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Is an addiction a disease?

Posted by on May. 4, 2014 at 9:48 PM
  • 57 Replies

 

Poll

Question: Addiction is a disease.

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Yes

No


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Total Votes: 38

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by on May. 4, 2014 at 9:48 PM
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annabl1970
by Platinum Member on May. 4, 2014 at 9:48 PM

Is Addiction Really a Disease?

If not, what is it? A new look at an old idea.
Published on December 17, 2011 by Lance Dodes, M.D. in The Heart of Addiction
 
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For many decades it's been widely accepted that alcoholism (or addiction) is a disease.  The "disease concept" is taught in addiction training programs and told to patients in treatment programs.  It is unquestioned by public figures and the media.  But is it true?  And if it is not true, is there a better and more helpful way to define addiction?

Let's start with a short history.  In the bad old days, before the disease concept became widely popular (about 40 years ago), our society was even more prejudiced against people with addictions than it is now.  "Addicts" were seen as different and worse than "normal" folks.  They were thought to be lacking in ordinary discipline and morality, as self-centered and uncaring.  They were seen as people who were out for their own pleasure without regard for anyone else.  They were viewed as having deficiencies in character.

Then came the idea that addiction is a disease: a medical illness like tuberculosis, diabetes or Alzheimer's disease.  That meant that people with addictions weren't bad, they were sick.  In an instant this changed everything.  Public perceptions were less judgmental.  People were less critical of themselves.  Of course, it wasn't welcome to hear that you had a disease, but it was better than being seen as immoral and self-centered.  So, the disease concept was embraced by virtually everyone.  With all its benefits, it's no wonder this idea continues to attract powerful, emotional support.

Widespread enthusiasm for the disease model, however, has led to willingness to overlook the facts.  Addiction has very little in common with diseases.  It is a group of behaviors, not an illness on its own.  It cannot be explained by any disease process.  Perhaps worst of all, calling addiction a "disease" interferes with exploring or accepting new understandings of the nature of addiction.

This becomes clear if you compare addiction with true diseases.  In addiction there is no infectious agent (as in tuberculosis), no pathological biological process (as in diabetes), and no biologically degenerative condition (as in Alzheimer's disease).  The only "disease-like" aspect of addiction is that if people do not deal with it, their lives tend to get worse.  That's true of lots of things in life that are not diseases; it doesn't tell us anything about the nature of the problem.  (It's worthwhile to remember here that the current version of the disease concept, the "chronic brain disease" neurobiological idea, applies to rats but has been repeatedly shown to be inapplicable to humans.  Please see earlier posts in this blog or my book, Breaking Addiction, for a full discussion of the fallacy of this neurobiological disease model for addiction.)

As readers of this blog or my books knows, addictive acts occur when precipitated by emotionally significant events, they can be prevented by understanding what makes these events so emotionally important, and they can be replaced by other emotionally meaningful actions or even other psychological symptoms that are not addictions.  Addictive behavior is a readily understandable symptom, not a disease.

But if we are to scrap the disease concept and replace it with something valid, our new explanation must retain all the beneficial aspects of the old disease idea.  It must not allow moralizing or any other negative attributions to people suffering with addictions.  In fact, we'd hope an alternative explanation would have more value than the disease label, by giving people with addictions something the disease concept lacks: an understanding that is useful for treating the problem.

Knowing how addiction works psychologically meets these requirements.  Recognizing addiction to be just a common psychological symptom means it is very much in the mainstream of the human condition.   In fact, as I've described elsewhere, addiction is essentially the same as other compulsive behaviors like shopping, exercising, or even cleaning your house.  Of course, addiction usually causes much more serious problems.  But inside it is basically the same as these other common behaviors.  When addiction is properly understood to be a compulsive behavior like many others, it becomes impossible to justify moralizing about people who feel driven to perform addictive acts.  And because compulsive behaviors are so common, any idea that "addicts" are in some way sicker, lazier, more self-centered, or in any other way different from the rest of humanity becomes indefensible.

Seeing that addiction is just a compulsive symptom also meets our wish for a new explanation: unlike the "disease" idea, it actually helps people to get well.  As I've described in this blog and my books, when people can see exactly what is happening in their minds that leads to that urge to perform an addictive act, they can regularly learn to become its master, instead of the urge mastering them.

Despite all its past helpfulness, then, we are better off today without the disease idea of addiction.  For too long it has served as a kind of "black box" description that explains nothing, offers no help in treatment, and interferes with recognizing newer ways to understand and treat the problem.

