Is Addiction A Disease?

By Steve K.

In this essay I will be specifically referring to alcohol and drug addiction or severe alcohol/substance use disorder, which is the terminology used in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The medical and scientific community, particularly in the USA, currently views addiction as a brain disease, and the following description taken from the US ‘Recognizing Addiction as a Disease Act of 2007’, outlines the general mainstream view:

Addiction is a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain’s structure and manner in which it functions. These brain changes can be long lasting, and can lead to harmful behaviours seen in people who abuse drugs. The disease of addiction affects both brain and behaviour, and scientists have identified many of the biological and environmental factors that contribute to the development and progression of the disease. (1)

This description fits well within general dictionary definitions of the term disease, for example; “A disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury.” (Oxford Dictionary)

“A pathological condition of a body part, an organ, or a system resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms.” (Dictionary.com)

Within the field of addiction treatment and research there is a long history of polarising views in terms of the nature of addiction. On one side those who focus upon the biological aspects of addiction, and on the other side those who favour environmental and behavioural explanations.

These different models are viewed as important in terms of how addiction is treated; with the biological perspective comes a focus upon medicalization and drug treatments, and with the behavioural viewpoint comes social and psychotherapeutic interventions.

Some researchers in the field, who favour behavioural learning explanations of addiction, don’t consider it to be a disease. In his latest book The Biology of Desire, the neuroscientist Marc Lewis argues that addiction is not a disease but the consequence of the brain’s natural capacity to change its structure and function in response to repeated behaviour that offers reward. These changes in the brain then stimulate the anticipation of reward, (desire or craving) that leads to compulsive patterns of alcohol and drug use.

“But is addiction really a disease? This book makes the case that it isn’t. Addiction results, rather, from the motivated repetition of the same thoughts and behaviours until they become habitual. Thus, addiction develops – it’s learned – but it’s learned more deeply and often more quickly than most other habits, due to a narrowing tunnel of attention and attraction. A close look at the brain highlights the role of desire in this process. The neural circuitry of desire governs anticipation, focused attention and behaviour.” (Introduction, p.x The Biology of Desire: Why Addiction Is Not A Disease. By Marc Lewis, 2015)

Lewis’s view of addiction not being a disease seems to rely on the changes in the brain’s structure and function being part of a natural process. I personally don’t find his reasoning that convincing. Yes, changes in the brain are the result of repeated behaviour, which is motivated by the euphoric high obtained from using alcohol or drugs. His viewpoint in the book seems to ignore the actual substances taken, suggesting they are not that important in the process, and offers examples of other powerful addictions such love and gambling.

I would suggest that the chemically induced high produced by alcohol and drugs, in some individuals, causes extremes in terms of learning and changes in the brain structure and function, to the extent that the brain becomes disordered. Also, his view ignores the potential for physical dependency with alcohol and some drugs which compounds matters.

Lewis himself doesn’t seem that convinced that addiction isn’t a disease in the following passage taken from an interview in the Guardian about his book.

The parts of the brain that become activated when craving is triggered by cues changes. So there’s something going on that makes it hard to stop for very good neurological reasons. So then, do you want to call addiction a disease? Well, maybe, then you’re getting close I think, because you could call it a pathology I guess. Because obsessive compulsive disorder, that’s a pathology right? So yeah, I think there is a point at which the line between those definitions starts to blur.

So it sounds like it comes to a point where perhaps addiction does fall into disease territory then?

[Pauses]. I wouldn’t say disease. I would call it disorder. Or even the adjective, “pathological”. But I just don’t like those words because they’re all part of this particular framework, and that’s the dominant framework in the US and parts of Europe, that this is in fact a chronic brain disease. It’s hard to talk about it as if sometimes it’s a disease or sometimes it’s not. Then the argument starts to get kind of mushy. But when you are in the grips of compulsion, yeah, there is a process going on that of course isn’t healthy and requires a certain amount of cognitive and emotional and probably therapeutic work to get out of. So yeah, OK, I’ll grant you that you could call that, certainly, a disorder.”

(Marc Lewis: the neuroscientist who believes addiction is not a disease. Interviewed by Melissa Davey, the guardian, Sunday 30th August 2015)

“Pathological”: relating to, involving, or caused by disease. (Collins Concise Dictionary)

The difficulty it seems to me of accepting alcohol and drug addiction as a disease is in its complexity. There are various components in the formation of addiction such as, genetic inheritance (in terms of character traits), upbringing and environmental influences, developmental difficulties and psychological trauma, co-occurring illnesses, availability and cultural influences. All of which can make an individual more or less vulnerable to developing an addiction.

