All major mental health organizations, including the American Society of Addiction Medicine (ASAM), the National Institute on Drug Abuse (NIDA), and the American Psychiatric Association (APA), define addiction as a chronic brain disease. These organizations have followed the lead of early research into the neurobiological foundations of addictive behaviors to define addiction as a disease and not a disorder or disability.
Interestingly, there is a fine line between the current definition of what constitutes a disease and what defines a disorder. Essentially, the difference between a disease and a disorder is that a disease is considered to be a pathophysiological response (a biological response) to internal or external conditions, whereas a disorder represents merely a disruption to regular functioning that is not due to biological changes.
The proponents of the disease model of addiction, like ASAM, provide evidence that addiction is a disease.
Neurobiological studies (imaging studies) have identified the disruption in areas of the brain that are associated with addictive behaviors.
Research has indicated that genetic factors account for about half of the likelihood that a person will develop addictive behavior.
Loss of control:
The syndrome of addiction typically encompasses several factors, including the inability to continually abstain, impairment in control, diminished recognition of significant problems associated with the addictive behavior, and a dysfunctional emotional response regarding the addiction.
Clinical interventions are necessary for an individual to overcome their addictive behavior, indicating that addiction is not a choice or a moral failure on the part of the individual.
The proponents of the disease model of addiction cite other clinical evidence that addiction is a disease. For instance, relapse rates that occur in addictive behaviors are very similar to the relapse rates of other physical diseases like diabetes and hypertension. The loss of control that inevitably occurs as a result of addictive behavior rules out the notion that individuals actively choose to engage in their behavior. Instead, it is more similar to a severe form of compulsion than it is to voluntary behavior.
Although neither necessary nor sufficient for a diagnosis of addiction, the development of tolerance and withdrawal is primarily a physical process. Individuals with physical dependence are further motivated to continue their addictive behavior even though they no longer achieve the same level of satisfaction from using their drug of choice.
The evidence for addiction as a disease also includes animal models of addictive behavior where animals and laboratory conditions develop severe addictive behaviors under experimental protocols.
The Other Side of the Coin
Although it is safe to say that the majority of treatment professionals agree with the disease model of addiction, the model is not unanimously accepted. There are numerous objections to the disease model of addiction. Individuals like neuroscientist Marc Lewis, psychologist Stanton Peele, and psychiatrist Peter Breggin, as well as a recent article in American Scientist, all object to the notion that addiction is a disease.
They feel the assertion that individuals with addictions experience changes in their neurobiology is inadequate to define addiction as a disease because neuroanatomical changes occur in response to nearly any type of repetitive behavior that a person engages in. For instance, your brain is experiencing changes as you read this article.
The simple observation that something may have a significant genetic component to it is not sufficient to designate that thing as a disease. A significant genetic influence accounts for much of the variation in the color of a person’s eyes, their height, their occupation, and even their political affiliation. These are not diseases.
Loss of control:
Simply demonstrating a loss of control over some type of behavior is not sufficient to designate that behavior as a disease. Individuals often have many bad habits that they have significant difficulty breaking and often need professional intervention to assist them, but these habits would not be considered diseases.
Treatment that is applied to addictive behaviors is not a medical intervention in most cases. Certainly, controlling withdrawal symptoms or cravings through the use of medications involves medical interventions, but these do not address addictive behavior. Individuals must get involved in some form of behavioral intervention, like therapy or support groups, to change their behavior. These are not medical interventions to treat diseases.
Many other objections to counter the assertions of those who support the disease model of addiction are also offered by detractors of this viewpoint. The majority of those who do not support the disease model of addiction believe that addiction represents volitional behavior that is reinforced by the principles of learning.
Does It Matter?
Conceptualizing addiction as a disease might refute many of the inaccurate stereotypes associated with people who struggle with substance use disorders. On the other hand, conceptualizing addiction as a disease allows some individuals to explain away their behavior as being out of their control as a result of external factors, something that is universally frowned upon by treatment professionals.
In terms of getting research money, grants, or insurance coverage for addictive behaviors, the conceptualization of addiction as a disease may lead to more fruitful outcomes. However, in the same way that the understanding of HIV failed to address the stigma aimed at the LGBTQ+ community, simply conceptualizing addiction as a disease will not necessarily reduce stigma for those with substance use disorders. Whether or not addiction is viewed as a disease has little practical impact on recovering from a substance use disorder.
What Really Matters
Whether addiction represents a disease process, a choice, or some other construct, there is one thing that really does matter: Recovery is a choice.
Even though some individuals may be coerced into getting into a recovery program by their family, friends, employers, the legal system, or some other external source, once they are in the program, they must choose to accept responsibility for their recovery and follow the principles of the program for their recovery to have the best possible outcome.
To continue to remain abstinent from drugs or alcohol, these individuals must choose to adopt compensatory behaviors to allow them to resist temptation.