Addiction Science Forum

I don't think that there is all that much difference between disease, condition, syndrome or disorder they all are something you can aquire or are born with, can be altered with medication or behavior modification therapy. Even the aquisition of an addiction is comparable to the contration of a disease.

You know that performing mouth-to-mouth resuscitation you might contract an bacterial or viral organisim that could cause you to have a "Disease, Disorder or syndrome" curable or incurable.

You also know that trying cocaine once could cause you to contract an addiction to the substance or it might not.

The major difference I think is the statistics of aqusition or Addiction Liability, the words are ambiguous they all cause changes in the body when present.

Wikipedia gives an interesting model of differentiation between disease, disorder, and illness:

http://en.wikipedia.org/wiki/Disease

In talking to people who know addicts, it seems that they generally blame the addict for being one. Calling it a disease might foster a different attitude towards addicts. Since "disease" is often a medical term, it might get the medical field more involved in addiction.

However, calling it a disease might have a negative effect... causing addiction to get lumped into the "pill-for-everything" criticisms.

If we decide to call addiction a disease, is there a specific point along the drug use continuum that it becomes one?

Some continuing thoughts on the use of the term "disease" to describe and classify drug addiction should help clarify why I think this is an important topic. And I go on record admitting that I have ignored this issue previously, thinking it wasn't really important; there are a lot of 'side shows' in the study of drug addiction that distract from the important issues. Often a lot of time and energy is wasted discussing issues that aren't really important, frequently involving seemingly trivial points that some make careers out of pursuing. The question of whether drug addiction represented a "disease, disorder, condition, syndrome" or whatever never really caught my interest before I was working recently on a seemingly unrelated project. Indeed, it seems important enough now to discuss it within the context of the Advanced Topics seminar, even though it should be a "Chapter 1" or "Chapter 2" topic in the previous course (i.e., PSY451 Drug Addiction).

Before doing the appropriate scholarly work (e.g., 'looking the term up,' consulting textbooks and review articles) and learning what I "should" think the term implies, I am curious about what implications it carries before thoroughly examining this issue academically and studying what other "addiction specialists" have to say about it.

First, "disease" usually implies "medical" and that's both good and bad. It's good because it suggests some organic/biological basis and not just the situation where one is misbehaving. It's bad because it implies the 'cure' is in medical treatment (aka the proverbial "magic pill") and even worse within the domain of the mainstream medical establishment (e.g., medical school, general hospitals and medical clinics). I find the last implication the most disturbing of all and of serious enough merit to consider avoiding the use of the term "disease." But of course there is more.

Second, the term "disease" seems to connote a disorder that is progressive if not checked by proper therapeutic intervention (and sometimes progressive even then because no effective treatments are available). Addiction and even the LATE stages of drug use leading up to addiction have this characteristic.

Third, "disease" implies a systemic disorder--the situation where an entire 'system' is affected and not just some isolated tissue like a simple infection. Addiction involves changes in brain reward and motivation systems and thus fulfills this characteristic as well.

The main downside of labeling drug addiction a "disease" is that it may be surrendering 'our' disorder (i.e., one clearly within the domain of motivational psychologists, behavioral neuroscientists, and psychopharmacologists) over to the "medical doctors" and at the same time disempowering the addict. (Interesting how well these two thoughts seems to fit into the same sentence, even 'stick' together, i.e., considering something within the domain of "medical doctors" while telling the patient they are helpless to remedy their own situation without a "real doctor's" guidance and help.) This attribute I certainly object to most strongly, and this single reservation may be enough to cause me to limit my labeling to that of a "disorder" and not a "disease."

The upside of considering drug addiction a "disease" includes:

1. biologically based, not within the normal control of the individual,

2. progressive, usually deteriorating condition that seldom spontaneously remits without appropriate intervention (often with a well-defined typical course), and

3. systemic disorder (i.e., involving an entire system, not just isolated tissue)--some integrative biological 'function' is seriously disrupted or threatened by the abnormal condition.

And there's the "1,2,3's" of why drug addiction should be considered a "disease." More thoughts are floating around in my brain that haven't yet crystallized enough to make it through to my finger tips (not even reaching the motor cortex yet), so that's enough for now. I'm more interested at present in learning what others think about this topic, particularly in light of my comments above.

(FYI: The issue that recently brought this to ‘center stage’ for me was my attempt to review several addiction treatment facilities that I thought were doing a reputable job of trying to treat drug addiction but which I soon discovered when delving into their treatment methods and ‘philosophies’ were in actuality pedaling psychodynamic BS, e.g., “we will help you discover the deep-seated psychological disturbances that led to your drug addiction and therefore maintain [non sequitur] your addiction.” Yuk! It briefly made me want to go back and complete medical school simply to dissociate myself from this type of thinking too often associated with “psychologists.” Labeling drug addiction as a “disease” [at least for me] quickly put some distance between my orientation and these charlatans. But then, I could be just trading one witch doctor for another!)

Replies specifically to the points raised by Joe and Tom.

