Drug addiction as a disease: examining the evidence and implications

Sociology - Drug Addiction Theory

DRUG ADDICTION and THEORIES of DISEASE

Drug addiction is unlike other medical diseases, primarily because it is the result of voluntary behavior rather from exposure to bacterial organisms, viruses, or from genetic disorder. Whereas symptoms normally associated with organic diseases are well defined in strictly objective terms, the symptoms of addiction rely on subjective definition, and to a large degree, on cultural norms and expectations (Reinarman, 2005).

According to the National Institutes of Health (NIH), drug addiction is a brain- based disease, but many researchers dispute that conclusion, because the brain studies upon which it is based pertain equally to other non-medical behaviors, such as gambling, exercise, sex, eating, and even shopping, all of which are also capable of being indulged without resulting in addiction. In many respects, addiction characterizes a particular response among some individuals to behaviors indulged benignly by many others.

Admittedly, addiction may represent numerous social and behavioral components, as well as genetic predisposition that varies significantly from individual to individual.

No single component of behavior and no single aspect of inherent predisposition necessarily results in addiction on its own. Furthermore, certain individuals with the genetic predisposition do not develop addiction, even after indulging in the behavioral component that gives rise to addiction in others.

Therefore, it may very well be that defining addiction strictly, either as a behavior or strictly as a disease, is impossible without at least some element of subjective classification that reflects the underlying belief of the researcher, as well as social norms and cultural expectations (Reinarman, 2005).

Distinguishing Disease and Behavior in Drug Addiction:

Ordinarily, persons suffering from organic disease present very specific symptoms by which the disease is identified. While many symptoms of disease are not, by themselves, associated only with a disease, certain combinations of symptoms are universally characteristic of specific diseases, with well-defined expected durations and outcomes. Where human disease or condition is a function of organic physiological abnormality, every individual plagued with the specific abnormality that characterizes a particular disease or condition presents the same types of symptoms, with relatively few exceptions. Likewise, where the etiology of a disease is linked to exposure to bacterial organisms or other naturally-occurring or synthetic contaminants, that exposure nearly always results in disease onset, except in cases of natural immunity. Unlike different responses to addiction-prone drugs, instances where immunity confers protection are capable of being definitively identified and their mechanisms understood, strictly in objective principle.

A fundamental difficulty in characterizing drug addiction as a disease is that so many individuals indulge in the very same behavior without developing any symptoms of addiction at all (Sullum, 2003). Conversely, other researchers suggest that addictive behaviors like adult alcoholism are capable of prediction far in advance, by quantifying general behaviors of pre-adolescence and adolescence (LeGrand, 2005). However, the observations relied upon by LeGrand for this conclusion likely pertain just as accurately to many other adult behaviors, including antisocial conduct, family violence, and criminality, in general. None of those behaviors qualifies for definition as a disease, despite their recognizable personality predispositions and environmental factors.

Reinarman (2005) points out that differentiating alcoholism and (other) drug addiction from other destructive or antisocial behaviors in order to define only the former as a medical disease is only possible through definitional "elasticity" and "conceptual acrobatics." Perhaps one of the best and most obvious examples of the subjective nature of this differentiation is represented by the comparative view of alcoholism and nicotine addiction. According to NIDA (2007), tobacco use resulted in the death of approximately 100 million people in the twentieth century, with a projected total approaching 1 billion by the end of this century at the current rate of usage.

Nevertheless, NIDA still currently considers "drug" addiction as a disease, despite its contradictory failure to ascribe the same characterization to nicotine addiction.

In justifying its position that addiction is a "disease of the brain," NIDA (2007) relies primarily on neurological data provided by advanced methods of brainwave studies and brain imaging technologies, which identify characteristic differences between neurological responses to the ingestion of drugs and alcohol by individuals prone to addiction and the responses of individuals less prone to addiction to the same agents.

These studies demonstrate that the brains of addicts respond very differently from those of non-addicts, in intensity, as well as in terms of regional involvement (NIDA, 2007).

However, as Reinarman (2005) and others explain, many of these differences represent learned patterns of autonomic responses rather than inherent physiological differences characteristic of other medical diseases. Similarly, the same brainwaves and other neurological manifestations of drug addiction are equally apparent in the brains of individuals addicted to food, exercise, sex, gambling, caffeine, tobacco, and even shopping. Therefore, in principle, the same criteria should justify classifying as a disease virtually any human behavioral activity that causes these neurological responses.

Conclusion: