Is Addiction a Disease?

For the past 20 years, mainstream medical science has defined addiction as a disease. However, new research questions the disease concept of addiction suggesting a shift in substance abuse treatment policy. Will the debate over the disease model of disease change the way addiction science treats substance abuse?
Addiction is a “Disease” Like No Other
The American Association of Addiction Medicine (ASAM), defines addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” Dr. Nora Volkow, of the National Institute on Drug Abuse (NIDA), the leading proponent of the disease model of addiction, states that addiction is “a brain disease because drugs change the brain…These brain changes can be long lasting and can lead to many harmful, often self-destructive, behaviors.”
And yet addiction is unique among diseases because it is a group of behaviors with no infectious agent, no pathological process, and no biologically degenerative condition (The Heart of Addiction, Dodes, Lance M.D., www.psychologytoday.com). 
It seems clear that addiction does not fit the traditional medical definition of disease. So why do we call addiction a disease?
The Disease Model of Addiction the Product of a Social Movement
In 1935, Alcoholics Anonymous formed as a faith-based self-help group for alcoholics. Alcoholics Anonymous introduced the disease model of addiction to mainstream medical science. However, the concept did not achieve widespread acceptance for another 50 years.
The father of the disease model of addiction was the famous Dr. E.M. Jellinek who in 1960 published his definitive book “The Disease Concept of Alcoholism.” E.M. Jellinek argued that alcoholism was not, as previously belived, a moral delinquency, but a physical sickness. In the mid-1990s, the National Institute on Drug Abuse (NIDA) introduce the idea that addiction is a “brain disease” because it is tied to changes in brain structure and function.
The disease concept of addiction revolutionized the way society viewed alcoholics and drug abusers. The disease model of addiction sought to remove the social stigma attached to addiction. Addicts were no longer bad people of weak character but the unwitting victims of a medical condition. The disease model of addiction fit perfectly with the 12-steps of Alcoholics Anonymous and the self-help organization promoted the disease model of addiction.
Addiction Becomes a Brain Disease
In the mid-1990s, the National Institute on Drug Abuse (NIDA) developed the idea that addiction was a “brain disease” (Is Addiction a Brain Disease?, Satel, Sally, www.psychologytoday.com). Addiction was in fact a brain disease because it is tied to changes in brain structure and function. Repeated use of drugs and alcohol change the brain circuitry involved in memory, anticipation, and pleasure. Over the past 20 years, new technologies have allowed neuroscientists to identify the differences in addict brains and non-addict brains. To be sure, the brains of addicts are physically different (Addiction is not a disease, Miller, Laura, www.psychologytoday.com). However, recent research has questioned the validity of the disease concept of addiction with ramifications for substance abuse treatment policy.
Addiction is a Severe Learning Disorder, Not a Disease
Leading the charge against the disease model of addiction is Dr. Marc Lewis, a psychologist and former addict, who authored a new book “The Biology of Desire: Why Addiction is Not a Disease.” Dr. Lewis claims that the disease concept of addiction is invalid because it fails to take into full consideration the plasticity of the human brain. Lewis argues that the brain is always changing and changes with addiction. However, the changes are not the result of a disease but the consequence of learning and development. The changes to the brain in addiction are not permanent and the changes wrought by addiction can be reversed with proper treatment. Addiction does not change the brain irrevocably.
Implications for Addiction Treatment Policy
Should the addiction medicine community adopt a new model of addiction that is not based on the disease model, what are the implications for substance abuse treatment? Dr. Lewis argues that the “disease label often leads to a sense of fatalism: ‘I’ve got a disease, what can I do? I need to go get help and if I can’t get better it’s because I have a disease” (Is Addiction A Habit or A Disease? Siegel, Zachary, Neuroscience). To the contrary, the learning disorder of addiction emphasizes empowerment, self-discipline, and intense self-reflection as core elements of effective drug treatment. Dr. Lewis notes that changes to one’s environment and intensive talk therapy actually reverse the effects of addiction on the brain by creating new synaptic structures.
As the nature of addiction continues to evolve in addiction medicine new addiction treatment models will emerge grounded in new science. Where the disease concept of addiction worked hand-in-hand with the 12-step model of Alcoholics Anonymous, the new learning disorder concept of addiction calls for a revolutionary shift in addiction treatment from the powerlessness of the disease model to empowerment and evidence-base strategies.
The Advantages of Evidence-Based Addiction Treatment
Numerous studies have shown that one-size-fits-all treatment programs are ineffective in treating addiction. Addiction treatment centers that use an evidence-based treatment model effectively address all major features of addiction.
If you are looking for an effective evidence-based addiction treatment center in Los Angeles, California, Boulevard Centers is one of the region’s top evidence-based treatment programs. Offering detox services, residential drug and alcohol treatment, and outpatient treatment, Boulevard Centers provides evidence-based addiction treatment that is specifically designed for your individual needs.


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