How should we view drug addiction? Is it a disease or a disorder? Is it evidence of deviance or despair? Is it something people fall into unawares or the fruit of many bad choices over time? And do these questions even matter? I would argue that they do. How we think about drug addiction impacts both our understanding of root causes and proper responses to this affliction that has engulfed a growing portion of our population.
How to think and speak about people enslaved to intoxicating substances has a protracted history. It appears that pastors and not medical men were the first to attach the label ‘disease’ to those driven by a craving for alcohol. Extant sermons from clergy in the 1600’s advanced the view that something overtook individuals such that drinking is out of their control. Benjamin Rush, the noted Revolutionary War physician and follower of Christ, did more than anyone to advance compassionate care for those afflicted with a variety of mental disorders. Rush promoted the notion that alcoholism was a ‘disease of the will’—indicating that something was amiss in such individuals leading them to compulsive and destructive use of alcohol. He even suggested that the propensity to alcoholism could be inherited, laying a framework for subsequent views on the biological predisposition to addiction.
Later advances in neuroanatomy and neurobiology led others to suggest organic causes behind all sorts of deviant behavior. Following this line of thinking, in the late 1970’s the medical community began to coalesce around the idea of drug addiction as a chronic brain disease. I have made the case in my book, Breaking the Grip of Addiction, that such a view is not supported by the best biomedical evidence. Nevertheless, drug addiction as a chronic brain disease remains the prevailing position among medical, psychological, and sociological professionals today. It is also clear that the desire to avoid moral judgment has served as a motivating force to view drug addiction as a chronic brain disease. The current classification of substance use disorders reflects this view.
The Substance Abuse and Mental Health Services Administration estimates that over 40 million Americans have a substance use disorder. Hence, it is inevitable that biblical counselors will encounter individuals bearing this ‘diagnostic’ label. In addition, parents seeking help dealing with rebellious children may also report that their troubled child has a substance use disorder. But what does this label mean and how should it impact how one engages such individuals?
Substance Use Disorder (SUD) is the recurrent use of drugs and/or alcohol that causes disruption in normal functioning through health or social consequences. The terms drugs abuse and drug dependence have been discarded as formal classifications in current diagnostic criteria. The 5th revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which serves as the primary source for mental health professionals diagnosing patients, outlines 11 diagnostic criteria for SUD. The criteria fall into four categories: 1) impaired control over substance use (criteria 1-4), 2) impaired social functioning arising from substance use (criteria 5-7), 3) risky use of substances (criteria 8-9), and 4) pharmacological consequences, such as tolerance and withdrawal symptoms (criteria 10-11).
Individuals who meet any 2 criteria are noted to have mild SUD, those meeting 4 to 5 criteria moderate SUD, and those meeting 6 or more criteria are designated with severe SUD. While the term addiction is not part of the DSM-5 diagnostic paradigm, most clinicians view addiction to equate with severe SUD. Thus, much like those bearing the diagnosis of autism or depression, SUD encompasses individuals with a wide range of ‘symptoms’ and impact arising from their use of intoxicating substances. This could include individuals who are social drinkers that have experienced one or two arrests for driving while intoxicated to individuals who inject heroin multiple times every day. A high functioning stock broker addicted to cocaine and a homeless methamphetamine addict both would bear the same mental health designation of an SUD. But what are the consequences of being tagged with this diagnostic label? That will be the focus of part 2 of this blog.
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