Gray Matters: Addiction as a disease

The following article contains discussions of addiction. Information can be found on the National Institute of Drug Abuse website. Click here for the Substance Abuse and Mental Health Services Administration national helpline.

Our conceptions of addiction, particularly substance addiction, have changed over time. Science has brought us new perspectives on addiction, but not ones that seem to paint the entire picture.

It is an enigma; at its base, we can think of addiction as really well-learned behavior. After all, given just a few uses of a particularly addictive substance, that is already enough to get you hooked.

But, I wanted to discuss what is happening in our brains as we learn these behaviors, how perspectives have changed and are currently changing, and to grapple with the question: should we consider addiction a disease?

The first thing to recognize about addiction, as far as anatomy, is that the neurotransmitter dopamine takes the forefront. Dopamine is the habit-building neurotransmitter. It is released when we do something our brain will want to repeat in the future.

The dopaminergic system is an umbrella term used to describe specific pathways, behaviors and interactions of dopamine. One part of the dopaminergic system, called the nucleus, accumbens is particularly important because it is associated with the anticipation of a large reward and related to strong feelings of happiness.

But, when activation of the forebrain dopaminergic system exceeds a certain point, people (or animals) are sensitized to the conditions (the drug) that elicit those habits (using the drug).

At the same time, overaction of these systems downregulates the dopamine receptors themselves (so that less is released), and this has the effect of leaving the person less interested in other activities and less able to experience pleasure  from the things they used to enjoy.

When these systems are routinely abused, the brain “forgets” how to regulate dopamine in the absence of the drug, causing compulsive use and influencing people to make inappropriate decisions when looking for their drug.

“Medicalization,” a term I learned in SOC 001, is when something starts being perceived as medical or biological when it previously had not been.

This is what happened to addiction: a long time ago, heavy addiction was perceived as a result of moral weakness (lighter cases of addiction were mostly ignored).

Beginning early in the 19th century, however, we began to conceptualize addiction as a disease. In 1956, the American Medical Association (AMA) labeled alcoholism as an illness, and in 1987, the AMA and others termed addiction a disease.

In many ways, this can be viewed as a good thing. This new label of “disease” would begin affecting legislation and criminality in regard to addiction.

During much of U.S. history, but most notably between the 1960s and 1990s during Nixon’s “War on Drugs,” politicians began further criminalizing drug use.

This new outlook particularly harmed communities of color because of law enforcement’s focus on urban areas and lower income communities.

However, efforts like the War on Drugs were still effective in convincing people that drug use and addiction is a crime.

Thankfully, in the meantime, scientists continued studying the mechanisms of addiction and psychologists speculated the reasons behind why people begin addictive behavior.

As information accrued, it became clear that the development of an addiction is not something that can be controlled because the processes are automatic. It even became clear that people can’t fully control their environment, and therefore can’t ensure they won’t live somewhere that encourages drug use.

This information has helped move addiction from a legal sphere to a medical one, but the question still remains … if not a crime, and because of its relation to biology, is addiction a disease?

On the one hand, having a “disease” might make people feel more willing to seek medical treatment and remove much of the crushing personal responsibility many addicts experience.

On the other hand, addiction is not a virus. It is not bacteria and it is a result of our brains working exactly how they are supposed to. But, if addiction represents the brain working properly, why are we calling it a disease? 

Whether one has an addiction to hard work or meth, it will function similarly in the brain. If we choose to medicalize only the kind of addictions that can lead to death, then we are letting social ideals influence how we engage with biology, and that is arguably not a good idea for the natural sciences.

Regardless, there comes a point in everyone’s life when they are taught about addiction, and whether we medicalize it or not has profound implications on how it’s understood. It’s important to recognize our responsibility to teach these kinds of phenomena in a socially productive way.