Addiction, and why it is a disease.
Hello, and welcome! In this week’s blog, I will be touching on substance addiction and why it should be considered a disease.
I’ve come to realize that the concept of disease is completely arbitrary. Most definitions are unable to fully account for the vast variety of diseases, but Dr. Duffin’s simplification of diseases as “bad and discontinuous” seems equally insufficient. Rather than trying to limit addiction to something so subjective, I’ve decided to restructure my argument to instead criticize the assertion that addiction is not a disease.
Let’s begin.
Perhaps the most prominent argument against addiction being a disease is the choice argument. It is illustrated by the following:
If an alcoholic were offered a drink while simultaneously being threatened at gunpoint to choose against it, they would.
This suggests that one can choose not to be an addict, whereas a cancer patient cannot simply choose to be healthy. The problem here is that choice implies will. Otherwise, the the person would not be in control of their condition, and the argument would fail. Considering our knowledge of addiction, and the extent of its destruction, I struggle to believe that anyone would independently choose the life of an addict. There must be some other factor at play.
Among all drug addicts, exists a symptom called craving, described as the “intense and uncontrollable urge to use substances”. Logically, craving seems to be the ultimate cause of substance addiction, while choices are merely an incomplete reflection of it. Thus, I would argue that addiction is not a disorder of choice, but rather a choice disorder. MRI scans have shown similar abnormal activity in the prefrontal cortex of subjects who frequently view pornography and engage in substance abuse. This is likely caused by the brain’s response to frequent exposure to dopamine, subsequently hijacking the reward circuit.
Simply put, the portion of the brain responsible for “decision making, and reward-aversion based learning” is hijacked. At this point, impulse control fails, and one becomes physically incapable of feeling happy, or even good, without practicing the addictive behaviour.
High and frequent exposures to dopamine builds tolerance by reducing receptors and stunting natural dopamine production.
So clearly, addiction like any other disease, is a malfunction of the body, and not exclusively our moral counterparts.
Furthermore, when considering the type of scenarios that initiate addiction, we typically think of foolishness. A person succumbing to peer pressure, or an adrenaline junkie, desperate to experience a new high. Research conducted by Joseph D. Deak, a scientist at Yale University, suggests addiction is usually comprised of factors beyond control. His studies have shown that genetics contribute approximately 40% to 60% to the influence of addiction. Over-expression of dopamine-related genes, or low expression of genes, such as CHRNA2, in the brain, have been linked to impulsive decision-making and indicate the predisposition of future involvement in addictive behaviours. This also applies to anyone who has experienced damages to the prefrontal cortex, and those suffering from traumatic stress and mental health disorders.
Such cases are common among addicts. Considering the plethora of predetermined factors that contribute to addictive behaviour, I doubt the choice argument’s ability to prove that addiction is not a disease.
In a final attempt to solidify the point at hand, let’s consider the comparison of disease that is well-established. Type II diabetes is often associated with obesity, inactivity, and high-sugar diets. Unlike addiction, denouncing diabetes as a disease because of its correlation with a person’s lifestyle choices would be met with severe criticism. I believe these biases exist due to a combination of the stigma that surrounds addicts and the physiological caused-based theory. Together, they emphasize patient-blame and create a more hostile attitude towards addiction.
The media’s frequent association of substance-abuse with poverty, unemployment, and homelessness, subconsciously affects our eagerness to consider addiction as a disease. As we know, shaming those who are experiencing genuine suffering has never been progressive. HIV for example, was thought to exclusively affect homosexuals and was even referred as the “gay plague”. This incredibly inaccurate stigmatization had no benefit to the treatment or research of the disease, and only succeeded in isolating patients from society. Similarly, by refusing to acknowledge that addiction is a disease, we are only contributing to prejudice and discouraging people from improvement.
Ultimately, I believe changing the definition not only promotes a more accurate representation of addiction, but also encourages the public to extend more sympathy and resources to recovering addicts.
By Angela Cai (she/her/hers) | Blog Committee Member
SOURCES:
25, M. (2022, May 25). How an addicted brain works. Yale Medicine. https://www.yalemedicine.org/news/how-an-addicted-brain-works
Altus, K. (2023, August 21). Recovering drug addict blames Philly leaders for “encouraging” criminals to “break all the rules” they want. Fox Business. https://www.foxbusiness.com/politics/recovering-drug-addict-blames-philly-leaders-encouraging-criminals-break-rules-want
Cleveland Clinic. (Year, Month Day of publication, if available). Is Addiction Genetic? Health Essentials from Cleveland Clinic. https://health.clevelandclinic.org/is-addiction-genetic/
Deak, J. D., & Johnson, E. C. (2021, October). Genetics of Substance Use Disorders: A Review. Psychological medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477224/
Demontis, D., Rajagopal, V. M., Thorgeirsson, T. E., Als, T. D., Grove, J., Leppälä, K., Gudbjartsson, D. F., Pallesen, J., Hjorthøj, C., Reginsson, G. W., Tyrfingsson, T., Runarsdottir, V., Qvist, P., Christensen, J. H., Bybjerg-Grauholm, J., Bækvad-Hansen, M., Huckins, L. M., Stahl, E. A., Timmermann, A., … Børglum, A. D. (2019, July). Genome-wide association study implicates CHRNA2 in Cannabis Use Disorder. Nature neuroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596896/
Harvard Health Publishing. (2021, September 28). Poverty, homelessness, and social stigma make addiction more deadly. Harvard Health Blog. https://www.health.harvard.edu/blog/poverty-homelessness-and-social-stigma-make-addiction-more-deadly-202109282602
Janet L. Brody, Ph. D. (2013, February 20). Your brain on drugs: What’s really going on? Youth Research Hub. https://youthresearchhub.wordpress.com/2012/11/30/your-brain-on-drugs-whats-really-going-on/
Mayo Foundation for Medical Education and Research. (2023, March 14). Type 2 diabetes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193
National Geographic. (2019, June 17). A day in the life of a baby elephant | BBC Earth [Video]. YouTube. https://www.youtube.com/watch?v=u_scpXuE4rk&t=32s
StefanoMirabello. (2023, September 4). How do you define disease?. NowPatient. https://nowpatient.com/blog/how-do-you-define-disease
The Independent. (2013, September 6). Pornography addiction leads to same brain activity as alcoholism or drug abuse, study shows. The Independent. https://www.independent.co.uk/life-style/health-and-families/health-news/pornography-addiction-leads-to-same-brain-activity-as-alcoholism-or-drug-abuse-study-shows-8832708.html
U.S. Department of Health and Human Services. (2023, June 2). Genetics and epigenetics of Addiction Drugfacts. National Institutes of Health. https://nida.nih.gov/publications/drugfacts/genetics-epigenetics-addiction
Valentish, J. (n.d.). Why addiction isn’t a disease but instead the result of “Deep learning.” NDARC. https://ndarc.med.unsw.edu.au/blog/why-addiction-isnt-disease-instead-result-deep-learning
By: Angela Cai
