There’s a new twist in the war over whether addiction is a disease. Animal rights activists in Europe are using public misgivings about the idea to call for bans on the use of animals in addiction research. But while scientists overwhelmingly oppose such prohibitions, some researchers are siding with the activists about the limitations of the disease model, re-igniting debate over the nature of addiction.
The ethics of animal research have long been a vexed question. In fact, the more that researchers study animals, the more similar they find mammals like rats, mice and monkeys to be to humans and the more difficult the issues become. When a rat expresses empathy—a “human” emotion—for a fellow rat trapped in a cage, it gets harder to justify experimentation. However, one thing is clear: As it stands, medical research relies on animal data and there are currently no alternatives to it in neuroscience and clinical testing of drugs.
The debate kicked off in the prestigious British journal Nature, spurred by the passage of a new law in Italy that prohibits addiction research on animals, starting in 2017. The journal published a strongly worded editorial opposing the legislation in February. Opening by stating simply that “Drug addiction is a disease,” the editorial went on to cite neuroscience research showing addiction-related changes in the brain’s circuitry and chemistry, explaining:
“Campaigners opposed to animal research have targeted addiction as the soft underbelly of political support for such work. Addiction is a social problem, they argue, not a medical one. And social problems are not solved by science, or by research on animals.
“That is a seductive message for politicians. Care and compassion for drug addicts is rarely a vote-winner. Care and compassion for animals is a sure thing. Many voters believe that funds are best focused on crushing drug barons and locking up dealers. Many also believe that addicts are at best weak-minded, at worst evil, and have only themselves to blame if their drug habits kill them. If the science of addiction can be questioned, then why bother pursuing medical cures based on scientific research?”
But then in March, Nature published a letter from addiction researchers and drug policy reform advocates that complicated the question. Signed by 94 experts including the Drug Policy Alliance’s Ethan Nadelmann and Columbia addiction researcher Carl Hart (disclosure: we worked on a book project together), the letter read:
“Irrespective of the animal-rights issues you discuss, we disagree with your one-dimensional view that addiction is a disease, and with your claim that this view is not particularly controversial among scientists…
“Neuroscience has been widely documented as just one of many important influences in drug addiction. Substance abuse cannot be divorced from its social, psychological, cultural, political, legal and environmental contexts: It is not simply a consequence of brain malfunction.”
Yes, folks, in the 21st century, we are still debating whether addiction is a disease—and people who think the question has been settled are often unaware of just how complex the issue has become.
What many don’t realize, however, is that this debate isn’t limited to the concept of disease as it relates to addiction. The same arguments now made against seeing addiction as a disease can be made with equal validity about other mental illnesses. Disease isn’t simply a medical classification: When it comes to conditions that affect behavior, social and cultural factors are impossible to entirely exclude.
Take depression, for example. As with addiction, there are changes in the brain seen in both animal and human research on depression—but these changes aren’t seen in all cases and there is no “biomarker” or medical test that can clearly distinguish between a person with depression and someone who doesn’t have it.
In both cases, you cannot look at the results of a blood test or brain scan and diagnose the condition: While claims have repeatedly been made that this is possible, in fact, it is not—and those who sell brain scans to addicted people or those with other mental illnesses do not have scientifically validated data to support their claims.
Similarly, both addiction and other mental illnesses—particularly depression—are profoundly affected by social circumstances. Both vary by socioeconomic status. For example, the prevalence of mental illness is roughly double among the long-term unemployed—and studies show that this is not simply because mentally ill people lose their jobs because they can’t function, but because unemployment isn’t conducive to mental health. The same is true for addiction: While people certainly get fired because of addiction-related issues, joblessness alone significantly raises the risk for addiction.
Indeed, as opponents of the disease model frequently point out, one of the best predictors of recovery has nothing to do with the pharmacological effects of drugs on the brain and is, in fact, employment status.
Social support is another big factor, both in who develops addiction and other mental illnesses and in who gets better. The main reason that even experts who think AA’s ideology is complete nonsense continue to recommend it to patients is that having a supportive community can be critical to overcoming addiction.
But does this mean that all mental illnesses aren’t diseases? No one makes the case that hypertension isn’t a disease when research is published showing that early childhood trauma and poverty contribute to risk for it. No one claims that if loneliness affects cardiovascular disease risk, heart disease isn’t an actual illness.
In a social species like humans, it’s hardly surprising that social factors are extremely important in both mental and physical disorders; it would be shocking, given what we know about how social support calms the stress system, if these elements didn’t matter.
There are many reasons to oppose animal research and many questions to raise about the nature of addiction. But the idea that social factors matter (which, by the way, has been shown in animals as well as humans) is not a good argument against considering addiction as a medical problem, nor is it a reason to single out addiction research as a domain of neuroscience undeserving of study.
That is merely promoting stigma and marginalizing people in the name of animal rights. If activists want to ban all medical research on animals, they should say so—and face the opposition that comes with this position—rather than picking on addicted people. It’s not so easy to argue that we shouldn’t study depression or schizophrenia while continuing other animal research—and since the exact same arguments apply, it’s unfair to target only addiction.
