Is addiction a disease?

Disease.
A disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.
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So,um...yes.
 
I think the severe dependence that results in illness or death upon withdrawal is definitely a disease, and the rest is probably better defined as a disorder, with some grey area between the two in the middle.

I think the "disease theory of addiction", where it's assumed to progress like stages of cancer, is overall deeply flawed, though.
 
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kellyb said:
I think the "disease theory of addiction", where it's assumed to progress like stages of cancer, is overall deeply flawed, though.
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However flawed it may be, it's worlds better than criminalization.
 
I dunno, but it's a bit hard to imagine my perpetual sweet tooth as an addiction, much less a disease.

Though I'm repeatedly warned by my dentist to reduce my consumption, lest my gingivitis flares up again.
 
Loss Leader said:
However flawed it may be, it's worlds better than criminalization.
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For sure, but I don't see the disease [progression] theory of addiction being the lone alternative to decriminalization. It's mostly just used to hawk rehab programs of dubious effectiveness.
 
kellyb said:
I think the severe dependence that results in illness or death upon withdrawal is definitely a disease, and the rest is probably better defined as a disorder, with some grey area between the two in the middle.

I think the "disease theory of addiction", where it's assumed to progress like stages of cancer, is overall deeply flawed, though.
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I absolutely agree. It was a great start and helps to re-think the concept of addiction away from the moral failing that it's still sadly all too commonly still thought of.

But choice plays a much larger role than most people will believe or accept. I've read several controversial books and peer-reviewed papers dealing with the subject of choice as it relates to addiction. I might dig around and suggest some for further reading if anyone is interested.
 
Being addicted to physically addictive substances, such as opioids or alcohol is a disease. Or if you prefer to avoid getting into meaningless discussions of the definition of "disease" then just say that these are severe health disorders that need to and should be treated medically. How much one may or may not be responsible for initiating the addiction is irrelevant; severe bleeding is a medical condition that needs medical treatment whether or not it was caused by the patient's careless use of a knife.

But I assume that you meant is the tentancy to be attracted to these substances and to easily become addicted to them a disease? . I think so. Substance abuse tends to run in families just like clinical depression or certain othe physiological problems. There are people who appear to have "addictive personalities" and these often include a variety of other physiological problems. The same initial exposure to a drug may result in one person going on to become addicted and another not. I think that one's biochemistry plays an important role, just like in other mental and emotional diseases and disorders.
 
The Norseman said:
But choice plays a much larger role than most people will believe or accept. I've read several controversial books and peer-reviewed papers dealing with the subject of choice as it relates to addiction. I might dig around and suggest some for further reading if anyone is interested.
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I am!
 
corybluefire said:
Is addiction a disease?
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No of course not. Also water is wet. But good luck getting anyone to get it. Just another in a long line of non-accountability moves by our brilliant society. All the rage.

:barf:
 
Venom said:
What?:eye-poppi
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What, you don't see that poor people prefer poverty wages to real jobs? You don't buy that people up and choose to become addicts and ruin their lives?

What are you, some sort of personal responsibility denialist?

;)
 
kellyb said:
How are you defining "physically addictive" here, tho?

Does, say, caffeine count?
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Changes your physiology in that you need to have another hit to feel "normal" again. Caffeine addiction counts, it is just a very, very, very mild disease.:)
 
Giordano said:
Changes your physiology in that you need to have another hit to feel "normal" again. Caffeine addiction counts, it is just a very, very, very mild disease.:)
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I can roll with that version of addiction-as-disease. :)

It's different from the "hijacked brain" "progressive disease" theory of addiction which I think is (mostly) bunk.
 
From the second post:

A disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.
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Could drinking or doing drugs excessively be that injury?

I don't like the term 'disease' for this. Sounds like political BS, as in, "I have a disease therefore it isn't my fault and you should pay to help me"

Let's draw a distinction at least between actual diseases and the willing abuse of one's own body with drugs. Addiction should be treated as a medical thing, but let's not get carried away.

ETA: I have a disease. It's called "I hate to work". Get me on disability and send me money please.
 
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Inasmuch as any mental health problem is a disease, addiction is a disease.

Fundamentally, addiction-the-disease is the physical or psychological dependance on a substance when using such substance causes problems in the person's life. If you can't stop using the substance despite the fact that it is causing physical harm (can't stop using alcohol despite the fact that the liver is being damaged), for example.

Addiction's pathology is centered around the alteration of the brain's reward system.
 
xjx388 said:
Inasmuch as any mental health problem is a disease, addiction is a disease.

Fundamentally, addiction-the-disease is the physical or psychological dependance on a substance when using such substance causes problems in the person's life. If you can't stop using the substance despite the fact that it is causing physical harm (can't stop using alcohol despite the fact that the liver is being damaged), for example.

