The annual number of overdose deaths in the United States recently surpassed 100,000, a single-year record, and this milestone demonstrates the tragic inadequacy of our current “addiction as disease” paradigm. Viewing addiction as a disease might simply imply that medicine can help, but the language of disease also oversimplifies the story and leads one to believe that medical science is the best framework for understanding addiction. Addiction becomes an individual problem, reduced to the biological level alone. It narrows the view of a complex issue that requires community support and healing.
Once I had a few years of recovery, I started studying addiction medicine, largely to figure out what was wrong with me and my family – both of my parents were alcoholics. I found little help in my own field, which is divided into sometimes conflicting schools of thought about how addiction works. Accordingly, I looked beyond medicine and science to history, philosophy and sociology; addiction is an idea with a long, messy and controversial history, dating back more than half a millennium. This story deepened my understanding of addiction and helped me make sense of my own experiences.
Around 500 years ago, when the word “addict” entered the English language, it meant something very different: closer to “strong devotion”. It’s something you did, rather than something that happened to you. For example, an early writer advised his readers to Have“administer all their actions in order to attain eternal life.” My experiences and those of my patients seem more in line with how sixteenth- and seventeenth-century writers described addiction: messy choice, decisions gone wrong.
Benjamin Rush, Founding Father of the United States and one of America’s most influential physicians in the late 18th century, focused particularly on mental illness. He was famous for describing habitual drunkenness as a chronic, recurring disease. However, Rush argued that medicine could only partially help; he recognized that social and economic policies were at the heart of the problem. It was the later temperance movements of the 1820s and 1830s that emphasized a harsher language of illness, insisting that people with alcohol problems had been damaged by some kind of reductionist biology, that the “demonic rum” took over you, as in a possession.
It is imperative to be careful with these types of deterministic stories. Such reductionist narratives have been used repeatedly to justify racist and oppressive crackdowns in the United States, against Chinese opium use at the turn of the 20th century and against crack cocaine in the 1980s, which has been described as a problem. mainly in black neighborhoods. Today, amid the opioid overdose epidemic, addiction is more likely to be called a disease, but the language of disease has not eliminated the misleading notion that drugs hold all the power. .