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Introduction: Addiction as a Disease

By Janet Firshein

Most Americans have been affected in some way by addiction to drugs of abuse such as alcohol, nicotine, and illicit substances. Yet addiction to alcohol and other drugs is a phenomenon that has been clouded by myth, misunderstanding, and moral judgments. The very nature of the problem -- what addiction is -- has long been debated. Most people probably continue to think of addiction -- particularly to illicit drugs -- as primarily a moral or character problem, something caused by degeneracy or lack of willpower.

Scientific research into addiction, however, has led experts to conclude that addiction is actually a disease, a chronic illness like diabetes or hypertension. The American Medical Association broke new ground approximately forty years ago when it declared alcoholism to be a disease. And in the past decade, dramatic advances in technology have allowed scientists to examine the brain itself in search of the causes, mechanisms, and consequences of addiction. Today, scientists and physicians overwhelmingly agree that while use and even abuse of drugs such as alcohol and cocaine is a behavior over which the individual exerts control, addiction to these substances is something different. Scientists have begun to understand why addicted people may sacrifice everything that's important to them -- their jobs, their families, their homes -- in the quest for a chemical fix.

"When you get into an addicted state, it's a disease of the brain," says Alan Leshner, Ph.D., director of the federal government's National Institute on Drug Abuse (NIDA). Leshner says the stigma associated with alcohol and drug addiction is one of the biggest problems experts continually face in dealing with it. Leshner says that the public has little sympathy for addicts, but he adds that "whether you like the person or not, you've got to deal with [their problem] as an illness."

The so-called disease model doesn't mean that addicts cannot stop using drugs -- only that doing so is difficult and often requires treatment and major lifestyle changes. Addiction is a disease that causes changes in the brain, which then drive certain behavior -- taking the drug compulsively -- but addicts can learn to change the behavior. Treatment of and recovery from addiction are possible. Steven Hyman, M.D., who directs the National Institute of Mental Health, compares the disease of addiction to heart disease, which may also necessitate major lifestyle changes. "Take heart patients. We don't blame them for having heart disease," he says, but we ask them to follow a certain diet, to exercise, to comply with medication regimes. So it is with the addicted person -- we shouldn't blame them for the disease, but we should treat them as having responsibility for their recovery. "

PET scan

Subject about to undergo a PET scan, a technology that can allow scientists to see the action of drugs in the brain.

Science Menu:



What Are the Differences Between a Drug User, a Drug Abuser, and a Drug Addict?

Crossing the Line to Addiction: How and When Does It Happen?

Relapse and Craving (with animation)

Why Do People Take Drugs in the First Place? (with animation)

Do All Drugs Affect the Brain Similarly? (with animation)

From Enjoyment to Dependence

Vulnerability to Addiction

Can the Addicted Brain Change Back?


       Alan I. Leshner, Ph.D.
       Steven Hyman, M.D.
       George Koob, M.D.

Photo: Paul Colliton

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