The Disease of Drug Addiction
Addiction is a chronic, often relapsing brain disease that causes compulsive seeking and use of addictive substances despite harmful consequences to the addicted individual and to those around him or her.
Dramatic advances in science over the past 20 years have shown that drug addiction is a chronic relapsing disease that results from the prolonged effects of drugs on the brain. (Leshner, 1997) It is considered a brain disease because drugs change the brain structure and how the brain works. (Volkow and Schelbert, 2007) As with many other brain diseases, addiction has embedded behavioral and social-context ...view middle of the document...
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...