Addiction is a hotly debated topic, especially with the current opiate epidemic. There are a wide range of beliefs and opinions about what addiction is, what causes it and what should be done about it. There’s no question that addiction is a huge problem that needs attention, but how should that problem best be handled? Understanding what addiction is — and isn’t — is the key to creating a solution for it.
Unfortunately, we don’t know as much about addiction as we would like to. Researchers maintain that addiction has its roots in both genetics and environment. We know that children who grow up around substance abuse are more likely to grow up to be addicts. We also know that there are individuals who grow up in stable homes who also grow up to be addicts. And, not all children who grow up in negative environments and around substance abuse end up using themselves. This only adds to the confusion. Why are some people addicts and others not? Why does treatment work for some and not others? Is it a choice? Is it some type of genetic lottery? How much does nurture versus nature apply here?
First, it’s helpful to look at the definition of disease. The Merriam-Webster dictionary defines disease as:
An impairment of the normal state of the living animal or plant body or one of its parts or modifies the performance of the vital functions, is typically manifested by distinguishing signs or symptoms, and is a response to environmental factors (as malnutrition, industrial hazards or climate) to specific infective agents (as worms, bacteria or viruses) to inherent defects of the organism (genetic anomalies), or to combinations of these factors.
From this perspective, we can see how addiction can be considered a disease. Both genetic and environmental factors are listed as causes for the problem, and addiction does have distinguishing symptoms. Other factors that back up the “disease model” of addiction include the fact that addiction is chronic and progressive, that it is a relapsing disease and that in some cases, if left untreated, it is fatal.
Not everyone subscribes to the theory that addiction is a disease. Many argue that disease is a behavior. While they may concede that environment plays a role, ultimately, they believe that addiction is a choice. At the far end of the spectrum are those that believe that addicts are inherently bad people, or people suffering from a moral deficiency who are choosing drugs over being good and productive members of society.
Does It Matter If Addiction Is A Disease Or A Behavior?
While pinning down the exact cause of addiction may be ultimately helpful in treating it, the cause isn’t nearly as important as the solution. What we know is that regardless of the original cause of substance abuse, addiction is a life-threatening problem that costs billions of dollars a year, tears apart families, contributes to violent crime and affects millions of children each year.
Just as there are those who can’t agree on what addiction is, there are those who disagree about how addiction should be treated. Those in the “addiction is a choice” camp will often state that imprisonment or other punitive measures are the best way to handle a drug addict, or a person who continues to get DUI’s.
Other people see addiction as a medical problem that should be treated with medicine. An example of medical treatment would be using drugs like Naltrexone to treat opiate or alcohol abuse. However, there are no drugs to treat an addiction to methamphetamines. Not only that, but while medication can be helpful in the treatment of opiate abuse, it doesn’t “cure” addiction. This is evidenced by the high rate of relapse following treatment with medication alone.
An evidence-based practice is one that is backed by research. This is done through rigorous study and documentation. Evidence-based practices are found more widely in other areas, such as mental health. When it comes to addiction, there are fewer evidence-based practices. Here’s a widely accepted definition of evidence-based practices, put forth by David Sackett and colleagues:
“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values.”
What are some examples of evidence-based practices in addiction treatment?
Well, that’s part of the problem. There really aren’t any. In fact, it’s much easier to find a list of treatments and therapies that have been determined to not be evidence-based. These are practices that have been researched, explored and not found to be effective in the treatment of addiction. Some examples would be scared-straight programs, neuro-linguistic programing and ultra-rapid detox for opiate and alcohol addiction.
Practices such as 12 step programs and cognitive behavioral therapy are considered for evidence-based practices, but no definitive conclusion has been drawn.
At this point in addiction treatment, it seems there should be at least some kind of evidence-based treatments that can truly help the addicted person overcome their problem.
It’s believed by many that part of the reason for the lack of evidence-based addiction treatment is that there is no one single practice that works for all people. For some, the combination of detox, residential treatment and 12 step programs seems to work beautifully. For others, it doesn’t appear to work at all.
This is another issue. How is success in addiction treatment measured? Current methods include following up with clients who have successfully completed an addiction program. How many of them have remained abstinent at 90 days post-treatment? What about at one year? Statistically, the success rates are low, with about a 40 to 60% relapse rate. But this doesn’t take all factors into consideration. For example, how many of the people have a mental illness? How many have experienced a trauma? How many of them live in a clean and sober, supportive environment, or have their basic needs for food and shelter met? These are all significant variables to consider when determining the success of a treatment program.
And, relapse is often a part of the process. With other diseases, such as diabetes, asthma and cancer, there are often periods of time when the disease is not active. During these times of remission, recovery is said to be successful. This is true despite the very real possibility of a relapse. Any period of time where the afflicted person experiences relief from their illness is successful. Relapse is treated and hopefully recovery will be the result. This may happen several times during the course of a lifetime, but the patient is not looked at as a failure because he or she relapsed. A person may go through treatment several times before they are able to stop abusing substances for good.
As research continues, we can only hope that regardless of the cause of addiction, a priority will be placed on finding evidence-based treatments for addiction. We need treatments that work. And, clearly recovery is not an overnight process. It’s ongoing, and requires support.
Rose Lockinger is passionate member of the recovery community. A rebel who found her cause, she uses blogging and social media to raise the awareness about the disease of addiction. She has visited all over North and South America. Single mom to two beautiful children she has learned parenting is without a doubt the most rewarding job in the world. Currently the Outreach Director at Stodzy Internet Marketing.