Addiction's pathology is centered around the alteration of the brain's reward system.
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Yeah, that's a decent summary of the prevalent thinking on the matter but there's more and more research that shows that to be too simplistic and ultimately the disease theory of addiction doesn't explain the evidence we see very well (such as natural rates of remission especially of those who sought no treatment at all).
 
The Norseman said:
Yeah, that's a decent summary of the prevalent thinking on the matter but there's more and more research that shows that to be too simplistic and ultimately the disease theory of addiction doesn't explain the evidence we see very well (such as natural rates of remission especially of those who sought no treatment at all).
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I'm not sure the reality of addiction-the-disease (physical dependence) is or should be considered predicated upon it causing you problems.

Someone could take relatively large doses of benzodiazapines daily with no major ill effect outside of potentially deadly withdrawal if they were cut off, for example.

eta: Addiction the DISORDER probably should be, though, and it looks like the APA has recently started to agree, since the general diagnosis for substance use and abuse as a disordered behavior is now just called "substance use disorder".

I normally don't like "semantic" arguments, but I think it's important that they finally got this right here.
 
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Semantic arguments aside ("what iiiiis disease... removes pipe from mouth, raises head to stare at ceiling,") there's a valid question about whether a disease model has better success with addiction management/treatment than a character flaw model.

My understanding of the literature (note: i am not an addictions therapist, but i was a cogbeh family therapist / medical genetics therapist for a few years, and am married to a psychiatrist who specializes in inner city emergency room / forensic patients and we discuss the literature daily) is that the disease model is night and day more effective in managing addiction to restore patient participation in society, ending addiction, and also maintaining sobriety/clean streaks, post-intervention.

So, it almost doesn't matter what I think about the label, the modelling seems to get the results most people say they want from a recovery strategy: a better probability of beating it and staying off.


Related: there are two high level categories of addictions or habits or behaviors or whatever we choose to call them. The most obvious category is the flat out chemical substances which directly interact with the brain without intermediaries. Opiates are an example, we are now also dealing with fentanyl as a rapidly growing issue.

But there is also the category that uses intermediaries, and an example of these was brought up earlier: poor diet. This is more of a mood affecting habit than a 'brain' affecting habit, if that makes any sense, and the disease model has less advantage over the personal responsibility model for these. But, worth mentioning, it's still superior in most programs.
 
blutoski said:
Semantic arguments aside ("what iiiiis disease... removes pipe from mouth, raises head to stare at ceiling,") there's a valid question about whether a disease model has better success with addiction management/treatment than a character flaw model.
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Of course. Anything is better than a character flaw model. That doesn't speak highly of the disease concept, though, either.


But, worth mentioning, it's still superior in most programs.
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Not really; (I looked it up to correct my earlier statement in a different thread) around 75% of all treatment in the US is 12-step based which pushes the disease concept model and they have very little in the way of success.
 
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The Norseman said:
Not really; (I looked it up to correct my earlier statement in a different thread) around 75% of all treatment in the US is 12-step based which pushes the disease concept model and they have very little in the way of success.
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Might be a terminology thing, sorry.

Just to clarify, by disease model, I mean modern medical disease model, which can include medical intervention/care &c. An example of that is here in Vancouver, my wife volunteers at an injection site.

This model also holds patients responsible for their choices, and there is progress being made toward environmental management. My specialty in family therapy made it 'obvious' to me that the family cooperation was key, but the field in general is not quite there yet.

12 step is fru-fru, total agreement there. Not a fan.
 
blutoski said:
But there is also the category that uses intermediaries, and an example of these was brought up earlier: poor diet. This is more of a mood affecting habit than a 'brain' affecting habit, if that makes any sense, and the disease model has less advantage over the personal responsibility model for these. But, worth mentioning, it's still superior in most programs.
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Just to add a bit of elaboration on why the category with intermediaries is a special challenge... most of the behaviors that are addictive in this category are excesses of healthy behaviors. We need to eat, have sex, shop. Even if we do go cold turkey on these, that's not really healthy either. Getting somebody else do to my shopping... for the rest of my life? Sounds insane. The desired outcome of these is normal participation.

In contrast, quitting heroin or smoking or drinking entirely, forever, is probably quite healthy. Granted, a harm reduced use condition may be the best possible outcome for many people.
 
arthwollipot said:
If it's a disease, it's more akin to a chronic disease than an acute one.
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I do not know.

However, how much family (and ancestors) behaviour affects its development is something I think should be taken into account.

My father and his 4 brothers were all alcoholics.

As a child I remember when meeting my grandfather on my father's side. When greeting, my father was not offered a cup of coffee, but a whisky.

Later in my teens, we would have a drink before dinner, myself included when 16.

Alcohol was part and parcel of my upbringing and needless to say, I am an alcoholic.

In addition, 3 of the brothers committed suicide in their 50s. I often have these thoughts being of the same age.

Still, whilst having intrusive suicidal thoughts, I refuse to do what early members of my family did.

I think I have control of that aspect.

