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Is Addiction Really a Disease?

“Another explanation of addiction disease which, I think, should be the subject of pathological research, is the probability that definite changes of the degenerative type occur in the nerve cells in the brain, and that this pathological change leads to the formation of abnormal channels of transmission of nerve impulses, whereby abnormal physical and mental effects are produced.” ~ Sir W. H. Willcox, M.D., a physician to St. Mary’s Hospital, delivering a speech before the Society for the Study of Inebriety, October 9, 1923 Although the American Medical Association did not officially declare that the most common form of addiction – alcoholism – was a disease until 1956, the concept of addiction as a disease has been around for hundreds of years.

The History of the Theory of Addiction as a Disease

In 1804, Thomas Trotter, a Scottish physician, wrote his M.D. dissertation entitled “An Essay, medical, philosophical, and chemical, on Drunkenness, and its Effects on the Human Body“. He is recognized as the first to classify excessive drinking as a medical condition. Around the same time, Benjamin Rush, a physician who was one of the Founding Fathers of the United States and a signatory of the Declaration of Independence, introduced the idea that alcoholism was a medical disease, rather than a sinful decision. Specifically, he believed that alcohol causes a person to lose control over himself, negating any conscious choice.

Determining If Addiction Is a Disease

To discuss whether or not addiction is a disease, questions must be asked within the accepted definition of what a “disease” actually is. To do this, let’s refer to Stedman’s Medical Dictionary:

  • Is addiction “an illness or sickness”?Absolutely. Alcohol-and-drug-related disorders are a major cause of death in the US, primarily in the form of cancer, heart disease, cirrhosis, accidents, and overdose. According to the National Institute for Alcoholism and Alcohol Abuse, alcoholism is the third-most frequent cause of death in the United States, after cancer and heart disease.

They also play major factors in rapidly-expanding health care costs. Nearly half of all inpatient hospital days and more than half of all emergency room visits are in some way related to drugs or alcohol.

  • Does addiction cause an interruption, disorder, or cessation of bodily functions, systems, or organs? – Again, absolutely. Over the years, there has been clear evidence that alcoholism/drug addiction causes damage to bodily systems and organs – damage to a degree that does not typically occur in non-addicted people.

The first, most-affected organ/system is the brain. Direct correlations have been made from numerous neuropsychological studies that the misuse of alcohol and drugs causes physical and chemical changes in the brain, resulting in cognitive and behavioral abnormalities. Other organs that are affected by substance abuse include the endocrine system, the heart, the pancreas, and especially, the liver. Excessive drinking can cause cirrhosis, or scarring, of the liver.

  • Is addiction “an entity characterized by an identifiable group of signs and symptoms”? – When the important distinction use and abuse are made, the answer is “yes“.

Alcohol use and occasional recreational drug use are not, in and of themselves, diseases. However, when the usage/drinking is heavy and frequent, a significant portion of those drinkers and users begin to experience substance-abuse related problems, including biomedical conditions.

  • Subjective distress – anxiety, shame, guilt
  • Interpersonal conflicts – arguments, divorce, ostracization from family and friends
  • Social issues – arrests, court fines, incarceration
  • Occupational problems – poor attendance, denial of promotion, loss of job
  • Incapacitation – cognitive/behavioral decline, inability to care for oneself, severe physical decline

Individuals with the disease of addiction also meet specific criteria for “Substance Dependence” as described in the DSM-IV:

  • Compulsive use – uncontrollable craving, inability to abstain or regulate the amount/frequency of use, drug-seeking lifestyle, loss of interest in other life activities, and continued usage, even in the face of problems and consequences
  • Tolerance – a need for ever-increasing amounts to achieve the same effect
  • Withdrawal – an array of physical/psychological symptoms when the substances discontinued
  • Mental disorders – specifically, those are caused by the physical changes in the brain that result from chronic alcohol/drug poisoning
  • Is addiction “an entity characterized by consistent anatomical alterations of known body systems”? – Once more, the answer is “yes”.

Alcoholism and drug abuse produce predictable symptoms and signs. There is clear evidence that there are biomedical changes that occur within the brains of drug abuser/alcoholics, especially when it comes to rewarding mechanisms. These changes in the brain reinforced continued and increased usage. In other words, the heavier and more frequently a person drinks or uses drugs, the more the brain changes, and the more likely the person is to increase the amount and frequency of use. It is a self-perpetuating cycle.

  • Is addiction “an entity characterized by a recognized etiologic agent/agents”? Definitely. There is a recognized connection between substance abuse and potential causal factors:
  • Genetics/family history – some experts are of the opinion that the biological component is responsible for up to 50% of addiction
  • Drug of choice – this is the catalyst that activates the genetic component
  • Environment – when there is a family/social history of drug and alcohol use and/or abuse, it is more likely that the catalyst will be introduced
  • Age of introduction – the earlier a person is exposed to drugs and alcohol, the more profound the effect is upon their brains

The Future of the Disease Theory of Addiction

Not everyone who ever experiences a drug-or-alcohol-related problem will develop the disease of addiction. Substance abuse disorder exists on a continuum, and there are many subtypes, primarily because there is no one single etiology. As the relationship between physiology, psychology, and neurology as they apply to the disease of addiction is further defined, there will eventually become less of a distinction between psychosocial and physical causes. The new accepted parameters will be an amalgamation of biopsychosocial symptoms and causes. In terms of recovery, this will mean that treatment will have to be multi-faceted, addressing biology, psychology, trauma counseling, environment, coping mechanisms, cognitive behavior therapy, interpersonal relationships, and any co-occurring mental conditions or disorders. If you think that you or a loved one are suffering from the disease of addiction and you want help, contact the experienced professionals at Ashwood Recovery. They help you regain your life with a multi-layered approach that can profoundly and positively affect your return to sobriety.