The hope among public-health officials has been that such messaging decreases the moral stigma that traditionally surrounds addiction, and instead will inspire suffering people to stop blaming themselves and get professional help. But newly published research suggests this framework "may have unintended negative consequences."
The results of a new study suggest that, for many people who need help, "I have a disease" translates to "There's nothing I can do about it," or "It's out of my hands."
An alternative message designed to make people with addictions "feel empowered and confident to change their behavior" is a far more effective way to get them serious about seeking treatment, reports co-author Sarah Desmarais, a North Carolina State University psychologist.
"The term 'disease' implies that one's physiology and genes are malfunctioning, and encourages the belief that addition is a fixed, unalterable aspect of the self," Desmarais and her colleagues, led by Jeni Burnette, write in the Journal of Social and Clinical Psychology. "Believing that addiction can, in fact, be managed is a critical first step in an individual's interest in pursuing substance-abuse treatment."
The team's study featured 214 Americans with likely substance-abuse issues, who were recruited online via Amazon's Mechanical Turk website. They were identified by their answers to a list of questions, including, "In the last three months, have you felt guilty or bad about how much you drink or use drugs?"
Ninety of those participants then read "a Psychology Today-type article about the fixed nature of addition, with a focus on the underlying mechanisms in the brain that lead to the disease." The article quotes a Stanford University researcher as saying that addiction "seems to be a fixed quality, remaining fairly stable over a person's lifetime."
The other 124 read a similar article that "also stressed the potential to change." It quotes experts as saying drug and alcohol addictions can be managed with "time and effort."
After reading one of the pieces, participants answered a series of questions about addition, and indicated on a one-to-five scale the likelihood that they would pursue three different substance-abuse treatment options: counseling, cognitive-behavioral therapy, and pharmacotherapy.
The researchers report that subjects who'd read the second article were more willing to try counseling and/or cognitive-behavioral therapy than those who'd read the first one. Both groups were equally open to drug-based therapies (which makes sense, if you conceive of your problem as a disease), but counseling of some sort is generally considered a critical part of successful addiction treatment.
Importantly, the researchers also found that members of the two groups expressed "similar levels of self-blame." That's important, because advocates of the disease-focused approach argue it decreases such potentially self-destructive feelings. The more empowering message apparently does so as well, while avoiding triggering the pessimism that a medical diagnosis can inspire.
"Overall, our findings support moving away from messaging about addiction solely as a disease," Desmarais said in announcing the findings. "It would be more helpful to talk about the many different reasons people become addicted."
For an alcoholic or someone addicted to drugs, "I'm to blame" is a disempowering message, but "I'm diseased" can be as well. Given the horrible cost of the current opioid epidemic, designing messages that actually encourage people to seek treatment is an urgent task. This new research provides a good template for what those messages could look like.