The Disease Model, Stigma, and Treatment Theme Analysis

In addition to recounting Nic’s personal struggle with addiction, his father, David, aims to educate readers on addiction generally. He provides scientific information on drugs and exactly how and why addiction is so harmful. He also examines the policies surrounding addiction that have exacerbated the issue nationally. In providing all of this information, David ultimately argues for the disease model of addiction, which holds that addiction has a biological basis and should be treated like any other illness, dispelling the stigma of addiction as being caused by a lack of will or a moral failing. With this framework in mind, David proposes that the government and individuals must treat addiction as a disease and take concrete steps in order to mitigate it.

David provides a background on drugs in the United States, illustrating how they have become more addictive and harmful than they have ever been, which leads to a general increase in addiction. David notes that a body of research has unequivocally shown a wide range of dangerous physical and psychological effects of drugs, and how they are becoming worse than they have ever been. For instance, there is twice as much THC in marijuana now than in marijuana a decade ago. Additionally, psychedelics and ecstasy are now frequently laced with meth. Without the knowledge of which drug a person is ingesting, it is easier for a person become addicted to something much more harmful. David then illustrates how drug use itself has increased. He writes, quoting statistics from the Center for Disease Control and Prevention (CDC), “’The mortality rates from unintentional drug overdose have risen steadily since the early 1970s, and over the past ten years they have reached historic highs.’ First-time users are younger, the drugs themselves are stronger, and there are many more types of drugs to abuse. Users can get their drug of choice whenever and wherever they want.” Meth specifically has become “more potent and pervasive than ever,” and this greater availability and potency has also contributed to addiction.

David then emphasizes the disease model of addiction, and how meth specifically manipulates the brain to cause addiction and relapses. Meth is quickly absorbed in the bloodstream whether it is sniffed, smoked, or injected. It stays in the body for 10 to 12 hours and triggers elevated levels of dopamine, which causes euphoria. However, after the high, those levels become severely depleted, and drug users often have to increase their dosages in an attempt to recreate the initial high. This, in turn, causes more nerve damage, which “increases the compulsion to use—a cycle that leads to both addiction and relapse.” Thus, the drug itself changes brain chemistry in a way that reinforces and increases harmful behaviors. David interviews a woman named Dr. Edythe London, a professor of psychiatry and biobehavioral sciences at UCLA. Her studies of brain scans of meth users versus a control group illustrate that when meth users try to stop using, withdrawal from the drug triggers depression, aggression, and anxiety in their brains. Her findings led her to conclude that  “meth addicts may be unable, not unwilling, to participate in many common treatments, at least in the early stages of withdrawal. Rather than a moral failure or a lack of willpower, dropping out and relapsing may be a result of a damaged brain.” Given the very real psychological and physiological symptoms of withdrawal, it’s important to treat addiction as a disease. The stigma of addiction as a moral failing rather than a medical problem leads to lack of support in funding treatments.

Finally, David illustrates how the government has not treated addiction as a disease in the past, and how it needs to do so going forward in order to find better treatments and preventative measures. David writes that “each year we spend, or rather misspend, more than $50 billion on the war on drugs. (In total we've spent more than $1 trillion.)” He explains that the United States spends billions more on prisons as a result of drug use, often jailing addicts rather than treating them. And yet the annual budget of the National Institute on Drug Abuse, which includes almost all drug-related research and development, is less than $1 billion. Twenty thousand people die each year of drug overdoses alone—yet health insurance companies, Medicare, and Medicaid, refuse to pay for treatment of illnesses or injuries caused by drugs or alcohol. Thirty-two states enforce statutes that allow insurance companies to refuse to cover medical care in an emergency room if drugs or alcohol contributed to the condition. Life insurance can be denied if drug or alcohol abuse led to death. All of these policies are based on the idea that addiction is a personal failing, rather than a disease which should be treated it like any other. Stigma and prejudice have also curtailed financial support for research into addiction, which has resulted in few effective treatment options. The cost of effective treatment programs is prohibitively high, often running from $30,000 to $50,000 a month. Therefore, addicts rarely seek treatment—only one in 10 do. The stigma of addiction versus an illness like cancer is apparent, and so is the difference in how research for the disease has been funded and how treatments have developed. “The incidence of cancer began dropping in 1990 and has continued to fall every year since then. Since 2004, the death rate from cancer has decreased at double the rate of the previous two decades.” David suggests that the war on drugs should be handled similarly to the war on cancer: well-coordinated and funded, with long-term goals. Changing the stigma of addiction, and thus funding the “war on drugs” in a way that treats it more like a medical disease, can save hundreds of thousands of lives each year.