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 says 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 disease concept can increase ?pessimism about recovery? and ?become self-defeating.?
It?s an old controversy but still worth revisiting. It?s useful to see addiction as a disease as long as we see the full picture?the many reasons people become addicted, the way forward from relapse, and the pathways to recovery.
The disease model helps people see that addiction isn?t a moral failing, and it causes progressive damage. Just as diabetes gets worse without care, someone may start with experimental substance use and progress to social use before developing a full-blown dependency. People often need some kind of structured intervention to improve, whether that?s twelve-step meetings, behavioral treatment, or medication to reduce cravings. While some people can quit without outside help, thousands of others do need professional help.
True, addiction to substances, whether it is food or drugs, isn?t a purely medical disease like cancer or heart disease. There?s a behavioral science component in addition to the brain chemistry side, too. 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) or 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 perhaps because they have a genetic predisposition. Treatment reflects this complex approach. We may give medication to reduce cravings, but we also help people see how they developed their patterns of use and deal with their physiological and psychological dependencies.
We focus not just on relapse prevention but also a safety plan and coping skills if relapse happens. When people do relapse, we help them see what factors led to the relapse. Sometimes it?s physiological cravings, behavioral patterns that repeat under stress, or emotional and psychological triggers. When our clients see us handling others? relapses in an empathetic and caring way, they see a relapse is not a shame or a failure but a chance to continue to learn and move forward.
As treatment providers, we communicate hope, empathy and support.? We help a client identify his or her strengths. We assist the client to find their own motivation to change.? We recognize that coming in for a substance use assessment takes its own kind of strength and courage. ?In treatment, as clients set and achieve short-term goals in the process of recovery, we help them recognize both their progress and their possibilities.
Psycho-education is a vital part of treatment, as many clients need to learn about addictions, relapse prevention and life skills. Finally, to give up a substance and old behaviors, most need to practice positive new behaviors and new ways of handling emotions and triggers. Seeing addiction as a disease is not a cause for pessimism or self-defeat; it?s a way to help people get intervention and care.
Melissa Thomasson, Ph.D.
Supervising Clinical Psychologist
Phoenix House Venice
Adult Residential and Outpatient Program
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