For roughly the last one hundred years in America, public perceptions of the nature of addiction have varied considerably, and addiction treatment programs have been equally inconsistent. However, the rise of Alcoholics Anonymous (AA) following prohibition can be said to be the genesis of the current movement to label addiction as a disease.
For its part, the US Government, as an agent of public policy, does not appear to have a consensus opinion. For example, the Centers for Disease Control in Atlanta (CDC) does not include addiction or alcoholism among its A-Z list of diseases, yet the National Institute on Drug Abuse readily defines addiction as a brain disease.
The question of whether or not addiction is a definable disease has long been a subject of debate in the medical community, but now this debate has reached the US Congress. In 2007 two identical bills were introduced, together called the Recognizing Addiction as a Disease Act of 2007. If this act passes, the names of two government research institutes will be changed to reflect addiction as a disease:
- National Institutes on Drug Abuse -- National Institutes on Disease and Addiction
- National Institute on Alcohol Abuse & Alcoholism -- National Institute on Alcohol Disorders & Health
To some degree it's simply semantics, but the more pressing issue is what, if any, long-term effect these name changes will have on such things as public health policy, criminalization, and the social stigmatization of addicts. In terms of immediate, instantaneous effects—nothing moves that quickly in a bureaucracy the size of the US
Proponents (Summary)
As a means of framing proponent arguments, I'll use the definition for addiction as presented by the Genetic Science Learning Center at the University of Utah:
"Drug addiction is a chronic disease characterized by changes in the brain which result in a compulsive desire to use a drug. A combination of many factors including genetics, environment and behavior influence a person's addiction risk, making it an incredibly complicated disease. The new science of addiction considers all of these factors - from biology to family - to unravel the complexities of the addicted brain."
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 in effect the brain reacts to the presence of the drug and tries to adapt to it.
Behavior
The most controversial aspect of this definition might be in its behavioral approach. Physician and addiction specialist Kevin T. McCauley, M.D defends this, writing, "the behavior of addicts can be frustrating, revolting — even criminal. But in medicine, the character of the patient is separated from his or her symptoms, however unpleasant or harmful. Patients are not judged based on the palatability of their symptoms."
Put another way, reading and interpreting the symptoms of a disease help doctors to diagnose it, but these symptoms themselves are not appropriate treatment pathways. For example, If a patient is screaming about some extreme lower body pain, doctors do not treat this pain by disabling or removing vocal chords.
Opposition (Summary)
The behavioral aspect of this model is what chiefly troubles its opponents, and it can be expressed in two ways.
The first is a very old approach: that addiction—at some point before it becomes a condition over which a person has no control—involves choice and human free will. To that end, it can not possibly be categorized along with conditions such as Parkinson's, Alzheimer's, or other neurological diseases.
The second 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, 1) without any consistent clinical data to support the claim, and 2) by offering a spiritual or religious approach in their 12-step program. One might imagine this ‘treatment' as being the equivalent of addressing a disease like MS with prayer.
Conclusion
There is a general agreement—albeit slim—that at some point, an addict loses the ability to control his urge or desire to use drugs. What happens in the time leading up to this is the debate's true battleground featuring a complex hive of factors, not all of them easily proven or disproved. The foundation of the medical community is on the scientific method, on research and clinical trials; it can't rely on anecdotal evidence. br>
Thus if changing the names of government research institutes to reflect addiction as a disease means more resources will be applied towards finding effective treatment options for addicts, it seems like an unimpeachable step in the right direction.
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