Why Do We Disagree About The Disease Status of Addiction?

Mary Jean Walker (La Trobe University), Wendy A. Rogers (Macquarie University)

Abstract

This paper aims to shed light on the much-discussed question of whether addiction is a disease by drawing on philosophical work about the meaning of the concept 'disease'. It first analyses this literature to show that states that count as diseases typically involve (at least) four main features: dysfunction, being harmful or painful, being beyond a patient's direct conscious control, and being in principle explainable by the medical sciences. The paper then aims to show why it can be contested whether addiction involves these features by drawing on philosophical analyses of semantic indeterminacy. It argues that the four features of the concept 'disease' involve conceptual vagueness or ambiguity. Vague concepts are defined as concepts that have fuzzy boundaries, so that there are borderline cases that do not clearly meet, but do not clearly fail to meet, criteria for inclusion in the concept. Ambiguous concepts are those that have multiple meanings. Since (as we argue) the four features of disease are vague and ambiguous, it can be contested whether addiction has these features to the required degree or in the appropriate sense for classification as a disease. The analysis suggests that disagreement over whether addiction is a disease or not does not significantly depend on disagreement over facts, but rather on semantic, normative, and pragmatic disagreements.