First to Joe: I agreed with you most emphatically in the past. I'm now considering whether there IS something to be gained by labeling addiction as a "disease." Certainly these terms are ambiguous; no one really owns the territory to give definitive definitions beyond that found in a dictionary. And it's the connotations not the denotations that we’re addressing here. We have the opportunity to refine our use of the term and perhaps to put useful meaning back into it much like the term "addiction" when properly defined become useful again (see "Chapter 2" discussion about the use of the term "addiction).

Now onto Tom [pun intended ]: Yes, the first thing I'll do is "look it up in my Wikipedia" (hum, I’m quoting myself here) and then consult the numerous textbooks and journal articles in my office and later the library when this initial discussion has run its course. But I wanted to contemplate what I thought first, before being "educated" by the "experts." I wanted to get a feeling for what the term conveys before being given by other authors a specific use of the term beyond its literal meaning--thus, my solicitation of opinions and thoughts here and in class.

When does an addiction become a disease? That's almost rhetorical--obviously when it IS an addiction. But when does one consider the progression along the drug-use continuum to be a disease leading addiction? (noting the analogy raised by Joe) That's a tougher question. My quick answer is when the biological processes take over from the psychosocial processes that are critically important only during the earlier stages of drug use but which are not the actual cause of addiction. However, because there is no clear demarcation but rather a gradual transition that varies across individuals, a more specific answer becomes very tough.

Hi Professor,

First of all, congratulations on the new blog! You've got so much to offer the community that a platform for discussion/dialogue is fantastic. Well done.

The contention against calling addiction a disease (implying - falsely at present - that a cure is available) is extremely problematic. Further, it allows con-artists to sell snake oil "cures" to the ignorant and desperate (often for obscene amounts of money). I'm ashamed to admit that I actually worked and supported one of these "charlatans" (as you accurately describe). The practice is unfortunately very alive, well and unregulated.

That said however, the disempowerment of an addict/alcoholic against their disease/disorder is a fundamental step towards recovery. Whether called "disease", "incurable" or otherwise, the addiction is something to which one must surrender in order to recover. Whether this benefits charlatans or doctors is secondary to the ultimate benefit of the person suffering, IMO.

"Disorder" on the other hand, does not offer the same degree of disempowerment. If one has a disorder (perhaps called "mild", or "slight"), one might suggest it could be easily overcome or simply tolerated. We know that addiction is far too destructive to foster any such mindset. For this reason, "disorder" might also have a similar drawback as a defining term as applied previously to "disease".

If one is suffering from an addiction, my hope is that the person is so completely and utterly defeated that he/she surrenders. Admitting that one suffers from a disease can be comforting and sufficiently daunting to make surrender a rational choice.

Disorder just doesn't cut it. Of course, I might be overly biased or not yet sufficiently informed about "disorder". Just my $0.02.

Hello Professor,
I was in the process of preparing a much longer response to this question including commentary on a recent article by Dagher & Robbins (2009). I must now forgo that response after viewing a recent webinar on translational neuroscience. The behavioral endpoint is now being viewed as a robust biomarker. As science progresses, the scientific community will begin to view more disorders as disease states. The evolution of the scientific view of addiction will shape the funding sources for research and treatment. The view of addiction as a disease or disorder will be a matter of selection by consequence.

John

I agree with what Tom said. Saying that addiction is a disease makes it more medically relavent to certain fields, and almost takes blame away from the addict for being an addict. Although, a disease isn't something that you would give yourself with any intent, and although I am not saying that an addict becomes an addict by choice, I do beleive there is some choice involved.

I would just like to clarify that drug addiction is not arguably a disease, it is a disease. It is easy for an outsider to look in on drug addiction as a choice, which it is at first, but so is overeating which causes multiple diseases. It is a an inner disease, a disease of the mind. Not something you can cure with drugs or treatments. the only person that can cure it is the pacient. This is the only disease of its kind, where it is souly up to the pacient to cure themselves. please understand that i am a drug addict and always will be due to my disease. although i have been clean for two years this deamon never goes away.

Nothing like just trying to kick someone when they are down by now saying that they have a disease. Altho an addiction could be considered a disease, its not like we just contracted a disease, it is something that is now trying to be proved that something in our genes may make us more prone to certain types of drugs. If anything, a great love shown by an intervention could open up one's eye's to an addiction they have. Narconon Vista Bay has some great information on how we can go about an intervention and the steps we can take afterwards. If we cant help ourselves, lets get help from a place or person who has a proven track record. Keep up the good fight, we will win Much love to all!

It's a disease, I totally agree.. Many factors are involve in it and practically those are the reasons why it can't be stop that simple.

Hello Professor,

This may not be the proper category to address my question. What is your opinion on the hypothesis that drug addiction is a form of self-medication. Within this view the addicted individual may have chosen their particular drug to reach a state of positive affect to avoid a negative affect state. The individual may have originally been seeking a homeostatic balance for positive affect, but in turn after time the drug has changed the homeostatic set point thusly the individual now seeks the drug to maintain a homeostatic balance.

John

I think calling addiction a disease is a cop-out.

I’ve never paid much attention to the differentiation between illness, disorder and disease… It was really interesting to read these comments and opinions. Still, whether it is a disease or not, I consider the drug addiction to be awful. I’ll use the post for my custom writing service.