Should Addiction Really be Considered a Disease?

For the last few decades, many addiction treatment professionals have adhered to the widely accepted school of thought that addiction is a chronic and progressive disease, much like diabetes, hypertension or asthma, and that biological changes persist long after the person has stopped use of the substance. Although the reasoning behind the disease model of addiction is complex, it is based primarily on the theory that addiction alters the makeup of the brain in very significant ways.

The National Institute for Drug Abuse (NIDA), an organization that promotes and funds scientific research of addiction, theorizes that although addiction is a chronic disease, an addict still has responsibility for maintenance of their illness through treatment and lifestyle changes. In many ways, this is no different than a person with diabetes who must take medications and forego sugary foods, or a person with heart disease who must maintain a healthy lifestyle, which includes exercise and a proper diet.

Others believe substance use is strictly a choice – not an illness, but a behavior - and that labeling addiction as a disease takes power and personal control from the addicted person. Many who question the veracity of the disease model of addiction reason that the brain is plastic, and that there is nothing abnormal about various areas of the brain becoming more or less active, depending largely on how much and in what ways the brain is used. The brain’s ability to change and adapt, a concept known as neuroplasticity, allows circuits to expand and strengthen when used, or to shrink and weaken when unused. It is these natural changes, some experts believe, that are responsible for the MRI’s used to explain chemical alternations that occur as a result of substance abuse and addiction. The biggest argument against the disease model, they argue, is that many people are able to make a conscious decision to stop addictive behavior in spite of structural changes in the brain.

Disease model proponents, however, recall times when addiction was considered a moral failing, a personal weakness, or an indication of poor character. As a result, shame and fear prevented many addicts from seeking much needed treatment. Treating substance abuse and dependency as a disease has removed harmful stereotypes that serve to keep people trapped in addiction. However, calling addiction a disease traps people in a different way. Often, addicts are inclined to give up hope upon being told they have a chronic, incurable disease, or they may believe that addressing the addiction will require a lifetime of treatment following by constant struggle and repeated threat of backsliding.

We at Paracelsus believe that addiction is a complex disorder that isn’t easily explained by either school of thought. Our philosophy is that addiction isn’t a disease in the traditional sense, nor is it a simple matter of willpower, as urges to continue substance use or addictive behavior are extremely powerful and can be overwhelming. However, we know that willpower and motivation certainly play a critical role in recovery, as do the physical, social and even political environments.

Addiction treatment requires a truly individualized approach, and there are no one-size-fits-all solutions. The tendency to explain away problems with simple reasons and predictable “fixes” is the reason why some treatment models, including Twelve-Step programs, have single-digit success rates.

We also believe that the concept of a hard-wired brain is becoming outdated. Taking its place, as neuroscientists clearly point out, is the truth that the brain is versatile and plastic, and that new structures are reinforced and established constantly by learning, repetition and habit.

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