Analyzing Why Addiction is a Disease 1
Patient vs. Prisoner: Analysis on Why Addiction is a Disease
Becky Lange
University of Cincinnati
Analyzing Why Addiction is a Disease 2
In the past, people who have addictions have been categorized as criminals, sinners,
thieves, and irresponsible excuse-makers who should be punished for their poor decision making.
Now with more science and education, the views of the causes of addiction are changing to
psychological, physiological, genetic, and biochemical instead of moral (McKim & Hancock
2013). With this new view, the stigma related to addiction is turning over from criminal to
medical. Before, an addict was “treated” by locking that person up in a prison. According to
Holden (2012), “A patient with cancer is not cured if locked in a cell, whereas an alcoholic is
automatically cured. No access to alcohol means no alcoholism” (p. 679). This outlook was
based on the idea of detoxification and punishment. If the addict cannot receive the substance, he
or she can no longer be addicted because the source of the addiction is eliminated. This theory
did not help any of the people who were addicted. Instead, this treatment caused an
overcrowding of prisons because the addicted individual kept being convicted for the same
charge, showing no improvement in health from the first prison sentence to the next
(McLaughlin 2012). An addicted person needs to receive true medical treatment in order to gain
health and resurrection from the crippling condition. This idea of medical assistance causes the
question to arise: Is addiction a disease? Since the process of addiction begins with the person
taking a substance, many people believe addiction is not a disease but a choice. Removing the
stigma that comes with addiction by saying addiction is a disease is just a way of making an
excuse for addicts (Holden 2012). This view is both ignorant and detrimental. Addiction is
caused by a mental dysfunction similar to other mental disorders such as bipolar disorder,
schizophrenia, and attention deficit hyperactivity disorder. This disease is caused by chemical
imbalances, genetic factors, social triggers, and behavioral problems. Even the model used by
scientists and doctors in categorizing a condition as a disease supports the notion of addiction
being a medical disease. The problem of overpopulation in the jails also significantly supports
the fact that locking an addicted person up is not a cure for an addict. Therapy, medicine, and
other medical treatments have helped people suffering from addiction. Society needs to view this
group of people as patients, not just to strip them of their poor decision making or relieve them
of the negative stigma, but to help this group of individuals’ physiological needs, and get them
back into a healthy, happy lifestyle. Although addiction is can be easily prevented, genetic
predispositions, physiological, psychological, social, and behavioral factors cause addiction to be
a mental disease that needs to be treated as a medical issue in order to effectively help these
people.
In a disease, there needs to be an organ that is dysfunctioning. In addiction, this organ is
the most vital organ in the body, the brain. Medical facts about the source of the disease in the
brain have been observed and defined into two different theories. A person does not become
addicted before the first use of the substance. However, after that initial use, even if innocently
taken, a person can become addicted to the substance without any control. The more well-known
theory describing this phenomenon is the hedonic dysregulation theory. The hedonic
dysregulation theory is based on the “see-saw” effects of drugs on the rewards system. When a
drug is originally administered, the effects of a high or euphoria are a reward. The negative
hedonic balance then comes in to effect when dysphoria and stress come into play. This is called
the allostatic process and was introduced by Koob and Le Moal. This theory is like the
homeostatic response view; however, it shows an inconstant set point. This means the person
will become increasingly depressed the more he or she uses the drug which causes the person to
want to use the drug more and more in order to not experience that depression. This theory
Analyzing Why Addiction is a Disease 3
explains how people can become hooked onto drugs. The cycle of depression and euphoria keeps
repeating, and dependence is learned.
The second and newer theory, the incentive sensitization theory, runs on the concept of
cravings. The mesolimbic system causes a stronger sensitization of a drug due to homeostasis
which gives motivational effects (Robinson & Berridge, 2008). The wanting or behavioral effect
comes from the positive reinforcement that the mesolimbic system provides when a drug is
administered. Learning and memory play an important role in addiction because of the
conditioning to the drug and memory of the drug’s effects. Any form of cue can lead to a craving
of the drug that gives a positive reinforcement. According to this theory, the wanting of the drug
leads to the craving the addicted individual feels. Since the drug becomes more powerful with
each administration, addiction can be easily developed. The more a person takes the drug, the
more he or she is pulled into all of these reinforcing factors, leading to the addiction. While both
of these theories view drug addiction development in different ways, both theories show
contributing factors to the beginning of addiction. A person may feel the after effects of a crazy
night of partying the next day, and as the saying goes, “nothing cures a hangover better than
alcohol.” This statement is obviously untrue; however, the theory behind it coincides with the
hedonic dysregulation theory. If a person feels sick or depressed after the effects of a drug wears
off, naturally he or she will want that drug again. Along with this model, the person is going to
begin having cravings for the substance because positive reinforcement has already been
introduced. The more the person intakes the drug, the more of the drug effect is felt, the more of
a depression that person will experience after the drug effects wears off, and then the again cycle
repeats.
