Opinion Should Addiction Be Viewed as a Disease? The New York Times

A key implication of this model is that genetic susceptibility for a complex, polygenic trait is continuously distributed in the population. This may seem antithetical to a view of addiction as a distinct disease category, but the contradiction is only apparent, and one that has long been familiar to quantitative genetics. Under the disease model, treatment for addiction focuses on managing symptoms and preventing relapse. This can include a combination of therapy, medication-assisted treatment, and support groups. The goal is to help individuals with addiction regain control over their lives and manage their condition in a way that allows them to live a fulfilling and healthy life. Addiction is a natural language concept, etymologically meaning enslavement, with the contemporary meaning traceable to the Middle and Late Roman Republic periods [115].

Subtypes in addiction and their neurobehavioral profiles across three functional domains

Thus, for both legal and illegal drugs some addicts conform to the expectations of the “chronic disease” label. However, as noted below, the correlates of quitting drugs are the correlates of decision making, not the correlates https://virginiadigest.com/top-5-advantages-of-staying-in-a-sober-living-house/ of the diseases addiction is said to be similar to. Those who believe that addiction is a choice may not understand that simple “willpower” is not enough to overcome the drastic changes that drugs cause in the brain.

Disease Model of Addiction

  • This is manifested in a prevailing attitude that labels people and withholds help to “bad people who are undeserving.” Compounding this is the common belief that people choose to become addicted, based on weakness, lack of will power and poor judgment.
  • As the National Institute on Drug Abuse points out, „many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa.“ Those with mental health issues are more likely to use drugs, perhaps to cope or self-medicate.
  • A plurality of disciplines brings important and trenchant insights to bear on this condition; it is the exclusive remit of no single perspective or field.
  • Politics and pontification aside, am I really so sure that addiction is NOT a disease?
  • For instance, consider the fact that most addicts mature out of their addiction by their late twenties and thirties.
  • Examples are needle-sharing despite knowledge of a risk to contract HIV or Hepatitis C, drinking despite a knowledge of having liver cirrhosis, but also the neglect of social and professional activities that previously were more important than substance use.
  • Addiction is considered a disease largely as a way to remove stigma, guilt, moral blame, and shame from those who use substances or certain behaviors repeatedly to feel intense euphoria and as a way to encourage humane treatment.

The matching law, melioration, and hyperbolic discounting predict that drugs and similar commodities will become the focus of destructive, suboptimal patterns of behavior. These same choice models also predict that individuals caught in a destructive pattern of behavior retain the capacity to improve their lot and that they will do so as a function of changes in their options and/or how they frame their choices. This viewpoint fits the facts of addiction and provides a practical guide to measures that will actually help addicts change for the better. For instance, in every national scientific survey of mental health in the United States, most of those who met the criteria for dependence on an illicit drug no longer did so by age 30, and addiction had the highest remission rate of any other psychiatric disorder. Those in remission may relapse at some post-interview date, and the subject rosters of the large epidemiological studies may be biased in favor of those addicts who do quit. For instance, addicts who remain heavy drug users may not cooperate with researchers or may be hard to contact because of their life style, illnesses, or have higher mortality rates.

Is Addiction a Choice?: Opponents of the Disease Model

  • And the prefrontal cortex, the area of the brain responsible for rational decision-making, judgment, and control of behavior gets weakened, its connections to other parts of the brain pruned away.
  • Meanwhile, however, genome-wide association studies in addiction have already provided important information.
  • One person, the therapist, tries to influence another person, the patient, to change their values and behavior.
  • I am purposely raising my kids to know that it’s not the substance (alcohol or drugs) that is the problem, but that other factors make some people more vulnerable to substance use becoming dysfunctional.

If we are to succeed in treating addiction as a disease — which it is — we need to acknowledge and overcome our negative attitudes so that we can help patients with addiction and guide how the public perceives them. My approach definitely isn’t popular (yet), but I am developing the Raising Resilient and Addiction-Resistant Kids program to provide a viable alternative to abstinence-only messaging. Many parents have trouble stepping outside of the narrative that trained them to think that providing honest education about alcohol and drugs somehow condones their use and leads to a higher risk of addiction, but many others are ready for a different approach. Likewise, nearly one in four people over the age of 18 with any mental illness also had a drug use disorder, and more than a third of those with a serious mental illness had a drug use disorder. In comparison, among those with no mental illness, only 5.5 percent had a drug use disorder, while adults with a mental illness were more than four times as likely to have a drug use disorder.

is addiction a disease or choice debate

Indeed, concerns were raised about setting the diagnostic standard too low because of the issue of potentially conflating a low-severity SUD with addiction [116]. In scientific and clinical usage, addiction typically refers to individuals at a moderate or high severity of SUD. This is consistent with the fact that moderate-to-severe SUD has the closest correspondence with the more severe diagnosis in ICD [117,118,119]. Nonetheless, akin to the undefined overlap between hazardous use and SUD, the field has not identified the exact thresholds of SUD symptoms above which addiction would be definitively present.

is addiction a disease or choice debate

Consequently, it is much more informative to attempt to reach a consensus regarding the capacities of the addict, most notably their ability for impulsivity and decision-making, rather than unnecessarily treating the two models as opposites. Importantly, proponents of the BDM not only refer to the neurobiological effects drugs have on the brain but also project this onto various impairments as a result of these effects. Cognitive control, attention or motivational bias, and negative emotional states are seen as major complications resulting from said Sober House brain changes [15, 16]. As a result, the behaviour of addicted individuals is considered compromised and disordered in those aspects. Besides generalized neural consequences from repeated substance use that may explain why the addicted population can experience certain dysfunctions, the BDM also explains the role of individual differences in acquiring and maintaining addiction [10]. Proponents of the BDM believe that the interaction between environmental factors and a genetic vulnerability may provide an explanation for this discrepancy [10].

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