Defining an addiction as a disease is an ethical issue that we want to address. The first thing to know is that there are three categories of diseases.
The first group consists of disorders known by their physical symptoms and caused by a microbe or virus. These include polio, malaria, influenza, AIDS, tuberculosis, and so on. This list once included cancer, heart disease, and stroke, which are now recognized as related to lifestyle choices involving diet, exercise, and stress. The standard medical approach for treating diseases on the first list is to identify the specific microbe that causes the disease and then develop antibiotics to kill it or prevent its spread in the body. Also in this group are diseases thought to be inherited, which include diabetes, cystic fibrosis, Down syndrome, and hemophilia.
The second category of disease includes mental or emotional, illnesses. People in this group are usually diagnosed not through blood samples or brain scans but through analysis of their thoughts, feelings, and behaviors, leading to a judgment that these social symptoms and behaviors are outside the normal range of accepted social norms. How far outside the social norms a person is judged to be determines whether he or she is said to have a neurosis, a personality disorder, a psychosis, or a character disorder.
The third category of (so-called) diseases is addiction. Addictions are even further removed from the microbe- or virus-caused physical diseases in the first group.
The Addiction-as-Disease Theory contends that
(1) you inherit a genetic disposition to the addictive behavior;
(2) the genetic disposition takes over your body and brain and causes addictive behaviors that exist independently of the rest of you; and
(3) addictions are progressive and irreversible and will lead to death if not treated The logic behind this all-encompassing theory breaks down quickly when applied to specific situations.
For example, when people addicted to smoking cigarettes give up smoking, they are no longer seen as addicts. According to addictionology (the study of addictive behavior), this is not true for people addicted to activities, relationships, sex, food, and substances. These people are told that there is no known cure for their disease, and that they will never get much better. In fact, they are told they could get progressively worse and die. The best they can hope for is to not get any worse. In the meantime, medical research money is being spent to look for chemicals that will bring relief to the countless millions of so-called addicts. According to estimates, 96-98 percent of the population has at least one addictive disease, and many people are diagnosed as having multiple addictions. Those who promote this idea about addiction usually describe it according to a specific disease model.
The Disease Model for Addictions
- The disease is marked by a loss of control over one’s behavior.
- Education and training does not enable the sufferer to gain control of his or her behavior.
- The disease will get worse regardless of any lifestyle changes.
- The disease is a permanent flaw or trait, and the sufferer must adjust to this reality for the rest of his or her life.
- The disease will eventually kill the person if long-term treatment is not used.
Traditional Approaches to Treating Addiction
- Sufferers are encouraged to join support groups organized by and for those who share the disease.
- Sufferers receive medical treatment in a hospital or clinic, under the supervision of a physician or trained specialist.
- Addiction is framed as a moral issue, and people with this disease may be shamed for not living up to the moral standards or codes of conduct of those who dont have the addiction.
- Friends, family members, bosses, therapists and ministers vigorously attempt to identify people with addictions and to force treatment on them, even against their will, because they deny having the disease.
This set of criteria has allowed 20 million Americans to be diagnosed as alcoholics and another 80 million as co-dependents. In addition, 80 million have been diagnosed as having eating disorders (if you count obesity), 50 million as being depressed and anxious, 20 million as gambling addicts, and about 25 million as love and sex addicts. Add to this number the countless workaholics, religious addicts, shopping addicts, addicted smokers, and spectator sports addicts who aren’t generally counted in the official statistics. Even without counting the unofficial addicts, the total number of people diagnosed as addicts in this country is over 275 million people. This means there are enough cases of addiction to allocate one to each man, woman, and child in this country. Yet as noted earlier, only alcoholism research shows evidence supporting the disease theory, since it may involve an allergic reaction to sugar rather than to alcohol itself. Other addictions that show no evidence of physical symptoms should not be labeled as diseases.
For a more complete discussion of addictions, see Chapter 4 of our book, The Flight From Intimacy.