With these theories, addiction is shown to be much more than just a habit.
Neurobiological happenings in the brain’s mesolimbic dopamine system help to explain why
addiction is not so much of a choice, but a control over the person’s behavioral functions. This
system spans from the ventral tegmental area and the nucleus accumbens. The mesolimbic
dopamine system plays a part in rewarding roles such as motivation, reinforcement, and reward
seeking and involves the motor loop which is the nucleus accumbens, basal ganglia, and ventral
tegmental area. The mesolimbic dopamine system is activated when there are homeostatic
imbalances, which causes the system to stimulate the motor system. Dopamine is a
neurotransmitter that contributes to learning, motivation, attention, and memory which explains
its association with drug dependency. When a person begins using a drug, he or she will have a
surge of dopamine which will help lead to the learning and reward of the drug leading to
repeated usage. The body will start becoming used to having the presence of the substance in the
body, which will cause craving when the drug is not available much like how we become hungry
when we have low glycemic levels. Thus, dependence is formed to the drug. This dependence is
the basis for addiction.
Like most illnesses, addiction is influenced by genetic predispositions and environmental
triggers. Merely being related to a person who has suffered from an addiction before can increase
an individual’s chances of developing this disease. Variation in dopamine signaling related genes
may contribute to the ventral striatum’s sensitivity to reward and, ultimately, to addiction
(Sweitzer, Donny, & Hariri 2012). Behavioral phenotypes, associated neural circuitry, and
underlying molecular signaling pathways also contribute the genetic link of addiction (Sweitzer
et al 2012). Along with addiction being partially caused by a genetic predisposition, overcoming
addiction also has a genetic base (McCauley 2009). If a father suffers from addiction to cocaine
Analyzing Why Addiction is a Disease 4
but overcomes that addiction, although the son has an increased risk of developing an addiction
over his lifetime, he also is more likely to successfully treat and prevent relapse from the disease
since his father did. With the motivation involved in addiction, the motivation and behavior in
treating addiction is also passed down through the genes. This is part of the reason why treatment
is so vital to not only the person being affected by the disease, but for future generations within
that family as well.
Stress, early development environment, and environmental triggers can also play a role in
drug addiction. Stress not only can lead to the initial use of an illegal and addictive drug, but it
can also increase the reinforcing value of the drug by making the rate of response quicker (Piazza
& Le Moal, 1998). The stress that evolves into drug use and abuse can begin at an early stage of
life. As shown in Sareen and Kaur’s (2012) study, Role of Family Environment in Drug
Addiction, families and the environment of early childhood life play a vital role in future
addictive tendency. In this study, 125 non-addicted and 125 addicted males were given the
Family Environment Scale and the personal information schedule. The results from these surveys
showed a significant difference in the two groups. The non-addicted males came from families
with independence, achievement orientation and family cohesion, whereas the addicted males
came from families characterized by conflict and control (Sareen & Kaur 2012). This study
supports the idea of how a family’s dynamics can lead to a healthy and successful adult, or a
sickly, addicted person. Beside the environment of the family, and stress from the environment,
most initial self-administration of an illegal drug begins with social factors. Although many
people brush the idea of peer pressure off as a simple excuse for teenagers to behave
irresponsibly, most first time users begin because of influence of friends or media. In 2009, over
one-third of high school seniors reported using illicit drugs during the past year (Levinthal 2012).
With these students being constantly surrounded by peers who are using and experimenting with
drugs, they are more likely able to easily get involved in this drug usage. Also, the education of
drug use tends to be avoided in schools. With these factors combined, the use of drugs is highly
appealing and, therefore, commonly looked positively upon in middle school, high school, and
college. The lack of knowledge is what tends to lead the initial drug use to a dependency and
addiction to the drug.
