From Criminal to Clinical | Part 2, Rethinking Addiction

By Nathan Grounds

In our previous blog post, we gave a cursory summary of the War on Drugs and revealed its failure to curb the American drug epidemic. In this post we’ll discuss the modern approach to addiction, which holds great potential in actually helping people stop their drug abuse.

Perhaps the biggest finding from the enormous body of research done in the topic of addiction over the past 50 years is this: Addiction is not a criminal issue, but a clinical one. Addiction is not delinquency, it’s a disease. David Sheff, author of Clean and  Beautiful Boy (from which the major motion picture by the same name received its inspiration), lays out the argument for why addiction should be classified as a disease. According to Stedman’s Medical Dictionary, a disease is “a morbid entity ordinarily characterized by two or more of the following criteria:

  1. Recognized etiologic agents
  2. Identifiable group of signs and symptoms
  3. Consistent anatomic alterations”

Addiction meets every one of these criteria. First, an etiologic agent is a $5 word for the root or cause of a problem. In the case of addiction, a substance can be the cause of the disease (just like eating fast food every day can cause you to develop heart problems). But most people who become addicted show signs of addiction before they ever use drugs. A study in 2012 by the University of Cambridge studied 50 people addicted to cocaine along with their siblings who had no history of drug abuse. After scanning the brain from both siblings, researchers found abnormalities in both people’s brains, regardless of drug use. These irregularities were especially apparent in the parts of the brain that dealt with self-control. What that means is that some people are at a biological disadvantage when it comes to stopping harmful self-inflicting behaviors. It turns out, addiction is to a large degree hereditary. Just as your likelihood of having a stroke is increased if you have a family history of it, so too is your likelihood of addiction if it runs in the family.

The second criteria for a disease is it must have an identifiable group of signs and symptoms. A quick WebMD search bears this out. Those who suffer with addiction often:

  • Must increase usage to get the same effects
  • Experience depression, nausea, headaches, fever, and changes of appetite when off of the drug
  • Can’t stop themselves from using the drug
  • Spend a great deal of time thinking about the drug
  • Lose interest in activities that once brought joy

These symptoms (and many more) are experienced among addicts regardless of age, sex, or race, and meet the second criteria for disease.

The third criteria is that a disease must demonstrate consistent anatomic alterations. Researchers have discovered that the brains of those who are addicted are significantly changed both structurally and functionally. One example of structural changes among addicts can be seen in the brain’s white matter. White matter is the network of fibers that link brain regions together. The white matter in a person’s brain who regularly smokes marijuana has much less integrity than the brain of someone who doesn’t. In some cases, regular THC exposure can even cause the white matter to atrophy. These alterations essentially minimize the brain’s ability to send signals necessary for proper functioning.

Addicted brains are also altered functionally. One example can be found in the altered flow of neurotransmitters, especially dopamine. Dopamine is a chemical that is responsible for the reward-system in a person’s brain. It is released when we do things that are enjoyable: eating, having sex, or working out. An influx of dopamine leaves us feeling great and makes us crave more. A major effect of using substances is the flood of dopamine released in the brain. For nonaddicts who use drugs, dopamine eventually levels out and the receptors for the chemicals close off. For those with addiction, however, the receptors wanting the dopamine may take much longer to close off, if they do at all. This means that the brain of a person with addiction is constantly needing the rush of dopamine, provided by the drug, in order to feel normal.

Sheff’s point is pretty clear: addiction meets the criteria for a disease and should be viewed as such. Unfortunately, most people who suffer from this disease have much more interaction with law enforcement than medical professionals and have a far greater chance winding up behind bars than in a rehab facility. Most people agree that we punish bad behavior and treat illness. We don’t throw people in prison who suffer from high blood pressure and expect them to get better. However, our current criminal justice system is set up to do just that, only it targets the disease of addiction rather than that of cardiovascular disease.

However noble or sincere our intentions may be, criminalizing addiction is not the way to solve our nation’s drug crisis. Any progress that can be made in reducing substance abuse must be accompanied by a shared shift in narrative regarding the stigma of addiction. Until we see addicts as people in need of treatment, rather than criminals in need of punishment, we’ll never be able to make progress in curtailing America’s decade-long drug problem.

At Next Step, we believe prevention is key in the fight against substance abuse. One of the best things you can do as a parent, is to talk to your kids about alcohol and other drugs. For more information on how to start the conversation, check out out “Five Tips for Talking to Kids About Drugs and Alcohol”.