Also, in terms of metabolism, it seems to me that some are more sensitive than others when it comes to processing alcohol and drugs. I am myself sensitive and affected by substances very easily compared to others. You only need to consider how GPs prescribe very different dosages of medications to their patients for the same illnesses, dependent upon their patients’ capacity to tolerate them. I accept that an individual’s psychology can play a part in these differences, but biology must do so as well. Admittedly, this is my layman’s view and of course I may be wrong on this issue.

The fact that addiction is not caused by purely physical disorder doesn’t stop it from becoming a disease in the opinion of Nora Volkow, Director of the National Institute on Drug Abuse:

“The non-inevitability of addiction is a point frequently emphasized by people challenging the brain disease model, with the faulty reasoning that it cannot be a disease because the condition is initiated by a decision to take a drug, which is viewed as a voluntary behaviour, and also because most individuals never escalate their drug taking. However, this is no different from many other diseases that also have complex genetic, environmental, and developmental origins, may be triggered by voluntary behaviours or their omission, and may only affect a small subset of those at risk.

I often compare drug addiction to another chronic, relapsing disease, diabetes. In diabetes, the pancreas is not able to make the insulin necessary for our cells to use glucose as fuel. No one thinks that, with sufficient willpower, a person with this condition could push through without medication. Their disease, even if it had behavioural antecedents and may have involved free choices in a person’s past — such as decisions about food or exercise — has a physical basis and requires medical management once it has developed.” (Advances In Addiction and Recovery. P17. Vol.3, No.3, 2015)

I think that the degree of alcohol and drug addiction is relevant in terms of language used, how it is considered and the treatment or interventions offered. The DSM-5 uses the terms alcohol use disorder and substance use disorder in an attempt to represent the wide spectrum of alcohol and drug problems, from mild to moderate and severe. I think once an alcohol or drug problem has developed into a severe and chronic addiction, it is more appropriate to use the language of disease. Maybe in the earlier stages the terms behavioural problem and disorder are more fitting. Lewis and others cite the research that in community populations most with addictions resolve them without help from treatment services.

According to William L White (the addictions researcher), in an email to me, they fail to mention the difference between community and clinical populations in respect of addictions ending ‘spontaneously’.

“People often note my reference to resolution of alcohol and other drug problems without professional treatment or recovery mutual aid involvement, but they often fail to mention (because it doesn’t support their argument) the tandem conclusion that the probability of this sharply declines as problem severity, complexity, and chronicity increases—this is the major difference between follow-up studies of community samples and follow-up studies of clinical samples.”

Bill White. November 6th 2015

In other words, the more established and severe the alcohol and drug problem the more likely the need for interventions, clinically and in terms of recovery mutual aid groups.

In his blog article ‘Predicting Addiction/Recovery Trajectories’(2), Bill White suggests several high risk factors that make it more likely a person will develop a chronic, complex and severe problem with alcohol and other drugs (AOD), such that they will require treatment or interventions. These risk factors include:

* Family history of AOD-related problems

* Early age of onset of AOD use

* Euphoric recall of first AOD use

* Atypically high or low drug tolerance from onset of use

* Historical or developmental trauma:  cumulative adverse experiences with traumagenic factors (e.g., early onset, long duration, multiple perpetrators, perpetrators from within family or social network, disbelief or blame following disclosure)–without neutralizing healing opportunities

* Adjustment problems in adolescence that contribute to adult transition problems, e.g., instability in education, employment, housing, and intimate and social relationships 

* Multiple drug use

* High risk methods of drug ingestion (e.g., injection)

* Co-occurring physical/psychiatric challenges

* Enmeshment in excessive AOD-using family and social environments, and

* Low levels of recovery capital (internal and external assets that can be mobilized to initiate and sustain recovery).

These risk factors don’t necessarily mean an individual will develop a chronic and severe addiction problem, but make them more vulnerable to doing so, particularly when the factors are combined.

Choice and Self-Medication models.

When considering the different viewpoints in relation to the causes and nature of addiction, Marc Lewis in his book, narrows them down to three broad categories; the disease model, choice model and self-medication model. All three are influenced by social and psychological factors.

Simply put the choice model suggests that people make decisions about payoffs and pleasure, particularly in the short term, and the decision to use alcohol or other drugs is often most attractive at the time and in the circumstances. It’s a view that’s given to explain people’s decision to stop using when the consequences of doing so become too unpleasant, or when their circumstances change.

