What is the Disease Concept of Addiction?

Throughout history, the attitude toward addiction has been one of disapproval.

Addiction was seen as a personal failing, one that resulted from a weakness or a lack of discipline. At best, addiction was a bad habit, at worst, it was a sin.

Although addiction has not entirely lost its stigma, it seems an increasing body of scientific research has improved people’s understanding of and sympathy for the problem. One major development in addiction research is the theory that addiction is primarily a biological phenomenon.

The Study of Addiction and Genetics

For years, addiction researchers have asserted that addiction has a genetic basis.  While studies seem to support the view that alcoholism is genetic, identifying the specific genes that lead to an increased risk of alcoholism has been a laborious task, since humans express more than one hundred thousand genes. The disease concept of addiction has always been fervurously debated.

However, in 1997, researchers at the Portland Alcohol Center announced that they had mapped three gene regions in mice that influence susceptibility to physical dependence on alcohol—information that they believe could lead to the development of new treatments for alcoholics.

Furthermore, research documenting the impact of drugs on the brain may shed light on why some people are more prone to addiction than others. Drug use (along with other potentially addictive activities such as gambling or sex) causes the brain to release dopamine, a chemical involved in experiencing pleasure.

The Brains Reaction to Dopamine

Surges in dopamine can be so powerful that it compels users to keep taking the drug. With prolonged use, however, drugs can alter the brain so that experiencing pleasure without the drug is nearly impossible. At this point, drug use does not raise dopamine levels or produce a “high.”Instead, the user keeps taking the drug to stave off painful withdrawal symptoms such as fever, cramps, violent nausea, and depression.

Based on their research of how drugs affect the brain, scientists have theorized that people who are deficient in dopamine may be more likely than others to become addicts. George Koob, a professor of neuropharmacology at the Scripps Research Institute in La Jolla, California, contends that the neurotransmitter systems affected by drug abuse may already be abnormal in people who are susceptible to addiction.

Biological Disease or Behavioral Problem? The Great Debate

While most people agree that biology plays some role in addiction, experts on addiction are generally separated into two camps: those who believe that addiction is a biological disease with behavioral aspects, and those who believe that addiction is primarily a behavioral problem that is sometimes influenced by biology.

The latter group maintains that labeling addiction as a medical condition creates a false assumption that addicts have no control over their own behavior. There are however cases of addicts who suffer from mental health problems which can be looked at in a different category. In the view of this group, people become addicts because of their behavior, not their brain chemistry.

Other critics question whether scientific research has proven that addiction is biological. Stanton Peele, a vociferous opponent of the belief that addiction is a disease, contends that the disease model of addiction is flawed for a number of reasons. First, he claims, most people who take drugs do not become addicted, but may take drugs for a period of time, then stop when they choose to do so. For example, most smokers who successfully kick their addiction to nicotine—a drug purportedly more addictive than heroin—rely solely on willpower to do so. Second, Peele challenges the theory that dopamine is responsible for addiction. He states, “The wide range of activities that stimulate the pleasure centers of the brain—including sex, eating, work- ing, chocolate—should alert us that these brain theories tell us nothing about differences in behavior, let alone addiction. . . . Chocolate stimulates the pleasure centers, but only a few people compulsively eat chocolate or sweets. Apparently, stimulation of the pleasure center is only one small component in the entire addiction syndrome.”