet.
In other words, they maintain that addiction is an example of brain plasticity and that its label as a disease is misleading, and not helpful or conducive to the treatment of addiction as a condition of the brain – in fact, there are suggestions that it may contribute to relapses. Which side is wrong? Which side is right? We suggest an alternative question: how are both sides similar?
Addiction as a Disease
The NIDA states that the chronic nature of drug abuse, the statistics on relapses, and the changes made in the brain through addiction all point towards addiction being a disease that needs to be treated as such, with a long-term model that emphasizes positive psychology, abstinence, adaptive habits and coping mechanisms to replace substance use.
They state that while initial drug use is typically voluntary, the brain changes made by drugs means people are stuck in a perpetual loop, even though drugs do them harm.
Addiction as a Behavior
Others state that addiction is nothing like other diseases. There is no biological process, no pathogens, no infectious agents. No pathological degeneracy. Instead, addiction is like any other highly emotive act, one that makes every bit of sense in the short term but only poses a threat in the long-term, thus evidencing a lack of sufficient rationality (as in other conditions, like being in love), and there is proof that talk therapy and understanding the consequences of addiction can be enough to reverse it and undo its effects.
People heal themselves of addiction all the time, often simply through growing up, or by finding something in life that fills them with purpose and the motivation to quit.
Both Sides Carry Truth
The ultimate truth is that both sides are right, to a degree, and there is no black-or-white answer. Addiction introduces changes in the brain and leads to a vicious addictive cycle. Breaking out of that cycle is hard, so much so that it affects our judgment in a way that means we often prioritize a fix over other, objectively more important things.
However, it’s reversible. People cure themselves of addiction by quitting after deciding to. Understanding the nature and extent of addiction can do a great deal towards ending its influence. Addiction is less like tuberculosis and diabetes, and more like a traumatic disorder – still a real mental illness, but one that can be overcome with the right treatment, whether alone or through a therapeutic process.
The Treatment Matters Most
Let’s not get things twisted: definitions are important. Understanding addiction is important. Understanding the brain, behavior, and disease is important. And finally, the pursuit of better, clearer and factually-correct terminology in the battle against addiction is always worthwhile.
But when you’re struggling with your own demons, the first and foremost priority is to find a treatment plan that best suits your schedule, your circumstances, and best helps you achieve sobriety and more importantly maintain it.
Remember – not too long ago, we solely blamed fat for being the cause of heart disease and obesity. Then data came out revealing that a whole foods diet in high in saturated fat did not necessarily correlate to heart issues (see the French paradox), and we began to target sugar.
But data exists that obesity has at some point been treated with a diet of refined sugar, meaning we’re not exactly right with that sweeping generalization either.
We’re constantly learning, coming across new information and stumbling upon old data that contradicts. Science isn’t always precise, studies can be fallible, and it’s important to peer-review and consider several sources. We’re not completely sure what’s most dangerous to your health in the realm of nutrition, but we can generalize. Eat a lot of vegetables. Avoid eating too much meat. Exercise. Get all your micronutrients. Avoid junk foods and sodas.
The same can be said for addiction. There’s a lot of confusing research, but we do have a myriad of proven treatments that work on a person-to-person basis, based on preferences and other factors. Group therapy works, as does sober living, the 12-step program, and other alternative treatments. Speak to a professional and find out what works best for you.
Every Individual Has Their Own Approach
There are people who swear off the 12-step program because they dislike the fatalism it speaks about. The idea that addiction is a condition you cannot control contradicts the fact that it can be fought against, and to them, admitting powerlessness in the face of addiction is a step they’re not willing to take. And it is step one.
Then there are people for whom the 12-step program does wonders, either because they swear by sponsorship and spirituality, or some other personal reason.
Sober living, for example, is a successful way of combatting addiction because it introduces forced abstinence while focusing on brain plasticity by utilizing new behaviors, stimuli and habits to rewire the brain and fight against the influence addiction had on it.
There is no concrete information on whether calling addiction a disease causes more relapses. But the safest course of action is to accept that addiction has some commonalities with diseases and some factors that contradict its status as a disease. Until we learn more about addiction and the brain, it’s basically your choice to listen to the government or the opinions of other scientists or conclude that the middle way is better.
In the end, whatever helps you better understand your experience with addiction and whatever you relate to the most is the best answer, at least until we know more.