In my view, while there is some truth in this understanding of alcohol and other drug use it’s far too simplistic and denies the individual’s predispositions and the changes in the brain’s neurobiology that strongly influence choice. This viewpoint also encourages an attitude of moral judgement towards those with addictions, and is a return to the concept of moral failure of character prevalent in the past.

The self-medication model of addiction suggests that people use alcohol and other drugs to relieve emotional or psychological distress. The model suggests that some individuals are more vulnerable to self-medicating due to trauma, particularly trauma experienced in childhood and adolescents.

I see truth in all three of the above models of addiction and would suggest that there is a complex interplay between them, and that this interaction is unique to each person who develops an alcohol or other drug problem. I think that an over emphasis on any one particular viewpoint is not helpful and that a holistic approach towards the causes and treatment of addiction is best.

Is addiction a disease? It seems to me a matter of interpretation and when considering the current definitions of the term disease, my view is that addiction, in its severe form, can legitimately be classed as such. However, in the earlier stages, alcohol or other drug problems are probably better described as a behavioural problem or disorder. Alcohol or drug use starts with choices that are influenced by biopsychosocial factors relating to the individual, but as the habit or dependency develops, choice becomes increasingly impaired and instead becomes a compulsive disorder. Addiction takes over to a large degree and has the capacity to make a person very ill, both mentally and physically (the symptoms of the disease), and quite often kills.


  1. The quoted disease model description is taken from; p.11, ‘The Biology of Desire: Why Addiction Is Not A Disease’. By Marc Lewis, 2015.
  2. ‘Predicting Addiction/Recovery Trajectories’, Blog Post, Nov’ 21st The Selected Papers of William L White.

About the Author, Steven K.

Steve K has been a member of AA for 24 years and lives in Cheshire, which is in the N. West region of England. He would describe himself as a humanist/agnostic. His home group is the Macclesfield Saturday morning AA group and he regularly chairs the meeting. He has a background in advice and counselling work, mainly in the areas of mental health and social welfare law. Steve enjoys swimming and going to the gym regularly at the local Leisure Centre and hill walking in the Cheshire countryside.

He’s recently started a recovery blog, 12stepphilosophy, and has self-published an eBook entitled “The 12 Step Philosophy of Alcoholics Anonymous: An Interpretation by Steve K.” The Third edition is available as both an eBook and a paperback at Lulu.

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  1. Richard Sandor, MD December 8, 2015 at 5:55 pm - Reply

    Dear Steve,

    A patient of mine (active in We Agnostics) sent me a link to your article, and I wanted to thank you for your calm and reasoned approach to what is so often a rancorous debate.  I have been working in this field for over 35 years now and am utterly convinced of the profound value of the 12-step program.  I’ve also spent a good deal of time thinking about the disease concept of addiction and published a book about it in 2009 (Thinking Simply About Addiction, Tarcher/Penguin).  In short, I don’t think it is necessary to refer to specialized knowledge (brain chemistry and such) to find the foundation for considering addiction to be a disease;  the overwhelmingly consistent experience of people who have an addiction (in recovery or not) as something that develops a life of its own, is sufficient.  Here’s a link to one of several reprints of an article I wrote as a condensation of the book.  Perhaps you will find it interesting.

    http://themphp.org/Archive/Articles/tabid/98/ArticleID/143/The-Disease-Concept-of-Addiction-Revisited-by-Richard-S-Sandor-MD.aspx

    Best regards and good luck with your work,

    Richard S. Sandor MD

     

     

    • Steve K December 9, 2015 at 12:57 am Reply

      Thanks for the link to your article Richard. I enjoyed reading it and you offer some great insights.

  2. Rob McC December 7, 2015 at 11:52 am - Reply

    What if we had called a four legged bovine that produces milk a pig?  And what if we had called a four legged animal from whence we acquire ham a cow?  Do the names change how we perceive our ham sandwich and glass of milk?  What happened to a rose by any other name….?

    Let’s get on with the entirety of the scientific work of understanding and explaining the phenomenon of alcoholism and stop worrying about common terminology that annoys or pleases us.

    • Dave J December 9, 2015 at 11:40 am Reply

      It helps to know what the problem is- it allows for a multi-layered approach to addressing it. AA has an approach which seems to work for a relatively small percentage of people (a more or less stable 1.2 million with a yearly wash of 800,000 or so). Folks in the pure brain science end of things seem to short change the power of peer support communities. How we frame these issues determines how we address them. So being mindful of different models of addiction are useful.

