Addiction Should Be Treated, Not Penalized: Health Focus

Addiction has long been stigmatized as a moral failing rather than recognized as a medical condition. This perspective has led to punitive policies that worsen the struggles of those affected instead of providing them with the help they need. Shifting toward a healthcare-focused approach can improve outcomes and reduce societal costs associated with substance dependence.

To effectively address addiction, it is essential to understand its biological basis and integrate comprehensive treatment strategies.

Classification of Substance Dependence as a Medical Condition

Decades of research confirm that substance dependence is a medical condition with physiological and psychological foundations. The American Psychiatric Association (APA) classifies substance use disorder (SUD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as a chronic, relapsing disorder involving compulsive drug seeking, continued use despite harm, and long-lasting brain changes. Similarly, the World Health Organization (WHO) includes substance dependence in the International Classification of Diseases (ICD-11), reinforcing its status as a legitimate medical diagnosis. These classifications, based on extensive studies, distinguish addiction from voluntary substance use.

The chronic nature of substance dependence aligns it with long-term medical conditions such as diabetes and hypertension, which require ongoing management rather than punishment. Research in The Lancet Psychiatry highlights neuroadaptive changes in the brain, particularly in the mesolimbic dopamine system, that contribute to compulsive drug use by altering reward processing and impulse control. These changes explain why individuals struggle to regulate consumption despite severe consequences. The National Institute on Drug Abuse (NIDA) emphasizes that these neurobiological alterations persist long after drug cessation, reinforcing the need for sustained medical intervention instead of punitive responses.

Recognizing addiction as a medical condition improves treatment accessibility and informs policy development. Countries like Portugal, which adopted healthcare-based approaches, have seen significant reductions in overdose deaths and drug-related infections after decriminalizing substance use and expanding medical treatment programs. A study in Addiction found that following Portugal’s shift to a public health model in 2001, opioid-related deaths dropped by over 50% within a decade while treatment engagement increased. These outcomes highlight the effectiveness of medical intervention over criminalization and the importance of integrating substance dependence treatment into mainstream healthcare systems.

Neurological Pathways and Brain Chemistry

The neurobiological mechanisms of addiction involve complex interactions between brain regions, neurotransmitter systems, and molecular pathways. Central to this process is the mesolimbic dopamine system, often called the brain’s reward circuit, which reinforces drug-seeking behavior. Substances like opioids, stimulants, and alcohol hijack this system by triggering excessive dopamine release in the nucleus accumbens, creating an artificially intense sense of reward that reinforces use. Over time, the brain adapts by reducing dopamine receptor availability, leading to diminished natural reward sensitivity and compulsive substance-seeking behaviors.

Beyond dopamine, other neurotransmitter systems contribute to addiction’s persistence. Chronic substance use disrupts glutamate, the primary excitatory neurotransmitter, particularly in the prefrontal cortex, which governs decision-making and impulse control. Studies in Nature Neuroscience indicate that prolonged drug exposure weakens synaptic plasticity in this region, impairing self-regulation and increasing relapse risk. The gamma-aminobutyric acid (GABA) system, responsible for inhibiting excessive neural activity, also becomes dysregulated, heightening stress responses and withdrawal symptoms. This imbalance drives compulsive drug use as a form of self-medication.

Neuropeptides such as corticotropin-releasing factor (CRF) and dynorphin further illustrate addiction’s complexity. CRF, involved in the stress response, becomes overactive in substance dependence, amplifying anxiety and negative emotional states during withdrawal. This heightened stress reactivity is a major factor in relapse, as individuals seek substances to alleviate distress. Dynorphin counteracts dopamine signaling and contributes to the dysphoria associated with addiction. Research in The Journal of Neuroscience shows that chronic drug use upregulates dynorphin activity, leading to persistent anhedonia, where natural rewards no longer produce pleasure. This shift reinforces drug-seeking behavior by making substance use one of the few remaining sources of relief.

