What is a disease? The American Society of Addiction Medicine listed four
criteria for defining a disease, and explained how the disease of addiction meets those criteria. 1. A disease has a biological
basis. Alcohol and other drug dependency often has a genetic basis. Research with
both animals and humans has shown inheritable differences in preference for a drug over water, tolerance (requiring more of
a substance to get the same effect), susceptibility to seizures related to substance use, sedation effects, and other indicators
of addiction. In addition, repeated use of a substance produces biological changes in the brain –
molecular adaptations that hijack the functioning of critical pathways in the brain that control motivated behavior.
Addiction is a brain disease. 2.
A disease has identifiable signs and symptoms. Major symptoms of addiction include tolerance,
withdrawal symptoms, using more of a substance than intended, unsuccessful attempts to control use, continued use despite
negative consequences, and a large time investment in obtaining, using, and recovering from use. The disease
is identified when several of these symptoms are present.
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3.
A disease has a predictable course and outcome. A number of studies describe a common pathway
of addiction whose onset is marked by heavy use and social and/or legal consequences, leading to loss of control and more
intense social consequences. Further along the pathway are serious problems in health, relationships, employment,
the legal system, and/or other areas of life functioning. The desired outcome is complete abstinence, but
short of this, it appears the natural pattern of the disease includes periods of abstinence and relapse. Unchecked,
the disease often leads to death. 4.
A disease’s condition is not caused by volitional acts. A feature of chemical dependence
is a person’s inability to control use. It is not a matter of willpower. Still,
many people deny addiction is a disease by saying that diseases ‘happen to’ a person, but addiction is caused
by a person’s decisions and behavior. Other diseases, such as lung cancer, heart disease, and diabetes,
may be highly affected by a person’s behavior. Yet, we still agree these are diseases.
When a chemically dependent person is drinking or using, this use becomes their top priority, despite willpower to
the contrary. This lack of volition is what distinguishes addiction from substance abuse. Addiction is comparable to other chronic diseases in terms of treatment compliance and outcome.
The genetic contribution to addiction is comparable to that of other diseases such as hypertension, diabetes, and asthma.
In addition, patients’ compliance with a treatment regimen, and need for repeated treatment, is similar across
all these diseases.
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