Why I am profoundly uninterested in whether or not we call addiction a “disease"

Is addiction a disease? Yes! No! Sometimes! Does it matter?

Sometime in the last week of January 2008, I arrived at San Francisco International Airport, fresh out of a Chicago psych ward. My mom waited outside the terminal, ready to toss my bags in the car and promptly usher me to rehab. Thanks to my relationship with alcohol, I’d blown up my life and pissed off everyone who cared about me, including—and perhaps especially—my mother. She’d grown up around alcoholism, married an alcoholic, and now had a daughter facing the same fate.

She gave me a quick hug; “I’m sorry,” I said. “It’s not your fault,” she replied, not meeting my eyes. “It’s a disease.” Then she ducked into the driver’s seat, and we headed to the inpatient treatment center where I would spend the next 28 days. 

Whether or not addiction is a disease has been debated for centuries—literally since Dr. Benjamin Rush called alcoholism “an odious disease” in the 1780s. If you’re interested in a detailed history of the debate, you can read more about it here. For our purposes, you just need to know that the following:

• The medical establishment eventually adopted the idea of addiction as a brain disease.

• Whether or not the ‘disease model’ is the most accurate or helpful way to think about addiction is still hotly debated in public and academic spaces today. 

• The arguments for and against the disease concept usually fall into one of two categories: 

1. Self-perception and public stigma—Some argue that the disease model stigmatizes people who have addiction and presents a fatalistic picture for those trying to recover. Others say that thinking about addiction as a disease can reduce the shame that people with substance use disorders feel about past actions and help them maintain abstinence. 

2. Medical accuracy—Addiction meets some disease criteria but not others. Critics of the disease model also argue that it focuses too much on what’s happening in the brain and not enough on the external factors—like environment—that can play a role in the development of addiction.  

Why does it matter what addiction is? Let’s put aside medical arguments like insurance reimbursement and research funding and focus on why it matters to people who are experiencing addiction or are a loved one of someone with an addiction. 

The way my mom said, “It’s a disease,” outside SFO in 2008 made me think she had been repeating it in her head like a mantra ever since she got the call that I was in the emergency room. She was angry and sad; thinking about my alcoholism as a disease helped her see me not as a wildly immoral stranger but as her daughter, who had a medical condition that could be treated and managed. 

My mom is the type of person who can take a medical condition seriously if presented correctly. ‘Disease’ feels more concrete and, I suspect, more “valid” to her than simply ‘disorder.’ I think there’s a part of her—and likely others—who see disorder as something akin to ‘disturbance,’ a disruption or unwanted behavior that can be corrected with the appropriate amount of willpower, focus, and discipline. 

The disease concept of addiction helps my mom wrap her head around the idea that addiction is a medical condition more than calling it a disorder would. That understanding is not rooted in any inherent truth in those terms—but in her subjective interpretation of each word. We’re all subjective interpreters to some degree. It’s one of the reasons that conceptualizing addiction as a disease can be liberating for one person and demoralizing for another.   

Clinically speaking, we know to describe addiction: It’s a severe substance use disorder that’s characterized by compulsive substance use despite negative consequences resulting from that use. It's not the most elegant way to say it, but it’s functional.

Beyond that, I don’t think a single definition could ever accurately encompass such complex and varied phenomena (I’m genuinely curious to hear others’ thoughts.).

Classification is inherently reductive. I say this as a librarian who sees tremendous value in organization and classification. Just as “cancer” is a single term for a huge range of different diseases with different projected outcomes, “addiction” encompasses many different types of behaviors and physiological processes.

There is one near-constant truth that runs through the many different kinds of substance addiction: it is a medical condition that requires medical, psychological, or behavioral intervention. I don’t mind that my mom might have needed the word ‘disease’ to truly understand how sick I was and how badly I needed help.

Whether addiction is defined as a disease, disorder, condition, or illness doesn’t change much for me. Its classification has no bearing on how I experienced addiction. Regardless of what label we give it—we already know some of the most important things about addiction. We know it can, and often does, kill. We know it hurts the people we love and ourselves. We know it’s a medical condition. And we know it’s possible to recover.

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I’m not a doctor or mental health professional, so my advice shouldn’t be construed as medical or therapeutic advice. You are free to take or leave it.