According to the National Survey on Drug Use and Health in 2020, 40.3 million Americans aged 12 or older suffered from a substance use disorder within the past year. Forty-three million is a lot of people, but it should come as no surprise that this many people use drugs. The verbiage of this statistic interests me far more than its raw magnitude. For a layman such as myself, a “substance use disorder” is an addiction. It doesn’t take a neuroscientist to determine that addiction is a less-than-ideal coping mechanism, but almost everyone has used caffeine or some other drug therapeutically — often with the desired result. At some point, which differs from person to person, this self-medication becomes unhealthy. In the past, crossing this line would have been an indication of moral failure, but as science progressed, we began to understand addiction as a mental illness — something uncontrollable. This shift began to destigmatize addiction, representing a triumph of modern medicine over a backward public consensus rooted in moralistic judgement.
Today, the brain disease model of addiction, which treats addiction as a disease categorized by neurobiological changes rather than a condition of moral failure, predominates. There are 10 classes of substance use disorders, and there are standardized treatment methods which include counseling and medication as well as treatment of underlying mental health conditions. Make no mistake — this is what progress looks like, but some, myself included, find flaws in the current model. I believe that our conventional disease model of addiction, though far preferable to earlier conceptions, is flawed because it disempowers those with addiction while only weakly destigmatizing their condition. We need a more flexible model of addiction.
Allow me to first elaborate on that latter point. The process by which conditions previously thought to be normal human conditions become classified as treatable diseases is known as medicalization. By renaming addictions to substance use disorders, we aim to destigmatize them, but does this even work? One study finds that while subjects are less likely to attribute blame to someone whose condition is labeled a “brain disease,” they are also less optimistic that the person will be able to recover as opposed to someone with merely a drug “problem.” Medicalization of addiction has attached a severity to the condition that is somewhat of a double-edged sword. The prognostic optimism of a different model could help those in recovery see their condition as something surmountable and impermanent, driving them to form healthier habits and overcome setbacks such as relapse.
Many scientists also believe that a flexible model of addiction is simply better aligned with reality. Former Harvard University psychiatry professor Lance Dodes believes that the disease model of addiction fails to give people with addiction “an understanding that is useful for treating the problem.” He believes that addiction is a symptom rather than a disease, and one which is fairly common and natural. I believe that a model such as the one that Dodes proposes offers hope to many. We should recognize addiction not as a disease, but as a symptom of something psychologically significant or damaging in one’s past. Through this lens, we refuse to alienate people with addiction, we recognize our own susceptibility and we highlight the individual or systemic factors which contribute to addiction. Ultimately, we forge a stronger and more productive understanding of addiction.
To destigmatize addiction, we should see the brain disease model as a temporary solution. Blame attribution is only one aspect of stigma, and compassion toward people with addiction should not be contingent on their lack of agency due to a medical condition. I truly believe that at some point in our lives, each and every one of us has developed and conquered an unhealthy dependency on something. According to neuroscientist Marc Lewis, the brains of those in recovery from cocaine, alcohol and heroin use can begin to replace lost synapses in as little as six months of abstinence. This is the hard-fought result of counseling, goal setting and medical support, but reaching out takes initiative, and an addiction model which centralizes experience, rather than predisposition, is likely to inspire more people to come forward and seek that medical support — the crucial piece of the recovery puzzle. If we acknowledge that addictions are driven by the same fundamental processes that all other impulsive behaviors are, then we can truly accept people with addiction. After all, we are all victims of impulse, whether or not we currently meet the conditions for a serious addiction to manifest.
Wherever the empirical truth lies on this subject, it should be noted that addiction research, as a field of specialization, is still in its infancy. Dissenting from what might appear to be a medical consensus is not something to be taken lightly, but scientists like Dodes and Lewis are a critical part of the constant refinement that theories undergo. Just 40 years ago, we didn’t have addiction psychiatry, so we should not assume that our understanding of addiction will remain static over the next 40 years. As someone who has grappled with unhealthy dependencies in the past, I know which one of these frameworks more closely matches my experience. The scientific community’s adoption of a flexible model, or the synthesis of some of its ideas into the medical mainstream, can only serve to help those suffering from addiction.
Jacob Wisnock is a freshman majoring in political science.