How the Disease Theory Conquered Drug Policy Reform

The disease theory of addiction is too American to be displaced.

Posted Oct 19, 2019

When I met Ethan Nadelmann in the 1980s, on the eve of his creating the modern reform giant the Drug Policy Alliance, it seemed as though drug policy reform would be a way out of America’s addiction-as-disease morass. (Which is why perhaps I received DPA’s career achievement award in 1994, 25 years ago.)

It hasn’t turned out that way. Instead, drug policy reform has embedded the disease model of drug use at the heart of its efforts, as represented by the following bullet points:

  • Pain relief as a right versus pain relief as addiction.
  • Social causation versus addiction über alles.
  • Social versus medical cures.
  • Addiction as a passage versus addict as an identity.

Drug policy reformers at one point stood at the vanguard of allowing pain patients unrestricted access to, and self-regulation of, drugs for pain relief. 

Reformers have now joined the proponents of severely restricting access to pain-killing medications. That is, rather than looking toward social and psychological causation of drug misuse and addiction (e.g., poverty, deprivation, powerlessness), reformers — like nearly all Americans — see addiction as stemming directly from drug use per se. MAT (medication-assisted treatment) — that is, solving addiction with medicine — is the logical outcome of this perspective.

Since the disease model is static and inevitable — drug use causes addiction — the idea of outgrowing (maturing out of) addiction is discarded in favor of lifetime addictive drug maintenance (e.g., methadone, suboxone).

So we have come full circle in America back to drug use as the inevitable, irreversible source of addiction, a view now fully ensconced in the drug reform movement, contrary to its origins.