Not a Disease

A bracing—and compassionate—challenge to the idea of addiction as a disease.

From a leading psychiatrist at the Yale School of Medicine and the medical director of a methadone clinic in Washington, DC.

Ask someone why they got a brain tumor. They won’t know. But ask someone why they developed an addiction and they’ll have a personal, meaningful explanation. Why? Because unlike a brain tumor, addiction, Sally Satel argues, is not a disease, and in particular, not a brain disease. Dismantling the conventional framing, Not a Disease, makes a compelling case for more refined—and useful—conceptual and clinical perspectives. Addiction, Satel suggests, is better understood as a symptom, not a disease—a symptom of psychic pain that needs to be anesthetized. Only by recognizing this will we find a more effective approach to recovery.

A practicing physician who has worked with addicts for many years, Satel explores why people consume substances to excess, and why conflicting ideas—held by physicians, scientists, policymakers, and the public—complicate treatment and policy. Without dismissing biological factors, she looks at the drug epidemic in Ironton, Ohio, a small American town in decline, breaking down the accepted wisdom that ascribes too much power to the capacity of drugs to enslave users’ brains, and too little to the vulnerabilities of people and places that draw them to drugs in the first place. Her analysis of the misguided responses to the crisis of addiction to prescription opioids illuminates the plight of millions of patients plunged into needless and solitary agony.

Boldly recasting the nature of addiction, from painkillers to fentanyl, Not a Disease holds out hope for a more humane way to meet this deep and widespread societal challenge.