There has been a bit of buzz lately about whether we should stop calling addiction a disease. Perhaps it’s time to have a little heart to heart about this. After all, with the opioid epidemic in full flower, it’s definitely worth pinning down exactly what we’re talking about.
What Is a Disease?
I feel this is a good place to start. If we’re going to discuss whether or not to stop calling addiction a disease, we should probably make sure we know what a disease is to begin with. Otherwise, we’re just wasting our time.
A disease is a condition in which certain processes or systems of the body are physically broken. The lungs don’t work correctly in someone with cystic fibrosis. In some forms of lymphoma, cancer cells sabotage the immune system. Parkinson’s disease is a disorder of the central nervous system. You get the idea.
Each of the above involves a function or system of the body that is no longer able to function properly. Something has physically happened to inhibit the health of that system. This is why addiction is a disease. It’s not merely an emotional or compulsive problem. There has been a real, physical transformation of the brain. And as with any other disease you care to name, it’s not a good transformation, either.
What has Physically Happened to an Addicted Brain?
There are a number of physical brain changes that occur with any addiction. Chiefly among those are: Sensitization, Desensitization, Hypofrontality and an Altered Stress Response. There are others, but let’s keep it simple and start there.
Imagine an FM radio. You can think of sensitization as fiddling with the dial in order to bring in the best possible signal for the music or radio program you want to hear. In the brain, creates more receptors and synapses that are dedicated to the addiction in question. Dopamine combined with DeltaFosB conspire to lock in the target of your addiction. Normally, the combination of these two neurochemicals are perfect for our survival. When we learn a new skill, this is what helps us to remember it so we don’t have to relearn it all the time. In this sense, addiction is really a warped, unproductive form of learning. Our brain thinks it’s doing something really important for survival but in actuality, it’s consumed with an endeavor that does nothing to further our lives in the least.
Desensitization can be simply recast as tolerance. Most of us are familiar with this idea so I won’t go into detail here. Likewise, hypofrontality can be rephrased as poor decision making, and the Altered Stress Response is the idea that pretty much any challenge or difficulty will lead the addict back to the object of his obsession. It’s just the thing to take the edge off.
Again, the above are all PHYSICAL brain changes. They aren’t abstract ideas or theories. They are observable and the difference between an unaddicted brain and that of an addict is obvious. That is why we should not stop calling addiction a disease. The brain of an addict is no longer functioning properly and propels the addict onward in a ravenous pattern of consumption despite any negative consequences.
So Why the Call to Stop Calling Addiction a Disease?
There has lately been some talk that, because the addict chose her path, addiction is not considered a disease, that doing so casts the addict as the victim. We can all empathize with the cancer patient being a victim of a terrible disease. For some people, classifying addiction as a disease devalues the cancer patient’s status as a victim. While I agree that part of the recovery process does often involve the addict seeing herself as a victim of her addiction, and while I agree that an addict casting oneself as said victim is ultimately incorrect, this is a short-sighted view of the problem.
Addicts are people who have made some poor life choices, let there be no doubt there. Quite often, they are victims of a different sort and the poor emotional health that results from often abusive or damaging life experiences can lead some to an addiction. Again, these life experiences are not meant to be an excuse for addiction. They can, however, help to explain how the addict made the life choices necessary to bring about his addiction. Knowing how someone arrived at addiction often holds the keys to getting out of it, and while the news media makes it a little difficult to see addicts as anything other than societal refuse, it’s important to understand how incorrect this portrayal is.
So when someone claims that a condition should not be considered a disease simply because it was brought about by poor life choices, we should draw the line there. Allowing that kind of shallow thinking to fester brings us into subjective, prideful and selfish territory.
Let’s consider the logic of the above thinking with a thought experiment. A teen might attend a number of parties and perhaps engage in sexual experimentation because, hey, that’s what teens do. There is, after all, a whole hormonal smorgasbord in play here and, for the teenager, it’s very new and exciting. This is life happening and good luck trying to stop it. Unfortunately, despite all our efforts to educate the youth on the risks involved, some of them will contract HPV and go on to develop cancer as a result. Since it was the result of poor life choices, I guess cancer is off the table as a disease then, right?
Cut the Shit
Look, we could go down a road similar to some in the evangelical school of thought and view physical ailments as mere manifestations of poor life choices but, in my mind, that’s not so different from seeing hurricanes as godly backhands for our societal acceptance of the LGBT lifestyle. We could allow ourselves to be unforgiving and indolent when it comes to a willingness to understand the problems of our world. We could continue to see a black and white world in which the good are always good and the bad are always bad.
Or we could understand that we’re all human and make mistakes. We could accept that sometimes good people can make horrible decisions. We can see that cardiovascular disease is something that can be curtailed through education and example. The real leap is knowing we actively create many of our diseases. Does that make those people unworthy of the help science and society can provide simply because they brought it on themselves?
We should not stop calling addiction a disease. Remember, we are at our strongest when we stand together and help those who are ready for it. The addict is simply lost. Hikers get lost all the time while trying to feed that part of their soul that longs to see the world from a new perspective. The addict longs for the same things but took a bad path and gave themselves a disease instead. It is a well-worn path now and it will require a lot of work and aid from others to keep the addict from venturing down that path again and again. Allowing ourselves to understand the machine of addiction, we simultaneously find the tools of liberation. If we can all learn to leave our pride at the door, we might even learn to prevent addiction altogether. I don’t see how that’s a bad thing.
Remember, I’m not a trained professional. If you are considering making a change in your life based on anything you find on my site, always consult with a therapist and/or doctor first. Have questions? Feel free to contact me!