by A. Tom Horvath Ph.D., ABPP
If you believe addiction is a disease, you won’t like this article. I am writing for individuals who are not sure what to believe about addiction. My hope is to persuade you that addiction is not a disease, but a type of habit you can learn to change just as you change other habits.
With the substantial attention given lately to pictures of the brain on drugs, it would be easy to overlook the fact that the brain will look different moment to moment, and that anything we do (or take into our bodies) will show up somehow in a brain picture. That different parts of the brain “light up” for different experiences is a basic fact of interest to neuroscientists, but what does it mean?
Let’s approach the question of addiction as a disease from a different direction. The disease concept appears to explain why people keep using substances or engaging in their activities (e.g., gambling, shopping, pornography, etc.). However, if one has a disease, how does one stop?
You might ask individuals who believe in addiction as a disease how they answer this question: If addiction is a disease, how do you stop? My own experience is that I never get an answer that makes sense: Because there isn’t an answer that makes sense.
There is the answer given in various 12-step groups such as Alcoholics Anonymous (AA), Narcotics Anonymous or Cocaine Anonymous. In these groups recovery is about letting go to a higher power. That process of recovery is fine if it works for you, but what other diseases do we treat by letting go to a higher power?
Aside from the 12-step answer, the rest of the approaches to “treating” addiction call upon the concept of a multi-factorial disorder, one which requires multiple efforts for recovery, such as better nutrition, attending support meetings, being in psychotherapy, learning to cope with craving, etc. You can form your own opinion, but I suggest these efforts are in fact all part of the process of habit change.
OK, maybe addiction as a disease doesn’t make sense, and changing addiction is really just a habit change process. Is there any harm in considering addiction a disease? Yes.
First, there are the distracting questions: Do I have a disease? Am I an addict or alcoholic? The important question is, regardless of what I call it, what do I need to do about my drinking, drugging, other behavior, etc? For many people deciding they don’t have a disease (“Really, those people have far worse problems than mine”) means they don’t address the problems they have. Some of those problems will get worse. Wouldn’t it be better to address them before they became a “disease?”
Second, the disease concept is de-motivating. “If I have a disease I can’t get rid of, maybe I should just give up?” Third, there are many complaints that we stigmatize individuals with addiction problems. We could make significant progress reducing stigma if we didn’t label them as addicts or alcoholics. Rather, we could recognize we all have bad habits, and that all of us face the same fundamental questions about how to control ourselves in the face of temptation.
If you still want to believe addiction is a disease, it’s obviously your choice. But if you want to view it differently, there are several good reasons to do so!
About the Author:
A. Tom Horvath, Ph.D., ABPP, is a board certified clinical psychologist and president of Practical Recovery (alcohol treatment), an addiction treatment facility in La Jolla (San Diego), CA, focusing on collaborative care and self-empowerment.