The Perpetual #Addiction Disease Debate

As the NHS point out – “If you have an addiction, you’re not alone” – many people have issues with addictive behaviours, possibly more than ever before but away from any politics, the charity Action on Addiction suggest that “1 in 3 people are addicted to something.”

Unlike in the USA, the problem of addiction is (in the UK) defined as: “not having control over doing, taking or using something to the point where it could be harmful to you.” A far more useful/helpful/simple definition, in my opinion, rather than the binary disease label that addiction attracts in America.

Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness. Addiction is the most severe form of a full spectrum of substance use disorders, and is a medical illness caused by repeated misuse of a substance or substances. (American National Institute on Drug Abuse)

But counter arguments to the “addiction is a disease” thinking have emerged and have continued to gather momentum over recent years. Not before time in my opinion. Thankfully, many are now coming to see that addiction is actually “a learned pattern of thinking and acting – a pattern that can be unlearned.”

I believe that the historic treatment modality for addiction ‘treatment’ is both counter-productive and in many cases, also harmful. Denial about personal issues like past trauma, or cognisance of consequences and individual responsibility resulting from personal ‘choice’ are ingrained within the traditional and still prominent ‘white-knuckle’ approach to dealing with addictions.

Answering that age-old question – Is Addiction a Disease? – Marc Lewis, a neuroscientist and author of Memoirs of an Addicted Brain and The Biology of Desire: Why Addiction Is Not A Disease pointed out; the ‘disease’ definition is way too simplistic, perhaps even harmful..

I see addiction as an attitude or self-concept that grows and crystallises with experience, often initiated by difficulties in childhood or adolescence. Indeed, addiction is in some ways like a disease, but that’s only half the story. (Marc Lewis)

The arguments rage onward amongst ‘professionals’ in the field of addictions treatment and recovery support however; which side you sit in that discourse often tends to revolve around the monetary drivers and aspects of the argument (see more). In 2018 Rehab4Addiction offered their arguments around why addiction is a disease and not a choice.

The debate whether addiction is a choice or a disease is still ongoing, but there now exists much evidence that addiction is not a choice but rather a disease. Saying addiction is a choice is really putting moral blame at the foot of individuals who are affected by addiction. We feel this is unhelpful and often hurtful. (Rehab4Addiction)

This particular argument (above) is understandable, especially when you realise it comes from an organisation making money from rehabilitation advocacy and referral services. And my opinion is in no way too cynical, despite being dismissed in some within this endless discord.

But if there’s no right answer, the best answer might be the one that generates the greatest benefits and causes the least harm. For me, that scorecard is filled in by addicts themselves. Many take comfort in the disease label, because it helps them make sense of how difficult it is to quit. But for others, the disease label isn’t just wrong, it’s repugnant – it’s a rationale for helplessness and an obstacle to healing. (Marc Lewis)

So why is it so wrong to simply define addiction as a ‘disease’? Again Lewis succinctly summarises the issue; “Apart from being scientifically baseless, the disease model undermines hope, fails to end stigma and doesn’t always get addicts the help they need” …despite me preferring not to use the word ‘addict’ which is stigmatising.

It would be a good idea if we could arrive at a place where we just described addiction as addiction. For many, me included, it seems to belong in a category by itself, neither a disease nor a moral failing. Addiction is a problematic issue on a spectrum of severity. But one where the ‘definition’ and ‘disease’ label are required by many; not least those organisations and individuals required to quantify and market their research, treatment services and support structures. There I go with my cynicism again however; addiction is indeed a misfortune, something that is easy to fall into and hard to get out of.

People who are connected to the world in which they live tend to be more mentally healthy than those who live in isolation. Those who are mentally healthy tend not to become addicted to drugs and alcohol. If you struggle with addiction, take a long, hard look at how you relate to your world, and have the courage to make changes where needed. We do recover, but only if we have the willingness to do what we must to make it happen. (Randy Withers, Addiction Counsellor USA)

Hopefully, our society can arrive at that place where, our understanding of recovery from addiction is on a par with mental health recovery. Maybe then the stigma would diminish to levels that are less problematic than now. Addiction can manifest itself in many forms, in different places along a spectrum, that can have profound impacts for many. By including addiction in our mental heath discussions we could improve the support services we provide and hopefully save some lives!