And there is one more advantage.  If we can eliminate the empty "disease" label, then people who suffer with an addiction can finally stop thinking of themselves as "diseased."

annabl1970
by Platinum Member on May. 4, 2014 at 9:49 PM

The Genetics of Addiction

 

The Role of Family History

Addiction is due 50 percent to genetic predisposition and 50 percent to poor coping skills. This has been confirmed by numerous studies. One study looked at 861 identical twin pairs and 653 fraternal (non-identical) twin pairs. When one identical twin was addicted to alcohol, the other twin had a high probability of being addicted. But when one non-identical twin was addicted to alcohol, the other twin did not necessarily have an addiction. Based on the differences between the identical and non-identical twins, the study showed 50-60% of addiction is due to genetic factors.(1) Those numbers have been confirmed by other studies.(2)

The children of addicts are 8 times more likely to develop an addiction. One study looked at 231 people who were diagnosed with drug or alcohol addiction, and compared them to 61 people who did not have an addiction. Then it looked at the first-degree relatives (parents, siblings, or children) of those people. It discovered that if a parent has a drug or alcohol addiction, the child had an 8 times greater chance of developing an addiction.(3)

Why are there genes for addiction? We all have the genetic predisposition for addiction because there is an evolutionary advantage to that. When an animal eats a certain food that it likes, there is an advantage to associating pleasure with that food so that the animal will look for that food in the future. In other words the potential for addiction is hardwired into our brain. Everyone has eaten too much of their favorite food even though they knew it wasn't good for them.

Although everyone has the potential for addiction, some people are more predisposed to addiction than others. Some people drink alcoholically from the beginning. Other people start out as a moderate drinker and then become alcoholics later on. How does that happen?

Repeatedly abusing drugs or alcohol permanently rewires your brain. If you start out with a low genetic predisposition for addiction, you can still end up with an addiction. If you repeatedly abuse drugs or alcohol because of poor coping skills, then you'll permanently rewire your brain. Every time you abuse alcohol, you'll strengthen the wiring associated with drinking, and you'll chase that buzz even more. The more you chase the effect of alcohol, the greater your chance of eventually developing an addiction.

Your genes are not your destiny. The 50% of addiction that is caused by poor coping skills is where you can make a difference. Lots of people have come from addicted families but managed to overcome their family history and live happy lives. You can use this opportunity to change your life. (Reference: http://www.addictionsandrecovery.org/

What Is Your Family History?

Most people don't know their family history of addiction very well. Addiction is not the sort of thing that most families talk about. Not too long ago you could have a raging alcoholic in your family and nobody would talk about it. Or they would make some quaint remark like, "Oh he drinks a little too much." There was so little people could do about addiction before that there was no point in talking about it.

But now that you can do something about addiction, a family history is worth talking about. Once you stop using and tell your family that you're in recovery, that's often when they will tell you about the family secrets. That's when family members will sometimes come out of the closet and tell you their stories.

Let your coping skills be the legacy you pass on to your children. Don't let your genes be the only legacy you pass on to your children. Your children are more likely to have an addiction because of your addiction. But their genes don't have to be their destiny. You can help your children lead happy lives by teaching them healthy coping skills - by being an example with your recovery.

Is Addiction a Disease?

Addiction is like most major diseases. Consider heart disease, the leading cause of death in the developed world. It's partly due to genes and partly due to poor life style choices such as bad diet, lack of exercise, and smoking. The same is true for other common diseases like adult-onset diabetes. Many forms of cancers are due to a combination of genes and life style. But if your doctor said that you had diabetes or heart disease, you wouldn't think you were bad person. You would think, "What can I do to overcome this disease?" That is how you should approach addiction.

Addiction is not a weakness. The fact that addiction crosses all socio-economic boundaries confirms that addiction is a disease. People who don't know about addiction will tell you that you just need to be stronger to control your use. But if that was true then only unsuccessful people or unmotivated people would have an addiction, and yet 10% of high-functioning executives have an addiction.

If you think of addiction as a weakness, you'll paint yourself into a corner that you can't get out of. You'll focus on being stronger and trying to control your use, instead of treating addiction like a disease and focusing on stopping your use.

Cross Addiction

You can become addicted to any drug, if you have a family history of addiction. If at least one of your family members is addicted to alcohol, you have a greater chance of developing an addiction to any other drug. Cross addiction occurs because all addictions work in the same part of the brain. If your brain is wired so that you're predisposed to one addiction, then you're predisposed to all addictions.

