November 30

Is addiction a disease or not?

Is addiction a disease or not?

According to literature, in today’s world, one of the most common diseases is addiction, but is it really? How psychologists and psychiatrists so certain that addiction is a disease? From past to present, there are many psychiatrist and psychologists claim that addiction should be classified as a disease. American Psychiatric Association (APA) (2017), clarifies that addiction is a complex condition, and it is a brain disease that is clearly shown by repeatedly substance use despite of its harmful consequences. One of the approaches that defines addiction as an illness is the Disease Model. According to disease model, addiction should be a disease because there are dysfunctional changes in brain that leads to addictive behaviors, and it claims that addiction is a genetic, biological and neurological disease (McLellan et al., 2000). Moreover, there are also many scientists that claim addiction is not a disease. For example, according to Cognitive theory addiction is caused by cognitive distortions and the way people interpret the social environment (McCusker,2001) or Classical Conditioning Theory supports that addiction is a behavior that is learned through the environmental stimuli and cues (Estes, 1950). It can be clearly seen that the definition of addiction is still not certain because of different point of views, opinions and approaches. In this paper, whether addiction is a disease or not is going to be evaluated and discussed, and explained clearly why addiction should be classified as a learned behavior rather than a sickness through environmental and psychological factors. First of all, according to disease model, addiction is a sickness caused by dysfunctional changes in brain, and American Medical Association classified addiction as a “treatable disease” in 1956 However, addiction should be more than just dysfunctional changes that prevent brain to function properly. That is, if addiction is a treatable disease why there is not any drug or surgery for preventing addiction completely, and make addicts stop showing addictive behaviors for sure exist. Even with drugs, addiction cannot be prevented exactly. Addicts don’t stop using drugs or smoking just because they take a pill. They may be helpful for reducing physical symptoms of withdrawal, but what about cognitive symptoms like depression, anxiety or social isolation? In addition, since the disease model defines addiction as a genetic disease, it argues that if a person is once an addict, s/he will always be an addict (Miller, 1993). However, this approach unfortunately, reduces addicts’ motivation for quitting addictive behaviors. That is, when people is stigmatized as “addicted” by doctors and their social environment, they might think that they have an untreatable disease, but humans are active creators. In these conditions, why would they try to take a responsibility for their choices, in these case addictive behaviors, and attempt to quit these behaviors at all? (Schaler, 2002). Therefore, if they accept these addictive behaviors, take the responsibility of these behaviors, and not consider themselves as sick, they can reduce the unwanted behavior much more easily. Also, less self-regulation might occur because of being less motivated for reducing unwanted behavior, and so self-regulation concept fails.
In addition to all these points, as it is mentioned before, disease model explains addiction as an inherited brain disease. However, in terms of concept of disease, an inherited sickness cannot be temporal. In other words, people cannot just stop being sick, but addiction is not like that. Addicted people can drop using drugs or stop smoking, if they want. Even though sometimes wanting is not enough by itself, addicted people can seek therapy for quitting addictive behaviors. Eventually, they quit if they make effort enough. On the other hand, diseases are not the same. A person who suffers from diabetes cannot stop being sick. Even she uses drug treatment, she would still be sick if she stops using the medicine that she uses or a cancer patient cannot stop suffering from cancer, unfortunately, regardless how much she wants to stop. Miller (1993) illustrates that there are many alcoholics who become a social drinker after getting the treatment, and their addictive behaviors almost never relapse, and attempt to overdose again. Also, for a child of an alcoholic parent is not certain that she become an alcoholic, too just like her parent. Reinarman (2015) made a study about the genetic components of addiction and found that scientist can make predictions about only the risks, vulnerability and the probabilities for addiction. Therefore, he stated that by looking at gene structure scientists cannot say that genetic background predicts addiction in the future. This proves that genetic background doesn’t show that if a person will become an addict in the future or not for sure. Because of this information about genes predicting addiction, many people think that addiction is related to a specific gene, and that gene determine whether a person become addicted or not. That is according to many people who think like that, they don’t have the power for stopping addictive behaviors. However, this is not the case. Then what is addiction if it is not a disease? It must be a learned behavior. That is, addiction is a consequence of classical conditioning which is one form of learning process that occurs when two stimuli are paired repeatedly. A response that occurs first by the second stimulus, then it elicits without second stimulus, it stands alone (Clark & Squire, 1998). In addiction process, classical conditioning is involved, and it makes even harder to quit addictive behavior. As it mentioned before, the environment is full of stimuli. These stimuli affects addicts in many ways. They can affect addicts through auditory, visual, olfactory, tactile or gustatory ways. For example, if a woman