We have all heard that addiction is a disease. But is it really a disease? To many people, addiction seems clearly to be a choice or a lifestyle. Doesn’t calling addiction a disease mean that addicts are not responsible for their actions, and should not be held accountable? Are doctors calling addiction a disease just so we can throw medications at it?
The Truth About Addiction
The simplest way to explain why addiction is a disease is to compare it with another condition that is undeniably a disease. Let us compare alcoholism (the prototypical form of addiction) with adult-onset diabetes. Let us examine the following similarities:
- Both diabetes and alcoholism run in “Having a positive family history of either condition increases the risks of developing that condition.”
- Both conditions depend on the “We know diabetes rates are much higher in states like Mississippi than states like Utah.” Similarly, alcohol-related death rates also show large differences from one state to another.
- Risks of developing either alcoholism or diabetes depend on one’s lifestyle: consuming a lot of fast food and soda, and never exercising, increases the risk of diabetes; drinking alcohol at every social event increases the risk of alcoholism.
- Both conditions affect multiple organs. Diabetes affects numerous organ systems including the kidneys, blood vessels, and nerves. Alcohol affects numerous organ systems including the liver, pancreas, and nerves.
- Most importantly, both alcoholism and diabetes involve the inability to control consumption. Alcoholics cannot control how much alcohol they consume while diabetics cannot control how much food and sugar they consume.
Based upon the above, it seems irrational to classify diabetes as a disease but to insist that alcoholism is not.
Is Addiction a Choice?
One might argue that, “Addiction is a choice!” The truth is, almost every condition I treated in 30 years as a family doctor (before I specialized in addiction) was affected by choices my patients made. People may develop cancers, heart attacks, and strokes because they chose to smoke. High blood pressure, obesity, heartburn, diverticulitis, diabetes, gout, etc. are related to dietary choices.
First responders, police officers, our military, all chooseto put their health and lives on the line. People may choose not to get vaccinated, refuse to wear seatbelts, choose to text while driving, or choose to participate in sports with high rates of injuries. Even medical conditions not triggered by our choices could be made either better or worse by how we choose to live.
Why are we so quick to blame people addicted to drugs or alcohol for their health problems but not diabetics, obese people, or football players who get concussions? We even say that people fell victim to heart attacks, strokes, or cancer – clearly not blaming these individuals, even though these conditions are strongly impacted by lifestyle choices.
We Must Start Treating Addiction as a Disease
If we accept that addiction is a disease, we need to treat it like a disease. In fact, the use of medications to treat addiction (medication-assisted treatment, or MAT) is supported by very strong scientific evidence. Let me use the example of methadone, one of the most disparaged and misunderstood of medicines. People often say things like, “I don’t believe in methadone.” Well, methadone is not a religion you have to believe in. Just examine the scientific evidence.
Methadone is one of the best studied pharmaceutical medicines. Methadone has been studied non-stop for more than 75 years (methadone was first approved in 1947). The only medication I can think of that has been studied continuously for a longer period is aspirin. Methadone clinics have been around since 1972. Methadone clinics would not have stayed around for this length of time if this were not an effective strategy.
The Harvard Review of Psychiatry has characterized methadone maintenance therapy as the “Gold Standard” of Medication-Assisted Therapy (MAT). Methadone is endorsed by the American Medical Association (AMA), the American Society of Addiction Medicine (ASAM), and numerous other regional, national, and international agencies.
Methadone therapy for opioid addiction is supported by the Substance Abuse and Mental Health Administration (SAMHSA). Even the Drug Enforcement Administration (DEA), part of the Department of Justice and the law enforcement agency charged with fighting drug addiction, supports methadone clinics.
Some people might think that the use of methadone for treating opioid addiction is being “soft on addicts.” They should know that methadone clinics are found in highly unlikely places, including Iran and China, which are countries notorious for dealing very harshly with drug addicts.
Methadone clinics are found all over the world, supported by the World Health Organization (WHO).
Methadone has been extensively studied. Treatment with methadone has been shown to dramatically reduce overdose deaths, reduce medical complications of addiction such as Hepatitis C and HIV, reduce criminality, as well as improve social functioning and quality of life for people addicted to opioids.
Many people do not understand why we should use opioid medications like buprenorphine (suboxone, subutex, and others) or methadone to treat opioid addiction (opioid use disorder). Using an opioid to treat opioid use disorder might seem counterintuitive. However, this concept is not actually that strange. After all, we fight fires with fire. We also use nicotine replacements (gums, inhalers, patches, lozenges) to fight nicotine addiction (smoking). Immunizations also use dead or attenuated viruses to teach the body to fight similar but much more dangerous real viruses. The important thing is that the effectiveness of these medications is supported by compelling clinical data. These medications work!
