I find this topic extremely exasperating; having to convince a colleague or a patient’s family member that addiction is a disease and not a moral weakness or strictly the result of poor choices. However, before we embark down this road, I feel compelled to provide some basic definitions of the word disease and its antonym health by utilizing some well-known resources.
What is disease?
The American Medical Association defines disease as an impairment of the normal functioning of some aspect of the body, characteristic signs and symptoms, and harm or morbidity.
Can we all agree that…
- The brain is the primary organ in the body that is deeply disrupted in addiction?
- The brain constantly evolves and changes throughout addiction?
- That these changes produce signs and symptoms consistent with drug withdrawal, physical cravings and a disruption in brain regions that are important for the normal process of motivation, rewards and inhibitory control.
- That left untreated, addiction leads to illness and death.
I am hopeful we can.
The choices made…
I agree that initial drug experimentation was a personal choice made by an individual and not some type of supernatural, unexplained phenomenon of which he or she had no control over. We, who advocate for the brain disease model, are not disagreeing with that.
What we are disagreeing with is that this choice to use substances remains static or unchanged during disease progression. Through advancements in neuroimaging, it has become very clear that brain tissue changes with chronic drug exposure and control/choice is markedly disrupted. By disrupted, I mean that the choice to use or stop using drugs has changed with continued substance use. This helps explain the process of increased “wanting” in contrast to just “liking” the drug in the addicted person. This also explains why an individual would continue to use a drug despite serious, sometimes life-threatening consequences.
Comparing diabetes and addiction…
I would like to look at another ailment in the medical community that we do view as a disease to see if there are more similarities than there are differences between a medical disease and addiction. How about diabetes mellitus?
Diabetes is a medical condition that is likely caused by genetics and lifestyle choices. I am of the understanding that these lifestyle choices tend to be deleterious to our health. Individuals with a genetic predisposition to high blood sugar, who routinely consume a poor diet with little to no exercise on their own volition, are at greater risk for developing diabetes.
Now this is where it becomes interesting.
We know, like mental illness, 40 to 60 percent of the risk for developing addiction lies in our genes. We also know that lifestyle plays an important role in the development of addiction. Growing up in poverty, growing up in a household exposed to drugs, use at an early age, past trauma, low socio-economic factors or choosing to use a mind altering substance can all increase the risk for developing addiction.
Genetics and lifestyle appears to be similar causes to two completely different illnesses – diabetes and addiction – in which one we treat without prejudice and the other we scorn and shame.
The Center for Disease Control (CDC) estimates that diabetes results in 76,488 deaths per year. If you combine alcohol, other drug addiction and tobacco abuse, the number of deaths per year is an astounding 680,000. Only cardiovascular disease has a higher number of deaths per year at 750,000.
Other lifestyle choice diseases…
Let’s look further to see if there are other well established and “accepted” diseases within the medical community that are also, in part, related to lifestyle choices.
My brief literature search has resulted in the following diseases; obesity, hypertension, stroke, osteoporosis and cancer are all listed as a “lifestyle disease”. A lifestyle disease by definition is a disease associated with the way a person or group of people lives. Perhaps critics of the brain disease model should view addiction as a lifestyle disease. Maybe this would help remove the stigma and stereotypes that our patients commonly encounter with our nonbelievers.
Now, let’s examine the meaning of health.
The World Health Organization defines health as a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity.
Fascinating, the last time I treated a patient who was actively struggling with their addiction, I do not recall them declaring that I feel physically, mentally and socially sound; quite the contrary in fact. If the critics do not accept addiction as a disease, then certainly I hope they can agree without debate that it is not health.
So, what is addiction?
The American Medical Association defines addiction as a primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. I could not agree more.
Addiction is no longer something that has to remain hidden or ashamed of.
There is treatment and hope. Many people who have reached for addiction treatment have changed their lives. I am completely honored and grateful to work in this field of medicine. I only hope more professionals can step up to the plate and help restore function and peace in our patients lives.
“Addiction becomes treatable when the right people come together.”
John Budnick, PA-C is a Board Certified Physician Assistant experienced in both inpatient and outpatient psychiatric settings. He has obtained a Master’s of Physician Assistant Studies from Grand Valley State University, and has practiced in the field of addiction medicine since 2002. John is an adjunct instructor in the department of Psychiatry for Michigan State University, College of Human Medicine. He is also a faculty member of the Addiction Psychiatry Fellowship starting at Pine Rest in 2018.
John has had extensive experience with evidence-based and system-based practice of different aspects of addiction psychiatry including; outpatient substance abuse treatment, inpatient detoxification, medication assisted treatment with buprenorphine and naltrexone, management of patients with dual diagnosis and consult addiction service at Pine Rest.
John’s area of expertise is in the diagnosis and medication management of psychiatric and substance use disorders in adults 18 years and older.