In our field of addiction medicine, we are often reminded and rightly so to refrain from using stigmatized terms and words like, addict, junkie, dirty urine etc. These kind of words and terms can be hurtful and demoralizing to the person and their families.
‘Addiction’ is often described as an incurable ‘disease’ that is best treated with substitution medications. What are the ramifications for using the noun ‘disease’ to
describe a condition that afflicts over 23 million people in this country? Disease implies incurability; a condition defying a cure. To add insult to injury, the disease is acquired by the subject through a conscious and deliberate act of using a substance that is deemed to be addicting. If the subject had not used opioids, alcohol etc., he/she would not suffer from the disease. A wonton disregard of the repeated admonishment of not using such dangerous substances deserves no sympathy and certainly no intervention. The disease was acquired through a self-inflicted act and therefore the cure must come through self-restraint and display of will power. Society has no obligation to display a modicum of sympathy. If anything, stigmatization, and punishment should be the more appropriate response.
We need to debunk two enduring myths – the incurable disease and the self-inflicted cause of addiction. Let’s start with the latter. In all the years I have been this field, I have not come across one person whose goal was to become addicted to a substance or behavior. I have not come across one person who wrote in the school yearbook that he/she wanted to become an addict! Addiction always happens accidentally. The act of trying drugs or alcohol for the first time is usually a voluntary act. It may be out of curiosity, peer pressure, family culture etc. The person did not know about the risk of pre-disposition to become addicted. For a myriad of reasons, the person liked the effects of the offending substance and the use continued, unbeknown that the continued used may drift into an involuntary act. Once the addiction has set in, the intense craving, the painful withdrawals and fear of pain withdrawals force the person to find the substance at any cost. Attempts to stop using the drug fail and the persons spiral downwards to the depths of addiction.
What are the ramifications of describing addiction as a disease? Many. Disease implies incurability. Some ‘diseases’ have no cure, but the signs and symptoms can be managed through medications, physical and behavioral therapies, and other chronic interventions. Science aspires to cure and if possible, protect the persons from reacquiring the condition through things like vaccinations and other preventive methods. When there are no effective diagnostic tests or effective medications or therapies to cure or control the symptoms, the only option is palliative care. Most palliative efforts involve mitigation and management of pain, the most common symptom of unmanageable disease. Morphine was once widely used to control the pain and coughs caused by conditions like tuberculosis and pneumonia. The development of diagnostic tests and effective treatments like antibiotics drastically reduced the need for the palliation of the pain. A more recent example is changing the description of sexually transmitted infections. For the longest time, sexually transmitted infections were called sexually transmitted diseases (STDs), implying there was no cure for STDs. We now have highly effective antibiotics to treat sexually transmitted infections and therefore the name change, STD to STI (Sexually Transmitted Infection)! This gives persons the hope of a cure.
Describing addiction as an incurable disease gives persons not much hope of a cure. Moreover, physicians have limited interest in treating an ‘incurable disease’. They are trained to treat, cure, or heal. Small wonder, the treatment of alcohol and drug use disorder remain outside the ambit of medicine. Why not describe ‘addiction’ an illness, disorder, condition, or state? All these words give persons hope of attaining a normal life. I will go further and suggest using a more action term ‘quit’ rather than ‘recovery’. I have borrowed the verb ‘quit’ from the very successful nicotine cessation programs. When one stops using tobacco products, the term used is quit. Let’s start using it our field.
So, let’s consider our vocabulary. It’s time for a change in our field. Maya Angelou famously stated, “Do the best you can until you know better. Then, when you know better, do better.” Addiction happens accidentally and the goal is to make it incidental—just one part of a person’s medical story. Let’s start describing the problem as a ‘disorder’ and when the disorder is resolved, let’s call it ‘quit’.
In 2021, we know better. So, let’s do better.
Percy Menzies, M. Pharm. is the president and founder of the Assisted Recovery Centers of America (ARCA), an integrated medical clinic based in St Louis. He can be reached at: pmenzies@arcamidwest.com