Addiction as a chronic illness. Treatment, stabilisation and the limits of punitive approaches in substance use disorders within international human rights frameworks (2026)

Background: Substance use disorders continue to occupy an ambiguous position between healthcare and criminal justice systems. Despite increasing recognition of addiction as a chronic condition, responses frequently oscillate between treatment and punishment, generating inconsistencies in clinical practice and potential conflicts with international human rights principles.
Methods: This perspective analyses addiction through a clinical and conceptual framework integrating contemporary knowledge on the developmental and chronic nature of substance use disorders with legal and ethical considerations derived from international human rights instruments. Particular attention is given to the distinction between physiological dependence and addiction, the progressive impairment of behavioural control, and the implications for treatment, responsibility and clinical decision-making.
Results: Addiction emerges as a chronic behavioural illness characterised by a transition from voluntary substance use to impaired control, requiring long-term treatment and stabilisation rather than punitive responses. The persistence of hybrid models in which therapeutic pathways remain intertwined with penal mechanisms risks reinforcing stigma, therapeutic omission and structural discrimination, while alignment between medical practice and human rights frameworks supports treatment-oriented approaches based on continuity of care, proportionality of intervention and protection of individual dignity.
Conclusions: Recognising addiction as a chronic behavioural disorder is essential to reconcile clinical practice with human rights principles. Effective responses require prioritising care over sanction and reaffirming the responsibility of healthcare systems to provide evidence-based treatment consistent with the rights and protections afforded to other chronic medical conditions. [Author's abstract]