Are Addicts Sick, Bad, Both, or Neither?


reason contributor Maia Szalavitz had an interesting essay in yesterday's Washington Post contemplating the essence of addiction, drawing on her own experiences as a cocaine and heroin injector as well as research and expert opinion. Her opening frames the issue this way:

Is addiction a disease? A moral weakness? A disorder caused by drug or alcohol use, or a compulsive behavior that can also occur in relation to sex, food and maybe even video games?

Yes, she more or less concludes:

So is addiction disease or learned behavior? Given its complexity, some experts say, what probably matters most is which view best yields compassionate and effective treatment.

This position seems backward to me. If you've already decided that "compassionate and effective treatment" is the appropriate response to addiction, that pretty decisively tilts your perspective toward the disease model. But as Maia notes, even people who claim to champion a disease model seem ambivalent about it: Can you think of any other disease for which the most widely accepted treatment involves asking the patient to surrender himself to a "higher power" and make amends for the wrongs he's done as a result of his illness?

My own view (which I think is similar to Maia's) is that addiction is a learned behavior that, like many other things in life, is influenced by various genetic and environmental factors. Viewing it this way neither requires nor precludes compassion for addicts. As with anyone in trouble, the moral evaluation hinges on the specifics of the individual's situation, including disadvantages that are beyond his control and the extent to which he has hurt other people. Drug addiction should be seen as part of the continuum of human behavior, not as a special case in which all-powerful chemicals take control of people and dictate their actions.

[Thanks to Jeff Schaler for the link.]