It is important for addicts, especially in our frum community, to know that addiction is a disease, and this disease cannot be dealt with like a regular Yetzer Harah; it is a chemical imbalance of the brain. Although there is no known cure, addiction can effectively be treated with the Alcoholics Anonymous 12 Step Program of Recovery. Whether one's addiction is AA, GA, SA, NA, CA, OEA or DA... the principles of 12 Step Recovery apply to each, albeit in the manner appropriate for each addiction.
Our modern concept of disease - the "Disease Model" - emerged from Germ Theory over a century ago, and evolved such that today it can be defined as a physical, cellular defect or lesion in a bodily organ or organ system that leads to the expression of signs and symptoms in the patient. This is a very rigorous standard for disease.
For most of the last century, it has not been possible to fit addiction to this standard. That has changed. The organ involved in addiction is the limbic brain (specifically the ventral tegmentum and nucleus accumbens/extended amygdala). The defect is a stress-induced/genetically predisposed dysfunction of the limbic dopamine system (specifically a hedonic dysfunction - a broken "pleasure sense"). And the symptoms of greatest importance are 1) loss of control, 2) craving, and 3) persistent drug use despite negative consequences. Addiction meets the standard definition of disease better than multiple sclerosis and schizophrenia, two diseases whose pathophysiologies are far less elucidated. This is why medicine can claim, with confidence, that addiction is a disease.
Some believe the stigma against addicts is good, and that shame motivates people to stop using drugs. The correct answer here is "sort-of." Stigma motivates drug and alcohol ABUSERS (as opposed to ADDICTS) to get sober. When faced with the negative consequences of their drug use, the abuser can bring these negative consequences to bear on their decision-making. But stigma, or shame, or the threat of prison or death, will not work to change the behavior of addicts because the limbic brain equates drugs with survival at a very deep and unconscious level of brain processing. In light of this and the failure of the "consequence appreciating" areas of the cortex, the utility of stigma and punishment in the motivation of addicts is dubious. When craving kicks in, the drug comes first. The addict literally believes that the best way to stay out of jail is to get high (secure survival) now, and deal with the consequences later. This is the most fascinating and frustrating feature of addiction: negative consequences have no effect on the pattern of drug use. If you really are dealing with an addict, punishment doesn't work.
(In regards to the 12-Step program) ...These deeply personally meaningful things - which will be individual to each person ("God as he/she understands Him") - have the power to break the hold of craving. They are spiritual. They restore the function of the prefrontal cortex, and with it the addict's power to choose meaningful things over drugs. The task of addiction treatment is to teach the addict stress coping tools to decrease their craving, while at the same time helping them find the one thing that is a little more meaningful (a little "higher in its power") than drugs or alcohol. Or food, or sex, or gambling. A.A. does this nicely, but none of this comes to the patient overnight.
So is addiction a disease? Yes. Do addicts need to take responsibility for managing their addiction? Certainly. But so do all patients. So do patients with multiple sclerosis and schizophrenia. And most people will take responsibility to the exact extent that they know how, or are supported. That is what good treatment is all about.
Kevin T. McCauley, M.D.
The Institute for Addiction Study
Park City, Utah