While the classification of addiction as a disease is largely accepted within the field of medicine, in the last few years it has become a subject of debate. Notably, Marc Lewis, a neuroscientist (who recovered from a crystal meth habit), has published books and articles challenging the brain disease model of addiction (BDMA). Lewis instead embraces a developmental-learning model, placing emphasis on the fact that substance use disorders occur as a result of classical conditioning and habituating behaviors associated with drug use.
Lewis’ publications are self-described as being “free from…the disease bias” (2017), by which he means that labeling people who have substance use disorders as “diseased” may not only misrepresent various neurobiological aspects of addiction, but also serve to reinforce already problematic associated stigma. Lewis (2017) calls for the “[reframing] of addiction as the development of coping habits within a social matrix…[and argues] that the brain is designed for exactly that.” Within this conceptualization of addiction exists a powerful and parsimonious solution to problematic substance use: removing environmental antecedents to addictive behaviors should, over time, eliminate these behaviors and their consequences altogether.
Dr. Lewis’ line of thought is in direct conflict with much of what is accepted in psychiatry, research, and the recovery community. According to his model, recovery is possible without any (let alone long-term) treatment. Great news, right? While the flourishing rehab industry, Big Pharma, and researchers (for whom much funding is justified by the disease definition), would likely not think so, it seems reasonable to assume a person who is penniless and addicted might.
Several researchers have evaluated the developmental-learning model. In her response to Lewis’ work, Maia Szalavitz (as cited in Snoek & Matthews, 2017, p.3) agrees that “disease…is an imprecise word (with a lot of damaging baggage) whose main function is to generate access to medical care.” Kent Berridge (as cited in Snoek & Matthews, 2017, p.2) expresses a similar but less critical sentiment about maintaining the current model, describing the disease label as something that “is not unreasonable and deserves to be tolerated” so as to ensure continued access to treatment for those who need it.
Financial and political considerations aside, there are pros and cons to this idea of recovery sans professional intervention. For every unique case of addiction there exists an individualized solution. There is however an unquestionable need for biopsychosocial care during the initial phase of recovery – detox. Detoxification from certain substances, such as alcohol or benzodiazepines can be incredibly dangerous – even potentially fatal. While withdrawal from other types of drugs, such as opiates, is less directly lethal, it is possible to die while detoxing from them mainly due to severe dehydration and hypernatremia from persistent vomiting and diarrhea, which may ultimately lead to heart failure. Detoxing furthermore presents with dangerous psychiatric symptoms such as hallucinations, depression, and severe anxiety – all of which should ideally be professionally monitored.
Once a person has finished detoxing, there is likely a need for a certain level of continued care, as reacclimating to life without drugs poses common challenges. With proper guidance and support, living a life free of addiction becomes more possible – and the chances of relapse diminish. Whether this care is necessary at a professional level is however something only assessable on a case-by-case basis. Overall, once a certain level of independence is accomplished, continued care may not be necessary at all.
Lewis’ theory is both progressive and valuable, at the very least sparking an open discourse about how best to classify and treat addiction. While acceptance of his model may yield (solvable) financial and political problems, it may also provide an insurmountable level of hope for people with substance use disorders. The developmental-learning model eliminates the widely accepted notion of “once an addict, always an addict”, the very crux of the disease model problem. Lifelong (mis)diagnoses proliferate self-fulfilling prophecy and inhibit potential recovery. Labels become trap doors. As such, this less permanent model paints an overall more hopeful picture of recovery.
Darke, S., Larney, S., Farrell, M. Yes, people can die from opiate withdrawal. Addiction.
Lewis M. Addiction and the Brain: Development, Not Disease. Neuroethics. 2017;10(1):7–18.
Snoek, A., & Matthews, S. (2017). Introduction: Testing and Refining Marc Lewis’s Critique of
the Brain Disease Model of Addiction. Neuroethics, 10(1), 1–6. doi:10.1007/s12152-017-9310-2