by Thaddeus Camlin, PsyD
New England Journal of Medicine Article Says: Addiction is Learning, Not Disease
One of the world’s most prestigious journals just published an article saying that addiction is not disease. Not surprisingly, an uproar is underway. Devotees to the disease model of addiction are not happy, but sometimes the truth hurts. The article in the New England Journal of Medicine is a major step towards improving the standard of care in addiction treatment and deepening our understanding of the true nature of addictive behaviors.
Including and Transcending the Disease Model of Addiction
The article in the New England Journal of Medicine, written by Marc Lewis, Ph.D., does a masterful job of presenting the current state of the evidence about the etiology and maintenance of addiction. Dr. Lewis does not dispute the numerous, important research findings that continue to clarify the neurobiological factors of addiction. Dr. Lewis argues that conceptualizing addiction as learning will include and transcend the disease model.
Expanding a Narrow View of Addiction
Continuing to label addiction as disease does not leave sufficient space in the conceptualization of addiction for social, cultural, and environmental factors. Conceptualizing addiction as learning allows for full inclusion of the empirical findings on the neurobiology of addiction while also giving due credit to other vitally important etiological factors. There are many important accuracies that continue to come from research into the neurobiology of addiction. However, the disease model is too narrow to fully capture the complexities of addiction and it tends to emphasize nature at the expense of nurture.
On Our Way Toward a More Helpful Model of Addiction
Dr. Lewis’ article, and its acceptance by one of the world’s most prestigious journals, is an encouraging event and a major step towards a more accurate and helpful understanding of addiction. When paradigms shift there is always resistance. However, the tide is turning and the disease model appears destined to be wrapped up into a broader, more accurate, and more helpful model of addiction.
