There has been debate on whether or not addiction to drugs should be considered a brain disease. The idea of addiction as a disease first came about in 1987, 31 years after alcoholism was labeled a disease by the American Medical Association in 1956 (n.d.c). In Unit 3 of Taking Sides: Clashing Views in Health and Society, Leshner and Slate (2018) both provide opposing arguments on the subject. Leshner is arguing that addiction is a brain disease while Slater argues that it is not a brain disease.
What is a Disease?
Disease is defined as “(an) illness of people, animals, plants, etc., caused by infection or a failure of health rather than by an accident” by Cambridge Dictionary (n.d.b). Before continuing further, it should be noted that some believe the terms disease and disorder are assigned to different ailments to which a person endures. However, these terms are used interchangeably in Taking Sides: Clashing Views in Health and Society by Leshner and Slate (2018) in their articles, as well as the editor, Eileen L. Daniel, in an introduction of the unit topic. Additionally, the Cambridge Dictionary (n.d.a) defines a disorder as “an illness of the mind or body” and has the two words as synonyms of each other.
Worldwide there are millions of people who abuse drugs each year, ranging from cannabis to cocaine to opioids. The United Nations Office of Drugs and Crime (UNODC) release an annual report of data, accomplishments, and goals related to drugs, crime, and terrorism. In their 2017 World Drug Report it is estimated that, in 2015, of the 250 million people who used drugs, about 29.5 million of those people suffer from a drug abuse disorder (2017). More alarming is that there is an estimated healthy years of life lost of around 28 million years due to premature death and disability that are a result of drug use (2017).
Alan Leshner’s article, “Addiction is a Brain Disease,” is included in Unit 3 of Taking Sides: Clashing Views in Health and Society (Leshner & Slate, 2018). His stance on the topic is that the reason for there being a debate on the matter is due to the misconception that drugs are either physically or psychologically addictive (Leshner & Slate, 2018). This would place focus on the withdrawal symptoms one may endure while abstaining from drugs, which is physical evidence of addiction. However, Leshner finds this to not be significant because of medical advances. The withdrawal symptoms can now be managed better when receiving medical aid (Leshner & Slate, 2018). And so, his opinion on addiction being a brain disease lies in the definition where “it is really only [the] compulsive quality of addiction that matters” and the change in brain structure and function (Leshner & Slate, 2018).
Koskela et al. – “Update of neurotrophic factors in neurobiology of addiction and future directions”
Koskela et al. (2016) define addiction in the same way as Leshner suggests people do, and that is by putting emphasis on the lack of control addicts seem to possess. The authors’ approaches to supporting that addiction is a brain disease is by looking at neurotrophic factors (NTFs), namely two known as brain-derived neurotrophic factors (BDNF) and glial cell line- derived neurotrophic factors (GDNF) (Koskela et al., 2016). The main substances in this article were alcohol, morphine, and methamphetamines. It was found that when these NTFs were present in the mesocorticolimbic dopaminergic system after one administers any of the above substances to oneself, cravings would increase (Koskela et al., 2016). This is significant because it is known that dopamine plays a key role in addiction due to its relationship with the reward system. This biological aspect, which is out of one’s control, can lead to people having a genetic predisposition for addiction, and their social environment could amplify the likelihood of suffering from addiction.
Levran et al. – “Susceptibility loci for heroin and cocaine addiction in the serotonergic and adrenergic pathways in populations of different ancestry”
Levran et al. (2015) also provide a definition similar, if not identical, to those of Leshner (2018) and Koskela et al. (2016), once again supporting the idea that addiction is a chronic brain disease. The authors conclude that addiction is very dependent on genetics, specifically on how the body produces and responds to glutamate and GABA (gamma-aminobutyric acid) neurotransmitters (Levran et al., 2015). Glutamate is an excitatory neurotransmitter while GABA is an inhibitory transmitter; they are antagonists of one another essentially.
Levran et al. (2015) found that taking drugs like opioids, for example, leads to the inhibition of GABA which therefore will lead to the brain not being able to regulate itself and possible overexcitement. This is also a biological process which is not in someone’s control, and treatments for substance abuse has been known to target the GABA system (2015). Glutamate is associated with memory and learning, and Leshner (2018) notes that there are environmental cues which can trigger cravings in addicts (Levran et al., 2015). Knowing this, it could be hypothesized that the effects of drugs on glutamate neurotransmitters create an association between the drug abuse and the environment in which it is done, and thus someone who is trying to abstain from drug abuse may involuntarily experience cravings when placed back into that environment.
Diana, M. – “The Addicted Brain”
This article is a review in opposition of Levy’s (2013) article “Addiction is Not a Brain Disease (and it Matters).” Diana (2013) argues that when thinking about disease, physically and pathologically, social context should not be taken into consideration as Levy (2013) suggests in his article. The effects addiction has on one’s behavior is a “product of brain activity” and can then justify the classification of addiction as a disease because the functioning of the organ (the brain) is impaired (Diana, 2013). Using the definitions of disease and/or disorder, this explanation of addiction would be able to classify as such.
A common trend in the debate of this topic is comparing addiction to other diseases such as diabetes. Diana does so, as well as comparing addiction to malaria. Although drugs can have negative effects when using them, addiction is not harmful until the substance of choice is no longer available (Diana, 2013). The same is true for diabetes because that involves the absence of insulin. In both instances, the absence of a substance disrupts the body’s homeostasis (Diana, 2013). In the case of addicts, although illicit drugs are not normally needed to maintain homeostasis, the drugs have led to physical changes where it is now a necessary component to maintain that internal equilibrium. For malaria, Diana (2013) poses a question of whether someone has malaria if their fever is present or not because typically the fever tends to rise every three to four days. So, do people with malaria only have a disease if they have the fever? If the answer is no, then Diana argues addiction cannot be excluded as a disease.
Steven Slate is the author who opposes the idea that addiction is a brain disease in “T aking Sides: Clashing Views in Health and Society.” Slate’s main argument is that it cannot be a disease because drinking alcohol or taking drugs is a voluntary action, so abstaining is, too (Leshner & Slate, 2018). Additionally, Slate denies that the change in brain structure is evidence of a brain disease because this change, known as neuroplasticity, is a normal process which occurs throughout our lives (Leshner & Slate, 2018). Examples provided include a study which involved former addicts being able to abstain from substance abuse in exchange for material objects, demonstrating the lack of compulsive behavior associated with addiction-as-disease mentality (Leshner & Slate, 2018).
Reinarman, C. – “Addiction as accomplishment: The discursive construction of disease”
Reinarman (2005) is in opposition of the addiction-as-disease argument and instead claims that it is a social construction. The formation of addiction-as-disease was said to be misleading because it rose from a public health standpoint rather than a scientific, which is generally where diseases arise from (Reinarman, 2005). It was more of a social movement to provide people struggling with addiction access to healthcare, but there was not a scientific basis surrounding the movement. Likewise, Reinarman (2005) mentions that it is generally clinical professionals that tell addicts they have a disease, and when addicts deny this “diagnosis” it is merely dismissed as the patient being in a state of denial.
Historical time periods also seemed to play a role in how substance abuse was viewed. Focusing mainly on alcohol use, Reinarman (2005) points out that there was a time, around the mid-1500s, where drinking alcohol was just a part of life, but then traditions changed, and drinking was then seen as the root of all problems in America.