“Scientific research into addiction . . . has led experts to conclude that addiction is actually a disease, a chronic illness like diabetes or hypertension.”
—Janet Firshein, independent health writer and former editor of Medicine and Health
“The disease concept [of addiction] is directly contradicted by a huge amount of research.”
—Neal Williams, writer for Gray Areas, a magazine exploring controversial social issues
Throughout history, the prevailing attitude toward addiction has been one of disapproval, even repugnance. Addiction was seen as a personal failing, one that resulted from moral weakness and a lack of discipline. At best, addiction was a bad habit, at worst, a sin.
Although addiction has not entirely lost its stigma, an increasing body of scientific research has improved people’s understanding of and sympathy for the problem. One major development in addiction research is the theory that addiction is primarily a biological phenomenon. As Alan I. Leshner, director of the National Institute on Drug Abuse, puts it, addiction is “literally a disease of the brain.”
For years, addiction researchers have asserted that alcoholism has a genetic basis. According to John Crabbe, a researcher at Oregon Health Sciences University and the Veterans Affairs Medical Center, “Alcohol dependence in humans is clearly influenced by genes as well as environmental factors. There is clearly an increased risk for severe alcohol-related problems in children of alcoholics, . . . even if they have been raised without knowledge of their biological parents’ problems.” While studies seem to support the view that alcoholism is genetic, identifying the specific genes that lead to an increased risk of alcoholism has been a laborious task, since humans express more than one hundred thousand genes. However, in 1997, researchers at the Portland Alcohol Center announced that they had mapped three gene regions in mice that influence susceptibility to physical dependence on alcohol—information that they believe could lead to the development of new treatments for alcoholics.
Furthermore, research documenting the impact of drugs on the brain may shed light on why some people are more prone to addiction than others. Drug use—along with other potentially addictive activities such as gambling or sex—causes the brain to release dopamine, a chemical involved in experiencing pleasure. This surge in dopamine can be so powerful that it compels users to keep taking the drug.With prolonged use, however, drugs can alter the brain so that experiencing pleasure without the drug is nearly impossible. At this point, drug use does not raise dopamine levels or produce a “high”; instead, the user keeps taking the drug to stave off painful withdrawal symptoms such as fever, cramps, violent nausea, and depression.
Based on their research of how drugs affect the brain, scientists have theorized that people who are deficient in dopamine may be more likely than others to become addicts. George Koob, a professor of neuropharmacology at the Scripps Research Institute in La Jolla, California, contends that the neurotransmitter systems affected by drug abuse may already be abnormal in people who are susceptible to addiction.
But while most people agree that biology plays some role in addiction, experts on addiction are generally separated into two camps: those who believe that addiction is a biological disease with behavioral aspects, and those who believe that addiction is primarily a behavioral problem that is sometimes influenced by biology.
The latter group maintains that labeling addiction as a medical condition creates a false assumption that addicts have no control over their own behavior. In the view of this group, people become addicts because of their behavior, not their brain chemistry. Neal Williams, a critic of the notion that biology is responsible for addiction, says that “the disease concept is so popular [because] it gives people an easy way out. They believe that they inherited their addiction, therefore they’re not responsible for their own behavior.”
Other critics question whether scientific research has proven that addiction is biological. Stanton Peele, a vociferous opponent of the belief that addiction is a disease, contends that the disease model of addiction is flawed for a number of reasons. First, he claims, most people who take drugs do not become addicted, but may take drugs for a period of time, then stop when they choose to do so. For example, most smokers who successfully kick their addiction to nicotine—a drug purportedly more addictive than heroin—rely solely on willpower to do so. Second, Peele challenges the theory that dopamine is responsible for addiction. He states, “The wide range of activities that stimulate the pleasure centers of the brain—including sex, eating, work- ing, chocolate—should alert us that these brain theories tell us nothing about differences in behavior, let alone addiction. . . . Chocolate stimulates the pleasure centers, but only a few people compulsively eat chocolate or sweets. Apparently, stimulation of the pleasure center is only one small component in the entire addiction syndrome.”
The two contrasting perspectives on addiction—biological versus behavioral—influence debate over the appropriate way to treat drug addicts and alcoholics. Those who believe addiction is a disease generally favor a treatment plan that includes both counseling and medications. Moreover, they maintain that abstinence is the best way to break an addiction to drugs or alcohol. In contrast, opponents of the disease model insist that many addicts recover without any type of psychological or medical intervention— and that some are able to moderate their intake of drugs or alcohol. In the following chapters—What Factors Contribute to Addiction? Is Addiction a Serious Problem? How Should Addiction Be Treated? How Should the Government Deal with Addiction?—Addiction: Opposing Viewpoints provides a variety of perspectives on the nature of addiction, and offers opposing views on the treatments and policies proposed to control this troubling problem.