(Let me start off by saying that I realize addiction is classified as a disease by medical professionals. So this post is not about the legitimacy of labeling it as such but whether it is helpful or hurtful to addicts to classify their problem this way.)
If someone stopped you on the street and asked you to name 5 diseases, well, first you’d probably take a few steps back and ask why the hell they want to know. Your next move might then be to name illnesses like cancer, cystic fibrosis, Parkinson’s, ALS, or MS. Most of us don’t think “addiction” when we hear the word disease.
Yet recently, this term has been used often when discussing the great actor Phillip Seymour Hoffman’s overdose on heroin. People have shown great compassion for Hoffman’s struggles with addiction, expressing sadness over his passing and shaking their heads at yet another soul lost to a compulsion they could not control. And while I am glad this tragedy has at least got people talking about this all too common but overlooked problem in our society, I still feel that twinge of resentment, that tiny flicker of anger when I hear that word, disease, used in reference to addiction. Perhaps this is because when I think of disease, I picture an illness that a person has acquired through no fault of his/her own, a condition that has no relationship to the behavior of the individual or the choices he/she has made.
But this isn’t entirely true for addiction. Because even with addiction, there are choices. A choice to do drugs (and this includes alcohol). A choice to escalate that use. A choice to not stop using in spite of the negative effects it has on yourself and others.
And yet, I recognize that there are many other “diseases” in which choice plays a significant role. Take Type II diabetes or lung cancer for example. Not everyone who has these illnesses “brought it upon themselves”, but more often than not, these conditions are the result of years of bad decisions. Now that doesn’t mean that I would say to someone with lung cancer, “good, you got what you deserved.” Or that I wouldn’t have compassion for those who are suffering from Type II diabetes, even if it is the result of their own choices. It just means I find the term disease troubling when used to describe these conditions because its connotations somehow imply that the person suffering shares no responsibility for their plight.
Don’t get me wrong. I realize that once someone is addicted it is not a simple matter of will power to overcome the temptation to use. However, I resent the idea that an addict is “powerless” over their addiction. I resent it because it does those battling their addiction a disservice while also providing them with a convenient excuse when they sometimes lose a battle.
Think about it. If there was no element of volition in addiction, then why is it that some addicts are able to stay sober while others are not? If it is truly a “disease” in which one is powerless, then how does one get or stay sober in the first place? Again, I’m not saying that there isn’t an element of compulsion or that the brains of addicts have not been altered due to their addiction. Just that in the struggle to stay sober, choice plays a role and that using the word disease to describe addiction sometimes undermines this fact. Furthermore, it discredits the efforts of the “recovering” addict as well. Staying sober is a hard, hard task. One that requires commitment and strength and honesty and a network of support. So when we say that addiction is a disease in which the addict is powerless, it feels like we are also saying that their sobriety is not their own, not something that they clawed and climbed their way out of the darkness to achieve.
Furthermore, referring to addiction as a disease provides the addict with a convenient scapegoat when they do relapse. They often use this “diagnosis” as a way of avoiding blame or explaining away their mistakes. “It’s not my fault. It’s a disease” is something I’m sure many a loved one of an addict has heard before.
And so it is for these two reasons that I resent referring to addiction as a disease. It doesn’t help the addict or those affected by addiction.
What might actually help addicts is to rethink how we discuss addiction. Not just whether or not it’s a disease but how we can prevent people from becoming addicted in the first place. After all, no one smokes their first joint, takes their first shot, or snorts their first line thinking they will be an addict. We all think we will be the exception, even when we have had front row tickets to the main event our whole lives and know the predisposition for addiction lies deeply embedded in our DNA. Even then many decide to play Russian roulette, never knowing whether they’ve lost or not until it is too late.
So this is what we should be focusing on when we talk about addiction: how to stop people from becoming addicts in the first place. To do this, we need to understand why some people become addicts and others do not. We need to know if there is an identifiable “tipping point” in which recreational behavior turns into something more sinister. Just when does a person’s brain chemistry or wiring change so that he or she is now an “addict”? Are there genetic tests that can determine the degree of one’s predisposition for addiction? Perhaps if we could tell people from a young age just how great their odds are, then maybe we could convince them to never pick up that beer or that joint or that pipe. Yes, most children of addicts already realize that they are at a higher risk for addiction themselves, yet there is no hard and fast rule for just how much so. Nor is there an explanation for why one sibling becomes an addict while the other does not. The one thing we do know is that the earlier one starts using the more likely he/she is to develop an addiction. Perhaps this should be emphasized in drug awareness programs rather than focusing on the immediate physical damage that can be done. Because the message we send to children is hypocritical, telling them not to drink as we lift our glass of wine. Maybe if instead of trying to scare them away from experimentation, we explain that waiting until their minds have fully developed will allow them to better enjoy the pleasure that mind-altering substances can provide, they might actually listen.
In addition to preventing addiction before it starts, we also need to know if there are different types of addicts (not just people addicted to different substances) so that we can better help people who become addicted. Currently, we rely on AA as the panacea for all addictions even though its long term success rate is abysmally low and it fails to recognize that addicts are a very diverse group of individuals. Because of this diversity, what helps one person stay sober may not be as effective for another. Sure, there may be some universal elements among all treatments, such as insisting on accountability for one’s actions, but there should also be some flexibility and individualization. Treatment should be tailored to the individual, perhaps combining pharmaceutical aids with behavioral modification therapy for one person while teaching another to place their faith in a higher power and to attend daily meetings.
These are the types of discussions we should be having in light of yet another life lost to addiction. Because even if Phillip Seymour Hoffman’s death was the result of his own poor choices, this does not mean we do not still mourn his passing.