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05-26 Is substance abuse a mental illness?

Is substance abuse a mental illness?

The National Alliance on Mental Illness (NAMI) defines a mental disorder as a “condition that impacts a person’s thinking, feeling or mood and may affect his or her ability to relate to others and function on a daily basis.” By parsing this definition, a case can be made that substance abuse falls well within the definition. As this article will show, addiction qualifies as mental illness without having to resort to semantics.

The argument against

People ingest substances to alter how they feel. There would be no substance abuse if substances failed to produce the brief euphoria people crave. Because people willingly ingest substances to achieve this euphoria, those who argue against the illness or disease concept point out these individuals do what they do of their own volition. Unlike a person with schizophrenia, whose illness results from an organic abnormality, addicts terminate their mental illness when they stop taking substances. Schizophrenia, depression and other mental illness do not go away.

A second line of attack against the illness/disease concept focuses on the addict’s brain. The Clean Slate points out the “myth” that brain scans of addicts’ brains reveal abnormalities. The site argues that these scans do not show abnormalities and also states that whenever a brain scan shows something unusual in an addict’s brain, such abnormalities typically resolve once the person stops ingesting substances. Again, Clean Slate notes the brain of someone with schizophrenia will continue to display organic abnormalities; this person has no choice in the matter. The site argues addiction is a choice.

The argument for

“The Big Book” of Alcoholics Anonymous describes sobriety as recovering from a hopeless condition of mind and body. The Diagnostic and Statistical Manual of Mental Disorders (DSM) includes a chapter on substance-related and addictive disorders. The chapter begins: “The essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.”

Self-preservation is a human instinct, perhaps the strongest instinct. The DSM defines substance abuse as continuously engaging in behaviors that cause problems; that is, counter to self-preservation. Individuals who participate in dangerous or extreme activities do so for external rewards (fame, money) and for internal rewards (sense of fulfillment or accomplishment). These individuals do these activities willingly. They go against self-preservation willingly; they also take safety precautions to mitigate the dangers associated with these activities.

Addicts’ sole reward is a euphoria brought about by an altered brain. Given a choice between a dirty needle or going without a fix; between drinking or driver sober; and between smoking meth or sleeping, addicts more often than not make the wrong choice. This is not because they want to; they have lost the will to make a prudent decision. They make it because addiction drives their decision-making processes.

The DSM includes substance-related and addictive disorders. Some argue this is sufficient to qualify as mental illness. Opposing camps argue addicts choose to be addicted. Nothing in their brains points to organic causes for their addiction. In the end, what matters is the individual in need.

If you or your teen is addicted to a substance, we can help. Sovereign Health Group’s Adolescent Program provides a way out of the darkness. Contact us via our 24/7 helpline to learn more about our treatment programs for substance abuse, mental health and co-occurring conditions.

About the author:

Darren Fraser is a content writer for Sovereign Health Group. He worked two and half years as reporter and researcher for The Yomiuri Shimbun until they realized he did not read, speak or write Japanese and fired him. Undeterred, he channels his love of research into unearthing stories that provide hope to those dealing with addiction and mental illness. Darren loves the Montreal Canadiens hockey club and horror films and would prefer to enjoy these from the comforts of his family’s farm in Quebec. For more information about this media, contact the author at

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