Imagine that you have a disease. A fatal disease that kills millions of people every single year. This disease is going to make you unable to work, alienate you from your friends and family, and change your mind and body in ways you cannot imagine. Now imagine that a large number of people, when they hear of your disease, will tell you that it’s your fault. That you are selfish, weak, and won’t take responsibility for your choices. This is the disease of addiction and millions face this horrible reality every day.
Addiction, a disease of the brain, is characterized by compulsive substance use, the inability to stop, and a dependency that is both physical and mental. Therefore, the stigma claiming that those who are addicted to drugs/alcohol/etcetera are lazy or weak-willed should be properly educated on the brain-science of addiction.
I acknowledge that the resources that go towards addicts attempting to quit aren’t few, and many alcoholics and addicts relapse after going to treatment. This outward behavior is likely responsible for so much of the stigma around addiction, but correctly seeing addiction as a disease does not ‘excuse’ personal responsibility. “The idea that someone with addiction has a brain disease might even reinforce stigma in some cases, contributing to pessimism about one’s chances of recovery and a lower sense of personal agency. Medicalising a condition does not automatically destigmatise it; in fact, disease labels themselves can be highly stigmatising, as seen in conditions like HIV/AIDS,” (Blithikioti and Cristea). The other major argument against the disease model is that addicts are making “bad choices.” This is dissected in more detail below, but if addiction were a matter of choice we would see comparable rates from before the disease model. However, before the introduction of Alcoholics Anonymous alcohol consumption was more than “three times” modern rates (Boston University).
What most don’t understand is that addiction is a compulsive disorder. Compulsive behavior meaning repetitive, persistent, and the uncontrollable urge to perform actions. “Addiction is a chronic (lifelong) condition that involves compulsive seeking and taking of a substance or performing an activity despite negative or harmful consequences,” (The Difference Between…).
Acts influenced by compulsive behaviours are not pleasant, although they feel as if they must be done. These acts are often time-consuming, distressing, and feel uncontrollable, providing only temporary relief. It’s not as if those who are addicted enjoy being discriminated against, all that does is push them further into their guilt and shame, which causes their minds to compulsively want to ease the stress by taking substances/drinking to calm nerves. “Alcohol use disorder (AUD) is a condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.” That means that people suffering from addiction are aware of the harm it causes themselves and others, but are unable to change addictive behaviors without medical support. Like a cancer patient cannot “will away” a malignant tumor, neither can an addict.
Additionally if willpower was effective against addiction, we’d see similar results for stopping addiction with or without treatment, instead we see the opposite. “Addiction treatment is significantly more effective than no treatment, with 40-60% of people who complete treatment remaining abstinent after one year, similar to success rates for other chronic diseases,” (National Institute of Health). Treatment, particularly when it includes behavioral therapy and medication (for addiction to opioids or alcohol), is highly effective in promoting long-term recovery, with roughly 75% of those who seek recovery achieving long term success. “While relapse rates are high (40-60%), studies show, for instance, that Alcoholics Anonymous and Medication-Assisted Treatment (MAT) for opioids drastically reduce mortality and criminality compared to no intervention,” (National Institute of Health). So we see that like any disease, treatment works. And like any disease expecting someone suffering from it to “cure themselves” is as helpful as expecting an amputee to regrow their arm.
When becoming addicted to a substance, the normal hardwiring of your brain starts to work against you, drugs and alcohol taking over the pleasure circuits in your brain, causing you to want and need more and more. “A common misperception is that addiction is a choice or moral problem, and all you have to do is stop. But nothing could be further from the truth,” says Dr. George Koob, director of NIH’s National Institute on Alcohol Abuse and Alcoholism. “The brain actually changes with addiction, and it takes a good deal of work to get it back to its normal state. The more drugs or alcohol you’ve taken, the more disruptive it is to the brain.” Addiction changes the structure of your brain, rewiring it around the need for this substance. “Brain imaging studies of people addicted to drugs or alcohol show decreased activity in this frontal cortex,” says Dr. Nora Volkow, director of NIH’s National Institute on Drug Abuse. “When the frontal cortex isn’t working properly, people can’t make the decision to stop taking the drug—even if they realize the price of taking that drug may be extremely high, and they might lose custody of their children or end up in jail. Nonetheless, they take it.” Meaning that, although there are mental factors involved in the addiction (like stress, guilt, shame), addiction is also a disease of the brain, it changes how humans function, think, affecting how people perceive judgement and the world around them.
In conclusion, the brain disease model, although it may have some doubters, is the most accurate method to describe addiction. Discriminating against those who are addicted helps no one, it just causes the victims to spiral further into addiction, their mind feeling stress causing them to compulsively drink to drown out the hateful thoughts and comments. Addiction causes both physical and mental dependency, so while it is partially mental, the physical effects of attempting to get recovery or stop are harsh and painful. Going forward, those who are uneducated on the brain science of addiction yet are still discriminating against those who are suffering should be properly taught about the facts of this process. In the future, it would greatly help many who are silently struggling if we, as a community, reduced stigma and learned about how to support those who need our help.
