Overview:
The term 'preaddiction' may be doing more harm than good for individuals trying to beat addiction and find recovery.
In an editorial on July 6th for the Journal of the American Medical Association’s JAMA Psychiatry, authors McLellan, Koob and Volkow argue in favor of adopting the term ‘preaddiction’ in order to assist addiction professionals in identifying people who are likely to be in the very early stages of failing to successfully manage their maladaptive habits. They liken addiction to diabetes, where the adoption of the term ‘prediabetes’ has proven helpful to many.
The CDC describes prediabetes as “a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Approximately 96 million American adults—more than 1 in 3—have prediabetes. Of those with prediabetes, more than 80% don’t know they have it.” The CDC adds a layer of diagnosis in order to assist the 76,800,000 Americans they claim don’t know are at risk for diabetes.
However, addiction is very different. As Tim Holden notes in this NIH reply, “Addiction does not meet the criteria specified for a core disease entity, namely the presence of a primary measurable deviation from physiologic or anatomical norm.” Stated simply, there are no markers in medicine for alcohol use disorder.
Further, the work from the Recovery Research Institute, under the tutelage of Dr. John Kelly, stated this rather starkly back in 2010: “Changing our language by dropping the term “abuser” and adopting terminology more consistent with a medical and public health approach may be one way to do this.”
The RRI further notes that “Recently, the International Society of Addiction Journal Editors, based in large part on these studies, provided guidance strongly cautioning against use of the term “abuse”, and advocated instead for either substance use disorder (if substance use meets diagnostic thresholds) or several variations on substance use that may cause harm, such as hazardous substance use or harmful substance use.
Adding an indefinable term such as ‘preaddiction’ to an already heavily-stigmatized area of medicine is maladaptive at best, and likely harmful.