A pragmatic approach to understanding the disease status of addiction

Debate about whether or not addiction is a disease has been central to practice and policy responses. In this paper, we aim to move that debate forward by understanding why the disease status of addiction is so unclear and contested, and draw on pragmatic considerations to suggest a partial resolution. To do this, we apply the vague cluster view of ‘disease’. This view is pragmatic since it allows appeal to the practical implications of considering a condition to be a disease in justifying the classification, for particular purposes. After explaining the view, we apply it to addiction to show that whether or not addiction has the typical features of a disease is unclear due to the vagueness and ambiguity of these features. We then examine pragmatic considerations often deemed relevant to deciding addiction’s disease status to see if these can suggest precisification. Pragmatic disease accounts are potentially problematic in that pathologising addiction simultaneously has both positive and negative effects, and it can be difficult to maintain different precisifications across contexts. Nonetheless we argue that the vague cluster approach circumscribes some ways of conceptualising addiction as disease, namely those that conceptualise disease as solely physiological dysfunction. It thus prompts a pragmatic shift to a broader understanding of addiction that partially resolves the negative consequences of disease designation. The discussion suggests that disagreements over whether addiction is a disease are primarily normative and semantic, rather than being disagreements over facts.