  3. Phil G December 7, 2015 at 3:53 am - Reply

    Bill White also stated in his book Slaying the Dragon (page 512):

    “Science is unlikely to destroy the disease concept, but a better metaphor could.”

  4. Laurie A December 6, 2015 at 3:41 pm - Reply

    ‘Alcoholism is an illness which only a spiritual experience will conquer’ (Big Book, We Agnostics). ‘… we have been not only mentally and physically ill, we have been spiritually sick. When the spiritual malady is overcome, we straighten out mentally and physically.’ (How It Works)

    If I went to a physician with, say, diabetes and they said, ‘Your only hope is a spiritual awakening’, I’d demand a second opinion. There are differences between being ill or sick and having a disease. For example, we talk of mental illness rather than mental disease.

    In any case to a lay fellowship like AA the definition of alcoholism as a disease is a Tradition 10 outside issue, best left to others.

    • Steve K December 6, 2015 at 4:22 pm Reply

      AA views alcoholism as an illness of the mind, body and soul. It adopted the mind and body bit from the medical profession. The ‘doctors opinion’ in the Big Book is clearly an early account of the the medical model, so how’s the subject an outside issue? Dr Silkworth was a big influence upon Wilson’s understanding in terms of the ‘problem’; the obsession of the mind and an allergy of the body. The spiritual solution was suggested by Jung.

      Although AA didn’t invent the disease concept and its understanding is different, it is associated with it and historically it’s played an important role in society accepting this model. It’s a relevant topic for discussion and Wilson addressed the issue publicly – see my comment in response to John S, in relation to Wilson’s talk to the National Catholic Clergy Conference on Alcoholism. (1961)

      • Laurie A December 7, 2015 at 1:54 am Reply

        An outside issue because AA – as such (not individual members) – neither endorses nor opposes the disease concept. Dr Silkworth’s opinion was just that – his opinion, not AA’s. He also believed addiction was an allergy, again just his opinion and subsequently disproved.

        AA Conferences have had ample opportunity in the past 80 years to pronounce on whether alcoholism is a disease and has chosen not to. The fact that the treatment ‘industry’, WHO, AMA etc choose to conflate AA’s nuanced understanding of our condition with the blunt disease model is not our fault since AA – as such – doesn’t get involved in controversy.

        Some behavioural psychologists believe problem drinking is learned behaviour and as such can be unlearned (didn’t work for me!); but again, AA has no opinion on this approach. ‘If you can drink like a gentleman ..’ Etc. But an invigorating debate.

        • Steve K December 7, 2015 at 2:46 am Reply

          I am speaking for myself not AA, and on a forum with other members of the fellowship. Dr Silkworth’s opinion was put into the basic text of the fellowship by Bill W. The book is supposed to represent AA’s views and is approved to do so. By using Silkworth’s opinion in the book AA is advocating this viewpoint, whether it acknowledges it or not. However, it does…..”As laymen, our opinion as to it’s soundness may, mean little. But as ex-problem drinkers, we can say that his explanation (Silkworth’s) makes good sense.” That statement is AA having an opinion on the nature of alcoholism and it’s expressed in the fellowships main text!

          • John S December 7, 2015 at 1:23 pm Reply

            I agree. I am not exactly an “A” student on the Traditions, and I’m sure that I’ve broken a few from time to time. I can see how maybe AA doesn’t have an opinion on this, but that shouldn’t mean that individual AA members can’t talk about it.

          • Laurie A December 7, 2015 at 4:24 am Reply

            Hi Steve,

            U.S. AAs must think we’re insomniacs (2.46am)! I like the cartoon of a woman standing in her nightdress and saying to her husband, ‘Time for bed.’ And he, peering at his laptop, replies, ‘Be up soon – but someone’s wrong on the internet’! I don’t think you’re wrong Steve, but there are different points of view.

            Insofar as AA has an  ‘official policy’ on alcoholism as a disease maybe it is expressed in this letter that I received from GSO, New York, on October 18, 2000:

            ‘Dear Laurie,

            I currently co-ordinate the Public Information assignment here at the New York General Service Office and have become quite adept at quoting our Tenth Tradition to journalists who contact this office looking for AA’s opinion on varied issues, some of which you mentioned in your letter.

            There was a recent TV program in the US which was highly critical of the AA program and generated anger and antagonism from many quarters of the AA Fellowship. The numerous requests for this AA office to react or defend Alcoholics Anonymous were met with the gentle reminder about our Tenth Tradition.

