Is Addiction a Disease?
Addiction, as defined by the National Institute on Drug Abuse, is a chronic brain disease that causes an individual to seek out and continually use drugs, even though doing so may have caused negatives consequences for the individual and the individual’s loved ones. Without question, addiction is a disease that affects both physical and mental health.
How Drug Abuse Leads to Addiction
When individuals abuse drugs, changes occur in the brain that affect either the brain’s communication system, reward system, or both. Such changes can drive an individual who started out with a completely voluntary experiment of using a drug “just once” to become an individual who is now dependent on that drug. The use of the substance is no longer a choice; it is now a compulsion. Learning and memory can also be affected.
When individuals feel pleasure, a chemical called dopamine is released in the brain. With long-term substance use or abuse, the brain is tricked into flooding itself with dopamine. Eventually, the individual finds it hard to feel pleasure at all – even while using the substance. The individual may feel the need to use the substance to feel “normal,” and possibly begin to prefer the substance over activities that used to bring pleasure, such as eating and spending times with loved ones. In cases of severe dependence, individuals will stop caring about their own wellbeing as well as the wellbeing of others.
The changes in the brain that result from long-term substance abuse can remain even after the individual receives treatment for addiction. Triggers, which are situations or cues that an individual relates to substance use, often remain and tempt the individual to return to substance abuse.
There are also multiple factors that come into play when it comes to an individual becoming dependent on a drug. These factors include:
- Genetic predisposition: Genetic makeup accounts for half of an individual’s drug dependence risk. If the individual has family members who are dependent on drugs, the chances are increased that that individual will become dependent on a drug at some point in life. Other genetic factors, such as gender, ethnicity, and the presence of mental illness, must also be taken into consideration as these can affect the likelihood of developing an addiction.
- Environmental factors: Socioeconomic status can play a large role in addiction risk, as well as a person’s friends and traumatic life events that may have taken place. Abuse of any kind, peer pressure, stress, and an individual’s home situation can all influence whether an individual begins to use drugs or not.
- Development: In the case of drug use and abuse, the earlier in life an individual is introduced to drugs, the greater the risk of serious substance abuse and dependence.
The Disease Debate
Psychology Today describes a time, approximately 40 years ago, when individuals with drug dependence were treated differently, as if there were flaws in their character that had driven them to become dependent on drugs or alcohol. When the idea surfaced that addiction was actually a medical disease, those battling drug or alcohol dependence were seen as ill and in need of medical assistance instead of simply being immoral.
The addiction treatment community, as well as the majority of the medical community, agrees that addiction is a disease; however, there are some that disagree with this stance. The Psychology Today post takes the position that addiction is not a disease – that addiction and disease have very little in common. A disease is defined as an abnormal condition that affects a part of the body – an organ, body part, or body system – and can have any of a variety of causes. Diseases have signs and symptoms that are characteristic of each individual disease.
Addiction, however, is described as more of a dependence on – as with drugs or alcohol – or an occupation with something. Addiction is also unlike a disease in that it is a set of behaviors, so it would be classified as a syndrome. There is no infection with addiction, nor any of the other causes for disease. The Psychology Today post goes on to state that the only characteristic of addiction that matches disease is the fact that it can make the individual’s life worse if not addressed.
Most established medical organizations and professionals disagree with this stance. There are various tenants of addiction that classify it as a disease. Chronic diseases are long-term conditions, as is addiction. Addiction cannot be cured, but it can be controlled – as with chronic disease. In an article for NBC News, Dr. Raju Hajela, who is the former President of the Canadian Society of Addiction Medicine, states that addictive behaviors are, in fact, manifestations of a disease, not the cause of the disease.
There are, of course, individuals who think that addiction is a choice, and therefore should be discounted as an illness. The first time an individual uses a drug (or a period of sporadic use before the use becomes regular) is usually voluntary. Again, however, drugs and alcohol change the brain into making the drug or alcohol use the individual’s top priority, meaning that once the changes have been made, the person cannot control drug-seeking behaviors.
In support of the fact that addiction is not a conscious choice is the fact that some other chronic diseases, such as heart disease, some forms of cancer, and diabetes, can be caused by an individual’s life choices. If an individual has a poor diet or chooses not to exercise, these choices can affect the long-term health of the individual.
The National Institute on Drug Abuse explains that the relapse rate for addiction is similar to the relapse rate for other chronic diseases. Various relapse rates are outlined below:
- Drug addiction relapse rate: 40-60 percent
- Type II diabetes relapse rate: 30-50 percent
- Hypertension relapse rate: 50-70 percent
- Asthma relapse rate: 50-70 percent
In short, as a publication titled “The Case for Chronic Disease Management for Addiction states, there is supporting evidence that substance dependence is a chronic disease, it should be monitored over the course of an individual’s lifetime, and individuals need more care than what is usually provided. This level of care has been beneficial in the treatment of other chronic diseases, such as diabetes and hypertension.