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Introduction
For a medical professional, philosophical approaches, especially to various health conditions, should be based on evidence. The latter can come from peer-reviewed research, as well as the recommendations of relevant organizations, including the American Psychiatric Association [APA] (2013) and the National Institute on Drug Abuse [NIDA] (2018b). However, philosophical statements tend to incorporate moral judgments as well. Here, a philosophical stance will be presented that is directed by evidence and the principles of beneficence, nonmaleficence, and justice, as described by Polit and Beck (2017), with respect to addiction.
Essence
It appears that the most appropriate attitude toward addiction is to treat it as a disease. Depending on the substance or another agent of addiction (for instance, gambling or the Internet), addiction can be a very common condition (APA, 2013; National Institute on Drug Abuse, 2018a). It develops for a number of reasons, which include negative emotional states, genetic predisposition, and compromised executive function (APA, 2013; Koob & Volkow, 2016; NIDA, 2018b).
The mechanism of addiction is associated with the addictive agents directly activating the reward system of the brain (APA, 2013). Consequently, addictive agents cause an uncontrollable desire to keep using them (NIDA, 2018; Piazza & Deroche-Gamonet, 2013). Moreover, as a result of addiction, people exhibit dramatic dysregulation of motivational circuits, as well as social and health problems (Koob & Volkow, 2016, p. 760). Thus, the causes and consequences of addiction are related to health. The principles of justice and beneficence imply that people with addictions have the right to the assistance of healthcare professionals.
It is also noteworthy that addiction and mental health are linked through comorbidity. While addiction has been considered a mental health issue, it is also highly comorbid with other mental health illnesses (APA, 2013). Common predictors of substance use and abuse are negative emotional states and compromised cognitive functions (Koob & Volkow, 2016), which are the diagnostic criteria for multiple mental health issues (APA, 2013).
As a result, people with diverse mental health conditions are more vulnerable to developing addictions. Furthermore, APA (2013) points out the issue of substance-induced disorders, including, for example, depressive or psychotic disorders. Thus, substance use and abuse would have been a concern for mental health professionals (from the perspective of the principles of justice and beneficence) even if the condition had not been a mental health problem.
Based on the recommendations of NIDA (2018b), the treatment for addiction should involve all three levels of prevention. Making relevant references, NIDA (2018b) suggests that for tertiary prevention, a combination of pharmacotherapy and behavioral therapy may be particularly effective, even though tailoring individual solutions is required.
This statement is supported by a number of recent articles, including those by Moura, Pinto, Ferros, Jongenelen, and Negreiros (2017), who studied Portuguese drug and alcohol abuse outpatients, and Kuss and Lopez-Fernandez (2016), who conducted a systematic review on Internet addiction. As a result, it is important to avoid viewing addiction in strictly medical terms; it is a complex disease that is best described with the bio-psychosocial model of health, which has implications for its treatment.
Conclusion
The principle of non-maleficence should also be mentioned in connection to treating addiction. Given that it is commonly associated with other mental health concerns (APA, 2013), the addictive properties of substances, including medication, require consideration while treating other disorders, as well as people who already have comorbid addictive disorders. Other than that, the moral requirement to treat addiction without prejudice is guided by the principles of justice and beneficence. They imply that patients with addiction deserve to be treated equally and receive the necessary help for the health condition that affects their brain.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorder (5th ed). Washington, DC: American Psychiatric Publishing.
Koob, G., & Volkow, N. (2016). Neurobiology of addiction: A neurocircuitry analysis. The Lancet Psychiatry, 3(8), 760-773. Web.
Kuss, D., & Lopez-Fernandez, O. (2016). Internet addiction and problematic Internet use: A systematic review of clinical research. World Journal of Psychiatry, 6(1), 143-176. Web.
Moura, A. D., Pinto, R., Ferros, L., Jongenelen, I., & Negreiros, J. (2017). Efficacy indicators of four methods in outpatient addiction treatment. Archives of Clinical Psychiatry (São Paulo), 44(5), 117-121. Web.
National Institute on Drug Abuse. (2018a). Commonly abused drugs. Web.
National Institute on Drug Abuse. (2018b). Drugs, brains, and behavior: The science of addiction. Web.
Piazza, P., & Deroche-Gamonet, V. (2013). A multistep general theory of transition to addiction. Psychopharmacology, 229(3), 387-413. Web.
Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
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