            We also pointed out Bill W’s guidance in Concept Twelve, “Let us suppose that AA does fall under sharp public attack or heavy ridicule; and let us take the particular case where pronouncements happen to have little or no justification in fact (as that AA promotes the disease theory of alcoholism – my comment, Laurie). Almost without exception it can be confidently estimated that our best defense in these situations would be no defense whatsoever – namely complete silence at the public level”

            ‘This public relations policy is one which we at this office heartily endorse. We also believe that it ought to serve as a thoughtful guide to members of the Fellowship. Though a response to an outside criticism may of course be done on a personal level, the mere fact of offering an opinion as an AA member may lead to a public discussion where the line between the personal and the Fellowship’s opinion may become blurry in the public’s mind (as on this and other websites, Laurie).

            ‘Our role as a society of recovered alcoholics helping others does not endow us with any medical or scientific stature. Therefore, the issue of a medical determination of a disease is something on which AA could have no position.

            Our Traditions are clear in reminding us not to be diverted from our primary purpose as a Fellowship, and as members of that Fellowship we should respect the limitations we have. Dr Silkworth’s view on alcoholism is still contained in the basic text of Alcoholics Anonymous, though as a separate and distinct Foreword. It may lack a certain medical credence these days, though the ideas still resonate with many AA’s and newcomers.

            ‘Laurie, we hope that the above reflections are helpful and that you know that we appreciate your concern for the integrity and continuity of the AA message…’

            Signed: Bill Archer, GSO staff

            Bill Archer’s careful caveat that the Doctor’s Opinion is included in the Big Book as ‘a separate and distinct Foreword’ suggests that GSO distances itself from the endorsement of his ideas as AA policy.

            • John S December 7, 2015 at 7:34 am Reply

              What a great letter! Thanks for posting that.

  5. Christopher G December 6, 2015 at 11:13 am - Reply

    Thank you, Steve. I found the last two paragraphs of your essay and the comments by Joe C and a few others to be precisely in line with my thoughts and feelings on the subject. Becoming too focused on definition obscures my ability to use an idea. To use BB advice, I have to ask myself what it means to me and is it true for me.

  6. Lance B. December 6, 2015 at 9:56 am - Reply

    Thank you for your thoughtful article, Steve.

    I regard myself as lucky on many scores, but having the humanist tradition of AA in England and the thinking it has produced is one of those which I’m not sure I could get along without any more.

    And another is the great complexity of alcoholism and addiction itself.  If I had developed any other less complex disease/affliction/malady/whatever, I’m sure I would be bored going to meetings and trying to encourage others by now.  The fact that there are, for me, no easy answers to so many addiction questions makes an attempt to synthesize different ideas fascinating over a long period of time.

    My suspicion would be that if I became bored and unconnected to the AA community, it would not be long before complacency dominated my attitudes and then a drink possible.

  7. Joe C. December 6, 2015 at 9:49 am - Reply

    I like your book, Steve because I enjoy your journalistic writing style. Some writers are the message and not merely the medium. That’s fine, of course but I like writers who let the story tell the story ( show me, don’t tell me).

    This is a great topic. When Marc Lewis was a guest on Rebellion Dogs Radio we got an extra 1000 listeners that week. People have strong feelings about this subject – for and against. NA, as we see in their literature, is married to the disease model. AA isn’t, maybe only because our text was written before the American Medical Association took dominion over treatment by labelling addiction a disease (sorry for over-simplifying a complex drama). AA may have found the more prestigious “disease” language irresistible, if we came later, too. It’s more affirming than “moral failing.” Disease requires medicine the same way a spiritual malady needs transcendence. I find these models to be binary ideas if you take them literally. But as a metaphor, “disease” is useful; addiction is a malady/disorder that ought not be ignored. That said, “The devil made me do it” and Dr. Jekyll & Mr. Hyde are perfectly legit metaphors, too.

    But  for me, literally thinking of my addiction as a disease is another way of seeing outside agency as necessary to “fix” me. I don’t see this as a flawed approach but it abdicates just a bit too much personal responsibility for my needs. That’s a personal choice I make. The choices are many.

  8. Roger C. December 6, 2015 at 9:41 am - Reply

    A well written and researched article on an important topic. Thanks, Steve.

  9. Thomas B December 6, 2015 at 9:41 am - Reply

    Thanks, Steve, for an informative and pertinent article . . .

    Though I greatly appreciate Marc Lewis’ work, especially his memoir, Memoirs of an Addicted Brain, which described his youth when he fell in love and his harrowing experience with drugs. I especially resonated with his description of massive unrequited love, which after satiation became boring — this described much of my callow youth when I fell in love with any girl I met.