The most prominent support of drug being a medical condition and disease is from the
disease model. The disease model is the way doctors categorize whether or not an ailment is a
disease or not and how to treat the disease. First, symptoms need to be identified. For addiction,
the symptoms may include: tolerance, withdrawal, repeated failed attempts at quitting, continued
use despite knowledge of adverse consequences, and social, occupational, or recreational
struggles (DSM-IV Criteria for Substance Dependence and Substance Abuse). Next, the defect
should be addressed. The defect is typically stress-induced hedonic dysfunction or incentive
sensitization (McCauley 2009). The defect is typically the part of the model that needs to be
treated in order to fix the symptoms and heal the organ that is infected. The organ is the last part
of the model that needs to be looked at. The organ being affected in the case of addiction is the
brain. Specifically, addiction is the product of disorder in the midbrain and partially from the
frontal cortex. In addiction, the midbrain and frontal cortex work in an opposite fashion than its
usual processing. Usually, the frontal cortex controls the midbrain in a top-down control. The
frontal cortex controls the choices for the midbrain. When a person becomes addicted to a
substance his or her midbrain starts controlling the frontal cortex. The midbrain is where the
reward system is located, including other anatomical parts of the brain such as the hippocampus
Analyzing Why Addiction is a Disease 5
which controls memory, and the amygdala which controls emotion. The frontal cortex’s role is to
give emotional, moral, and spiritual guidance, conceive choices, and create attachment. Since the
frontal cortex typically controls the midbrain in making these choices, a healthy person does not
loss self-control; however, addiction causes the midbrain to control the part of the brain that
controls choices, attachment, and guidance. Not only does this result in addicted people losing
their control over the use of drug, but also explains how drugs become more important than
eating, killing, sleeping, and sex. The drug equals survival. The pleasure center of the brain
makes the drug the number one survival mechanism to the brain. Drugs create an anhedonia set
point which means that only drugs work in creating pleasure. (McCauley 2009). With the three
portions of the disease model fulfilled, addiction can be shown as a disease, and one that needs to
be medically treated. The addict is not a person with low morals, but a patient.
Other models associated with disease defining also support addiction being defined as a
disease. The American Medical Association agreed in 1956 that addiction fit the criteria for a
disease because of following these standards: Addiction is permanent, addiction shows a
predictable course of action, and addiction can be described. In the DSM-IV, addiction was first
named a disorder. The DSM-IV-TR and the DSM-V also have and will have addiction listed as a
disorder, only with many changes from the original listing. In 2011, the American Society of
Addiction Medicine defined this disease by stating:
Addiction is a primary, chronic disease involving brain reward, motivation, memory and
related circuitry. Dysfunction in these circuits leads to characteristic biological,
psychological, social and spiritual manifestations. This is reflected in persons
compulsively pursuing reward and/or relief by substance use and other behaviors.
Addiction cannot be cured but can be brought into remission through a program of
treatment, abstinence from all psychoactive substances, and supported recovery (Smith
2012).
These three associations set the standards for diseases and categorize diseases. If all three of
these groups define addiction as a disease, then the people addicted need to receive treatment in
order to go into remission. Defining addiction as a disease is not done to destigmatize these
people, but to help them receive the treatment they need to help them overcome this disease and
return to a healthy lifestyle.
A major issue that arises with the fact that addiction is a disease is the expense, both
economical and human costs, that then goes to punishment and/or treatment (Maisto 1993).Drug
addiction is commonly associated with the law because of its effects on the community as a
whole. In the study Legal Aspects of Drug Addiction, the researcher explains why addiction is
intertwined with legal legislation, “The law is so closely involved in the regulation of drug
addiction because, firstly, the disorder follows the epidemiological model of a communicable,
'infectious disease', and needs containment. Secondly, drug addiction imposes enormous
personal, social and economic burdens” (Lader 2012). The person addicted tends to become
involved in other illegal activities such as stealing and fighting. Since illicit drug use is illegal,
the law is naturally allowed to get involved. The problem with this is that most of the time this
involvement includes a prison sentence and parole. Most of the sentences an addicted individual
receives do not have any treatment options available. This is a very large problem because not
only are the citizens of the community paying for the person to be in jail, the likelihood of that
Analyzing Why Addiction is a Disease 6
person returning to jail is very high. This is partially why proper treatment is so vital to the
community, not just the individual. With the overpopulation in the United States’ prisons due to
the “War on Drugs” and other contributing factors, many inmates are being released because of
the prisoner’s right of no cruel or unusual punishment is being compromised. Although
treatments for these individuals may be pricey to the community, the cost of treatment is going to
be much cheaper than the excess of prison stays and releases, court prices, and possible human
costs.
