Image: Alan CleaverTo understand if addiction is correctly defined as a disease it is first necessary to define what a disease actually is. The obvious source for this definition should be the medical community, as it is medical professionals who deal with the subject. Even here it is difficult to find a consistent definition, but let us take a few examples:
a definite pathological process having a characteristic set of signs and symptoms. It may affect the whole body or any of its parts, and its etiology, pathology, and prognosis may be known or unknown. For specific diseases, see under the specific name, as addison's disease. See also illness, mal, sickness, and syndrome.
disease. (n.d.) Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved February 25 2017 from http://medical-dictionary.thefreedictionary.com/disease
1. An interruption, cessation, or disorder of a body, system, or organ structure or function.
See also: syndrome. Synonym(s): illness, morbus, sickness
2. A morbid entity ordinarily characterized by two or more of the following criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomic alterations.
See also: syndrome.
[Eng. dis- priv. + ease]
disease. (n.d.) Farlex Partner Medical Dictionary. (2012). Retrieved February 25 2017 from http://medical-dictionary.thefreedictionary.com/disease
An abnormal condition of a part, organ, or system of an organism resulting from various causes, such as infection, inflammation, environmental factors, or genetic defect, and characterized by an identifiable group of signs, symptoms, or both.
disease. (n.d.) The American Heritage® Medical Dictionary. (2007). Retrieved February 25 2017 from http://medical-dictionary.thefreedictionary.com/disease
So based on these definitions addiction would appear to fit with all of them. In the first case it has a definite pathological process and a characteristic set of signs and symptoms. In the second case it is a disorder of the brain with identifiable changes to certain brain structures. In the third case, it is an abnormal condition of the brain resulting from various causes including genetic defect and characterised by an identifiable group of signs and symptoms.
This then begs the question, if addiction fits with the definition of a disease, why are people arguing that it should not be called one? Let us examine those arguments.
In an article by Carl L. Hart and published by Nature Human Behaviour, the author argues that addiction rather than a disease is a learned behaviour. He criticises neuroimaging studies for not sufficiently accounting for psychosocial factors and co-occurring mental disorders. His argument however does not account for the fact that many of those same co-occurring mental disorders are similarly affected by psychosocial factors and co-occurring mental disorders. Are we to then start defining mental disorders as learned behaviours and not diseases? Even if a learned behaviour and psychosocial factors or co-occurring mental disorders do contribute to the pathology of addiction, there is nothing in the definitions of disease that excludes it on those grounds.
The article then goes on to discuss how calling addiction a disease may contribute to the disparities in addiction statistics across socioeconomic divides. The author argues that calling addiction a disease has led to funding for the treatment and prevention of addiction being funnelled primarily into the health and criminal justice systems, and away from social interventions that may be effective. This is a valid concern, but is changing the definition of disease the answer to that, because that is essentially what is required to logically exclude addiction from the current definitions. Ultimately the authors objections to the categorising of addiction as a disease appear to be based primarily on socioeconomic factors rather than clinical ones.
Another article by Marc Lewis and published by The Guardian takes a different approach. In it they argue that calling addiction a chronic disease encourages a kind of fatalism that is unhelpful to addicts in recovery. The author argues that the idea that the disease cannot be cured makes addicts in recovery more susceptible to relapse, and that this is backed up by statistics. He says addiction is a learned behaviour that may be unlearned. It is a compelling argument, but the author is taking aim at the wrong word here. Diseases are not always incurable, there are plenty of diseases that we treat and cure every day. The issue here is with the word chronic, not the word disease.
The author of this article also makes the point that neural plasticity plays a role in all learned behaviours, and that structural brain changes may be observed in all of these cases. Another compelling argument, but one that fails to account for other aspects of addiction such as the known genetic predisposition in some people. Even should plasticity play a major role in the development of addiction, it still may be considered a mental disorder if the behaviour of the addict falls outside the range of behaviour which we deem as normal and leads to extreme distress, suffering or impairment. That is after all what defines a disorder, to be dis-ordered, and if other mental disorders are diseases, how can we then consider addiction not to be?
It is easy to understand why there is a movement to try and change addiction from being considered a disease. There are practical considerations and calling it a disease may lead to funding being funnelled into areas where is it not as effective, and it may influence how the addict views themselves, sometimes negatively. Telling a person that they cannot be cured is distressing, and at the moment the jury seems to be still out on that one, so it is probably not in their best interests to tell them that if like the statistics suggest it leads to more relapse. These are issues that require education to correct though, not redefining the language we use. Any word we attach to the term addiction will have consequences because common usage of it will influence how it is interpreted. Getting the correct definition of the term into common usage should be the priority rather than arguing the semantics of something that clearly already fits into an existing definition.
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Addiction is not a disease - A rebuttal
A rebuttal of the arguments against the disease model of addiction recently published through various websites and news outlets.