Jan Hoffman in The New York Times: The message emblazoned on a walkway window at the airport in Burlington, Vt., is a startling departure from the usual tourism posters and welcome banners: “Addiction is not a choice. It’s a disease that can happen to anyone.” The statement is part of a public service campaign in yet another community assailed by drug use, intended to reduce stigma and encourage treatment.
For decades, medical science has classified addiction as a chronic brain disease, but the concept has always been something of a hard sell to a skeptical public. That is because, unlike diseases such as Alzheimer’s or bone cancer or Covid, personal choice does play a role, both in starting and ending drug use. The idea that those who use drugs are themselves at fault has recently been gaining fresh traction, driving efforts to toughen criminal penalties for drug possession and to cut funding for syringe-exchange programs. But now, even some in the treatment and scientific communities have been rethinking the label of chronic brain disease. In July, behavior researchers published a critique of the classification, which they said could be counterproductive for patients and families.
“I don’t think it helps to tell people they are chronically diseased and therefore incapable of change. Then what hope do we have?” said Kirsten E. Smith, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine and a co-author of the paper, published in the journal Psychopharmacology. “The brain is highly dynamic, as is our environment.”
The recent scientific criticisms are driven by an ominous urgency: Despite addiction’s longstanding classification as a disease, the deadly public health disaster has only worsened.
Almost no one is calling for entirely scrapping the disease model. Few dispute that constant use of stimulants like methamphetamine and opioids like fentanyl have a detrimental effect on the brain.
But some scientists argue that brain-centric disease characterizations of addiction do not sufficiently incorporate factors like social environment and genetics. In the recent critique, researchers contended that, rather than emphasizing the brain’s brokenness in perpetuity, an addiction definition should include the motivation or context in which the person chose to use drugs.
That choice, they said, is often about seeking an escape from intractable conditions such as a fraught home, undiagnosed mental health and learning disorders, bullying or loneliness. Generations of family addiction further tip the scales toward substance use.
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