Substance Use Disorders and The Disease Concept

Hi Everyone! I hope you’re having a great weekend, and Happy 4th of July! Today’s post comes from an article a couple of friends asked me about on Facebook. You can check out the original article here. 

The article is basically a review of this book, which won't be released until later this month according to Amazon.

Even if you don't want to read but the actual book, I encourage you to click on the link above and read the blurb. Obviously Marc Lewis is more of an expert on these topics than I will likely ever be. I'm looking forward to reading the book. The article this all orginated from is a bit trickier. I have read it again and again, and while I don't have a problem with any one particular thing the author, Laura Miller at is saying, the logic gets kind of screwy for me. Here are the main points I picked out:

First there was AA, and AA called Substance Use Disorders a Disease.

Yes. This is accurate. Miller goes on to talk about how useful this was. I've talked about this paradigm shift with regard to Mental Health. You can read about it here. But when Dr. Bob started calling Alcohol Use Disorder a disease it was because of observations of behavior. It wasn't because he had brain scans or could do a blood test. He reasoned that for someone to drink themselves to death and be unable to quit there most be some sort of disease process going on. For decades most people considered this a useful metaphor for addiction and considered 12-step intervention the cure.

Then as technology advanced we realized that there are physical changes in the brain as a result of using drugs of abuse and we all went "Aha! It is a disease. See. Dr. Bob was right!"

True again. One of the best documentaries ever done on this topic is The Addiction Series from HBO. While it's getting older you can watch all of it on the HBO website I think. An especially good segment is the one where Dr. Nora Volkow explains what addiction is. You can see it here.

The changes in the brain are due to normal processes gone awry....therfore it's not a disease.

Here is where it gets tricky. The first part of this statement is true. Addiction is due to normal processes in the brain. They have gone awry. But that doesn't mean it's not a disease. We use the word disease to describe similar phenomena in our bodies all the time. I decided now was a good time to explain what is happening with the neurochemicals in your brain, and I just happened to have a dry-erase coffee cup while I was writing this post. I was going to try to do this with pictures, but it got really cumbersome really fast. So I filmed it. It ain't fancy, but it should do the trick..

Since it's not a disease we need to look at alternatives to AA, and stop saying that AA is the only way to get sober.

What does one have to do with the other? Yes, we need to stop saying that AA is the only way to get sober. Yes there are valid alternatives. But, AA isn't predicated on the idea that addiction is a disease--not really. It's, in my opinion, predicated on admitting you've lost control, asking for help, and then being of service to others. AA works or doesn't work for people based on their own belief systems and experiences. Addiction being something besides a disease doesn't support or negate the efficacy of AA. 

So yeah...the logic is all kinds of flawed. However, I'm looking forward to reading the book. From the blurb on the back it seems like the author gives some really good reasons why it could be detrimental to conceptualize Substance Use Disorders as a disease, and I'm really interested to see what he has to say. Language does matter, and he might just change my mind on this topic.

What do you think? Do you have questions? Let me know below, and thanks for suffering through my very amature video. Do you want more videos? Should I never do a video again?