By Paul Devenyi

In 1960 Dr. E. M. Jellinek (not a physician) wrote a landmark book:  "The Disease Concept of Alcoholism".  He did away with the commonly held concept that alcoholics are weak, morally bankrupt individuals and even offered a scientific classification for different forms of alcoholism (Jellinek, 1960). Many people jumped on the "disease concept" bandwagon and it was extended from alcoholism to other drug addictions. Political correctness demanded that addicts   are to be regarded as unfortunate sick people who need treatment and not jail or other harsh methods. We have lived under the "disease concept" for half a century. But not everybody bought into this concept (Heyman, 2009). Nonetheless, the addiction treatment industry mushroomed, ranging from dingy clinics to posh luxury resorts. The net result was that there was no progress in 50 years; addictions are just as untreatable today as they were half a century ago. 

Addictions are not diseases, but the results of foolish human behavior, nourished by individual or social-cultural facilitating circumstances. They are not diseases per se, but in the process they may reach disease proportions.

Treatment consists of counseling, ("stop drinking", "quit drugs") and occasional pharmacotherapy (e.g., disulfiram to create an unpleasant reaction to alcohol, naltrexone to block the brain opioid receptors thus render the drug useless). The pharmacological approaches failed, because the patients have to be motivated to take the drugs indefinitely or at least for long periods and they don't.  The treatment centers (so-called: "Rehab") are largely useless.   Currently the US congress is planning to conduct an audit of them.

After nearly 50 years practicing as an addiction internist (mainly concentrating on physical complications), I drew the above conclusions and I am offering the following points for debate:

1, Addictions are not diseases but disorders of choice.

2, Some addictions become diseases by virtue of their complications.

3, There has been no progress in "treatment" in the last 50 years.

4, There is spontaneous recovery in a minority of addicts, but that is independent of the intensity of "treatment".

5. To solve the problem of addictions is not a matter of individual therapy, but social engineering, such as law enforcement and education.

References:

Heyman GM. Addiction. A disorder of choice. Cambridge: Harvard University Press; 2009.

Jellinek EM. The Disease Concept of Alcoholism. New Haven (Conn): College and University Press; 1960.

Paul Devenyi
August 22, 2013