who is addicted to nicotine tries to quit smoking, and she used to smoke a cigarette while drinking her coffee, she would remember smoking cigarettes whenever she drinks a cup of coffee. In this example, gustatory stimulus affects the smoker. A visual stimulus might be seeing a cigarette butt or walking in front of a market that she used to buy cigarettes from there, and even hearing a lighter noise might activate the brain and the smoker’s body wants to smoke again. About 45 years ago, around 1970s Vietnam War occurred. In 1983, Heater and Roberson conducted a research about American soldiers that became addicted to heroin during the war. The results of the study show that 20% of the soldiers reported that they became addicted to heroin after they came Vietnam for war. However, after they returned to their hometowns, only 7% of them were diagnosed as addicted. Here, the important point is that 13% of the addicted soldiers did not continue using heroin. The reason behind this might be classical conditioning. As it is mentioned before, environment is full of clues and it stimulates people all the time. Majority of the addicted soldiers quitted using heroin that’s because when they got back their hometowns, there were probably little reminders, cues that remind them heroine. Since there was almost no reminders, the soldiers have shown total recovery. According to the findings, it can be said that living environment is very important for both developing addictive behaviors and stopping the behaviors. Without changing the environment, an addict cannot recover from addiction. In addition to all these, the concept of addiction is like deciding to do more sport or eat more healthily. People decide to do something better for their life, but they might end up with failure obeying all the rules they decided to obey before. Addiction is no different than this. Most of the addicts want to quit using the drugs or smoking, and they might actually do that for a little while, but eventually end up with failure. To solve this problem, psychologists or psychiatrists must teach them how to cope with addiction. Teaching coping with withdrawal symptoms and stress is very important, especially for preventing relapse. That’s why psychotherapy must be used in the treatment of addiction. Also, like many other psychologically abnormal behaviors, social support is essential. If addicts get social support from their family, spouses and friends, they are much more likely to quit the addictive behaviors that they have. For example, Bruce K. Alexander conducted an experiment in 1978 to show how social support is important for reducing addictive behaviors. Alexander and his colleagues built a house which is much larger than a regular rat cages, and that’s why this experiment was called Rat Park Experiment. This experiment tried to prove that the biggest reason for addiction is one’s psychology, not the drug itself. His goal was proving that drugs do not lead to addiction, but the environment that people live can cause addictive behaviors. There were about 20 rats from both sexes, and they all were interacted with each other. In the Rat Park Experiment, the social rats which are the rats that interact with others, had actually choice to drink fluid from one of the two dispensers. One dispenser had water, and the other one had morphine. He did many experiment to test rats’ willingness to consume the morphine by comparing Rat Park rats and cage rats. Finally, he and his team found that cage rats consume 19 times larger doses than the Rat Park rats, and even the cage rats voluntarily went through withdrawal when they moved to Rat Park. He and his colleagues proved that it’s not the drug itself that feeds addiction, it is the environment (2016). Therefore, feeling isolation, poor living conditions and hopelessness might make a person develop addictive behaviors. To sum up, as it was mentioned in the light of above researches, there are many reasons why addiction should not be classified as a disease. First of all, an inherited disease cannot be temporary, and addicts can quit addictive behaviors. Secondly, defining addiction as a sickness just because of preventing the labelling and stigmatizing is not an effective way, and it reduces addicts’ motivation for recovery. Thirdly, a treatable disease can be treated, so if addiction was a disease, it could be treated with just medicine or physical treatment methods. However, this is not the case of course. To conclude, an addicted person requires psychotherapy for gaining some coping skills for withdrawal symptoms like anxiety or depression. Also, to stop addictive behaviors, addicts must change the environment that they live in because of the stimuli that activates their brain, and reminds them the drugs or cigarettes whatever they are addicted to.

References

American Psychiatric Association. (2017). Diagnostic and statistical manual of mental disorders (5th ed.)* American Psychiatric Publishing*. Bruce K. A. (2010). Addiction: The View from Rat Park. The Globalization of Addiction: A study in poverty of the spirit. Clark, R. E., & Squire, L. R. (1998). Classical conditioning and brain systems: the role of awareness.* Science, 280(5360), 77-81*. Estes, W. K. (1950). Toward a statistical theory of learning. Psychological review, 57(2), 94. Köpetz, C. E., Lejuez, C. W., Wiers, R. W., & Kruglanski, A. W. (2013). Motivation and self-regulation in addiction: A call for convergence.* Perspectives on Psychological Science*, 8(1), 3-24. McCusker, C. G. (2001). Cognitive biases and addiction: an evolution in theory and method.* Addiction, 96(1), 47-56. Miller, W. R. (1993). Alcoholism: toward a better disease model. Psychology of Addictive Behaviors, 7(2*), 129-136. Reinarman, C. (2005). Between genes and addiction: A critique of genetic determinism.* Drugs and Alcohol Today*, 5(4), 32-33. Schaler, J. A. (2002). Addiction is a choice. Psychiatric Times, 19, 10.

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