Addiction: Is It a Disease, or … Something Else

The question of whether addiction constitutes a “disease” is a perennial source of disagreement among the "experts' and among addicts themselves. Much depends on the definition of “disease.” Used casually, the term implies some sort of breakdown in the body, stemming from bacteria, or viruses or things like cancer which have a clear and negative effect on the sufferer. Addiction clearly isn’t caused by a virus or bacteria or other foreign agent.  And while the effects of drinking and drug use cause damage which can lead to conditions that are clearly diseases (cirrhosis, for example), that is not the same as the addiction itself being a disease.

A recent blog post ( in the magazine Psychology Today bywriter/physician Lance Dodes (author of the book, Breaking Addiction) gives a very brief history of the label as applied to addiction and then contends that addiction is a behavioral problem, a compulsion, no different – except perhaps in the physical damage it can do – from other compulsive disorders, such as out-of-control gambling:

"When addiction," he writes, "is properly understood to be a compulsive behavior like many others, it becomes impossible to justify moralizing about people who feel driven to perform addictive acts.  And because compulsive behaviors are so common, any idea that "addicts" are in some way sicker, lazier, more self-centered, or in any other way different from the rest of humanity becomes indefensible."

Dodes holds that the “addictive acts occur when precipitated by emotionally significant events” by which he presumably means events that lead to emotions that are very difficult to deal with. He goes on to say “they can be prevented by understanding what makes these events so emotionally important, and they can be replaced by other emotionally meaningful actions or even other psychological symptoms that are not addictions.  Addictive behavior is a readily understandable symptom, not a disease.”

Boy, I wish it had seemed so simple and straightforward to me when I was struggling to get sober! For that matter, I wish I could be certain, after 12 years of sobriety, that I had overcome the underlying cause and didn't have to worry any more. It’s an interesting way of looking at it that undoubtedly has some truth. But it seems to me that the problem is more complex than he implies. I don’t much care if we call it a ‘disease’ or a ‘condition’ or a ‘problem;’ but I do think it takes every ounce of determination one can marshal, plus some sort of supportive help,  to overcome it. It's not simple, whatever you call it.

-- Craig Whalley


  1. JeffK on November 14, 2013 at 6:08 am

    I’m sure glad LifeRing does not official engage in the “disease” debate, because a lot of energy can be spent arguing about what amounts to semantics. :-) But I do think the author misses the boat, and I wonder if she has any personal experience in all this. Huge piles of research and lots of MRI scans show that she is wrong stating there is “…no biologically degenerative condition (as in Alzheimer’s disease)” related to alcoholism. It’s a brain disorder with many identifiable biological symptoms related to chemical dependency. I’d also part ways when she says, “addictive acts occur when precipitated by emotionally significant events” – maybe that’s true sometimes, but doesn’t explain why some of us drank ourselves to blackout every single night for years, unless the aftermath of the previous night’s binge counts as an emotionally significant event. “Addictive behavior is a readily understandable symptom” seems just plain wrong as well. There are reasons why we drank or used ourselves to the point where addiction came into play, and it’s often important to understand those reasons, but once addiction (chemical dependency) comes into play it’s a different game because you’re causing significant changes in brain function that make it harder and harder to stop, and easier and easier to rationalize all kinds of behavior that the sober you would be repelled by.