This month, the American Medical Association decided obesity is a disease, a decision that prompted some outcry from commenters who call both obesity and alcoholism invented illnesses. On Fox News, Dr. Keith Ablow said that people choose addiction: “When an alcoholic chooses alcohol over being available to his or her family and friends, that person is making a decision. When a heroin addict chooses heroin over financial stability and performing well at work, that person is making a choice, too.” At TIME, Maia Szalavitz writes that the idea of addiction as a “chronic relapsing disease” can increase “pessimism about recovery” and “become self-defeating.”
There are many reasons people become addicted and many pathways to recovery, but we do know this: addiction isn’t a moral failing. Instead, it’s a chronic disease that can cause progressive damage without treatment. Just as diabetes gets worse without care, people often need some kind of structured intervention—like twelve-step meetings, behavioral treatment, or medication—to help them manage their addiction. While some people can quit without outside help, thousands of others require professional help.
Here are the facts. A person’s genes account for 40 to 60 percent of their vulnerability to addiction, just as genes increase risk for other diseases. Drug addiction changes the way the brain sends, receives, and processes information. Brain scans show that drug abuse changes brain metabolism, similar to the way heart disease changes a patient’s heart metabolism.
True, you don’t have surgery for addiction like you would have surgery for cancer or heart disease. The disease of addiction is more like the disease of depression; while there’s a component that’s medically identifiable, there’s also a behavioral science component.
I look at it from a bio-psycho-social viewpoint. A person is complex and multidimensional, and people have different pathways to addiction. They can become addicted for physiological reasons (they’re taking an opiate medication for pain and become dependent), for social reasons (they’re in a group of friends that abuses substances to have fun), for psychological reasons (to self-medicate a preexisting psychological condition), and/or because they have a genetic predisposition. Treatment must reflect this complexity. We help people see how they developed their patterns of use, and we also offer medication to reduce cravings and help clients deal with their dependencies.
When our clients see us handling others’ relapses as a doctor would guide a diabetic patient back to a treatment plan, they see that a lapse is simply a symptom of their disease. We help them see the factors that led them to pick up the substance again—whether they were physiological cravings, behavioral patterns that repeated under stress, or emotional and psychological triggers. Then we help them get back on track.
As treatment providers, we communicate hope, empathy and support. We help each client identify his or her strengths. We assist clients in finding their own motivation to change. As clients set and achieve short-term goals in the process of recovery, we help them recognize both their progress and their possibilities. We recognize that coming in for a substance use assessment takes its own kind of strength and courage.
In U.S. News and World Report, Joe Nadglowski, president and CEO of the Obesity Action Coalition, writes that people with addiction and mental illness struggled before we recognized the true nature of their illnesses: “Today, we clearly take these issues very seriously and treat them as diseases.” Nadglowski is right. Managing addiction may be a struggle, but recognizing its true nature as a disease makes all the difference in recovery.
Melissa Thomasson, Ph.D.
Supervising Clinical Psychologist
Phoenix House of Los Angeles
Adult Residential and Outpatient Program
If you or a loved one needs help for a substance abuse issue, Phoenix House is here for you. Email us or call today at 1 888 671 9392.
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