This is especially important for women who may come from alcoholic families, but who often develop addictions that go undetected, like addictions to tranquilizers, pain relievers, or eating disorders.

One addiction can lead to other addictions, and one drug can make you relapse on another drug. That's one of the consequences of a brain that's wired for addiction. Suppose you're addicted to cocaine. If you want to stop using cocaine then you have to stop using all addictive drugs including alcohol and marijuana. You may never have had a problem with either of them, but if you continue to use alcohol or marijuana, even casually, they'll eventually lead you back to your drug of choice. Recovery requires total abstinence.

How does cross addiction cause relapse:

  1. All addictions work in the same part of the brain. Addiction is addiction is addiction. Therefore one drug can lead you back to any other drug.
  2. Even moderate drinking or smoking marijuana lowers your inhibitions, which makes it harder for you to make the right choices.
  3. If you stop using your drug of choice but continue to use alcohol or marijuana, you're saying that you don't want to learn new coping skills and that you don't want to change your life. You're saying that you want to continue to rely on drugs or alcohol to escape, relax, and reward yourself. But if you don't learn those new skills, then you won't have changed, and your addiction will catch up with you all over again.

(Reference: http://www.addictionsandrecovery.org/

ashellbell
by shellbark on May. 4, 2014 at 9:49 PM
I think it is.
annabl1970
by Platinum Member on May. 4, 2014 at 9:50 PM

 

I can't make up my mind on it

I used to think is not

Now honestly I don't know...

Quoting ashellbell: I think it is.

 

FromAtoZ
by AllieCat on May. 4, 2014 at 9:57 PM
1 mom liked this

I can't answer yes and I can't answer no.

It most certainly can be, and is, a disease for many.  

Others are able to stop what ever their addiction is with more ease than others.

It begins as a choice and can spiral from there.

EireLass
by Ruby Member on May. 4, 2014 at 10:00 PM
5 moms liked this
Its a choice that then develops into a bad habit, which then becomes an addiction. But not all people have addictive personalities.....even those predisposed.

Medically its labeled a disease, and insurance will pay. Socially its labeled a disease, and people dont look down on those afflicted.
annabl1970
by Platinum Member on May. 4, 2014 at 10:02 PM

 I agree with you, if it started by choice.

But how about addiction to morphine?

It certainly doesn't starts with choice  

Quoting FromAtoZ:

I can't answer yes and I can't answer no.

It most certainly can be, and is, a disease for many.  

Others are able to stop what ever their addiction is with more ease than others.

It begins as a choice and can spiral from there.

 

stormcris
by Christy on May. 4, 2014 at 10:06 PM
2 moms liked this

I know for many it is a defense mechanism and sometimes a co-morbid condition but that doesn't make it a disease. Labeling it a disease seem to be more about getting insurance coverage and pacifying the public. The underlying issues are treatable but the condition of addiction will still exist until the underlying causes are addressed. Even in the most stable healthy individual the underlying cause of addiction is most often, if not always, poor impulse control. The genetic idea is still underlying with poor impulse control issues which is the true problem. So I would conclude it was merely a symptom not the disease. But, in western medicine we often treat the symptoms.

annabl1970
by Platinum Member on May. 4, 2014 at 10:07 PM

 Even addiction to painkillers, which started after lets say with need to ease a  pain after having major surgery?

Quoting EireLass: Its a choice that then develops into a bad habit, which then becomes an addiction. But not all people have addictive personalities.....even those predisposed. Medically its labeled a disease, and insurance will pay. Socially its labeled a disease, and people dont look down on those afflicted.

 

annabl1970
by Platinum Member on May. 4, 2014 at 10:14 PM

Poor impulse control  is psychological disorder, right?

What is the difference between disorder and disease in your opinion?

Quoting stormcris:

I know for many it is a defense mechanism and sometimes a co-morbid condition but that doesn't make it a disease. Labeling it a disease seem to be more about getting insurance coverage and pacifying the public. The underlying issues are treatable but the condition of addiction will still exist until the underlying causes are addressed. Even in the most stable healthy individual the underlying cause of addiction is most often, if not always, poor impulse control. The genetic idea is still underlying with poor impulse control issues which is the true problem. So I would conclude it was merely a symptom not the disease. But, in western medicine we often treat the symptoms.

 

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