    Nevertheless, his interview with The Guardian certainly indicates that even he has “mushy” thinking about the complexity of this pervasive aspect of the human condition, the tendency of some individuals to become addicted to behaviors and/or substances.

    I suggest the hard, cold reality is that it is most unlikely that government, private and public treatment agencies, funding sources, society at large, to include the the vast majority of the general public, will ever *unlearn* that addiction is a disease since it has been accepted as such throughout North America and Europe for the past 80 or so years.

  10. Neil F December 6, 2015 at 9:35 am - Reply

    Personally I don’t believe that alcoholism or other addictions are diseases but I do think that they do lead to other diseases such as cirrhosis of the liver etc.  The initial changes to the brain that lead to deeply engrained habits are a result of  plasticity of the brain; a normal process.  I have Marc Lewis’ book on my reading list as I’d like to see what he has to say.

  11. John S December 6, 2015 at 8:47 am - Reply

    I seem to recall reading somewhere that the authors of the Big Book intentionally used words such as “illness”, “malady” or “allergy” when describing alcoholism and purposefully avoided the term “disease”. I may be mistaken on that, but still the disease concept seems to have gained headway after AA came on the scene.

    I think for the most part it’s been helpful to look at addiction as a disease because it takes away the judgement factor for both the addicts and those close to them, and it allows the person to focus on treatment.

    It certainly is complex, especially when you add the physical component, the physical addiction to the drug. I know for myself that though I was young, I was unable to stop on my own. I really needed support from others to not drink. That was key to me.

    Thank you for the great article. It was well researched and intelligently written. I continue to be impressed with the amazing talent in our community and I’m very grateful for your contribution and to all those who contribute to the discussion here.

    • Christopher G December 6, 2015 at 11:00 am Reply

      Yes, John, the word disease is only used once in the first 164 and once in the 12 and 12:

      12&12 Tradition Five, p.150;  “Alcoholics Anonymous can be likened to a group of physicians who might find a cure for cancer, and upon whose concerted work would depend the answer for sufferers of this disease.”

      and;  BB How It Works, p.64,  “From it stem all forms of spiritual disease, for we have been not only mentally and physically ill, we have been spiritually sick.”

      Anonymous (2013-12-30). 164 and More – Big Book and 12&12 Reference Guide (Kindle Locations 74352-74353). Recovery Press LLC. Kindle Edition. Copyright © 2005-2015, All Rights Reserved.

    • Steve K December 6, 2015 at 10:48 am Reply

      Bill W gave this response in reply to being asked his view on alcoholism being a disease in an address given to the National Catholic Clergy Conference on Alcoholism in 1961:

      “We have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore we always called it an illness, or a malady – a far safer term for us to use.” 

      I’m not so sure his viewpoint would still be the same today considering the amount of brain research in the past 10 – 15 years. Brain scanning technology clearly wasn’t available in the 1960’s.

      Ironically, before I started reading Marc Lewis’s book, I was doubtful about addiction being a disease and like Wilson preferred the term illness. However, the further I got into researching the topic the more I came around too seeing that in its severe form addiction can be validly described as a disease. (only my take)

      Interestingly, researchers like Nora Volkow and Marc Lewis understand the neuroscience of the brain in relation to addiction in the same way, but somehow come up with different conclusions as to addiction being a disease or not. Clearly a case of cognitive biases, we interpret information in way that suits what we already believe.

      Disease or not, addiction certainly involves a complex interplay of biopsychosocial factors which are unique to each person. Therefore a person-centered approach which considers this interplay of factors seems the best strategy in terms of treatment.

  12. Annette S. December 6, 2015 at 8:41 am - Reply

    Thanks for your article! Alcoholism certainly fits the simple definition of a disease: It’s diagnosable, treatable and has a predictable course. But it is a complex disease that encompasses much more than brain chemistry, and the approach to treatment must be comprehensive and responsive to individual needs and situations.

  13. Jane T December 6, 2015 at 8:18 am - Reply

    Thank you, Steve, for this thoughtful and informative article.

    I tend to be wary of medical or drug treatments for alcohol and drug dependency and favor cognitive/behavioral treatments, but that is just my distrust of the pharmacy business and their aggressive sales tactics in the medical community. For very severe cases this type of treatment, temporarily, might be the best option.

    Anyway, I agree that alcohol and drug dependency is complicated in its inception, continuation, and treatment for each individual. Thanks for sharing your research!

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