Is Addiction a Disease?
The question of Is Addiction a Disease? is an important one because both medical treatment and insurance reimbursement are diagnosis driven. Standards of care are drawn up based on recognized disease states. Insurance companies make decisions on what they will cover by looking at standard treatment plans for approved diagnoses. Government policies are also influenced by how you define addiction.
Whether or not addiction is a disease has other consequences as well. If addiction is a disease, then it isn’t a moral failure or a character flaw. Although the results of addiction may be criminal charges and toxic behaviors, if it is a disease, the root cause cannot be blamed on a spiritual defect alone. This has an impact on how addicts themselves cope with their problem and how they understand their condition.
Official rulings on the addiction question
2007 – Then Senator Joe Biden introduced the “Recognizing Addiction as a Disease Act”1 in the U.S. Senate (similar legislation is simultaneously introduced in the House). The act was calendared and didn’t pass. The introduction of legislation at the federal level does show how important the issue is.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), revised in 2000, does not include the diagnosis of addiction. Rather, the manual lists substance dependence, defined as:
"When an individual persists in use of alcohol or other drugs despite problems related to use of the substance, substance dependence may be diagnosed. Compulsive and repetitive use may result in tolerance to the effect of the drug and withdrawal symptoms when use is reduced or stopped. This, along with Substance abuse Substance Use Disorders...."
Although the Centers for Disease Control2 website mentions that excessive alcohol use is the third-leading lifestyle related cause of death in the U.S., neither alcoholism or addiction appears in their list of diseases.
In October of 2008, as part of the Economic Recovery Act, a provision to require insurance companies to treat “substance abuse disorders” in the same manner as chronic physical diseases passed the U.S. Congress. This marked a large step forward for the idea of addiction as a disease, if not medically, at least legislatively.
The National Institute on Drug Abuse does refer to addiction as a ‘brain disease’. Interestingly, a 2006 suggested name change for the organization to: National Institute for the Disease of Addiction did not occur when legislation failed to pass the House in 2007.
Substance Abuse is Damaging, Regardless of Its Origins
Regardless of the official rulings on is addiction a disease, addiction remains a well studied condition. Research indicates that drugs have an intense and immediate effect on the brain's physiology. Over time the changes contribute to profound alterations or 'hard-rewiring' within the brain because the brain reacts to the presence of the drug and tries to adapt to it. The modifications are real.
This physical change of state is balanced by the arguments that addiction is simply an unwanted behavior, a behavior that doesn’t fit the traditional idea of what a disease is. At some point before it becomes a condition over which a person has no control, addiction involves choice and human free will. To that end, it cannot possibly be categorized along with conditions such as Parkinson's, Alzheimer's, or other neurological diseases.
AA and the disease of addiction
Another argument against the ‘disease’ terminology rests in the spirituality of Alcoholics Anonymous and its relative success as a treatment for addiction. Some opponents think AA may have unknowingly hurt their cause by asserting addiction as a disease for so many years; AA accepts a disease model without much clinical data and offers a spiritual or religious component in most of its meetings. This point of view might imagine AA's approach to 'treatment' as equivalent to addressing a disease like MS with prayer.
For anyone touched by addiction, there is little doubt that it manifests itself as an uncontrolled and uncontrollable desire and craving to use something with known harm. The bottom line for those touched by addiction, no matter the underlying cause, once addiction emerges there is a real disease present.
While the rehabilitation community and most addicts will agree that addiction is a real disease – and a chronic disease as well – the established medical community defers from using the word "disease." In the middle are psychiatrists and some psychologists who use alternative terminology to dodge the controversy – substance abuse disorder, behavioral disorder and others. The fight will not be settled until the drivers of addiction are clearly laid out. Research continues to find the extent of genetic influence and to illuminate the brain chemistry and remodeling that happens during addiction.
Alongside the academic debate, legislative bodies, insurance companies and criminologists also have a stake. The trend, as of 2010, is to accept the disease terminology but retain the idea that addiction is a ‘special category’ of disease, one with sociological as well as physiological triggers.
photo by John Nyboer