Addiction as Disease
48 Pages Posted: 23 Mar 2019 Last revised: 2 Apr 2019
Date Written: March 1, 2019
The opioid addiction epidemic is the most overwhelming public health crisis our country has faced. It is now creating a legal crisis, as the its poisonous fruits spill over into the criminal, tort, and family courts. The epidemic costs the U.S. economy about $500 billion every year, and the pressure is crippling our legal systems. This Article is an attempt to relieve some of that pressure, by advocating for a comprehensive public health campaign based upon a new model of addiction. Research shows that the prevalent “moral choice” model of addiction has facilitated stigma and discouraged treatment, by viewing affected individuals as blameworthy, different in kind, and hopeless. Even when programs are accessible, which they often are not, individuals will not seek treatment because they fear adopting the label of “addict.” In this Article, I affirmatively reject the moral choice model, identifying it as an obstacle to mitigating the opioid epidemic. In its place, I offer a model of addiction that more closely tracks its complex disease etiology, while humanizing people with addiction, removing stigma, and encouraging treatment. I refer to this model as the “integrated disease model,” or IDM, as it explains addiction as a neuro-genetic phenomenon, but does not locate addiction entirely in the brain. Rather, it places addiction on equal footing with other chronic diseases, such as lung cancer or diabetes, each of which has significant genetic, behavioral, and environmental causes. This Article will explain 1) how the moral choice model leads to no treatment and poor treatment, 2) how the law has furthered stigma through the criminalization of addiction, 3) and why we need to fund a comprehensive public health campaign based upon findings from neuro-genetics and public health. The IDM emphasizes the biological continuum of genetic risk factors to which we are all susceptible, the neurological networks that are impaired once the addiction has taken hold, and finally, the incredible power of evidence-based treatments. Explaining addiction in this way – as a treatable, complex disease — has been shown to reduce stigma and encourage treatment.
Keywords: opioid crisis, addiction, mental health, stigma, neuroscience, genetics
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