Addiction as a Disease: A Critical Literature Review

This critical literature review analyzes the controversy surrounding the idea of addiction as a disease and its impact on preventive measures, treatment interventions, and public health policies for substance use disorder. It examines different research papers to clarify the arguments supporting and criticizing the Disease Model of addiction. The review concludes with the need for further research on substance use disorders and new opportunities for prevention and treatment.

COU301A Working with Addicted Populations
Assessment 2: Critical literature review
Word count: 1465
Lumana Maharjan A00064653
10-23-2022

The idea of addiction as a disease is controversial. This paper analyses why people support or
criticize this idea. Different research papers are reviewed to clarify the impact of the Disease
Model of addiction on preventive measures, treatment interventions, and public health
policies for substance use disorder. This paper will also research the current methods of
addiction treatment and address some of the common criticisms of the disease model of
addiction. The below literature review concludes the need for research on substance-use
disorders and new opportunities for the prevention and treatment of substance dependency.
The brain disease model of addiction(BDMA) categorizes addiction as a disease. According
to the National Institute on Drug Abuse(NIDA), addiction is “a chronic, relapsing brain
disease that is characterized by compulsive drug seeking and use, despite harmful
consequences.” (NIDA, 2020). Neuroscience has provided suggestive evidence that drug-
seeking behaviour is compulsive rather than a conscious choice. Chronic use of drugs
changes brain functioning, and an addict will always be at the same risk for relapse as when
he entered treatment after damage to the brain. The BDMA also suggests that recovery
consists of developing and maintaining complete abstinence from all addictive substances
and activities. It is believed that this portrayal will inspire insurance companies to expand
coverage for addiction and politicians to allocate more funding for treatment (Satel &
Lilienfeld, 2014). The BDMA is supported by all major psychiatric authorities, including the
NIDA, the Diagnostic and Statistical Manual of Mental Disorders(DSM), the National
Institute on Alcohol Abuse and Alcoholism (NIAAA), and the American Society for
Addiction Medicine (ASAM) (Hall et al., 2017). Therefore, the BDMA is highly supported and
prevalent for dealing with substance dependency.
Leshner (1997) argues that recognition of addiction as a brain disease will increase access to
medical treatment, reduce stigma and discrimination, and minimise punishment for drug-
using individuals. Treating people with substance dependency as an individual with chronic

illnesses, rather than a criminal can alleviate the overwhelming guilt and shame. This may
result in decreasing numbers of addiction-related deaths or illnesses, as individuals would
feel comfortable seeking treatment. Moreover, research implies that one’s beliefs about the
BDMA are related to one’s attitudes towards individuals with substance dependency (Avery et
al., 2020). The weaker the support for BDMA, the more negative attitudes towards individuals
with substance abuse. Hence, addressing negative attitudes towards individuals by adopting
the BDMA could be important for decreasing stigma and encouraging proper referral and
treatment engagement.
However, some individuals counter the idea of addiction being a disease by claiming
addiction is a choice. Heyman(2009) contends that addiction is directed by personal choice and
therefore does not fit into a clinical conception of a behavioural illness. He points out that
neuroimaging research indicates that most addicts can quit their addiction. Besides, research
claims the brain is neuroplastic, which means the brain can change accordingly (Hall et al.,
2017). So, the damages done by drugs are reversible, a fact inconsistent with the BDMA.
Additionally, the BDMA eradicates the consideration of outside factors such as cultural
background, personal issues and social circle which could affect substance use patterns (Hall
et al., 2017). Also, heritability does not represent an individual's risk of disorder (Urbanoski &
Kelly, 2012). Genes are not a major part of the story as the BDMA claims. It involves a
combination of factors, including different genes, environmental, and lifestyle influences.
Lastly, categorizing addiction as a disease ignores people’s motivation to use drugs, taking
away individual responsibility for bad choices. Hence, numerous research criticizes the
BDMA and claims that addiction is not a disease.
Interestingly, there is very little evidence that the BDMA has reduced stigma or
discrimination. An Australian survey on public attitudes showed that considering addiction as
a disease is not associated with reduced stigmatisation or with reduced support for treatment

