Doubt Addiction Is A Disease? I Did.
Two-thirds of respondents as recently as a 2004 poll attached a stigma to addiction, so a large majority doubts it’s really a disease.1 When I was carted off to rehab I was among them. I believed alcoholism resulted from moral defects, weakness chief among them, and that I was “Exhibit A.”
When I detoxed to sufficient coherence, rehab insisted addiction was a disease. Contrary to what I presumed, they said addiction didn’t result from a willpower deficit or a perverse failure to curb one’s baser impulses. Such attitudes were ignorant folklore since dispelled by medical science. I had a brain disease, they said, and I shouldn’t confuse the symptoms with the cause.
I didn’t believe them for an instant.
I considered myself an “evidence guy,” and I saw precious little evidence. I’d been a DA investigator and an Assistant DA. I was trained to be skeptical of every statement until it was vetted and verified. I was looking for hard facts proving addiction was a genuine disease (to get me off the guilt-and-shame hook, no doubt) but didn’t find any.
To me, the disease model was just another thing I was supposed to take on faith and I refused to take anything on faith. I couldn’t shake the inherent contradiction between the theory of what was wrong with me and the treatment. If addiction was a disease, a physiological failure, why wasn’t there a medical intervention? Why was recovery dependant on AA and a spiritual solution, which is what rehab prescribed? Because it works, I was told. But they never explained why, at least not to my satisfaction. As a result, I left rehab talking the talk of the disease model, but didn’t really believe it.
I was so consumed with not drinking one moment at a time, however, so confronted with the reality of daily life sober, I had neither the energy nor the inclination to think much about the disease model. As a topic for discussion, it seemed to fall off the end of the Earth. It wasn’t addressed in the multitude of AA meetings I went to where “the Disease” seemed like a catch-all term for addict thinking not a medical diagnosis. Sure, AA’s bible, The Big Book, said alcoholism was a disease, but I didn’t put much stock that opinion, at least not at first.
Then in the fall of 1997, a year after my second stint in rehab, a manila envelope arrived in the mail from my retired-scientist father. It contained the latest issue of Science Magazine, a special addiction issue. It said: “The addicted brain is distinctly different from the non-addicted brain … That addiction is tied to changes in brain structure and function is what makes it, fundamentally, a brain disease. A metaphoric switch in the brain seems to be thrown as a result of prolonged drug use.”2
Science went into exacting molecular-level detail describing precisely what parts of the brain were different in addicts and how those changes resulted in addict behaviors. Here at last was the proof that had been lacking in rehab.
Accepting that addiction was a brain disease relieved me of the shame and humiliation I felt over not being able to control myself. That, in turn, led to the emotional acceptance necessary for long-term sobriety. (For more, click on How Becoming a Neuroscience Geek Explained and Supported My Recovery.)
That issue of Science was nearly a decade and a half ago. Since then, addiction research has significantly strengthened the case for the disease model. But negative perceptions lag behind. Experts trust the abundance of evidence will eventually change attitudes. As researcher Dr. Charlotte Boettiger, of the University of North Carolina at Chapel Hill, put it, “It’s not unlike chronic diseases such as diabetes. It wasn’t that long ago that we believed schizophrenia was caused by bad mothers and depression wasn’t a disease. Hopefully, in 10 years, we’ll look back and it will seem silly that we didn’t think addiction was a disease too.”3
There’s reason for hope. The American Journal of Public Health reported in 2006, that although most people believed depression and schizophrenia to be treatable diseases, that was not the case for addiction. However, the study also found that people were open to persuasion: the more likely they were to believe addiction had a biological basis, the more likely they were to support treatment for it.4 I believe it, because that was precisely my experience.
For the next article in the Preconceptions series click here.
For more on the disease of addiction, click on the Addiction Science Intro/Menu.
1. An Anti-Addiction Pill?, The New York Times Magazine, June 25, 2006
2. Addiction is a Brain Disease, and It Matters, Science Magazine, October 3, 1997.
3. Brain Imaging and Genetic Studies Link Thinking Patterns to Addiction; Journal of Neuroscience, Dec. 26,2007.
4. Public Has Preconceived Ideas On Psychiatric Therapy, Reuters, October 13, 2006.
Have you read:
1. Brainwashed: The Seductive Appeal of Mindless Neuroscience.
2. The Sober Truth” by Lance Dodes, MD
No, I haven’t yet, though I intend to when I get the chance.
Deep thinking – adds a new dismenion to it all.