Addiction is NOT a Disease???

The author of the recent Time Magazine article on addiction has posted a retort to Satel here:

This clueless pair doesn't argue that the neurochemistry of an addict's brain is no different from that of a non-addict. They can't, because it demonstrably is. Instead, they offer gems of wisdom like this:

Characterizing addiction as a brain disease misappropriates language more properly used to describe conditions such as multiple sclerosis or schizophrenia—afflictions that are neither brought on by sufferers themselves nor modifiable by their desire to be well.

This presumes that there's no underlying neurological basis that predisposes someone to addiction. Those who actually know something about it know this is a false presumption. Addiction, as Satel and Lilienfeld have somehow failed to learn, is not simply the behavior of abusing drugs—if it were, then all of the college students who drink too much would be alcoholics. Most aren't; they grow out of it.

Addiction is actually a disorder in which the brain's reward system is conditioned to value the reward of getting high over pretty much anything else. It's a disorder, in other words, in which the brain is malfunctioning. And it malfunctions even when the addict isn't actively using the drug. Satel and Lilienfeld would have you believe that the decision to use a drug when the addict knows full well it will lead to disaster, as it has every other time--a behavior every addict is all too familiar with—is just a habit. Like throwing your socks on the floor instead of into the laundry hamper, maybe.

Sure, recovery from addiction requires some change in behavior. So does Type 2 diabetes, which requires the sufferer to avoid sugar and simple carbohydrates, but who nevertheless (unless Satel and Lilienfeld beg do differ) has a disease. An addict has to choose not to use, which is overwhelmingly difficult. It's overwhelmingly difficult but not impossible for someone with depression to get out of bed and put on a good face. But Satel and Lilienfeld don't harangue people with depression to change their "bad habits." Or..maybe they do, come to think of it. It wouldn't surprise me. If medications can help an addict resist the urge to use, why, precisely, is this something to avoid?

and here is a response to some comments from his first post:

We've had a bunch already, some thoughtful, some not so much. Here's a thoughtful one. Tom writes:

To call addiction a disease only validates the feelings of powerlessness that addicts feel. It undermines the fact that behavioral change is the only solution to their condition, and allows them to deny responsibility for their condition. Beating addiction is incredibly hard as it is, and the last thing drug counselors need is people coming to them with the belief that they have a disease which is beyond their control. If you believe your addiction is beyond your control to change, then you might as well be dead already because you're never going to do what you have to do to beat it.

A reasonable argument, but I don't agree. Diabetes is a disease, but people who have it can and do change their behavior to keep the symptoms of the disease at bay. For addiction, twelve-step groups like AA take the position that "we are powerless over alcohol"—i.e. that they have no responsibility for the underlying condition—and then provide practical steps to help them deal with that powerlessness by staying away from alcohol. I strongly believe that the underlying addiction itself is beyond personal control. But the behavior that will help you beat it is quite the opposite.