To be frank, I have no idea whether it is a disease (genetic) or conditioning.

With C2H5OH - it is so far impossible as some of my posts show.

I have tried therapy including Naltrexone to no avail.

I hope to stop one day, but it could be my last.

Interestingly, after years of abuse, my liver (after scans) and my blood show nothing bad.

This brings me to genetics.

Beer or wine was the only safe way to drink water many moons ago. Europeans/Middle Easterns fermented it.

Asia boiled water and added tea as a flavour.

If you (speaking as a Western European) have ever drunk beer with Chinese people, many will be under the table after the third drink. Koreans and Japanese fall less since their culture fermented more.

If you (speaking as a Western European) have ever drunk spirits with people from cold European countries - lack of natural fruit and vegetables led to distillation as being the main tool to "clean" water . You will be the first under the table.

A mixture perhaps - make mine a Gin and Tonic :)
 
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I am going to use a jargon term here:

biopsychosocial disorder

- in the past I have been more of a behaviorist mind set and insisted that addiction is a strictly behavioral disorder. Except for the various actual potential withdrawal syndromes

More recently I have begun to give the biological basis more weight, I still thing it is mainly a behavioral disorder but it has high biological consequences. And social interactions.

Now I believe in hard reduction as a first step and find the 12 step structure onerous and over laden with cliches. It works for some and is an absolute failure for others.

I like Trimpey's Big Choice model but find his stances to prone to solely attacking others.

So it takes behavioral change, I like CBT models myself.
 
Myles said:
Does anyone profit by addiction being labeled as a disease?
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Treatment centers used to get a lot of mileage out of it, when sort-of normal U.S. insurance could give you 4 weeks as an inpatient. I'm pretty sure that's changed, though. There's still an industry but it seems more like an acute-management phase, then 8 weeks or so of outpatient treatment which is focused on identifying triggers, having a plan if tempted to relapse, etc.
 
Minoosh said:
Treatment centers used to get a lot of mileage out of it, when sort-of normal U.S. insurance could give you 4 weeks as an inpatient. I'm pretty sure that's changed, though. There's still an industry but it seems more like an acute-management phase, then 8 weeks or so of outpatient treatment which is focused on identifying triggers, having a plan if tempted to relapse, etc.
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And what entity had the authority to label addiction as a disease? Was there more than one?
 
bigred said:
No of course not. Also water is wet. But good luck getting anyone to get it. Just another in a long line of non-accountability moves by our brilliant society. All the rage.

:barf:
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Much experience with the subject matter otj and in my personal life leads me to believe that you have no idea what you're talking about.
 
Myles said:
And what entity had the authority to label addiction as a disease? Was there more than one?
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I don't think there was one infallible entity charged with the authority to call addiction a disease. The American Medical Associated started calling alcoholism a disease in 1956. Insurance paid for treatment and insurance was funded by employers and (ultimately) employees. HR departments got involved in sending people for treatment.

Addiction could be labeled as a medical issue, or condition, or disorder, or syndrome. People die from it, so I wouldn't call it the peak of health.
 
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jrhowell said:
Is lung cancer a disease?

What about if it is contracted by a cigarette smoker?
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That's a result of that particular addiction, not the addiction itself.

But I agree, the fact that a disease might be self-inflicted is no reason to not think of it as a disease. So yes, obviously, any and every addiction is indeed a disease.
 
Myles said:
Does anyone profit by addiction being labeled as a disease?
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Thinking of addiction as a disease (even if self-inflicted) might help take away some of the stigma that attaches with addictions and addicts. What they need is treatment (physical, psychological, situational, whatever), not condemnation, not even implicit.

To be clear : the choices they made, that led to their addiction, those may indeed merit criticism. But not the addiction itself, that just needs to be treated. Like if I drive drunk and crash my car, I need treatament to get my broken bones together, and not criticism, not even implicit criticism, not so far as my broken bones are concerned.
 
The Norseman said:
ultimately the disease theory of addiction doesn't explain the evidence we see very well (such as natural rates of remission especially of those who sought no treatment at all).
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I don't understand this. Is the rate of remission part of the definition of what's a disease? Is classifying something as a disease meant to explain its rate of remission? Is how often something clears up without treatment part of the definition of disease?

Influenza goes away within days without medical treatment nearly all the time. Does that affect whether or not it's classified as a disease? :confused:
 
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Loss Leader said:
However flawed it may be, it's worlds better than criminalization.
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True, but that's not the default alternative. Alcoholism and smoking cause more problems than all the illegal substance abuse problems put together, and they're legal.

Not only legal, but in the case of alcohol, actively endorsed by a lot of societies and cultures. I'm an alcoholic and when I was a drinker, one thing I was never at risk of was being arrested for buying, possessing or partaking in my addiction. I could of course get into trouble for what I did when under the influence or where I did it (drinking in public for example), but the addiction or substance use itself was never a legal issue.
 
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