I spotted a tweet earlier today vigorously opposing the notion of addiction as a disease. A week or two back, someone I follow on Twitter was advocating for the terms “addict” and “alcoholic” to be abandoned because they are stigmatising. I thought of the tens of thousands of recovering people meeting weekly in Britain’s six and a half thousand 12-step groups who routinely introduce themselves as addicts or alcoholics or even alcoholic-addicts. There’s a similar issue with the word ‘clean’ which some see as stigmatising, but it’s a word that recovering people use liberally.
Jason Schwartz at Dawn Farm takes a compelling look at the pros and cons of framing obesity as disease in Addiction and Recovery News and compares this with what happens when addiction is labelled as a disease. In obesity there is some evidence that when people believe it is a disease, their foot comes off the accelerator pedal in terms of addressing health and they go for more calorific foods. He quotes from a study discussed by the British Psychological Society:
Unfortunately, it is the very thing that makes the “disease” message desirable that also makes it a curse. Yes, treating obesity like a disease can help reduce stigma, increase body satisfaction, and aid self-esteem. Yet it is precisely these things that can undermine actual goal pursuit
It sounds like the negatives can act as drivers which leaves a dilemma of how to categorise obesity.
It’s not particularly hard to see why the labeling of obesity as a “disease,” which decreases perceptions of controllability or stigma, would increase obese individuals’ levels of body satisfaction – and it’s not particularly surprising to see why that could manifest in poorer nutritional choices.
Quite often people feel the disease model absolves people of their responsibility: poor you, you can’t help it. There, there. Tragic thing, isn’t it? But we don’t take that approach with other diseases. We don’t say to the diabetic, what a shame; get stuck into these buns. Go and sit in the corner with them. We tell them: ‘okay it’s not good news you have a disease, but what is positive is that you can do something about it. You can take the reins and get on top of it once you know how to manage it. It’s the same with other diagnoses of chronic conditions; we teach the patient how to manage them (though self-management is arguably less helpful than mutual management).
Jason sees differences between obesity and addiction:
What I find interesting here is that was very often see a very different phenomena when we talk about addiction as a disease. We also see their [clients’] self-esteem improve. Addicts tend to construct narratives to explain their behavior in their addiction and these narratives tend to be organized around character based explanations–”I must not love my kids as much as I thought”, “I’m weak”, “I’m a loser”, “I’m lazy”, “I’m bad”, “I was born a liar”, etc. The disease model offers a different and much less stigmatizing narrative. However, this seems to increase motivation to change rather than undermine it.
He has a theory about why this might be and this relates to my earlier reference to addict identity. He says accepting addiction as a disease offers a pro-change group identity and quotes from a study which looked at pros and cons of adopting a ‘recovering alcoholic or addict’ identity. There were significant gains associated with those who did this compared to those that didn’t, particularly around self-efficacy (belief that you ‘can do it’):
The researchers then assessed each participant for their self-efficacy, which is measured by having them respond (again on a scale of one to seven) to statements such as: “I can remain abstinent,” and “I can manage my addiction.” Again, the higher the score, the more the individual experiences self-efficacy.
- The more the individual identified him/herself as a recovering alcoholic (addict) the higher was his/her level of self-efficacy.
- Higher self-efficacy was associated with more months clean and/or sober.
- The more the individual leaned toward the recovering identity the less likely she/he was to report having relapsed into drinking or drug use during the pervious two years.
This backs up other research which suggests that adopting a new ‘recovering’ identity is part of the process for many folk in recovery. I find this study relevant and interesting. Not for the first time, I’m left wondering if well-meaning professionals who want recovering people to abandon their ‘recovering addict’ terminology might be doing them a disservice. I think I’ll take a full look at the paper in due course, but in the mean time, I’m pretty comfortable with the conclusion:
So, is it really stigmatizing these days to identify yourself as a recovering alcoholic or addict? The evidence suggests that, to the contrary, coming to the point where an individual is able to embrace that identity can help to solidify his or her recovery. It most likely makes it easier for those individuals to “get active” in one fellowship or another, as opposed to having a more tepid identity with those who they see at meetings.
[Thanks to Jason Schwartz & all at Dawn Farm. Take a look at Addiction & Recovery News; you won’t be sorry.]