Another major area of misunderstanding in addiction treatment is the concept of harm reduction. Many people believe harm reduction means condoning drug use. In reality, harm reduction principles also apply to the treatment of other diseases, such as diabetes. Many diabetics struggle to get their diabetes under control, just as people with addiction struggle to get their addiction under control. Partially controlled diabetes is not as good as completely controlled diabetes, but still much better than uncontrolled diabetes – partially controlled diabetics have much better outcomes with fewer heart attacks, strokes, blindness, amputations, kidney failure, etc. Similarly, incompletely controlled heroin addicts are also less likely to die of fatal overdoses, be infected with Hepatitis C or HIV, get arrested, lose a job, lose custody of their children, etc. Harm reduction in addiction treatment does not mean condoning drug use any more than harm reduction in diabetes means condoning unhealthy diets and lifestyles in diabetics.
Medication-Assisted Treatment for Opioid Use Disorders
Another common misconception: opioid addicts treated with buprenorphine or methadone are still addicted to opioids because these medications are also opioids. This is why some people claim that methadone or buprenorphine is only “legal heroin.” While understandable, this point of view is incorrect, based on confusing “addiction” with “dependence”. An easy way to explain the differences between these two conditions is that dependence means the body needs something to function normally. Addiction means the mind wants something desperately, regardless if the body needs it or not.
Almost every serious chronic condition we treat successfully in medicine will make patients “dependent” on their treatments. People with severe heart failure cannot function without their heart medicines. People with severe chronic obstructive pulmonary disease (COPD) may become dependent on their oxygen tanks. Diabetics who need insulin are known as insulin-dependent diabetics – without insulin, they get very sick and could die. Why do we not say that people who need insulin are addicted to insulin? Because it is only the body that needs insulin; the mind does not want insulin. On the other hand, someone addicted to gambling wants to gamble even though their body does not need it. Put simply, diabetics on insulin do not rob gas stations or break laws to get insulin; they do not lose custody of their children to Child Protective Services over insulin. Problem gamblers may lie, cheat, or steal to get money for gambling.
The problem with opioid addiction is that it involves BOTH addiction and dependency. The addict’s body is no longer able to function normally without opioids, but the mind will also crave opioids even when the body no longer needs it. For example, a heroin addict thrown into jail for a week may experience intense withdrawal, but the withdrawal only lasts 3-5 days. This person will emerge from jail with the body no longer needing heroin. The dependency to heroin will have healed, but not the addiction. To paraphrase Charlie Pride, a jazz musician with a heroin addiction, “You can get heroin out of my blood, but not out of my mind…” The risk of relapse is very high.
We Must Be Proactive Against Addiction
It is high time to recognize that addiction is a disease that needs to be treated just like diabetes. Medication alone cannot control diabetes; we also need a better diet and hopefully an exercise program for weight loss and better sugar control. Similarly, medications alone are insufficient for addiction; we also need counseling, mental health support, and social work. This is the reason we describe the use of medications in addiction as “Medication-Assisted Treatment.” Medications alone are not enough. Addiction needs to be recognized and treated like a disease in every way.
For those readers who are religious, I would offer the following. The closest biblical parallel to heroin addicts in Jesus’ time would probably be lepers. Today, we know that leprosy is caused by a type of bacteria, but in biblical times, lepers were considered dirty, unworthy, and subhuman. They were shunned and marginalized. They were mistreated or even abused, physically and mentally. Yet, Jesus touched and healed lepers. It is high time we see people with addiction as human beings suffering from a treatable disease. They deserve our compassion and care, not scorn and denigration.
We’re here to help
Our facility, located in Greenwood, Indiana, provides adults inpatient an outpatient treatment for substance abuse. Once we assess the addiction issue for an incoming patient, our staff develops a personalized plan for treatment.
Located roughly 15 miles south of downtown Indianapolis, Indiana, Valle Vista Health System offers no-cost assessments 24 hours a day, 365 days a year that will assist you in finding the drug or alcohol addiction resources for you or a loved one. We can also be reached by calling 317-792-8148 or contacting us online.
Simon Feng, MD is an Addictionologist at Valle Vista Health System.
- Alcohol Abuse Statistics : National + State Data. (2022). NCDAS. Retrieved August 6, 2022, from drugabusestatistics.org
- Connery, H. S. (2015). Medication-assisted treatment of opioid use disorder: Review of the evidence and future directions. Harvard Review of Psychiatry, 23(2), 63–75. doi.org
- Robeznieks, A. (2019, November 20). AMA to boost education on methadone maintenance therapy. American Medical Association.
- SAMHSA. (n.d.). Methadone.
- World Health Organization. (n.d.). Methadone used for the treatment of opioid dependence. Retrieved April 7, 2022, from who.int
- National Academies of Sciences, Division of Health & Medicine, Committee on Medication-Assisted Treatment for Opioid Use Disorder. (2019). The Eﬀectiveness of Medication-Based Treatment for Opioid Use Disorder. In M. Mancher & A. I. Leshner (Eds.), Medications for Opioid Use Disorder Save Lives. National Academies Press (US). ncbi.nlm.nih.gov
- Matthew 8:1-3