A cornerstone of current treatment of a substance use disorder is to consider it to be an expression of a disease with biological, psychological, and social dimensions. That nicotine addiction is rarely approached in this way is puzzling, as well as a partial explanation of disappointing treatment outcomes.
The idea that addiction reflects a disease process in a person is not a new one . In 1784, Dr. Benjamin Rush, a Philadelphia physician and a signer of the Declaration of Independence, wrote a monograph presenting the idea that alcoholism was a disease. The idea was formally supported by the World Health Organization in 1951 and later adopted by the American Medical Association in 1954.
The contribution to this idea by the Alcoholics Anonymous (AA) organization is somewhat complex (Kurtz, E. (2002). Alcoholics Anonymous and the Disease Concept of Alcoholism. Alcoholism Treatment Quarterly, 20(3–4), 5–39. In order to avoid increasing tension with the medical profession, the founders chose to use the word “illness” instead of “disease.” Furthermore, AA literature focused on the “spiritual” aspect of the problem more than the biological.
Although supported by creditable people and organizations, the disease concept has been controversial. Challengers in the psychoanalytic world regarded alcoholism as deriving from very early developmental stages, burdening the person with an “oral fixation” that was seen as the reason for their unresponsive to treatment. Social commentators saw it as a reflection of a moral failing. Even AA referred to “character flaws” that needed to be addressed.
Personally, adopting the disease approach was a turning point in my professional career. When I was introduced to this approach, I at first rejected it. It seemed to me to be a “cop out” – a way of avoiding responsibility for one’s behavior. I was not clear, initially, about the distinction between not being responsible for having the disease, which is genetically influenced, as opposed to being responsible for taking care of one’s disease. What finally convinced me to try out the disease approach was a practical one – those clinicians who adopted it were having better rates of treatment success than I was having when using other approaches.
Considering addiction from a disease perspective freed me from a critical and moralistic judgment, which had interfered with my ability to be compassionate toward my patients. Using this different approach, I found that my patients began to improve at much better rates than when I had used a psychoanalytic approach. Fast forward 50 years, and findings from neurobiological research, especially brain imaging studies, have provided substantial evidence to support the existence of a biological component of the disease concept.
If using the disease approach is so effective, why has it not been applied to nicotine addiction, where treatment outcomes are in such need for improvement? Rather than speculate on possible answers, I will use upcoming blog posts to describe the encouraging results that we have been getting by using it in the Triple Track treatment program.
If you would like to explore your own path to quitting addictive use of nicotine, please use this link: https://www.tripletrack.com/lets-talk
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