Addiction is a Complex Condition

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History has made it clear there is no simplistic, single-model solution to addiction.

We can’t arrest our way out of the problem, nor can we eliminate drug abuse by trying to scare everyone out of starting. Similarly, it’s long been known there are many pathways to recovery.

In our attempts to understand and address drug addiction, it is natural to try to fit it into a framework with which we are familiar. The most common current framework describes addiction as a “disease” which has some use, but is limiting.

As is covered elsewhere, the scientific community is divided over the underlying nature of addiction — whether it is a disease or something else — and our understanding of it continues to evolve.

But it is clear that in some ways it looks nothing like a disease. For example, “contingency management has proven to be a highly effective address to addiction, but trying to treat most diseases with it would make no sense and would properly be decried as malpractice. Offering a monetary reward to someone for no longer having cancer or diabetes would not work, though it can be effective when it comes to addiction.

Addiction has many apparent causes — economic, social, family-related, physical abuse, underlying pathologies, etc. It also impacts many areas of an individual’s life — family, work, community, etc.

Because of these varied ramifications and the scientific uncertainty about its nature, it is more properly viewed as a complex condition rather trying to shoehorn every aspect of it into a disease model.

For some people and some aspects of addiction, the disease model is helpful, perhaps even vital. But for the vast majority of drug abusers, the disease model does not lead to either a better understanding of or address to the condition.

When we broadening the framework we use to understand addiction, away from any single-model view and understand it as a complex condition, there are immediate, helpful results and we can avoid some potential problems and unintended consequences.

For example, most diseases today are addressed with drugs. In contrast, some studies have demonstrated that many people recover from addiction without the use of any treatment medication — giving treatment drugs to these people would not be productive. Moreover, the treatment drugs most often used for opioid addiction are themselves opioids and have themselves become drugs of abuse.  

The point is simple: when it comes to dealing with an individual addiction or when making policy decisions about how to address addiction in a community, it is more effective to approach addiction as a complex condition, which certainly has medical components, rather than trying to force it into a reductionist disease model.