We somehow want to sympathize or diminish the fact that addicts in fact DID "choose" to take that first drink, smoke that cigarette, snort that first line, etc. despite the well known
risks.
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One of the risks is addiction, and addiction has started to become defined in terms of a disease model. So, while yes, they are often aware of the consequences, the consequence is a disease.
Sex can be the same way. Traveling to Africa is also a risk for contracting a disease. So while it's fairly common knowledge that using a drug can cause desire to use more of a drug which can lead to addiction, I think you can look at other risky behaviors that people weigh the pros and cons of. Some people drive fast, some use guns. Some think that using coke one time won't hurt. Some people think riding a horse won't hurt and can have paralysis, which is treated as a disease. My point is that in all of these cases there is a risk people accept, but I think that the differentiator is that with many drugs there is no possible long-term pay off and the behavior is riskier, so I can understand the stigma.
From my lay perspective, I have heard of two reasons for drugs causing a diseased state of addiction: 1) a suggestion of genetic susceptibility 2) the drugs themselves activate reward centers which then need constant stimulation, which is then inherently described a diseased state.
The other thing about addiction is that it is a disorder that is psychiatric in nature, due to the obsessive need to continue taking drugs in spite of harming the body, just like cutting oneself in spite of the harm. But in the case of someone cutting themselves, which is defined as a disease, there is no known cause. Drug addiction actually has clearer known causes, which I think would make it in some ways more eligible to be elevated to disease status. And while I'm not familiar with anyone saying it, I'm sure some psychiatrists would say drug addiction helps them understand other psychiatric diseases like cutting, in terms of activating that pleasure center.
I've also wondered whether you could argue it's environmental (besides having addicts as parents). For example, dentists have higher rates of drug abuse than other professions, and many suggest it's due to easy access. I doubt many people go into dentistry for drugs, but once it's easily available, it seems to make a difference.
I also don't think you can say that people always know their actions will lead to addictions. Neonates can be born addicted to a variety of drugs, and while I don't want to start an argument, I know that there are patients who are prescribed benzodiazepines without being told about the potential for addiction/tolerance. And then you have to consider that whenever new drugs come out, they are often at first thought not to be addictive (such as benzodiazepines were when first brought to the market, and as were z-drugs, which some doctors are first thought were non-addictive replacements for benzos and even used in the daytime, and later found could be just as difficult to quit). These thoughts are sometimes later disproven.
Also, if it being thought of a disease meant that research were being done into ways to help people withdraw, I think that would be beneficial. My own research has turned up agents like XBD-173, neurontin, l-theanine, suriclone, and others as helping during benzodiazepine withdrawal. None of them is marketed or even researched as potential agents to help with withdrawal, but I identified each as having potentially helpful properties. Unfortunately, it seems like very little if no research is done into that field. If treating it as a disease helped research along, that would be great.
In addition to treating addiction as a disease to help with prevention and treatment, I think it could be helpful in terms of fostering curiosity over the state of the brain even after the addiction has stopped. Going back to benzos since it's what I'm familiar with, brain scans dating back to 1982 showed brain damage in people who took benzodiazepines chronically; however, there hasn't been funding to do MRI studies of benzodiazepine patients, so the topic of brain damage is still unsettled. Some like Professor Heather Ashton think it's a lingering chemical state that causes protracted symptoms, but some scans have found brain shrinkage and other brain damage similar to what alcoholics suffer with.
I think if these are labeled as disease states, they would possibly just from a practical point of view get more attention. I think anything that becomes codified gets more attention and is taking more seriously. My concern with your point is that if you just think of addicts as people who chose a bad way of life and think of the effects of those drugs in a conventional way, you close off the possibility for further interest in developing non-addictive drugs, developing addiction treatment, and understanding long-term physiological changes, which are certainly a disease state, and how those changes should be dealt with.
I think with addiction the most obvious thing to say is how little is known about it and that we should stay open to understanding it. And to me, it seems at least, things don't tend to get cared for or studied unless they are diagnosed and named.
Finally, I don't think the change is to be politically correct. Having a disease doesn't really elevate you to a better place. If you're on a transplant list, having been diagnosed with an addiction is probably a worse disease to have than many others because of the belief that you can't control the disease/addiction.
For me, whether it's a disease or not would only benefit me in terms of potential treatment options as I mentioned. Because I know that in spite of an iatrogenic tolerance to benzodiazepines, the responsibility for withdrawing is completely in my hands. I wouldn't have said that 10 years ago. But now I realize it is reality. There is no one else. If there were a type of proven adjunctive aid, I would use it. And maybe classifying it as a disease state could help with that. But it doesn't change that it is my life and in spite of decisions other people have made, I am the one who will benefit or not depending on far I can get with my withdrawal.
