2018 – Yet the disease concept of addiction may do more harm than good, to addicts, their families, the surrounding community, and the public health system at large. Here’s how.

First, if people feel that their addiction results from an underlying pathology, and if that pathology is chronic, then they are less likely to believe they will ever be free of it. They are less likely to hope…and to try. More specifically, they are less likely to believe that willpower, self-reflection, or simple effort will have any impact on their condition. The resultant passivity or fatalism is all too obvious at the front line of publicly funded treatment programs. In fact, there are no medical treatments that reliably and successfully target addiction. There are medications that can shift drug dependency from one substance to another, and opioid substitution therapy is proven to be the most effective means for preventing opioid overdose deaths. But this is a very different goal than overcoming addiction, which applies to substances like cocaine that don’t produce physical dependency, not to mention the many behavioral addictions (e.g., gambling, porn addiction, binge-eating) that can also destroy lives.

Rather than a one-size-fits-all medical solution, addiction workers generally agree that a sense of empowerment and belief in one’s own agency are the most important resources for overcoming addiction. This perspective corresponds with the idea that successful pathways to recovery must be personal and unique, not standardized. Most people diagnosed with a substance- or alcohol-related use disorder do in fact quit–a finding that completely overturns the assumption that addiction is a chronic condition. And most of those who quit do so without any formal treatment. Others need the help provided by psychotherapy, meditation, contingency management programs, therapeutic communities, and so forth–none of which make use of medicine. The rapid rise of harm reduction policies points to the growing realization (e.g., among treatment providers, researchers, legal experts) that people in addiction need time to find out what works for them, and until they are ready to move forward, the support they need most is to minimize the harm they cause themselves and others (partly because such harm fuels the addiction itself). Since addiction arises from the confluence of psychological, economic, and social factors in unique configurations, it makes sense that pathways out of addiction could never be boiled down to a single universal formula.


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