Recently, the annual U.S. overdose deaths exceeded 100,000, a record high. This is in no way a good milestone, as it demonstrates that we are doing something wrong with respect to addiction treatment. Part of the issue is the terminology used to describe addiction, as Dr. Carl Fisher asserts in a recent New York Times article. People are taught in medical school that addiction is a disease – a biological imbalance in the brain which leads to binging. While not technically incorrect, using this definition of addiction is extremely problematic. Classifying addiction as a disease implies that medicine is the solution and reduces the complex mechanisms of addiction down to a matter of medical science. Addiction, in this way, is defined by society as an individual issue, not a matter of the structure of our society and communities.
Redefining “addiction” for political gains
Dr. Fisher, seeking to understand the etiology of addiction that lay beyond the poorly understood biological mechanisms, examined the history and sociology behind the term “addiction.” In the 16th and 17th centuries, writers used the word “addict” as a verb rather than an adjective, indicating that it was something that people did, rather than something that happened to them. This understanding of addiction is closer to how it actually works, for addiction is a condition that impairs one’s ability to make rational decisions about the addictive substance. Benjamin Rush, a founding father of the United States and an important figure in the history of psychology, recognized that addiction was a condition with social roots, not just biological ones. In the later temperance movements of the 1820s and ‘30s, however, people leaned on the terminology of addiction as a “disease” in order to blame addiction wholly on alcohol and promote legislation banning it. In more modern times, people have imposed unfair crackdowns and criminal penalties on drug users, which were predicated on the idea that the drugs were at fault, so by reducing drug use it would be possible to eradicate addiction. In reality, though, unemployment, health inequities, socioeconomic status inequalities, or explicit oppression are often drivers of addiction, and the current definition of addiction simply ignores these factors and only promotes counterproductive practices. Disadvantaged and marginalized communities often found themselves riven with drugs because of the egregious conditions there, and then were ravaged by crackdowns aimed specifically at them not just because of the narrow definition of addiction, but also because of the resulting stereotype connecting race and drugs. Terming addiction as a “disease” dehumanizes addicts and takes away all their agency and hope, which is precisely the opposite of what should be done.
Moving toward a holistic understanding
This article is an eloquent argument for intersectionality. Intersectionality is the idea that all the aspects of one’s identity are interconnected and inform each other. For example, matters of gender are not separate from matters of race, and it is incorrect to assume that they are. In this case, it is being argued that medicine should be viewed with a lens that considers the diverse social factors, which may be social, economic, political, etc., which may affect addiction (a medical condition). In other words, it is an argument for interdisciplinarity as well as intersectionality. In fact, I believe that the current treatment of addiction by the public is a continuation of a larger, more underlying pattern. Oftentimes, when tackling societal issues, institutions and activist groups focus on addressing the most superficial problems. In the case of the war on drugs, the administration penalized drug abuse, which was the problem they were trying to fix, but ignored the underlying root causes of drug abuse. Over time, not only has such policy harmed the people it is designed to help, but it has also done nothing to remedy the situation it was designed to fix. Activists groups seeking social justice often also focus their efforts on the surface-level problems, but do not address the source of those problems, such as systemic discrimination or stereotyping. Naturally, that is much easier said than done, and what these activist groups are doing is commendable. Even so, our mindset needs to shift towards a more inclusive and nuanced worldview to impose long-lasting, overarching change. In the case of addiction, this could mean changing the word for “addiction” and, at the same time, changing the way we teach the public about addiction and drugs, to ensure that the new word does not go down the same path as the one we have now. We need to consider that everything we do has an impact – even the words we use to describe a condition can be just as harmful as the actual symptoms themselves.