Wednesday, October 08, 2003
Rush Limbaugh, Drug Policy, and Addiction as Disease
The op-ed page in today's Trib includes a Clarence Page column on Rush Limbaugh's alleged drug use. (Here's Rush's latest
commentary on the allegations.) Page suggests that "perhaps [Limbaugh] might speak out for more enlightened treatment of
non-violent drug offenders." Page also asserts that "Drug Addicton is a disease." Is it?
Well, I certainly cannot settle that one. Whether or not addiction should be considered a
disease may be largely a matter of the definition of disease. Addiction is surely not a
disease with a single cause or a single cure. It does resemble certain diseases in being a
chronic, recurring condition, and one that can be ameliorated but not necessarily cured --
in these respects, addiction is similar to rheumatoid arthritis, to use a common analogy.
Neurobiological factors play a key role in much drug use, but simultaneously, there is a
volitional element in addiction -- as there is in many diseases, even infectious diseases:
people make choices that put them at a greater or lesser risk of contracting the disease.
For some addicts, viewing their predicament as a disease might be helpful, even if it is not
descriptively accurate. Addicts themselves struggle with gauging the extent to which their
condition is physiological, a disease, as opposed to a moral failing, a weakness of will.
The incoherence of views towards addiction is a long-term phenomenon. Addiction
traditionally has been perceived as some (possibly incompatible) combination of moral
failure (poor or weak, but rational choices) and disease. The relative strength of these
dual approaches changes over time, though not primarily as a result of improved scientific
information. The "disease" portion of this ambivalent view towards addiction has
garnered strength in the past two centuries.
Though connecting addiction with disease is generally put forth as a reason to move away
from a punitive model of drug control policy -- this is the manner in which Clarence Page
employs it -- that need not be the final destination. Indeed, a disease view of addiction
can be used to justify very strict controls on drugs. Policy towards those who are not
regarded as responsible, such as children and the (mentally?) ill, tends to be very coercive.
Civil commitments already take place with respect to mental patients and sexual
offenders who are deemed to be dangerous to themselves or others. If the actions of
addicts are beyond their control, could Millian self-regarding addicts, those who commit
no crimes (other than purchasing their illegal drug, perhaps) be forced into treatment or
In other words, the disease view of addiction potentially provides a considerable
justification for strict drug regulations. If we go further and view addicts not just as
diseased in themselves but as carriers of a latent epidemic, then there is an even greater
rationale for coercive measures based on public health considerations. Forced
institutionalization of addicts could be undertaken in the name of quarantine.
This just brushes the surface of the addiction-as-disease issue. I'll conclude by noting that
many treatment programs, in the Alcoholics Anonymous mode, explicitly adopt a disease
view of addiction, while simultaneously stressing personal responsibility. Some addiction
researchers, including Stanton Peele and Herbert Fingarette, have provided important contributions
challenging the association between addiction and disease.