Why Isn't Drug Addiction Considered A Mental Illness?

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Way back a long time ago – probably when I was in high school, I learned about how wine was made. Wine is made by letting yeast go hog-wild in suger-rich grape juice. Yeast are little microscopic creatures that like to eat sugar and poop out alcohol. The little yeasts eat and multiply like crazy, turning the sugar into alcohol. Ultimately they poop out so much alcohol that they drown in their own poop. If you graph the number of yeast over time throughout this process (called ‘fermentation’) you see a dramatic rise in the number of yeast until they reach the point where they drown in their own poop, at which point the number of yeast crashes to almost zero. This graph is called the ‘yeast curve’.

The yeast curve image comes to my mind when I am asked to think about why people do stupid things that ultimately harm themselves over the long run. The reason we do this sort of thing is probably because human beings are as much driven by short term hungers and are as blind to longer term consequences of behavior as yeast. We like to think we are smarter than bacteria or mold (or whatever sorts of creatures yeast really are) – but in many ways we are not. Drug addicts get hooked on their drugs because they chase the short term ‘high’ that they get from taking those drugs. They don’t think about the longer term health consequences of being an addict until it is too late. This doesn’t make them mentally ill – it just makes them human. The same sort of process (of chasing short term goals at the expense of longer term ones) is at work when someone takes up smoking, or eats unhealthy food at a fast food restaurant, or has unprotected sex or makes any number of questionable lifestyle choices. We may call these behaviors short sighted, but we generally fall short of calling them symptoms of mental illness.

This being said, diagnoses for substance abuse and substance dependance are included in the Diagnostic and Statistical Manual of Mental Disorders, which in technical way makes them a sort of mental illness diagnosis. However, agencies that deal with substance abusers and agencies that deal with mental illness are distinct and separately funded so there is a political will to think of these things as different things. This plays some havok when patients present with dual diagnoses (two distinct simaltaneously occuring diagnoses; one substance abuse (like alcoholism) and one mental illness (like depression).