Addiction and the Scope of Ableism

John T. Maier explores the idea of addiction as a disability and proposes a moral and metaphysical argument for its reclassification in UK law.

Even when we aim to be inclusive, it can be difficult to arrive at a clear picture of what disability can be, in all its diversity. Our conception of disability is structured by anecdotes, images and metaphors that invariably focus on one part of the spectrum of disability, at the expense of many others.

Blurred photo of a person smoking.
Does stigmatizing addiction constitute a form of ableism?

One such bias, now widely recognized, is the thought that a disability must be immediately apparent to an outsider. Many of the disabilities that we knowingly witness in everyday life are like this: the use of a wheelchair or of a white cane is a readily recognizable symbol of a disability. This can lead to the belief, or at least to the presupposition, that all disabilities must be legible in something like this way.

As a counterpoint to this tendency, a number of writers have noted the pervasiveness of hidden or ‘invisible’ disabilities (Kattari, Olzman and Hanna 2018). Among the disabilities that might be properly understood as hidden are chronic physical disabilities such as arthritis and diabetes, and psychiatric conditions such as ADHD and major depression. These disabilities do not make themselves known in the same way as some other disabilities, but they nonetheless constitute disabilities and objects of disadvantage and discrimination.

There is another kind of hidden disability that belongs on that list. I have argued that addiction is a disability, and that the priority of addiction treatment should be accommodation for persons with addiction (Maier 2021). This view is already law in the United States, where addiction is recognized as a disability in the Americans with Disabilities Act of 1994. It is specifically excluded, however, as a disability under the UK’s Equality Act of 2010, an exclusion I will return to below. Setting aside these legal questions for now, there are moral and metaphysical reasons for regarding addiction as a disability: roughly, addiction involves an atypical psychology that is subject to pervasive discrimination, and is in this sense as much a disability as are conditions such as ADHD and major depression.

Addiction, we might say, is even harder to recognize than are typical examples of hidden disabilities. It is not merely a hidden or misread disability; addiction does have visible signs – from substances themselves to the physical damage caused by their sustained use – but these are not recognized as signs of disability. They are taken to be signs of something else instead: of a moral failing in certain circles, or of a medical problem in others.

Once we recognize addiction as a disability, we understand the essentially ableist aspect of these perspectives. The visible signs of addiction are properly understood as signs associated with a disability. From this perspective, the clean syringes that are made available at safe injection sites are as welcome a sight as are accessibility ramps on buildings. It is common to hear complaints about both of these as somehow objectionable, but once addiction is recognized as a disability we can recognize the ableist orientation of such complaints.

Still more generally, I want to suggest, the well-known stigma that confronts people with addiction is best understood as a form of ableism. From one point of view, this is discouraging: ableism generally is deeply entrenched and not easily overcome. From another, it suggests a way forward: the stigma to which addicted people are subject is not a unique problem, but an instance of a more general form of discrimination, which can be addressed on its own terms.

Understanding the stigma associated with addiction as ableist is helpful, because some kind of way forward is needed. There have been great advances in moving addiction from being primarily a legal and penal issue to primarily a medical one. In turn, there have been great advances in the medical treatment of addiction, from better treatment for acute withdrawal to the long-term benefits of medication-assisted treatment for opioid use disorders. Yet these advances have been made within a framework where addiction is seen as a medical problem in need of treatment, typically as some kind of brain disease (Leshner 1997).

An approach to addiction that genuinely rejects ableist presuppositions will be one that endorses an alternative to this medical model of addiction. The disability model is just such an alternative. Recognizing addiction as a disability allows us to make room for medicine in the management of addiction – just as it has a role in the management of physical and mental disabilities – without thereby regarding it as a medical problem in need of a cure.

This is a task for the medical humanities just as much as it is a task for medicine. The effects of language on the perception and treatment of people with addictions are well-known (Kelly, Saitz and Wakeman 2016) and there has happily been a move towards person-centered language in our discussions of addiction, paralleling a similar movement in discussions of other disabilities. But these issues are just the beginning. Our understanding of addiction is shaped by tropes and narratives that have the effect, as noted above, of disguising rather than underscoring the disability of addiction. A genuinely humanistic approach to the question of addiction might be expected to do better.

As an example of what this might look like, consider the exclusion of addiction from the class of recognized disabilities in the UK’s Equality Act of 2010. In an insightful survey of the legal and philosophical questions surrounding this exclusion, Simon Flacks cites work in political science (Schneider and Ingram 1993) in which disability is seen as a kind of ‘dependence’ whereas addiction is seen as a kind of ‘deviance’. It is precisely this kind of false dichotomy that seems to have been baked into law in the United Kingdom, with predictably damaging results. As Flacks writes, ‘the continued, express exclusion of drug and alcohol addicts from UK disability discrimination legislation reinforces their marginalized status, and reproduces their inhumanity in the same way that others excluded from human rights legislation, such as refugees or those seeking asylum, are similarly dehumanized.’ (Flacks, 2012, p. 407).

Recognizing addiction as a disability requires advocates, philosophers and legal scholars to broaden their focus. The idea that addiction is a disability challenges basic ideas about what addiction is, and what disability is, and the false but seductive idea that people with addictions are somehow objectionable in a way that people with abilities are not. Addiction is a disability, but we need new narratives around addiction, and around disability, in order to make that understood.

About the author

John T. Maier (PhD, MSW) is an Outpatient Clinician at the Freedom Trail Clinic in Boston, as well as Adjunct Faculty in the Department of Philosophy at Bentley University. He is the author of multiple peer-reviewed articles on agency, language and addiction.

Twitter: @John_T_Maier

References

Flacks, Simon. 2012. “Deviant Disabilities: The Exclusion of Drug and Alcohol Addiction from the Equality Act 2010.” Social & Legal Studies 21 (3): 395–412.

Kattari, Shanna K., Miranda Olzman, and Michele D. Hanna. 2018. “‘You Look Fine!’ Ableist Experiences by People with Invisible Disabilities.” Affilia 33 (4): 477–492.

Kelly, John F., Richard Saitz, and Sarah Wakeman. 2016. “Language, Substance Use Disorders, and Policy: The Need to Reach Consensus on an ‘Addiction-ary.’” Alcoholism Treatment Quarterly 34 (1): 116–23.

Leshner, Alan I. 1997. “Addiction Is a Brain Disease, and It Matters.” Science 278 (5335): 45–47.

Maier, John T. 2021. “Addiction Is a Disability, and It Matters.” Neuroethics, forthcoming.

Schneider, Anne, and Helen Ingram. 1993. “Social Construction of Target Populations: Implications for Politics and Policy.” American Political Science Review 87 (2): 334–47.

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