Substance abuse disorder (SUD) is a very complex condition that involves uncontrollable use of a substance despite harmful health and social consequences. People with SUD are intensely focused on using a particular substance (illegal drugs, tobacco, alcohol) to the point where their ability to function in their day-to-day life is significantly affected. The most severe SUDs are called addictions.
Addiction disrupts a person’s brain and body function. Today, addiction is recognized as a chronic disease that should be treated and monitored over a person’s lifetime.
Disease Model of Addiction
The traditional medical model of disease defines disease as an abnormal condition that causes discomfort, dysfunction, or distress to the afflicted individual.
The disease model of addiction defines addiction as a compulsive disorder with biological, neurological, genetic, and environmental sources of origin. Addiction occurs due to chemical changes in the brain induced not by conscious decisions but by regular abuse of drugs or alcohol. The disease theory focuses on the user’s loss of control, emphasizing that addicts cannot stop substance abuse without proper treatment.
Disease Model of Addiction: A Short History
For decades, experts have debated between two ideas: that substance abuse is a choice vs. a disease. After World War II, the formation of Alcoholics Anonymous (AA) began to shift the collective stigma on alcohol abuse. The focus turned to healing addicts instead of punishing them.
In 1960, E.M. Jellinek published The Disease Theory of Alcoholism. Now known as the father of the disease theory of addiction, his theory about alcohol dependence centered on these four concepts:
Alcohol tolerance – An alcoholic needs to consume more alcohol in order to achieve the desired effects.
Withdrawal – Stopping alcohol consumption leads to physical symptoms.
Lack of control – An alcoholic cannot control their alcohol consumption.
Impairment – An alcoholic’s physical and social behavior is impaired due to the uncontrollable consumption of alcohol.
Today, the American Society of Addiction Medicine defines addiction as “a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.”
The disease model of addiction relates this relapsing, chronic brain disorder to other chronic medical illnesses such as diabetes, asthma, and hypertension, whose relapse rates are around 40% to 60%. Life-threatening diseases can cause body dysfunction and severe consequences if left untreated. Most importantly, while these chronic conditions are preventable to a point, proper care is required throughout a person’s lifetime. If left untreated, these conditions become disabling and life-threatening.
Where Addiction Begins
Over the years, research has shown that genetics is one of the most significant contributing factors to developing an addiction. Approximately 50% of a person’s likelihood of developing an addiction can be connected to genetic factors. Some people are just genetically much more prone to addiction than others.
By studying the DNA of addicts, scientists have been able to isolate gene sequences that indicate a greater risk of becoming addicted to drugs. This shows that addiction, along with other chronic illnesses, can run in families.
Aside from genetics, environmental factors also play a substantial role in addiction. It’s no longer a question of nature or nurture. Instead, it’s that a person’s overall health and habits result from dynamic interactions between genes and the environment they grow up in. Peer pressure, childhood trauma, and lack of parental involvement can lead to experimentation with substances in early life. And the earlier a person experiences alcohol or drugs, the more likely they will develop an addiction in later life.
Addiction and the Brain
Drug-seeking behavior is not a conscious choice but is instead a compulsion driven by chemical changes in the brain. Over time, these changes continue to affect an addict’s self-control, leading to the impulse to take more of their substance of choice.
Taking drugs and alcohol leads to the release of excess serotonin and dopamine, giving users a feeling of pleasure and relaxation. Continued use changes the physiology of the brain. Because so much of these neurotransmitters are being released unnaturally, this triggers the brain to reduce their production. As a result, an addict develops a dependence on these substances because they are the only things that can make them happy.
When an addict stops using these substances cold turkey, withdrawal symptoms aren’t just physical in nature. Emotional withdrawal lowers executive function, impulse control, and decision-making processes in the brain, leading to very high chances of relapse.
Addiction and Responsibility
Using substances early in life is a conscious choice usually influenced by their environment and the culture in which they grow up. After all, most people who engage in substance use never develop addiction. They are able to stop or regulate use, and their lives are not affected or controlled by these substances.
Once brain pathways have been altered by addiction, however, choice and willpower fall by the wayside. People cannot choose how their brain responds to drugs and alcohol. Those with addiction cannot control their substance use without external treatment and medication, so they should not take the blame for having a disease. With the application of quality care and peer support, an addict can recover and survive this disease.
Is Addiction a Disease?
The contemporary medical model of disease attributes addiction to changes in the brain’s reward pathway. Addiction is a progressive, relapsing, chronic disease that can only be controlled, and not cured. While intensive treatments can lead addicts to stop using substances, they remain addicts for the rest of their lives. Continuing aftercare and monitoring is needed to ensure that their recovery is constant and that there are no chances of relapse.
The Benefits of Accepting Addiction as a Disease
The acceptance of the disease model of addiction has led to the destigmatization of the struggle of being an addict. For decades, many people blamed addicts for making the destructive choice of regularly using harmful substances. Accepting addiction as a disease has opened more pathways in addiction research and humane treatment for addicts.
Looking at addiction as a chronic disease leads to medical treatment and social support. Professional treatment and lifelong support are crucial for anyone with a substance abuse disorder, whether the addiction is mild or severe. Even though addiction is a permanent illness, evidence-based actions can be taken to alleviate the worst symptoms and for an addict to live a healthy life for many years.
People suffering from other chronic diseases such as asthma and heart disease are never blamed for their condition. They did not choose to be sick, and they are not expected to have any control over their lungs or heart. If more people looked at addiction in a similar way, more addicts could feel that they can reach out for help with no judgment. The lack of stigma results in many more recoveries and more lives saved every day.
Conclusion
Addiction is a chronic disease that causes severe malfunctioning in an addict’s brain chemistry. Addicts cannot control their brains any more than asthmatics can control their lungs, so they cannot be blamed or maligned for their condition. The key to addiction recovery is to get evidence-based treatment and lifelong support for this disease.
Sources:
https://www.asam.org/for-the-public/definition-of-addiction
https://www.drugabuse.gov/publications/drugfacts/genetics-epigenetics-addiction