Disease Model Of Addiction Essay Topics
Is addiction a disease? Most people think so. The idea has become entrenched in our news media, our treatment facilities, our courts and in the hearts and minds of addicts themselves. It’s a potent concept: if you’re an alcoholic or a drug addict, then you’re ill. And you’re going to remain ill. According to Nora Volkow, head of the National Institute on Drug Abuse, “addiction is a chronic, relapsing brain disease,” and that definition has been adopted by medical researchers and policy makers everywhere.
Two huge benefits of the disease concept are frequently touted by Volkow and others. First, addicts need treatment, and if we don’t define addiction as a disease, they won’t get the help they require. Second, addicts don’t deserve to be scorned or denigrated: they have a disease, and we don’t put people down for being sick.
There is evidence willpower can be crucial in beating addiction, yet it doesn't work for cancer, pneumonia or malaria
Recently, the supremacy of the disease model was highlighted by an article in the New England Journal of Medicine. Volkow and colleagues proclaimed that “research has increasingly supported the view that addiction is a disease of the brain”. But they also inserted a caveat: “Although the brain disease model of addiction has yielded effective preventive measures, treatment interventions, and public health policies to address substance-use disorders, the underlying concept of substance abuse as a brain disease continues to be questioned ... ” Those words triggered an allergic reaction in me. Effective? Could anyone deem society’s response to addiction effective? As you might guess, I’m one of the questioners.
There is good reason to ask whether addiction actually is a disease. If it is, then we might expect it to have a specific cause or set of causes, an agreed-on repertoire of treatment strategies, and a likely time course. We might wonder how the disease of addiction could be overcome as a result of willpower, changing perspectives, changing environments, mindfulness or emotional growth. There is evidence that each of these factors can be crucial in beating addiction, yet none of them is likely to work on cancer, pneumonia, diabetes or malaria.
Neuroscience is a young discipline, and the distinction between brain development and brain pathology remains muddy (think ADHD, autism, depression) – ideal terrain for drawing arbitrary lines in the sand. For example, the brain changes observed in long-term substance abusers are nearly identical to those seen in people struggling with obesity, porn aficionados, gamblers, internet “addicts”, compulsive shoppers and simply those involved in intense romantic relationships. They involve overactivation of a part of the brain that directs goal pursuit (the striatum) in response to cues predicting their preferred rewards, and long-term desensitization in response to rewards more generally.
Along with an assortment of other psychologists and neuroscientists, I’ve been challenging the disease model for years. One result has been a volley of counter-attacks: how dare I pull the rug out from under the feet of addicts who rely on the disease label to get help and avoid stigmatization? So, I’m going to put the scientific debate aside for now and challenge the idea that calling addiction a disease is beneficial for addicts. On the contrary, I think it increases their burden.
Do people have to have a disease in order to get help?
People in today’s world face a vast array of problems, including violence in all its forms (for example, child and spousal abuse, bullying), unemployment, poverty, obesity, social isolation, unplanned pregnancy, and plain old unhappiness. But we don’t need to call these problems diseases in order to tackle them. Instead of medical interventions, we implement inventive, humanistic, often community-based measures, including education, social and psychological support, financial aid, access to special programs, specialized personnel, and other public resources. Nor must we call these problems diseases to justify funding for prevention and intervention. For example, anti-racism policies and bullying prevention initiatives embody extensive, often expensive means for confronting pervasive social ills. The equation help = medical care only makes sense for medical diseases.
We are starting to recognize addiction as a consequence of social ills rather than individual flaws.
It’s true that health care systems in the US and Europe provide various services for people struggling with addiction. However, patient advocates, judges, clinical researchers, and those seeking help almost unanimously point out the inadequacy of these services. In the US system, such inadequacies seem directly tied to the profit motive. The majority of patients relapse, not once but repeatedly, following residential programs that typically run between $10,000 and $100,000 per month. (State-run facilities are notorious for long waiting lists, inadequate resources, and a shocking absence of supervision.)
