“Physicians Group labels obesity a disease“; this was the article featured on CNN’s website recently that captured my attention and provoked questions about what I perceived to be an addiction. It prompted me to delve further into the correlation between an addiction versus a disease.
There are many definitions of the terms addiction and disease available online. I have chosen the simplest forms taken from the Merriam Webster dictionary for the purposes of this article. A disease is an illness that affects a person, animal, or plant: a condition that prevents the body or mind from working normally. An addiction is an unusually great interest in something or a need to do or have something.
Now that we have the basics down, let’s explore the theories surrounding an addiction being classified as a disease.
In 2011, The American Society of Addictive Medicine (ASAM), after a four year process involving more than 80 experts, defined an addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviours”. By virtue of this definition, as with all other chronic diseases such as Cardiomyopathy, Chron’s disease, diabetes, amongst others, one would expect that an addiction would be treated as any other disease would.
There is an ever-expanding support base for this definition. Dr. Marvin D. Seppala in a CNN article entitled “Addiction, the disease that lies”, has stated that an addiction is a misunderstood and deadly disease. He argues that addictions reside in the Limbic system (the part of our brain that is involved with memory, emotion and reward). He states that in the late stages of addiction, that aspect of the brain is re-prioritized. This is evident in cases where persons with no ill-intentions forsake their loved ones, risk their jobs and disregard their ethical principles to satisfy their addiction, not knowing that their addiction is now the most important thing in their life. He goes on to say that addicts are unable to make decisions to seek treatment as their addictions now takes precedence over their survival. He feels that with our expanding knowledge base, we are now able to treat addicts. His thoughts on the matter are seemingly in sync with what the American Society of Addiction Medicine has stated, “Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death”. I would assume that 80 experts over 4 years have done their due diligence, in which case, who am I to argue?
There’s always a flip side to every coin and in this instance, there are those medical practitioners whom seemingly reject this new definition. Lance Dodes, in his article entitled ‘Is Addiction Really a Disease? asserts several thought provoking points negating an addiction being termed a disease. He starts off by highlighting the fact that addicts were once seen as ‘different’ or ‘worse’ than normal persons. By virtue of their addiction, they were considered to be selfish, as only selfish people would seek to pleasure themselves regardless of the consequences of their actions. With redefining an addiction as a disease, it essentially removed the preconceived notion that addicts were morally reprehensible and beyond help. Dodes argued that an addiction cannot be explained by a disease process and interferes with identifying what the nature of a true addiction is. He asserts that in addictions there is no infectious agent, no pathological or biological process and no biological degenerative condition. He further asserts that an addiction is essentially the same as other compulsive behaviours such as shopping or cleaning. Recognizing this as a behaviour facilitates the recovery of addicts.
I can choose to accept or reject either of the above findings. That’s important, I can choose. I feel anyone can become addicted to a substance or process. I am not an expert in this field and as stated in my previous articles, my intention is not to rubbish the views of others or try to persuade anyone; instead, I wish only to express my own views on this. I acknowledge the fact that there are addictions that are the result of psychological disorders e.g. eating soap; however, I do not believe that someone addicted to say child porn should be treated in the same way a diabetes patient should be treated.
My thoughts are best expressed through this quote, ‘Everything in moderation, including moderation itself’ -Oscar Wilde. Many addictions are as a result of our failure to moderate. Not only do I reject an addiction being labelled as a disease, but I feel labeling addictions as diseases absolves us of our responsibility for our own actions. We run the risk of overlooking the root of the problem, thus not actually treating the source of our addictions but merely treating the symptoms.
So I just lost custody of my two children, husband filed for a divorce, having car problems and to top it off, I was just told they’re restructuring the organization and my position may no longer be needed. I see no light at the end of the tunnel so I dowse my problems in a bottle of vodka, head down to McDonald’s for that Big Mac I’ve been craving for the longest while and I decide to start smoking marijuana. I continue along this self-destructive path every day to the point where I am unable to function. Addiction as a result of emotional distress? or disease for which medical treatment is needed? If we accept the findings of the ASAM, I have a brain disease that can only be treated through medication.
Now let’s paint another scenario; John Doe had a hard time growing up, no father figure and his mother could not afford to send him to school. He joins a gang because they can offer him money for his services. He is now caught up with the wrong crowd and starts doing drugs. Years later, we find John Doe addicted to drugs, unable to make it throughout a day without ‘shooting up’. What is the source of John Doe’s problem? It could be that as a child, he was misguided, influenced by the wrong people, not afforded an opportunity to attend school and make a meaningful contribution to society. You could council John Doe, help him to go back to school, help him to find a job and make something out of his life or we could help John Doe the way the ASAM would help anyone with an addiction. Treat John Doe as someone with a brain disease and medicate him. Tell John Doe it is not his fault, his brain is just not working properly, never truly tackling what led John to start abusing drugs but let John know that there are other drugs available that can help him. Seeing a problem yet?
According to the CDC- Percent of adults 18 years of age and over who were current regular drinkers (at least 12 drinks in the past year): 51.5% and more than one-third of U.S. adults (35.7%) are obese.
According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Survey on Drug Use and Health, 23.5 million persons aged 12 or older needed treatment for an illicit drug or alcohol abuse problem in 2009 (9.3 percent of persons aged 12 or older). Of these, only 2.6 million—11.2 percent of those who needed treatment—received it at a speciality facility.
These statistics are disconcerting as they are, now throw in the fact that every one of those persons are being classified as ‘diseased’ and those are only statistics for drug abuse, obesity and alcoholism. We still have a barrage of other addictions to consider.
Now let’s take a look at the most popular addictions; alcohol, smoking, drugs, gambling, food, sex, the internet, games. What do these substances/services have in common? While I fully acknowledge other purposes of each of the above, it would be naive of me to disregard the fact that they also represent an escape. Our way of ‘dealing’, we have a drink when we have problems, we eat in excess, browse the internet or try drugs, instead of tackling the problem.It provides comfort to us in our weak moments, ‘takes the pain away’, if only momentarily. That is where moderation comes in, the onus is on us or those close to us, to help us control our intake. Now back to my first statement, we CHOSE to have that first shot of alcohol, it was not forced, should we continue with another 10 shots whenever we are having an off day, that is on us. One does not simply choose to have cancer, diabetes or any heart disease. There is a difference,sex addiction, drug abuse, alcoholism, obesity, these are addictions, a behavioural disorder not a disease. The first step is, as Dodes said, acknowledging the fact they are compulsive disorders and treat them as such.
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