The annual number of overdose deaths in the US has recently surpassed 100,000, a record for a single year, and that milestone demonstrates the tragic inadequacy of our current “addiction as disease” paradigm. Viewing addiction as a disease might simply imply that drugs can help, but disease language also simplifies the story and leads to the view that medical science is the best framework for understanding addiction. Addiction becomes an individual problem, reduced to just the level of biology. This narrows the view of a complex problem that requires community support and healing.
A few years into my recovery, I began studying addiction medicine, not least to understand what had gone wrong with me and my family—both of my parents were alcoholics. I found little help from my own field, which is divided into sometimes conflicting currents about how addiction works. As a result, I looked beyond medicine and science to history, philosophy, and sociology; Addiction is an idea with a long, messy and controversial history, going back more than half a millennium. That history deepened my understanding of addiction and helped me understand my own experiences.
About 500 years ago, when the word “addict” entered the English language, it meant something completely different: more akin to a “strong devotion.” It was something you did, rather than something that happened to you. For example, one early writer advised his readers to: B“addicted all their actions to attain eternal life.” My experiences and those of my patients seem to be more in line with how 16th and 17th century writers described addiction: a disordered choice, failed decisions.
Benjamin Rush, one of the founding fathers of the United States and one of the most influential physicians in America in the late 18th century, was particularly focused on mental illness. He was known for describing habitual drunkenness as a chronic and recurrent illness. Rush argued, however, that drugs could only help partially; he recognized that social and economic policies were central to the problem. It was the later moderation movements of the 1820s and 1830s that emphasized a harsher language of disease, insisting that people with drinking problems had been damaged by a kind of reductionist biology, that “demon rum” took you over, as if in a possession.
It is imperative to be careful with these types of deterministic narratives. Such reductionist narratives were repeatedly used to justify racist, oppressive repression in the United States, opium smoking in China in the early 20th century, and crack cocaine in the 1980s, which was seen as a problem especially in black neighborhoods. was depicted. Today, amid the epidemic of opioid overdose, addiction is more likely to be called a disease, but the language of disease has not dispelled the misleading idea that drugs have all the power.