Out In the Open

Is addiction a disease? Two experts weigh in on the issue

Marc Lewis and George F. Koob debate the pros and cons of viewing addiction as a disease.
Listen13:22

Most people in the addiction field today—those doing research, setting public health policy, running treatment centres—think of it as a disease. They define addiction as a chronic, recurring brain disorder—so no matter how desperately someone wants to quit, it's not that easy.

But recently there has been a schism in the field, with some addiction researchers challenging the widely-accepted model. They say that addiction is not a disease, and they believe that thinking of it as such can be dangerous to the addicts.

On this week's episode of CBC's Out in the Open, two experts in the psychology of addiction debate the question of whether defining addiction as a disease is helpful or harmful.

Director of the U.S. National Institute on Alcohol Abuse George F. Koob said that addiction changes the circuitry of the brain and it is a disease that should be treated similarly to other mental illnesses.

"We are in the addiction field where we were 20 years ago with mental illness," Koob told host Piya Chattopadhyay. "People have to accept that drug addiction is a brain disease, can be facilitated with medication, can be treated with behavioural treatments."

Koob said that seeing addiction as a disease can help eliminate some of the stigma that prevents people from seeking the help they need.

On the other side of the debate is Marc Lewis, a professor of developmental psychology at Radboud University in the Netherlands and the author of The Biology of Desire. Calling addiction a disease, he said, works against people's sense of empowerment: if a person thinks he or she is sick, they put their recovery in the hands of others.

"When you call something a chronic brain disease, there's a strong implication that it's a static, permanent condition," Lewis explained.

Lewis said that while some people may find the disease label a relief, for others it can be seen as a sentence or a cross to bear. He agreed that there are brain changes, but said many experiences change the brain and that in itself doesn't make those experiences a disease.

Koob countered by saying that the non-disease approach trivializes the issue. 

Lewis suggested the alternative way to see addiction is to treat it as a difficult, behavioural problem learned through repeated behaviours, which requires willpower and motivation to change.  

We spoke with former addicts and current drug users to get a better sense of how the definition of addiction has affected their lives. Hear their stories.