The Disease of Drug Addiction
Addiction is a chronic, often relapsing brain disease that causes compulsive seeking and use of addictive substances despite harmful consequences to the addicted individual and to those around him or her.
Dramatic advances in science over the past 20 years have shown that drug addiction is a chronic relapsing disease that results from the prolonged effects of drugs on the brain. (Leshner, 1997) It is considered a brain disease because drugs change the brain structure and how the brain works. (Volkow and Schelbert, 2007) As with many other brain diseases, addiction has embedded behavioral and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioral, and social-context components. Recognizing addiction as a chronic, relapsing brain disorder characterized by compulsive drug seeking and use can impact society’s overall health and social policy strategies and help diminish the health and social costs associated with drug abuse and addiction (Leshner, 1997).
Addiction as a Disease
For decades, the orthodox view in neuroscience and psychiatry has been that addiction is a psychiatric disease (Jellinek, 1960). In 1968 it was included in the second revision of the Diagnostic and Statistical Manual of Mental Disorders, positioning it explicitly as a mental illness for the purpose diagnosis and treatment (APA, 1968). In the 1990’s, however following the new advances in neuroimaging, some of the biological mechanisms of addiction became apparent and some scientists conceptualized addiction as a disease of biological, rather than purely mental origins. For example, in his capacity as the director of the National Institute on Drug Abuse, Alan Leshner wrote that the reason we ought to think of addiction as a disease is that it ‘is tied to changes in brain structure and function’(Leshner,1997). This reasoning is echoed in the work of several other authors. Heyman, Heather and Alexander, among others, have challenged the disease status of addiction on primarily empirical grounds (Heyman, 2001; Heather, 1992; Alexander, 1988). Philosophical accounts of disease, which attempt to clarify the concept, come in many shapes and sizes. For example, Boorse argues for a naturalistic conception of disease in which a disease must be reflected in a loss of function in an organ (Boorse, 1977). At the other end of the spectrum, Nordenfelt argues for a normative conception, which defines diseases as conditions which prevent us from meeting our ‘vital goals’ (Nordenfelt, 1995). It is still an open question whether Boorse’s view, Nordenfelt’s view or some other view gives the best rendering of what we mean when we call something a disease, but the published accounts can support the claim that changes in brain structure and function are enough to constitute a disease. The concept of addiction as a neurobiological disease has taken hold, thanks largely to the efforts of both NIDA and the World Health Organization (WHO) that addiction is a disease (NIDA, 2009 ; WHO, 2004)
“Substance Dependence or Drug Addiction”
The term “substance dependence” has gained great currency because of its use in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM, both in its revision of the third edition (DSM- III- R; American Psychiatric Association [APA] 1987) and in its most recent edition (DSM- IV; APA 1994), avoids the term addiction, preferring instead to use the diagnoses of substance abuse and dependence, collectively referred to as substance use disorders. Beginning with DSM-III-R, the criteria used to diagnose substance use disorders were applied more or less equally to all of the substances that are commonly mis-used by individuals. In the DSM, therefore, individuals are differentiated onto three mutually exclusive categories: no substance use...
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