When some think of substance use disorders, they think of it as a choice. According to their viewpoint, people consciously make a decision to pick up a bottle or use drugs, and continue engaging in this behavior to the point of addiction. It’s also completely up to them to stop using substances at any time.
However, other schools of thought see addiction as a disease. In fact, it fits the criteria for a disease in many capacities. This perspective reduces stigmas, but doesn’t override the fact that choice is involved.
Let’s look at both schools of thought to better understand the mechanisms of drug abuse.
The History of Drug Addiction as a Disease?
The concept of drug addiction as a disease was first brought to light by Swedish physician Magnus Haus in his 1849 essay Alcholismus Chronicus, which described alcohol use disorder as a chronic condition with specific symptoms. His theory was popularized throughout the 19th and 20th centuries by other medical and mental health professionals, including Benjamin Rush, Thomas Trotter, and E.M Jellinek. However, the theory was more widely accepted in 1956 when the American Medical Association declared alcohol addiction an illness.
This later extended to other substances, seeing all drug addiction as a disease.
Why Is Addiction Classified as a Disease?
Various factors contribute to drug addiction’s classification as a disease. Here are some to consider:
- Biological Brain Changes: Like other diseases, substance use disorders produce changes in the body, specifically the brain. It acts as a chronic brain disorder, altering the reward system, impacting dopamine levels, impairing the prefrontal cortex, affecting decision-making and self-control, and sensitizing stress and craving systems. These changes are measurable through imaging and behavioral assessments and don’t resolve without treatment.
- Predictable Course and Risk Factors: Another common denominator is notable risk factors, including genetics (family history), environmental factors such as trauma, high-stress environments, and peer pressure. Addiction also follows a predictable course with chronic relapses, similar to asthma or diabetes.
- Responds to a Specific Treatment Plan: Addiction can also be compared to diseases because it can be overcome with specific treatment approaches, typically a combination of addiction medicine, which reduces cravings and withdrawal symptoms, and evidence-based therapies that teach people to deal with their emotions in a healthy manner, without self-medicating with drugs and alcohol.
The Benefits of Classifying Addiction as a Disease
The biggest benefit of classifying addictive disorders as a disease may be stigma reduction, but there are other advantages to consider. This section will review how it can improve perspective and care.
Stigma Reduction
Stigma is a major reason people don’t reach out for the care they need. Society often sees addiction as a moral failing due to weak character or a lack of willpower, making individuals ashamed to admit they have a problem and seek the necessary treatment.
Framing substance use disorder as an illness encourages people to seek out addiction treatment instead of hiding. It also means families and physicians are more likely to support these individuals rather than punish them.
Reduced Self-Stigma
Addiction can also promote self-stigmas, especially when relapse occurs. They may see themselves as failures.
Seeing addiction as a disease means understanding drug addiction cycles and knowing there will be ups and downs. They won’t be as likely to blame themselves and will develop the confidence and faith to keep trying.
Better Access To Treatment and Insurance Coverage
When society sees substance use disorder as a disease, it is more likely to provide low-cost clinics, intensive outpatient programs, residential treatment centers, and specialized services. There are also greater odds of addiction treatment being covered by insurance.
A National Institute of Health study notes the many benefits of framing addiction as a disease, including the Mental Health Parity and Addiction Equity Act of 2008, which mandates equal insurance coverage for addiction and other illnesses.
More Effective Treatment
When addiction is framed as a disease, it leads to more research into brain mechanisms, meaning more effective therapies and treatments, and more standardized guidelines for treatment. A report published by the National Institute on Drug Abuse reveals evidence-based therapies are most effective in addressing brain changes such as prefrontal cortex impairment.
Early Detection and Intervention
Families and doctors better understand the signs of addiction so they can intervene early, before problems get worse. Doctors can also screen for addiction through blood pressure and cholesterol levels, offering a more precise approach that goes beyond guessing.
Integrated Care
Physicians are now more aware of how substance use is tied to other mental disorders like depression, anxiety, and post-traumatic stress disorder, bipolar disorder, and physical health issues such as liver disease, heart disease, HIV, and hepatitis. This allows providers to take an integrated approach, addressing the physical, mental, and emotional aspects of drug misuse for long-term results.
Care may be more guided by the Diagnostic and Statistical Manual (DSM), a standard handbook published by the American Psychiatric Association and used by clinicians and researchers to diagnose mental disorders, including substance use disorders, supporting a more integrated approach.
Shift from Punishment to Treatment in Policies
When governments and local organizations see substance use as a brain disease, they often shift their focus on drug use from punishment to treatment, recommending treatment programs instead of jail, and offering harm-reduction approaches, such as needle exchanges, naxolone distribution, and supervised consumption sites. They recognize that treating the disease reduces crime, overdose rates, and healthcare costs.
Science.Org research shows how a community approach to mental health and substance abuse reduced crime in Denver.
Legal and Occupational Protections
Workplaces that see addiction as a chronic disease may offer more protections, such as disability and medical leave. They are also more likely to offer employee treatment referrals and assistance programs instead of immediate termination.
More Support for Family Members
Standardized guidelines help family members understand what to expect from their loved ones during recovery. They recognize the need for boundaries, treatment, and support, and build resilience through Al-Anon, family therapy, and education.
Framing Substance Use as a Chronic Disorder Doesn’t Eliminate Responsibility
While framing drug dependence as a disease is beneficial, it shouldn’t replace accountability. People shouldn’t assume their choices don’t matter or that nothing is expected of them. However, it does mean their ability to choose is impaired, and that they need structured help to improve.
Just like many diseases, addiction treatment requires healthy lifestyle changes – and that’s a choice. However, additional measures are typically required to achieve full recovery, including evidence-based care and addiction medications.
Capital Recovery Offers a Comprehensive Approach
Capital Recovery recognizes the benefits of diagnosing addiction as a disease. We understand how this can lead to more effective treatment and reduced stigmas and fully support the concept. Our team utilizes this approach in a comprehensive care plan that includes evidence-based therapies, medication-assisted support, and aftercare planning.
Contact us to learn how we can help you improve your quality of life.
FAQs
What causes addiction according to the disease model?
According to the disease model, addiction is caused by genetics, brain changes from repeated substance use, impacting the dopamine reward system, and environmental factors, like stress, poverty, and trauma.
Why is addiction not simply a choice?
Substances alter brain function and structure, impairing decision-making, impulse control, and judgment. They compromise rational choice, leading to compulsive use, making it difficult to stop, even when people want to.
How does addiction affect the brain?
Drugs overstimulate the brain’s reward system, leading to increased tolerance and withdrawal symptoms. These occur due to how drugs interact with the basal ganglia, which controls habits, the prefrontal cortex, which is involved in decision making, and the extended amygdala, which plays a role in stress and cravings.
Is addiction chronic and relapsing like other diseases?
Yes, like other diseases, addiction follows a pattern of remission and relapse, requiring ongoing therapy.
What treatments does the disease model recommend?
According to the disease model, addiction can be treated with evidence-based therapies, medication-assisted treatment, support groups, detox, and holistic practices.