Another reason the law is so closely tied to addiction is because of the human costs this
disease has on the person and the community. Many lives are affected and lost because of events
that happen due to drug usage. Approximately 25% of all inmates in federal, local and state
prisons have been sentenced for drug use (BJS 2005). The percentage of homicides related to
drug use ranges from 3.9% to 7.4% depending on the year (BJS 1987-2007). Drugs were
involved in violent crimes 26% of the time (BJS 2007). These statistics from the Bureau of
Justice Statistics shows how detrimental drug use and addiction is on criminal activity in the
community. Not only does this large percentage of inmates in jail due to drug use cause the
overpopulation in our jails, but this overpopulation will continue growing if treatment is not
incorporated into the inmate’s sentencing. Throwing a person into prison for a year is not going
to treat the addiction. Instead, it will allow an addicted person back into society with no gain and
high potential to repeat criminal activity. This criminal activity could result in homicide through
driving while intoxicated, violence, robbery, and rape. Two-thirds of driving while intoxicated
people were regular users of the drug they were intoxicated with (BJS 1999). Treating the
addicted individual could save the lives of many people who have never used the drugs and the
life of the patient.
Many people are weary of identifying addiction as a disease. People believe addiction is a
choice, or the person who is addicted is immoral and irresponsible. The choice argument
theorizes that drug taking is a behavior and, therefore, a choice. The addicted individual can stop
at any time but lacks the motivation to do so (McCauley 2009). Ironically, motivation in an
addicted person is increased through drug usage. That increase of motivation is focused on the
drug instead of eating, sleeping, sex, and defense (McCauley 2009). The drug takes over and the
person does not have control over his or her own self. No matter how much the person tries to
stop taking that substance, he or she is drawn back into the addiction. Like anyone who has ever
had a craving for chocolate in their life, the addicted person gets a craving for the drug that is
multiple times stronger than any craving for food, sex, or sleep can ever be. The brain views the
drug as a way of surviving. Even though the victim may even know that this is not true, the brain
is tricked by the mesolimbic dopamine system to believe that is needs the drug more than any
other substance (McCauley 2009). Addiction is not a choice, but a way of survival for these
people.
Although the choice argument sees addiction as a choice instead of a disease, other
theories against addiction as a disease deal with more educated views. In the article, Dopamine
and the neural 'now': Essay and review of Addiction: A disorder of choice, Dr. Lewis writes”
Neuroscience does not have to frame addiction as a disease. Rather, it can help explain
how addicts make impulsive choices in the moment and distort appraisal and decisionmaking habits in the long run. […] I conclude that addiction is not a monolithic state but
Analyzing Why Addiction is a Disease 7
a recurrent series of choices that permit negotiation, and sometimes cooperation, between
immediate and long-range goals (Lewis 2011).
In his article, he writes about how addiction is an impulsive decision making habit. He concludes
that addiction is not a disease, but while saying that, he also does not believe addiction needs to
be defined as a disease in order to understand addiction. There are two main issues with this
justification, 1. Addiction is not merely a decision-making habit. It is a complex illness that
involves brain mechanism dysfunction along with several crippling effects. 2. In order for a sick
person to receive the treatment needed, addiction needs to be labeled as a disease so that the
addicted person can be viewed as a patient. Defining addiction as a decision-making habit is
saying that the addicted person has a habit of making impulsive decisions. In which case,
addiction should be defined as an impulse control disorder. Also, refining addiction into this
three word definition is not satisfying for the needs of the addicted individual to receive adequate
care. Dr. Lewis is basically showing he agrees with addiction qualifying as a disease, but does
not believe it should be categorized. Without this categorization, however, addicted individuals
cannot receive proper care. This is why this debate is so important to the health of these patients.
Because the addicted person is sick, treatment is a necessity in returning this patient back
to health. As stated before, one of the main problems with the hypothesis that addiction is not a
disease is that this theory means the person who is addicted does not need to be treated in any
other way other than a detoxification which can be self-treated. In 2004, only 17% of substance
abusers received treatment (NSDUH 2004). With a change of views and better education on why
addiction is a disease, this percentage can grow and more people can be helped.
