Addiction as a Disease: A Critical Literature Review

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