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Is Addiction-as-a-disease a Scientific (falsifiable) Idea?

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Author: A. Tom Horvath, Ph.D.

A scientific idea is one which can be proved or disproved on the basis of facts (evidence). If there is not yet enough evidence to decide, and the idea is an important one, scientists will keep looking carefully for evidence that confirms or disconfirms the idea. For instance, it is important to have treatments for diseases, and important to know whether proposed treatments work better than existing treatments or placebo. Consequently we are regularly testing proposed medications and treatments.

The idea that god exists is not a scientific idea, because no matter how strongly some people believe it or disbelieve it, there are no facts that a believer could amass that would convince a non-believer, or vice versa. For instance, does the fact of pain and suffering in the world indicate that a loving god does not exist, or merely that God is a mystery beyond human understanding? The fact of pain and suffering is real, but the interpretation is open to debate. Ideas of this type (god's existence) are sometimes called metaphysical ideas. No amount of evidence will resolve them. They are matters of belief.

Of course, all facts are open to interpretation, but as evidence emerges over time in the scientific community many ideas become well accepted and established: the earth is not flat but a sphere, gravity is a force of attraction between bodies, behavior increases when it is rewarded, etc. New facts may emerge that place these facts into perspective (the earth is very, very slightly pear-shaped; Newton's understanding of gravity has been modified by Einstein's, determining "rewards" for some human beings is difficult). Because there is no predicting when new facts may emerge (or new interpretations) we need to accept all scientific ideas as tentative. However, in our day to day lives, it works well enough not to question too much at once.

Here is an idea that I suggest is worth questioning, for all of us. Is addiction as a disease a provable or disprovable idea? You might wonder at this question. Have we not heard many times that addiction is a disease (or a brain disease)? Why would one even ask this question?

If it turns out addiction-as-a-disease is not a provable or disprovable idea, it would change how we talk about addiction. We might stop trying to encourage a particular belief about addiction, and instead invite people simply to consider various forms of belief about addiction, to determine which belief fits best for them (much as people might choose a religion). The enormous advantage of this approach would be to encourage people to pursue approaches to recovery that make sense to them, rather than feeling forced into approaches they don't fully accept.

But isn't the evidence in, that addiction is a disease? Here are the facts: 1) genetics and/or biology alone do not explain addiction. Social and psychological factors are also involved (there is no medical test that can tell you who is an "addict" or "alcoholic"—although some tests identify the damage substances have caused); 2) "loss of control" is variable, and can be influenced by, or may even be entirely explained by, psychosocial factors like expectation (when alcoholics are drinking alcohol but don't realize they are drinking alcohol their behavior does not exhibit loss of control, until they discover what they are drinking); 3) craving, like anxiety, will diminish substantially (or go away entirely) if not acted on—most ex-smokers will tell you this; 4) none of the current scientifically-supported treatments for addiction require someone to believe addiction is a disease. Indeed, the idea of addiction-as-a-disease seems to provide little guidance about how to change; 5) although some people with addiction problems have those problems progress over time, most people do not have this progression occur; 6) the majority of individuals with addiction problems resolve those problems without treatment or support group attendance.

One could read these facts, have a very heavy drinker in mind, and conclude: 1) over time, this person just seemed to be more and more influenced by alcohol. Regardless of what might have happened to others, this person gradually lost the power to choose, and ended up hopelessly alcoholic. Or 2) whenever it is important enough, people change, even if because of genetic predisposition and current problems they get greater positive effects from alcohol.

Perhaps it would be more sensible to conclude that addiction-as-a-disease is a metaphysical idea, and that recovery is best enhanced by letting people know that they have choices about how to think of themselves and addiction recovery. In the US (and to a lesser extent in other countries) we would stop confronting people about who/what they are ("You need to accept that you have a disease")—a encounter beyond which many angry drinkers and users will not budge—and instead attempt to collaborate on how recovery might begin.

Adapted with permission from an article originally published in the SMART Recovery newsletter. A. Tom Horvath, Ph.D., ABPP, is a board certified clinical psychologist and president of Practical Recovery (http://practicalrecovery.com), an addiction treatment facility in La Jolla (San Diego), CA, focusing


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