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Do we disable people by calling addiction a disease?

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Disease of addictionI spotted a tweet a few weeks back vigorously opposing calling addiction a disease. A few weeks before this, 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.

Addiction a disease? Pros and Cons

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.

Disabling?

SconeQuite 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.

Addict identity

Time-for-change

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 Results:

  • 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.

“Recovering” identity important

Recovery-ManThis 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’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.

You might also be interested to read Addiction is like diabetes, so treat it the same way.

Thanks to Jason Schwartz & all at Dawn Farm. Take a look at Addiction & Recovery News; you won’t be sorry.

[A version of this blog was first published in May 2014]

    3 Responses to "Do we disable people by calling addiction a disease?"
    1. Steve NBA says:

      To stop calling it a disease would give an open door to the NHS to stop treating it, it is a form of mental illness though, and can lead to physical disease in various organs. One thing that does put me off in groups is the introduction when you have to declare yourself an addict or alcoholic, I have never liked it or seen the point, why else would you be there? You don’t get an a bus and declare that you are a bus user, also some people may feel uncomfortable naming and labeling themselves.

      What is needed is for the “disease” to be recognised as a very serious and costly illness and needs addressing at grass roots level, It’s not your fault if you have the illness but it is up to you to help yourself. However alcohol has never been more freely available or cheaper than it is today. Alcohol should be treated like smoking is and taxed more, made harder to buy and more done to dissuade people from getting it in the first place; after all smokers are addicts yet they are not discriminated against in the same way

    2. Detox Nurse says:

      I’m inclined to agree with Vaillant. Whether addiction can be considered a disease in the word’s purest definition is a moot argument. Conceptually, it may be useful for ‘addicts/alcoholics’ to see it as a disease as it promotes responsibility and thus recovery.

      With regards to the terms ‘alcoholic’ and ‘addict’, their appropriateness to describe someone is all in the context. If it is meant as an insult, then it is insulting. If it’s used without malice, then I don’t see a problem with those terms. I think this was (partly) the thrust of Billie Gledhill’s article on Recovery Review.

    3. Lisa Neumann says:

      For me, this line sums it perfectly, “Unfortunately, it is the very thing that makes the “disease” message desirable that also makes it a curse.” In my perception as a life skills (recovery) coach, recovered alcoholic, recovering human, and author I see changing our attitude toward the disease model and understanding “disease” to be most helpful.

      The idea that we call forth our own life experience based on the experience we choose to have here on Earth is a concept that future humans will hopefully grasp. Our collective consciousness of “this disease is chosen and that disease was not chosen” will need to be smashed. Whatever you suffer from it is your choice to overcome it or not.

      All humans are diseased in some manner of speaking. An addict’s disease is simply too glaring to not notice and too easy for people to stigmatize or hide behind.

      Good reading. Thank you for posting this. Lisa

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