Is Addiction a Disease?

According to the news, drug addiction is at an all time high.  Many more young people are now overdosing on narcotics than previously.  Most Americans agree that something needs to be done, but there is no consensus as to what.

Last week I wrote that it was ridiculous to call addition a “disease like any other.”  I said that if it were, the authorities would not need to keep repeating this mantra.  My goal was not to explain addiction, but to use this as an analogy for the nonsense spouted by some in the mainstream media.

Yet when I read this to my wife, she objected.  A medical sociologist by trade, she defended the practice of calling addictions a disease.  She described the ravages caused by drugs and argued that medical treatment was often the appropriate response.

I, however, was not persuaded.  Although I knew about the death toll created by heroin and cocaine, I persisted in my opinion.  Mine was not, I believed, an uniformed attitude.  Having worked for years as a methadone counselor, it was grounded in painful experience.

Consider alcoholism.  There is no doubt that this condition can be fatal.  An over-use of alcohol destroys the liver and rots out the brain.  This is physiological damage of the worst sort that can indeed benefit from medical treatment.  But does this demonstrate that we are dealing with a disease?

I submit not.  Let me start with a pair of analogies.  If a person swallows a bottle of poison, is she sick?  Going to a hospital to get her stomach pumped out is a good idea, but was she ill.  Isn’t it more accurate to describe her as having injured herself and then required assistance in mending this wound?

Wouldn’t the same be true if a man had driven a nail through his foot with a hammer?  Suppose this was an accident.  Would that convert the damage he had done into an illness?  No doubt antiseptics would reduce the possibility of a subsequent infection, but should this later development be equated with his original mishap?

The point is that non-medical factors can create the need for medical interventions.  Not only diseases, but other causes generate physiological damage that responds to physiological treatment.

So what?  Why make a big deal about this distinction?  The answer has to do with causation and control.  In sociology we talk about the “sick role.”  When a person gets sick, let us say with the flu, he is advised to see a doctor so that he can be cured.  The disease is something that happens to him and the doctor is the person responsible for a cure.

Let us now return to alcoholism.  It is not something we “catch.”  There is no virus that has invaded our system.  People become alcoholics when they indulge in alcohol to excess.  This is something they do, not something that just happens to them.  Initially, they have a degree of control that folks who come down with the flu do not.

But again I ask, so what?  The “what” is that alcoholics are responsible for their condition in a way that those who suffer from the flu are not.  They could have prevented the eventual damage by reducing their consumption.  This was in their hands, not the lap of the Gods.

Medicalizing addiction places the responsibility in the hands of the doctors.  It absolves the sufferers of culpability and therefore lessens the demands that they refrain from dangerous conduct.  We are asked not to judge them for their irresponsibility, when that is exactly what we should do.

Drug addiction of virtually every sort would be easy to prevent if people simply stopped using drugs.  So why don’t we make this demand?  Regarding addiction as a disease is not only wrong—it is misplaced compassion.  Kindness of this variety has been complicit in many deaths.  We call it “enabling.”

Some would argue that addiction is too attractive to be prevented.  I say this is an excuse.  Some cultures, for instance the Jewish and Italian, have low rates of alcoholism.  Social pressures, combined with personal courage, can, in fact, reduce what is being described as an epidemic.  But first, we need to stop mislabeling the problem.

Melvyn L. Fein, Ph.D.

Professor of Sociology

Kennesaw State University