Volkow and others argue that discarding the disease label would cut addicts off from the services presently available to them. However, not only are those services generally inadequate and financially ruinous. They also embody a profound logical flaw – the idea that the current healthcare landscape should determine our definition of addiction. Shouldn’t it be the other way around?
What about reducing stigma?
If we don’t call addiction a disease, don’t we risk going back to the bad old days of denigrating addicts as self-indulgent, spineless pariahs? Not necessarily. Despite the anger and confusion many feel when confronted with the ravages of addiction, we’ve gotten better at recognizing that life circumstances can dictate personal suffering and tragedy. Many of our favorite public figures have crossed the line into addiction, from Elton John to Philip Seymour Hoffman to Robin Williams to Prince. Social norms seem to be advancing (rather than regressing to Victorian settings) as personal struggles are made public in the internet age. We are also starting to recognize addiction as a consequence of social ills rather than individual flaws. Yet the disease label locates the problem of addiction in the individual. It’s hard to see how that counteracts stigma.
Why do we even imagine that a medical diagnosis makes addicts feel better? Being diagnosed with a chronic brain disease is hardly something to celebrate. Pointing to a disease doesn’t necessarily diminish stigma, as exemplified by attitudes toward Aids patients. Even the designation of “mental illness” provokes stigmatization. Apparently, emotional associations color people’s judgments far more than rational reflections on health v illness.
Once they recover, as most addicts eventually do, it is confusing and debilitating to be told they are chronically ill
I have heard from hundreds of addicts who recoil at the notion that they have a life-long disease. Especially addicts who are determined – and successful – in galvanizing their willpower and rejigging their habits, their personal goals, and their capacity for self-control. Once they recover, as most addicts eventually do, it becomes confusing and debilitating to be told they are chronically ill. Recovered addicts want to feel that they have developed beyond their addiction and become better people as a result. Many would prefer respect for that achievement over the pity bequeathed by the disease definition.
Where do we go from here?
A remarkable solidarity has emerged between some addicts and the authorities responsible for treating them (as sometimes occurs between doctors and their patients, regardless of treatment quality, and more generally between those who have power and those who lack it). These are the addicts who insist that they have a disease and any attempts to dislodge that definition are hurting them. Other addicts and, importantly, former addicts, see their problems in an entirely different light. For them, the disease label is a damaging sentence and an additional cross to bear.
I don’t expect this debate to be resolved any time soon. But until it is, I urge anyone who has struggled with addiction or who loves or cares for someone who has to keep an open mind. Calling addiction a disease has had its benefits (like the discovery of new drugs that help a subset of addicts, often temporarily). And the disease label continues to simplify our conceptualization of an extremely messy issue, making it appear easier to understand and resolve. But the net value of the disease definition needs to be questioned. It may be time to move on.
What is addiction and is it a choice?
According to DrugAbuse.gov, “Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences to the addicted individual and to those around him or her.”
The key here is that the addicted person will continue using even when they see the harm their addiction is causing. They know it’s bad for them, and they don’t want to be addicted. But addiction is characterized by the inability to stop.
Why is addiction considered a disease?
Drug addiction follows a similar pattern to other chronic diseases such as asthma and diabetes. The patient will go into remission, but may have several relapses before beating the disease entirely. And like these diseases, addiction too can be treated and managed.
Many people who combat the disease model of addiction will make the point that the addicted person chooses to start using drugs or alcohol. This is true, but beside the point.
Some people try drugs or alcohol and never get addicted. Others, however, have a biological or situational predisposition to addiction.
Once they begin using, the addiction takes on a life of its own and is much harder to control.
Addiction is also considered a disease because it can cause changes to the brain. Not only does it create a physical dependency in which the individual cannot stop taking the substance without experiencing withdrawals, but it also affects the individual’s ability to make reasonable decisions.
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How drugs change the brain
Every drug, including alcohol, disrupts the reward system in the brain. Unfortunately, long-term usage can cause changes in the reward circuit that influence the brain’s ability to function. Specifically, the areas of the brain that are tied to making decisions, learning, remembering, and controlling behavior are all affected.
