Quality & Science

Addiction: Character Defect or Chronic Disease?

by Richard G. Soper, MD, JD, MS, FASAM | March 13, 2014

Recently, numerous media sources have implied that "addicts" ought to make better choices; addiction science cautions that is not always possible. Describing addiction as a reflection of moral character and choice takes us back to an earlier, more ignorant time. Science now shows that addiction, including alcoholism, is not a simple phenomenon. It stems from multiple causes rather than character flaws.

Many of us as medical professionals use a medical model to understand addiction. Drugs, alcohol, and illicit substances activate reward systems in the brain, which cause people to feel pleasure and create memories. Each individual has a unique tolerance to drugs and alcohol; the effects of drugs and/or alcohol are individually specific. Individuals may have genetic predispositions and different brain inhibitory circuits. Addiction is a disease, just like asthma, diabetes and heart disease.

Most drug treatment professionals and facilities speak of stages of change. Those who suffer from substance use disorders are not necessarily aware of the disease of addiction. Recovery is a lifelong process. William White - addiction writer and author of Slaying the Dragon - talks about our need to focus more on recovery. Most people come into drug treatment in a state of unawareness or ambivalence. Stereotyping addiction sufferers as immoral characters is not helpful. It is a shame-based concept that perpetuates the addiction problem and discourages a person from reaching out for help. Who would choose to feel worse about themselves than they already feel? This is why it can be so hard to enter recovery programs.

It is deeply disappointing and disingenuous to see again how the media, professionals, and members of our society repeatedly demonize, marginalize and even re-criminalize a chronic, recurrent, progressive and ultimately fatal brain disease. A recent brochure advertising an upcoming medical professional meeting in my region has a workshop on discussion of medication assisted therapy becoming or being addicting. I respectfully ask again, are we, the addiction treatment professionals, part of the solution or part of the problem?

Richard G. Soper, MD, JD, MS, FASAM
Editor-in-Chief, ASAM Weekly

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