Definition of Disease
Is addiction really a disease? Websters Medical Desk Dictionary (1986) deﬁnes a disease as:
disease ii : an impairment of the normal state of the living animal or plant body or of any of its components that interrupts or modiﬁes the performance of the vital functions and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to speciﬁc infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as various genetic anomalies), or to combinations of these factors: SICKNESS, ILLNESS …
Depending on whether you strictly or broadly employ this deﬁnition, you could either argue that addiction has or has not been shown to be a disease. As an either/or question, it becomes an academic exercise.
First generation: lab testable Lab testable disease includes the physical kinds of diseases that can be clearly identiﬁed by lab test or trained physical observation. Stanton Peele, in his book Diseasing of America (1989), lists malaria, tuberculosis, cancer, and AIDS as examples. He says these diseases are deﬁned by their measurable physical effects. These are the diseases that are least contested by medical insurance. They represent conditions that are easier to pin down.
Second generation: mental illness Emotional disorders are not currently measured by blood or urine tests but by the thoughts, feelings, and behaviors of those who suffer from them. Schizophrenia, clinical depression, and autism may respond to drug therapy, but diagnosis depends much more on what a person says and does than anything as objective as a brain scan.
Third generation: addiction Peele says that addiction is one step farther from a lab testable disease. While schizophrenics can be identiﬁed from their disordered thinking process, We cannot tell an addict in the absence of the ongoing addictive behavior -- the drinking, using, eating, smoking, gambling, etc.
Fourth generation: dysfunctions Although Peele lumps codependency, adult children of addiction or dysfunctional families, and other trauma or addiction-related conditions in with second and third generation disease, we are inclined to extend his model to include these in a fourth generation of disease. These are all those character and personality characteristics that are generally dysfunctional for the individual, and may be related to addiction, trauma, or other problems in the family of origin, present family, career, etc.
Multiple categories Most diseases do not ﬁt in only one category. Diabetes, for example, clearly ﬁts in the ﬁrst generation description. You can measure the high blood sugar on a test paper or a meter. It can be very dangerous, even with a careful nutritional regimen, frequent monitoring, and insulin therapy. But most people who suffer severe consequences have not followed their diet carefully. Most people who have fatal heart attacks increased their risk factor by smoking, poor nutrition, lack of exercise, or by ignoring signs of danger. How many other “physical” diseases are in some sense self-induced?
Bulimics may have dangerously low electrolyte levels or other life-threatening “lab testable” medical conditions resulting from their bulimia (ﬁrst generation disease). They may also have severe depression (second generation) following or preceding their binge/purge episodes. Their eating pattern may almost exactly match their alcoholism before they stopped drinking (third generation), and they may be unable to establish or maintain healthy relationships (fourth generation) because of unresolved family issues. They may need immediate medical attention, an antidepressant drug, bulimia treatment, and ongoing counseling to deal with all levels of their recovery.
We ﬁnd it works to treat addiction with a disease model. A disease has signs and symptoms, a predictable course of progression, a causative agent (though it may not be identiﬁed), and it is primary, not a result of something else.
Labeling addictions “disease” does not absolve you of responsibility for your behavior, for decisions that affect your life, or for the consequences of over- or undertreating yourself. You must make the best decisions you can, whether the question is buying a new car, changing jobs, getting married, deciding whether you need treatment, and when you need help.
Disease concept, see also: Addiction model (PEMS), Binge history, Dual diagnosis, Intervention, PEMS model, Paradoxes in addiction, Powerlessness, Psychological problems, Therapy & treatment, Unmanageability.
Updated 8 Sep 2015
Addictionary 2 by Jan & Judy Wilson
is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.