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The Message That Addiction Is a Disease Makes Substance Users Less Likely to Seek Help

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For Immediate Release

Jeni Burnette

Research finds that people with substance-use problems who read a message describing addiction as a disease are less likely to report wanting to engage in effective therapies, compared to those who read a message that addiction behaviors are subject to change. The finding could inform future public and interpersonal communication efforts regarding addiction.

“When we began talking about addiction as a disease, the goal was to decrease stigma and encourage treatment,” says Sarah Desmarais, coauthor of a paper on the work and an associate professor of psychology at North Carolina State University. “That worked, to an extent, but an unforeseen byproduct was that some people experiencing addiction felt like they had less agency; people with diseases have no control over them.”

“We wanted to see if an alternative message aimed at changing that mindset could affect how people with substance-use problems viewed themselves with regard to addiction,” says Jeni Burnette, first author of the paper and an associate professor of psychology at NC State. “Specifically, we focused on using a growth mindset message. The growth mindset message stresses that human attributes are malleable, and we know from previous work that it encourages better self-regulatory strategies such as seeking helping from others.”

For this study, the researchers enrolled 214 men and women who screened as positive for substance-use problems. One hundred and twenty-four of the study participants received the growth mindset message, whereas 90 participants received the message that addiction is a disease. The growth mindset article described various factors that can contribute to substance abuse, and stressed that there are multiple ways for people to address their addiction. The disease article described the changes in the brain that take place during addiction.

After reading their respective articles, participants in both groups completed a survey that asked them about how much they felt they could change their substance abuse; how confident they were in their ability to address the problem; how much they blamed themselves for their substance abuse; and the extent to which they planned to seek several types of treatment for addiction.

The researchers found that study participants who received the growth mindset message reported stronger growth mindsets and more confidence in their ability to handle their addiction, relative to the study participants who received the disease message. Importantly, there was no difference between the two groups regarding the extent to which they blamed themselves for their addiction.

“These findings are good news,” Desmarais says. “We want people to feel empowered and confident to change their behavior, but not to feel guilty about it.”

Additionally, participants in the growth mindset message group reported stronger intentions to seek counseling or cognitive-behavioral therapy, compared to the participants who got the disease message. There was no difference between groups when it came to seeking pharmacological treatment for addiction.

“It’s promising to see the growth mindset group express a greater willingness to seek treatment via counseling or cognitive-behavioral therapy,” Desmarais says. “And the lack of difference between groups on medication treatment is also good news, because it reflects the fact that both groups equally appreciate the medical aspects of addiction.

“Overall, our findings support moving away from messaging about addiction solely as a disease,” Desmarais says. “It’s more complicated than that. Instead, the finding suggests that it would be more helpful to talk about the many different reasons people become addicted.”

“The findings also highlight the potential to use growth mindset interventions to help substance users engage in effective treatments,” Burnette notes.

The paper, “Mindsets of Addiction: Implications for Treatment Intentions,” is published in the Journal of Social and Clinical Psychology. The paper was co-authored by Rachel Forsyth of the University of Florida and Crystal Hoyt of the University of Richmond.

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Note to Editors: The study abstract follows.

“Mindsets of Addiction: Implications for Treatment Intentions”

Authors: Jeni L. Burnette, Rachel B. Forsyth and Sarah L. Desmarais, North Carolina State University; and Crystal L. Hoyt, University of Richmond

Published: May 2019, Journal of Social and Clinical Psychology

DOI: 10.1521/jscp.2019.38.5.367

Abstract: Introduction: The goal of the current work is to contribute to the critical dialog regarding consequences of different communications about the nature of addiction by offering a new theoretical approach. Specifically, we merge a mindset perspective, which highlights the importance of beliefs regarding the malleability of human attributes, with the attribution literature to explore how messages stressing the changeable vs. fixed nature of addiction influence beliefs and treatment intentions.

Method: We crafted a message about addiction designed to induce the belief in the potential to change without influencing self-blame (compensatory-growth mindset message) and compared it to a message focused on the fixed underpinnings of addiction (disease-fixed mindset message).

Results: In an online sample of probable substance users (N = 214), we found that the compensatory-growth, relative to the disease-fixed message, led to participants reporting stronger growth mindsets and efficacy without an impact on blame. Additionally, the compensatory-growth, relative to the disease-fixed message, led to stronger intentions to pursue counseling and cognitive behavioral treatment therapies.

Discussion: The current work finds support for an innovative theoretical approach for understanding motivation to seek treatment among individuals with probable substance use problems.

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  1. What is a “probable substance user”? To me, that sounds like someone who might have used cocaine during college, but only on the weekends…Someone struggling with SUD is a definite substance user.

  2. I appreciate the authors work in trying to determine the best messaging strategy to increase agency and improve outcomes. I have not read the full paper but wonder if the two comparison groups are applicably to people with SUD. SUD is a chronic disease of the brain with genetic, social, and behavior factors which each contribute to the development and manifestation of disease. SUD is not Hunnington’s disease or other diseases with 100% penetrance. It is more like diabetes, HTN, CAD, or other chronic disease for which medications and behavior changes can change the course of the disease. To add complexity, there are different phenotypes of the disease for which the various factors have different attributions toward disease development/manifestation. We (i.e. clinicians/counselors/all people who work with PWUD/people with SUD) should always approach patients with the understanding that there are very real genetic, social, and behavioral contributions toward SUD and that specific actions like counseling, mutual help, and medications can have significant improvement on a person’s life.

    1. Yes. This. The participants had “problems”, not SUD. I’d be interested in reading the two messages myself to see how much the word disease was steered toward fear/death. Yes we use terminology like chronic and incurable, because if you have the disease of addiction those things are true. That doesn’t mean it’s terminal. It does mean that I get to choose whether I am going to die with it, or from it. Substance dependence temporarily quiets the noise/numbs the pain of a malady of the heart that lives in the brain and alters the perception of myself and the world around me.

  3. This makes sense. If you tell someone that they can’t be fixed, why would they want to try? However, drug and alcohol prevention and intervention courses, like the ones at provide people http://www.3rdmil.com with substance abuse disorders with things they can change. By tackling the mental and behavioral aspects of addiction, they have a better chance.

  4. Many diseases can actually be cured. Perhaps the real issue is the historical
    view that classic alcohol and drug addictions were viewed as treatable but not “curable.” Maybe the shift needs to emphasize the potential
    for cure, meaning no detectable evidence of the “disease” for, let’s say, five years. Worth considering?

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