In order for a person to benefit from a treatment program, many factors need to be
considered. The person’s level of addiction, addictive tendencies, drug of choice, age, gender,
psychological, medical, and legal issues, and the individual’s willingness to cooperate. After
these things are addressed, the rest of the treatment should be shaped to help this individual. The
main goals of treatment are to help the sick person and to prevent relapse. With an effective
treatment program, the individual can be assured that he or she will have the best chance of
improving his or her life and avoid repeating the destructive life style from the past. This
treatment can help prevent repeated jail visits, loss of jobs, homelessness, and other trials
associated with drug abuse. The optimal drug abuse treatment program needs to look at each
person individually to see what needs are most important for this person’s condition. Since not
everyone responds to all treatments, specializing treatments for the individual is beneficial in
assuring both short and long term effects. Ideally, the program would be a long term program in
order to achieve long term goals for the treatment. Once individual needs are identified, the
process of counseling, management therapy, behavioral therapy, medication, and group therapy
should be acknowledged. These forms of treatment and the timing of these treatments should be
associated with the level of problems in the individual’s life such as personal, family, career,
medical, and legal problems. Making sure all of these problems are addressed through treatment
advised for the individual can help to cure and prevent relapse. Treatment is not an easy process.
It requires multiple steps and therapies in order to show its effects. With patience and flexibility,
the addicted person can hopefully start a life of sobriety and success.
Like any form of treatment, there is a chance of an individual not responding to the
program. People who believe addiction is a choice use this as proof to why addiction is not a
disease because the addict does not want the treatment, and therefore does not respond to the
Analyzing Why Addiction is a Disease 8
treatment. This “proof” is irrational and poorly supported. In other diseases, the placebo effect is
widely known as a mind over body medical treatment. If a person believes a medicine will work,
even if it has no chemicals but instead is just a sugar pill, that person can start feeling better. The
same is true if the person does not think the medicine will work yet does receive a real
medication. He or she will not feel any change or benefits from the treatment. The placebo effect
is similar to the reasoning people who are in denial of their addiction or do not want treatment do
not respond to the treatment given. Another counter-argument presented is that the treatment
options of the substance abusers do not consider the individual differences of the people
receiving the therapy (Mann 2013). Group therapy does not work for many people because it
does not focus on the individual person. Just because this form of treatment does not work on a
person does not mean that the person does not need any treatment in order to get over his or her
addiction. The person needs a different treatment program based on his or her personal needs
instead of a group environment. Hopefully, with more people viewing addiction as a disease, less
money will need to go into the wallets of the judicial system, and more can go toward helping
these individuals gain better treatment options.
Overall, addiction needs to be viewed as a disease in order to help recover the lives of the
addicted individuals and improve the economic and judicial issues associated with substance
abuse. More people need to be educated in understanding why addiction is a disease instead of
assuming this theory is based on the goal of trying to victimize and destigmatize these people.
The hedonic dysfunction theory and the incentive sensitization theory show the ways addiction
can form and how the mechanisms in the brain work for a person who is suffering from and
addiction. Addiction goes much deeper than just the repeated usage of drugs. It is a result of
brain dysfunction in the midbrain and frontal cortex. Mental illnesses are framed similarly to the
issues associated with the brain mechanisms in addicted patients. Genetic and environmental
factors play a key role in addiction, like many other illnesses. Not only does genetics create a
higher chance of addiction if the person has a genetic predisposition, but the ability to overcome
the addiction can also be passed down through the genetic coding of the parent. Environmental
influences such as family relations, social triggers, and stress also add to the risks of developing
a drug addiction. Addiction is a disease that follows the disease model of organ, the midbrain,
defect, stress- induced hedonic dysfunction and incentive sensitization, and symptoms,
withdrawal, tolerance, etc., approach. The American Society of Addiction Medicine’s definition
of disease accepts addiction as a disease in which the patient cannot be cured, but can and should
be treated. The law system is connected to the addiction complex because of the prominence of
drug abuse and criminal behavior. This has cost society a large financial and personal burden.
This burden is increasing with the overpopulation of the jails due to the repeated visits of drug
abusers in jails. This problem can be eliminated by incorporating proper treatment programs into
the community. These treatment centers need to look at the person individually rather than as a
group and treat the addicted individual as a sick patient. As with any patient, the individual needs
will differ from one person to the other. Personal, career, financial, family, and criminal
problems need to be addressed in these treatments in order to benefit the patient. Without
addiction being viewed at as a disease, the addicted person will never be viewed as a patient, and
will not receive treatment. If this happens, the problem of drug addiction in society will continue
to get worse. No matter what, helping the person who is addicted is better than denying that
person of treatment, and letting him or her continue on a path of destruction.
Analyzing Why Addiction is a Disease 9
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