The idea that addiction is a disease is a recent one. It makes little difference whether it first surfaced in the 17th century or the 19th: The point is that it was not there before, and that cavemen, Greeks, Romans and knights in shining armour all managed to muddle along without it. Some people overindulged, others criticized them, a few even wanted to help, but one thing they did not do was turn their vices into so many pathologies.
Myself, I have never bought into the whole disease concept of addiction. The strongest argument in its favour, that the body undergoes physiological changes when its owner is hooked on a substance or behaviour, is at best descriptive: The fact is that all actions have a physiological component. When, for example, I think of Sarah Palin, I experience a build-up of acid in my stomach. Does that make it a disease?
Then there is a genetic argument. If you buy it, and a great many people in the research and treatment communities do, then addiction is involuntary and therefore must be a disease.
But that still leaves the old question of nature versus nurture, and so I am not exactly sure what this piece of the puzzle gives us.
Presumably parents who know their child has the “addiction gene” will know to lock up their liquor and medicine cabinets. Or perhaps their physician will advise against their having children in the first place.
The death of addiction?
The case for the disease concept of addiction becomes weaker still when you consider its tenuous place in the history of ideas. Sooner or later, maybe in 20 years, maybe in 50, the odds are that it will be dead and gone, buried alongside Mesmerism, phrenology, the Ptolemaic model of the universe, trickle-down economics and all the other ideas that seemed so good at the time.
I say this because ideas are ultimately only as credible as the people or groups making them. The point is something of a cliché among historians of science, but in the hands of Harvard University's Steven Shapin it becomes a starting point for thinking of science as a series of cultural “performances,” performances that include “displaying the marks of integrity and entitlement: expertise, to be sure, but also the signs of dedication and selflessness.”
In the case of alcoholism, to give the most obvious example, we have a term that was first coined by a physician, Swede Magnus Huss, and a pathology that has since been championed by institutions whose very names gleam with high purpose – the National Institute on Alcohol Abuse and Alcoholism, the Alcohol, Policy and Safety Research Center, the National Council on Alcoholism and Drug Dependence, to name just a few.
But what if the idea had originated with a Wiccan? Or if the institutions that variously research and treat it were headed up by performance artists? The idea would be the same, but would we automatically believe it?
Dr. Shapin is also a big believer in context. Context, in fact, is everything, and by this logic, scientific discoveries, far from being eternal verities, are merely the products of their time and culture and, by inference, potential casualties when their historical moment passes. In the case of the disease concept of addiction, we have an idea that came along just as physicians were starting to expand the number of ailments they could and would treat. But what happens when cash-strapped states start reducing the number of conditions they are willing to insure?
A disorder of choice
