Understanding this thing we call addiction is proving to be complicated. Very brilliant thinkers have come up with all sorts of answers, from a bad habit to a matter of motivation. But the dominant theory, endorsed by the Canadian and American societies of addiction medicine, is that it is a “disease,” although psychiatrists officially call it a “mental disorder,” in the same category as depression or bipolar disorder.
Historically, the disease model was a response to the ‘moral model’. Prohibition came to Canada in 1918 and to the US in 1920, largely under the influence of the Woman’s Christian Temperance Union and similar movements. The prevailing belief was that the alcoholic was an irresponsible or sinful male, wasting the time and money that ought to be devoted to family.
The US repeal of prohibition in 1933 opened the doors to the scientists, particularly Elvin Morton Jellinek. His desire was to prove that addiction was not a moral issue, but a medical one, and Jellinek led a crusade to change public opinion. Today, many experts continue to push the disease model because of the continuing influence of the moral argument. Despite science, popular culture still often demonizes the addict. The drug users in movies such as Leaving Las Vegas or Hurly Burly are misguided and troubled outcasts, hardly comparable to victims of cancer or heart disease.
Calling addiction a disease appears to give it some objective, scientific validity, but appearances are often deceptive. There is a great benefit, politically, of endorsing the disease model. If the addict is not defective morally, then at least he or she is defective physically. Interpreting addiction as defectiveness seems to have some reassuring effect on the public. And if the disease model is correct, and addicts are powerless over their condition, then we almost have a moral duty to help those who have no control over themselves.
Remember Robert Downey, Jr.’s sentencing on national television after he relapsed yet again? The judge made it clear that sending Downey to jail was not merely a legal obligation, but a moral one. If Downey could not clean up on his own, the judge would force him to.
In our scientific and technological society, popular magazines and television programs now prefer to show brain imaging scans, which are proof, they say, that addiction is a disease.
But it’s a strange disease. Unlike cancer, addicts willingly go to great lengths to give themselves the problem. George Vaillant of Harvard University, the most famous living physician in addictions, doesn’t really believe it’s a disease. He points out that the label is problematic because we don’t even understand what a disease is. Yet in public he says it is a disease. His reasoning is simple: many addicts refuse to ask for help because of the stigma attached to drug use. If they believe that they have something like cancer, they’ll be more likely to seek treatment.
The disease model has other benefits. If addicts want treatment, they often have to supply a medical diagnosis. No employer will give time off for a ‘moral’ issue, and no insurance company will pay for a problem of morality. So we call it a disease, or some medical variation. The Canadian Human Rights Act, for instance, appreciating the ‘disease’ controversy, refers to addiction as “medical disability.”
As an addictions counsellor, I don’t really care if addiction is a disease or not. What I do know from the scientists is that it has a physical basis in the brain. Does this physical basis equal a disease? I leave that to the medical doctors to debate.
But there are some serious worries about the disease concept. Scientists have created a vaccine for cocaine, which has already been tested on people. And they’re working on vaccines for other drugs. They want to inoculate every kid in the US. Issues such as human rights seem to be forgotten in their enthusiasm.
But perhaps most troubling is that reducing addiction down to a bunch of chemicals in the brain doesn’t say much for addicts as human beings. In fact, it almost suggests that they are out of their minds, that their personalities and ability to choose have been hijacked by their addicted brains.
But all people have minds, as well as brains, and experts are not convinced of a strictly biological argument. Most scientists typically say that biology accounts for 40 to 60 percent of addiction. The rest is psychology and environment.
Our powerful modern psychology is showing just how remarkable the human mind is and what we are capable of. Researchers are compiling impressive evidence that addicts may not be as powerless over drugs as the disease model argues. These experts do not dismiss the biology, but they do say that those who have succumbed to drugs need not be victims of their brains.
About the Author
Geoff Thompson, MA, is the Program Director at Sunshine Coast Health Center, a private addiction treatment facility for adult men. His book, A Long Night’s Journey into Day, explores Eugene O’Neill’s life to uncover the truth of addiction and recovery.
