The Disease of Drug Addiction

For example, in his capacity as the director of the National Institute on Drug Abuse, Alan Leshner wrote that the reason we ought to think of addiction as a disease is that it ‘is tied to changes in brain structure and function’(Leshner,1997). This reasoning is echoed in the work of several other authors. Heyman, Heather and Alexander, among others, have challenged the disease status of addiction on primarily empirical grounds (Heyman, 2001; Heather, 1992; Alexander, 1988).

Philosophical accounts of disease, which attempt to clarify the concept, come in many shapes and sizes. For example, Boorse argues for a naturalistic conception of disease in which a disease must be reflected in a loss of function in an organ (Boorse, 1977). At the other end of the spectrum, Nordenfelt argues for a normative conception, which defines diseases as conditions which prevent us from meeting our ‘vital goals’ (Nordenfelt, 1995).

It is still an open question whether Boorse’s view, Nordenfelt’s view or some other view gives the best rendering of what we mean when we call something a disease, but the published accounts can support the claim that changes in brain structure and function are enough to constitute a disease. The concept of addiction as a neurobiological disease has taken hold, thanks largely to the efforts of both NIDA and the World Health Organization (WHO) that addiction is a disease (NIDA, 2009 ; WHO, 2004) Substance Dependence or Drug Addiction” The term “substance dependence” has gained great currency because of its use in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM, both in its revision of the third edition (DSM- III- R; American Psychiatric Association [APA] 1987) and in its most recent edition (DSM- IV; APA 1994), avoids the term addiction, preferring instead to use the diagnoses of substance abuse and dependence, collectively referred to as substance use disorders.

Beginning with DSM-III-R, the criteria used to diagnose substance use disorders were applied more or less equally to all of the substances that are commonly mis-used by individuals. In the DSM, therefore, individuals are differentiated onto three mutually exclusive categories: no substance use disorder, abuse only, or dependence. With this approach, abuse is diagnosed only if the individual does not meet the criteria for dependence. Accordingly, an individual meeting the criteria for both abuse and dependence is diagnosed only with dependence.

The most recent text revision of the DSM (DSM-IV-TR; APA 2000, p. 192) identifies impaired control over substance use as the essential feature of dependence, which is “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. ” The dependence syndrome, which forms the basis for the diagnostic approach used in DSM-III-R, was first described for alcohol by Edwards and Gross (1976); it was later broadened to include other drugs (Edwards et al. 1981).

However, as was true for DSM-III-R (APA 1987), the inclusion of abuse as a distinct category in DSM-IV deviated from the purely dimensional approach (in which all dependence occurs on a continuum, varying from no dependence symptoms to severe dependence) taken by Edwards and colleagues. This dimensional approach recently has been supported by findings from a large, nationally representative sample of more than 43,000 people. Saha and colleagues (2006) found that, except for alcohol-related legal problems, all DSM-IV criteria for alcohol abuse and dependence formed a continuum of alcohol use disorder severity.

Moreover, only one of four diagnostic criteria for alcohol abuse (i. e. , hazardous use) fell among other criteria associated with mild dependence, whereas the other three abuse criteria clustered with the most severe symptoms of dependence. These findings call into question the distinction between abuse and dependence and the identification of abuse as being milder than dependence. O’Brien and colleagues (2006) have argued against the use of the term substance dependence, calling for a renewed emphasis on addiction. Dependence, they pointed out, is often confused with physical dependence (i. e. the adaptations that result in withdrawal symptoms when substance use is discontinued), which can occur with therapeutic applications of a variety of medications. This terminological confusion may make clinicians reluctant to prescribe pain medications, for example, for fear of causing addiction. By emphasizing the behavioral aspects of compulsive substance use, addiction captures the chronic, relapsing, and compulsive nature of substance use that occurs despite the associated negative consequences. On that basis, these authors urged the APA to restore the use of the term addiction in the DSM-V, which currently is in development.

A disadvantage of the term addiction, however, is that it often is used pejoratively and can lead practitioners to avoid its use for fear of stigmatizing their patients and damaging their relationship with them. Further, the term addiction has been used so widely and variably that, like “alcoholism,” its meaning has been diluted, substantially limiting its value. The terminology used to describe alcohol and other drug use disorders is of key importance to both the study and the clinical care of people suffering from these conditions (Kranzler, Ting-Kai; 2008).

Addiction Is a Disease Drug addiction is a compulsive behavior that creates a desire to use a dangerous substance, despite the health repercussions and sometimes irreversible consequences. Drug addiction is a chronic, often relapsing brain disease. It is important not to confuse drug addiction with drug dependency, drug dependency does not always manifest into drug addiction. Understanding what happens in the brain with addiction is key to understanding drug addiction. Once a brain is exposed to a substance it changes.

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