Is Addiction a Disease?
How about Diabetes?
How is type 2 diabetes a disease? Most people with type 2 diabetes are not born with it. Due to overeating, insulin is produced in higher and higher amounts to compensate for high blood sugar. Insulin pushes sugar from your blood into your cells for your body to use as fuel. Over time your body will become resistant to over production of insulin.
As insulin resistance develops, blood sugar levels will rise. This causes damage to your body by various mechanisms. Your body was not designed to constantly be flooded with sugar. Every organ in your body can be damaged and your white blood cells will no longer migrate effectively to fight infections.
People overeat for a number of reasons. High calorie foods are consumed because they taste good which makes you feel good. Overeating may also be due to stress. Type 2 diabetes is mostly due to behavior and partly to genetics. DMII is often the result of over indulging in a substance (food), that makes you feel good, or helps you cope with stress. This ultimately results in damage to your body.
How is DMII treated? Your doctor will probably tell you to work on your diet and exercise. Would they withhold life saving medication such as metformin or insulin? Would they tell you that you have weak willpower and that DMII is not a real disease? DMII is lethal when mismanaged.
How about opioid addiction? A substance is ingested (opioids) that makes people feel good or helps them initially cope with stress. Over time their body becomes tolerant to the substance. As this happens brain circuits in the reward pathway become damaged and no longer work as intended. This influences people to make poor decisions, which can lead to a lethal outcome due to overdose or misadventure.
Both DMII and addiction have a genetic and environmental/behavioral component. Neither are contagious, and generally are not born with either one. The disease processes are conceptually identical. However, how many times have you heard that addiction is not a real disease? That using medication to treat addiction is looked down upon? That weak willpower is the problem?
Both DMII and addiction have a spectrum of severity. Once brain circuitry is damaged from addiction or organs damaged from DMII, the strongest willpower in the world will not fix your body. Altered brain circuitry causes someone with addiction to form a compulsive and obsessive relationship with the substance causing poor judgement leading to bad decisions. By the time most people get help for addiction their life is in ruins and the severity of the disease is high.
We would not withhold medication to treat addiction the same way your family doctor would not withhold insulin to treat diabetes. Another perspective to consider if we take a look at the willpower argument is the following. What is more difficult to stop, heroin or a hamburger?
Every tool that exists should be used to increase your chance of surving this lethal disease.
Addiction
What is it exactly?
The American Psychiatric Association defines addiction as :
Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems. Yet a number of effective treatments are available and people can recover from addiction and lead normal, productive lives.
The American Society of Addiction Medicine defines it as:
Addiction is 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 behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
How do you treat it?
Addiction is a complex condition to treat. Current thinking suggests that addiction is due 50% to genetics and 50% to environment.
Treatment involves addressing any additional mental health conditions such as patients with "dual diagnosis". Often substances consumed in an addiction can create other mental health problems or self treatment of mental health problems can lead to an addiction. This is what the "dual diagnosis" term refers to.
As the patient receives treatment such as MAT (medication assisted treatment) or abstinence depending on the problematic substance we hope to bring stability and support in their life through various ways.
Support and stability will help the patient better deal with and address the problems in their life. This is the basis of addiction treatment in a very "bare bones" explanation.