The stigma of addiction is alive and well. Whether you believe in the disease model or not, it seems that people’s judgments regarding what it means to be an addict are well entrenched.

I’d like to work on that a bit.

Why is addiction a disease?

In numerous posts on this site I’ve addressed issues like genetic predisposition and the effects of drugs on the brain that impair addicts’ ability to control their choices. A disease is commonly defined as “A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.” (See Answers.com) I don’t think there’s a question regarding whether or not addiction involves a pathology of a body part, namely the brain.

It would definitely be easier if we could all just say that addiction is the product of bad choices. Nevertheless, all the science I’ve seen points to the fact that addicts have impaired decision making to begin with that is only made worse by the drugs they take in.

A comparison with Diabetes

For some reason, this still leaves a lot of people seeing addicts as the only ones to blame. I’d like to try a different approach:

We’ve all heard of type 2 diabetes. It’s the kind people aren’t born with, but rather are develop later in life. Most cases are the result of an over exposure of the body to sugars that breaks down its ability to produce insulin, leading to the disease. There are an estimated 15 million people in the U.S. who have type 2 diabetes. They make up 90% of diagnosed diabetes cases.

I think that type 2 diabetes is a disease that can help many reformulate the way they think about addiction.

Patients with adult onset diabetes likely have genetically reduced insulin receptor functionality and possibly other factors that increase their likelihood of developing the condition. They also likely consume more sugars than people who don’t develop type 2 diabetes, though the exact causes are still uncertain. Nevertheless, with early detection, the disease progress can certainly be slowed and perhaps even halted. As the disease progresses, the body’s response to sugar is altered, eventually resulting in what looks like a severe alergy to sugars. However, once developed, type 2 diabetes patients often require similar treatment courses, including medication, exercise, and dietary changes that patients with type 1 diabetes (the type present early on in life). At this point, simply cutting back will no longer do.

This is not all that different from addiction.

Addicts are often born with a set of genetic and environmental factors that predispose them to impulsively engaging in and seeking out, risky, exciting activities. Moreover, the addict’s reaction to drugs is often different than that of non-addiction-prone individuals. For example, many stimulant abusers report a calming, rather than excitatory, effect of drugs like methamphetamine, cocaine, and the likes. That was certainly my experience back in my crystal meth days.

It is true that here the predisposition is more abstract, since it resides in brain activity patterns, but as I’ve said many times before, the brain is certainly a physical part of the body and should be treated as such. Like diabetic patients, once addicts begin using the drugs in large quantities and for extended periods, the drugs cause alterations in physical systems. Like diabetics, once these changes occur, they are certainly long lasting, if not permanent. Dopamine function in the brain of crystal meth abusers has been shown to take as many as 2 years to return to anything resembling non-user levels and we have no way of telling if the newly formed dopamine activity is at all related to what was previsouly there. Once the disease we know as addiction (or dependence) takes hold, there are specific recommended treatments that need to be followed. Simply cutting back will no longer do.

The bottom line?

Addiction fits the model of a disease as well as many other conditions. I have no doubt that people’s moral judgments get in the way sometimes and make it hard for them not to fully blame an addict for their trouble. I don’t doubt that addiction can only develop with the use of drugs, but if there are pre-existing conditions that make that use more likely, I think it need to be taken into consideration as well.