or punishment for addiction (Trujols, 2015). This rather entrenches negative public attitudes
towards drug-using individuals. The public may reinforce new fears of addicted individuals
as their behaviour is due to permanent changes in their brains. As a result, it may instead
attach a new stigma by using the word disease.
Findings demonstrate that the BDMA has not contributed to the development of more
effective treatments and has had a modest effect on public policies toward substance
dependency (Hall et al., 2015). Authors assert that the BDMA is heavily reliant on animal
models and small sample case-control neuroimaging studies with highly selected samples of
severely addicted persons, not at the population level. Medicalizing addiction has not led to
any management advances at the individual level (Holden, 2012). Not to mention, the non-
drug intervention as well as the current treatments, such as, approved medications for
stimulant and cannabis addiction are limited, proving that the BDMA has not been able to be
beneficial as it promised.
Contrary to the criticism, the BDMA has led to improvements in the understanding and
treatment of substance use disorders. The additional work on genetics and epigenetics has
developed evidence of biomarkers that directly or indirectly affect the neurobiological
processes involved in developing addictions (Volkow et al., 2016). Today, most of the
treatment methods and techniques used in substance abuse treatment programs are informed
by the BDMA. Treatment includes patient detoxification, outpatient services and
rehabilitation services (NIDA, 2022). The BDMA has also fostered the development of
behavioural interventions such as peer group support, cognitive behavioural therapy,
community reinforcement or contingency management, motivational enhancement, family
therapy, physical therapy, group therapy, and recreational and physical activities. Continued
advances in neuroscience research will refine present treatments and preventions and provide
new and effective ways to deal with substance dependency (Butler Center for Research, 2022).

Such interventions focus on teaching individuals to develop mindfulness, manage stressful
situations without drug use, mitigate anxiety and pain and adopt positive behaviours.
Psychodynamic theories of addiction are strongest in their rich explorations of their subject's
internal, experiential space (Hanjie, 2014). They try to recognise several factors that can cause
a person to become addicted. Nowadays, medical specialists apply the combined model’s
approach where the overall psychological factors are included with the usage of medicine and
drugs.
Regardless of the present preventive measures and treatment interventions, their effectiveness
is still challenged. The DSM is a vital diagnostic tool published by the American Psychiatric
Association(APA) (APA, 2013). This text heavily influences how disorders, such as addiction
are investigated, diagnosed, and treated. Unfortunately, with only two out of eleven
symptoms being sufficient for a diagnosis of substance dependency, DSM covers a single
diagnostic label in a mild category only, making the diagnosis questionable. Likewise,
twelve-step facilitation, based on the BDMA, adopted by Alcoholics Anonymous and other
organizations is very popular (Heilig et al., 2021). Even though many people have testified that
this saved their lives, and with some scientific research supporting the efficacy, other people
have criticized 12-step groups, pointing to the high rates of dropout, the heavy spiritual and
moralistic emphasis, the inconsistent and contradictory logic in its literature, and the
variability of groups depending on who is in them. This represents a very small return on
large, sustained research investment in neurobiological research and drug development.
Despite the strong promotion of the BDMA in the US, the extent to which the BDMA is
officially supported within Australia remains uncertain. Notably, at an Australian drug policy
level ( National Drug Strategy 2010–2015), statements of the type made by influential
American agencies characterising addiction as a brain disease appear largely absent (Barnett &
Fry, 2015). While the view that addiction was a brain disease was not fully supported, there

was some acceptance that treatment attends to the individual’s multiple needs, not just his or
her drug abuse.
In conclusion, the extent to which the BMDA clinically impact addiction treatment and client
behaviour remains unclear. Disagreements with the BDMA reveal the need for
multidisciplinary research that integrates neuroscientific, behavioural, clinical, and
sociocultural perspectives. To summarise, the initial decision to take drugs is typically
voluntary. Even if substance use began as a choice, changes in the brain can cause a person to
lose control of their behaviour with continued use. They cannot just quit their dependency.
Regardless of the classification of addiction, an individual with substance dependence is not a
victim and must take full responsibility for the consequences of their recovery. Moreover,
treatment should depend on the type of drug and the patient’s characteristics matching their
treatment settings, dosages, interventions, and services. Successful addiction recovery also
involves continuing aftercare. Addiction as a disease may be justified and beneficial,
however, there is a greater need for focusing on preventive measures, early diagnosis, and
treatment. The treatment and services plan must be personalized, assessed continually, and
modified as necessary to ensure that it meets his or her changing needs.

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