What carries more stigma: whether someone misuses/abuses substances by choice, or if it because addiction is a chronic disease?
The courts have historically viewed addiction as a choice, not a sickness. Thus, people with addictions have gotten jail time instead of professional help.
When we fight for the human rights of those affected by Substance Use Disorders (SUD's), we need to improve the perception of addicted individuals as a public health issue.
Many advocates speak out to destigmatize addiction by proclaiming substance use is a decision, NOT a "sickness", "condition", "ailment" or treatable "disease." Meanwhile, the White House Office of National Drug Control and Policy's Czar, Michael Botticelli, defines SUD's as a "brain disease."
According to the National Institute on Drug Abuse, "Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and lead to many harmful, often self-destructive, behaviors."
NIDA reports it is because of stigma that:
Some people don’t get treatment.
Some doctors won’t treat addicts.
Some pharmaceutical companies won’t work toward developing new treatments for addicts.
Does it make any difference how addiction is defined? You bet it does! But not for the reasons you might think. Political ramifications of how the public perceives addiction abound with great impact.
For instance, imagine the cost if insurance companies, the courts, medical establishments, and the general public believed repeated substance use is by choice.
Insurance companies would debate about what constitutes medically necessary treatment, drug courts would become even more powerful, there would be fewer treatment facilities, less funding for addiction programs and research, disdain and judgments by the general public against people with an SUD or other addictive disorder, shame for individuals and families struggling with this disorder, and a greater number of fatalities. A scary thought!
The conundrum is that whether you believe addiction is a disease or a choice, it may hold less stigma to regard SUD's and addictive behaviors (such as compulsive gambling, debiting, gaming, sex, etc.) as a treatable sickness.
We need to strategize which option empowers the most people psychologically, emotionally, financially, socially and medically.