According to a paper published by Ruben D. Baler and Nora D. Volkow (both from the National Institute on Drug Abuse), “there seem to be intimate relationships between the circuits disrupted by abused drugs and those that underlie self-control […] the time has come to recognize that the process of addiction erodes the same neural scaffolds that enable self-control and appropriate decision making.”
With addiction eroding self-control, it’s no surprise that it’s supremely difficult for a drug abuser to quit on their own. Volkow drives her point home in a TEDMED 2014 presentation that, “for us to be able to exert self-control, we require the proper function of the area in our brains that regulate out behaviors.”
What this means to the addict
Why is it so important to recognize addiction as a disease? The answer is that the way we view a condition heavily influences the way we treat those who have it. When you learn that addiction is a disease, three truths become clear:
It’s not all about willpower
When a person loses their life to a drug addiction, someone undoubtedly says something along the lines of “they made their choice.”
The thought goes that the addicted person made the conscious decisions to continue their drug addiction and they got what was coming to them. But this perspective is not only unhelpful, it’s untrue.
While there is an element of choice involved, making the right choice is so much harder for someone with an addiction. The vast majority of addicted individuals are not addicted because they want to be, but because they feel they need the substance. And in many cases, their bodies are so dependent on the substance that they really do.
Treatment is effective
Getting sober and staying sober on your own is difficult. And unfortunately, for some substances, detoxing can be extremely dangerous. This is where a rehab center comes in. Just like other chronic recurring disorders, repeated treatments are often necessary to achieve success in the long run.
At a recovery center, these treatments will take the form of talking with your counselor, taking medication to help ease the withdrawals, and taking part in activities that are focused on helping you heal. You’ll regain abilities that you may have forgotten about, as well as learn techniques for managing cravings and continuing sobriety long-term.
Relapse is normal, expected, and manageable
Following the model of addiction as a disease, relapse is not a failure of treatment. Relapse happens, and it simply means that treatment needs to be changed in order to continue being effective.
You can overcome addiction
At The Recovery Village, we full heartedly believe that addiction does not have to rule your life. We’ll guide you throughout your recovery, from preparing for detox to getting treatment to experiencing your new life. Learn about our treatment options, and feel free to reach out to one of our compassionate representatives with any questions you have by calling us today.
Baler, Ruben D., Nora D. Volkow. “Drug addiction: the neurobiology of disrupted self-control.” ScienceDirect. Elsevier Ltd., 27 Oct 2006. Web. 7 June 2016. <http://www.sciencedirect.com/science/article/pii/S1471491406002413>.
“DrugFacts: Understanding Drug Abuse and Addiction.” National Institute on Drug Abuse. U.S. Department of Health and Human Services, Nov 2012. Web. 8 June 2016. <https://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuse-addiction>.
Leshner, Alan I. “Science-Based Views of Drug Addiction and Its Treatment.” The JAMA Network. American Medical Association, 13 Oct 1999. Web. 8 June 2016. <http://jama.jamanetwork.com/article.aspx?articleid=191976>.
Volkow, Nora. “Why do our brains get addicted?” TEDMED. TED Conferences LLC., 2014. Web. 8 June 2016. <http://www.tedmed.com/talks/show?id=309096>.
“When and how does drug abuse start and progress? National Institute on Drug Abuse. U.S. Department of Health and Human Services, Oct 2003. Web. 10 June 2016. <https://www.drugabuse.gov/publications/preventing-drug-abuse-among-children-adolescents-in-brief/chapter-1-risk-factors-protective-factors/when-how-does-drug-abuse-start-progress>.
For centuries, addiction to alcohol and drugs has been seen as a moral failing. The person addicted was viewed as lacking in willpower. But while that view is still held by some individuals, a new model for understanding addiction has risen to the forefront in the scientific community. The reality is that addiction is a disease, and the research is there to support it.
Drugs physically change the brain and create a compulsive drive to continue using while inhibiting normal decision-making abilities.
This development has huge implications for those who are living with and fighting against addiction.