Interdisciplinary Approaches in Healthcare

Effectively addressing addiction requires collaboration across multiple medical disciplines. Given its complexity, treatment benefits from a combination of pharmacological, psychological, and social interventions tailored to the individual. Primary care physicians, psychiatrists, neurologists, and addiction specialists each contribute distinct insights, ensuring comprehensive care beyond symptom management.

Pharmacotherapy plays a foundational role, with medications such as methadone, buprenorphine, and naltrexone proving effective in managing opioid use disorder by reducing cravings or blocking euphoric effects. For alcohol dependence, acamprosate and disulfiram help prevent relapse by modulating neurotransmitter imbalances. However, medication alone is rarely sufficient. Cognitive-behavioral therapy (CBT) and contingency management improve treatment adherence and reduce relapse rates. A JAMA Psychiatry meta-analysis found that combining pharmacotherapy with behavioral interventions significantly increased sustained abstinence compared to either approach alone.

Social determinants of health also influence treatment outcomes, requiring the involvement of social workers and public health professionals. Housing instability, unemployment, and lack of support often perpetuate substance dependence, making it necessary to address these external stressors alongside medical treatment. Programs integrating vocational training and housing assistance have shown success in improving long-term recovery rates. Research in the American Journal of Public Health indicates that individuals receiving stable housing alongside treatment are more likely to remain in recovery than those facing continued socioeconomic instability.

Physical and Psychological Comorbidities

Substance dependence frequently coexists with physical and psychological health issues that complicate diagnosis and treatment. Chronic drug and alcohol use can exacerbate cardiovascular disease, liver dysfunction, respiratory disorders, and gastrointestinal complications. For example, prolonged stimulant use increases the risk of hypertension and arrhythmias, while chronic alcohol consumption contributes to cirrhosis and pancreatitis. These complications not only impact overall health but also require simultaneous management alongside addiction treatment.

Psychiatric disorders are particularly prevalent among individuals with substance dependence, with mood and anxiety disorders being common comorbidities. Depression and post-traumatic stress disorder (PTSD) often co-occur with addiction, creating a cycle where individuals use substances to self-medicate emotional distress, only for substance use to worsen psychiatric symptoms. Studies in The American Journal of Psychiatry indicate that individuals with co-occurring mental health disorders and substance dependence face higher relapse rates and poorer treatment outcomes unless both conditions are addressed concurrently. This underscores the necessity of integrated treatment models incorporating psychiatric care alongside addiction therapy.

Screening and Diagnosis in Healthcare Settings

Early identification of substance dependence in medical settings improves treatment outcomes, yet many cases go undetected due to stigma, lack of standardized protocols, or patient reluctance to disclose substance use. Healthcare providers play a central role in recognizing addiction, particularly in primary care and emergency departments where individuals frequently present with related health complications. Routine screening using validated tools such as the Alcohol Use Disorders Identification Test (AUDIT) or the Drug Abuse Screening Test (DAST) enables clinicians to assess risk levels and identify patients in need of intervention. The U.S. Preventive Services Task Force (USPSTF) recommends screening all adults for unhealthy drug use in primary care settings, reinforcing the importance of early detection in mitigating long-term health consequences.

Beyond self-reported measures, laboratory diagnostics enhance the ability to confirm substance use and assess physiological impact. Toxicology screenings, including urine, blood, and hair analysis, provide objective data on substance exposure and can be useful when patients minimize or deny use. However, these tests have limitations, such as variable detection windows and potential for false positives or negatives, necessitating careful interpretation alongside clinical assessment. Biomarkers related to liver function, such as elevated gamma-glutamyl transferase (GGT) levels in chronic alcohol use, can also indicate substance-related organ damage. Combined with comprehensive patient histories and behavioral assessments, these diagnostic tools help healthcare professionals develop individualized treatment plans tailored to addiction severity and coexisting medical conditions.