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Comment by caymanjim | Hacker News Reader

Really getting sick of voluntary behavior being labeled as a "disease" or "disorder". That's the mainstream, PC way of presenting it, and while a number of doctors do support that labeling, it's by no means a universal consensus. Plenty of doctors push back against this, but most of them just avoid picking a fight you can't win against the rabid faction that wants to remove any vestige of personal responsibility. And I say this as someone who's (ab)used his fair share of substances.

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Psychiatrist (and addiction psychiatrist in training) here. I agree that calling substance use disorders a disease is highly problematic. However, I think that while the majority of people who use substances don't have a problem, there are many people who use substances in a maladaptive (or disordered) way that dramatically impacts their ability to function, and we need a name to describe that. Substance use disorder is a pretty neutral term, and much better than the older "abuse" and "dependence" terminology for a number of reasons. The wording isn't intended to suggest that personal responsibility isn't required--and any treating clinician would quash that idea right away. It's a way to describe patterns and determine what might be helpful for an individual. It's certainly imperfect, but a much better description than past nomenclature.

Thanks for replying. I agree with what you've said, and agree that it's helpful to have a term for use that dramatically impacts a person's ability to function. "Use disorder" here does seem to be a reasonable, neutral term for differentiating between normal (or even heavy) use that doesn't cause significant problems and use (at any level) that does cause significant problems (physical, mental, financial, or social).

I have a knee-jerk reaction to calling problematic drug use a "disease". "Disorder", as you've described it, does seem like a reasonable term.

Agreed. This paper https://www.nejm.org/doi/10.1056/NEJMra1602872 (which isn't available open access, unfortunately) argues that the brain changes in substance use are more likely normal learning associated with very strong stimuli than actual disease processes. I find this to be a more helpful, optimistic, and accurate interpretation of the data than the disease model. (And it really complements the other evidence-based interventions for substance use disorders we have!)

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