It is a truth universally acknowledged, that addiction is more akin to a disease than a moral failing. Or almost universally acknowledged. There are still some who see substance use disorder (SUD) as the result of indulgence, laziness, the unwillingness to summon the willpower to stop.
That group is becoming smaller, especially in the face of the opioid epidemic which includes a great number of people who were taking legally prescribed medicines for pain relief and became addicted, including some older people who do not fit the scenario for beginning substance use disorder (usually though not exclusively adolescence and young adulthood).
In 2016, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Stated unequivocally that “addiction is not a character flaw – it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”
That the disease model of addiction took so long to take hold is in part because of a misunderstanding of what the term means. Obviously, addiction is not viral, you can’t catch it from randomly encountering someone or having them cough or sneeze on you. But that is not the only definition of disease.
According to the National Institute on Drug Abuse (NIDA), “Addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking, continued use despite harmful consequences, and long-lasting changes in the brain. It is considered both a complex brain disorder and a mental illness.”
Likewise, NIDA says addiction is not a disease that can be cured with a drug alone (although some drugs may help control it). “Treatment of chronic diseases involves changing deeply imbedded behaviors.”
There is a third opinion on addiction, however, one voiced by noted addiction journalist and former addict Maia Szalavitz, and predicated on the fact that most addicts seem to stop using drugs without any form of treatment at all. They just grow out of it.
In a Nov. 2014 column, Maia Szalavitz wrote:
“I prefer to see addiction as a learning or developmental disorder, rather than taking the classical disease view. If addiction really were a primary, chronic, progressive disease, natural recovery rates would not be so high and addiction wouldn’t have such a pronounced peak prevalence in young people.”
That high rate of “natural recovery” she mentions is the under-reported finding that most people with addictions do stop using the drugs of their own accord without going through treatment, usually in their mid-20s, “also the period when the prefrontal cortex – the part of the brain responsible for good judgment and self-restraint – finally reaches maturity.”
NIDA agrees that the risk of developing a substance use disorder is greatest if your use starts younger than age 18.
So, does this mean we can ignore the problem and let addicts mature out of it? No, of course not. If that were our approach, it obviously isn’t working. The rate and number of deaths due to a drug overdose is increasing. It may mean we have to change the way we treat and respond to addiction.
For one thing, we need to help make sure more young addicts have access to treatment. Just this month The Washington Post reported that “Not only are relatively few young people within this emergency receiving treatment, but the percentage is falling.”
Changes Maia Szalavitz recommends, based on how those who quit on their own did it, include:
- Find something (or someone) to be passionate about: a cause, a job, a hobby, a faith, etc.
- Find a more structured environment, such as a full-time job.
- And, in contradiction to the 12-step mantra, don’t see yourself as an addict. That may be self-defeating.
Those drug rehab treatment strategies won’t work for everyone every time, and Szalavitz concedes that includes a “significant minority,” but we must try every tool in the toolbox.
