There is an increasing movement, particularly in the medical community, to classify addictions as diseases, and to gear “treatment” for them accordingly. Medical professionals are claiming more and more that the biological elements of an addiction outweigh any choice element the individual may have. I completely disagree with this position. It is a position that is not motivated by actual reality, but rather by a mistaken perception of the increased utility of a different perspective. In this post, I want to discuss some of the common arguments supporting the disease theory of addiction and contend that they are misguided.
The first argument I want to discuss is perhaps the most common. It is articulated by Dr. John Halpern in his 2002 article “Addiction is a Disease“. Like many other medical professionals, Halpern contends that there must be a dominant biological component of addiction because people would otherwise stop once they realized that the harms outweigh the benefits. This argument seems to make sense, but you don’t have to be an incisive scholar to point out all the things that are wrong with it. The condition that people need to realize that the harms outweigh the benefits is complicated enough in itself. Different people place different value on different things. If we all thought about potential harms and benefits in a reasoned way, then nobody would go bungee jumping or skydiving. People wouldn’t eat fast food, and there would be no such thing as Olympic gymnastics. Yet, nobody will claim that proclivity toward these behaviors is a disease. The gymnast who trains from the age of seven to win the gold medal at the Olympics is applauded. However, she has likely done irreparable damage to her body, shortened her lifespan, and altered her metabolism for the rest of her life. Not to mention, such training is incredibly emotionally taxing as well. Is that worth the Olympic gold? To some, it definitely is. To others, it really isn’t. This argument ignores the subjectivity of value systems. As outsiders, we can easily sit back and say that the harms of addiction outweigh any perceived benefits, but we don’t actually understand the extent of those perceived benefits. Addicts do not make this distinction as easily. Continually, this argument assumes that people behave in a reasonable fashion when faced with obvious facts. If this were true, there would be no suicide bombing. The global warming problem would be solved, and there would be no nuclear weapons. Unfortunately, most of the world does not operate reasonably. This does not mean, however, that everyone has some sort of disease.
Research studies further contend that repeated use of an addictive substance can alter structures in the brain or body which make it much more difficult to stop. I do not dispute this point. In fact, it is fairly obvious that toxic substances will alter one’s body and mind. However, the point to be noted is that this exposure needs to be repeated. This means that, before a certain point, the power of choice is far greater than any biological imperative. As such, the person can prevent themselves from going down the addiction path to begin with. Granted, the willpower required to overcome an addiction is much greater than the willpower required to prevent an addiction. The point is that, in both instances, willpower is what is required. More importantly, any change in neurological chemistry occurs as a result of the behavior. This means that it is the person’s actions which lead to their body being damaged or altered. The biology does not precipitate the behavior, but rather the other way around. As such, it is difficult to claim that addiction is a disease.
Those arguments aside, there are a lot of problems with the disease theory of addiction. It directs efforts in a misguided way to try and find a “cure.” Unfortunately, you cannot cure an addiction with other chemicals. A person can be forcibly detoxed in a hospital, and the symptoms of detox can be managed with medication, but that is the extent of what can be done. A person can be “weened” off tobacco, but that requires giving them doses of nicotene. This is no different than anti-depressants. The pills help the symptoms of depression, but they don’t get rid of the underlying problem(s) causing the depression to begin with. Furthermore, the disease approach divests the addict of responsibility. If an alcoholic kills somebody drunk driving, they can’t claim that they are subject to a disease, and that disease made their behaviors uncontrollable. Addiction is not an unavoidable uncontrollable mental illness like schizophrenia or bipolar disorder. The person is aware of what they are doing, and they are doing it voluntarily. I will grant that the decision to say “No” is not an easy one. Addiction is a very difficult problem to overcome, but that does not make it a disease.
So what does all this mean? I can sit here and say that addiction isn’t a disease, but I should also provide a way to interpret addiction which is better, should I not? Well, logically speaking, I don’t have to, but I will nonetheless. Addiction is a behavior which can be caused by a variety of emotional problems. Some people become more prone to addictions because of abuse, social circumstances, or the need for affection. People can have issues with their parents, or be troubled by the loss of a loved one, and all these things can make them more prone to trying addictive substances. When it comes to cigarettes, social circumstances are likely what cause most people to become addicted. People want to fit in or look cool, and that leads them to indulge in these substances. Like depression and anxiety, addiction is an emotional state associated with particular chemical states in the brain. However, it is best addressed not through medication, but through interactive therapy. Addiction can be managed, but only cured if the underlying problem which led to it in the first place is addressed, just like depression and anxiety. At the same time, it is up to the addict to seek help. There are effective therapies for addiction, but none of them work if the addict does not have the will to follow through.
Throughout history, mental problems and illnesses have been stigmatized and addressed using a variety of illegitimate methods from genital mutilation to shock therapy. As a response, the modern medical community is attempting to treat mental issues like other biological illnesses which can be treated using medications or surgical procedures. Unfortunately, mental issues are more complicated. They are not caused by pathogens, and their associated chemical states cannot be easily addressed by biological interventions. There is a middle ground, however, which does not stigmatize psychiatric issues, and yet does not medicalize them either. These issues need to be better understood in the context of the individual to which they apply, and therapies need to be developed to address them. This will require a more in depth understanding of the person, and it is difficult territory to navigate. Nevertheless, difficulty does not mean that the path is the wrong one to take.