Afternoon Inquisition

AI: Is Addiction a Disease?

I tend to quickly grow weary of viral topics on the Internet and subjects the media have no qualms about driving into the dirt over and over again, and as a result, I am loath  to mention Charlie Sheen in any manner in any personal discourse for the rest of my life.

But his brand of crazy has sparked a lot of chatter recently about addiction, and I thought perhaps it would make for a decent discussion.

There are those who view addiction as a disease, and there are those who say it is not. The various treatment programs for addiction can run the gamut from something resembling an actual medical process to something resembling a cult.

But what do you think? 

Is addiction a disease? Do you, or someone you know, suffer from addiction? What of the treatment programs? Do they work? Do they only work for some? If you have Adonis DNA or tiger blood and fists of fire, do you need a treatment program at all?

The Afternoon Inquisition (or AI) is a question posed to you, the Skepchick community. Look for it to appear Tuesdays, Thursdays, Saturdays, and Sundays at 3pm ET.

Sam Ogden

Sam Ogden is a writer, beach bum, and songwriter living in Houston, Texas, but he may be found scratching himself at many points across the globe. Follow him on Twitter @SamOgden

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42 Comments

  1. My brother and father are both addicts in their own right, both have suffered enormous consequences in their life and continue to choose their drugs of choice over sanity and family. It’s hard for me to believe addiction is just a disease. I know this is purely emotional but if we blame the disease, it removes all culpability for the addict. They leave trails of devastation and destruction in the lives of everyone around them and they repeatedly just blame their disease. I also work in a hospital and deal closely with addicts on a daily basis. I have empathy to some degree, that they feel out of control but at what point are they responsible for their terrible and destructive choices? Sorry if this is terribly unsympathetic and pious but it’s hard to watch addicts muddle through life in both my personal and professional life…

  2. Most of the reputable medically based treatment programs approach addiction as a disease. They often cite the definition of disease and then ask the addicts to see if they can think of ways that addiction does not meet the definition.

    AA and NA also refer to it as a disease in some of their discussions.

    “a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.”
    http://www.merriam-webster.com/dictionary/disease

  3. I think you can bend the definitions of the word whichever way you want. The reason people want to label an addiction a disease is to remove blame. To me blame is irrelevant. If you have an infection you take antibiotics. If you have an addiction you take therapy or maybe even a drug that helps break addictive behavior. To me finding and implementing the most effective ways to treat things that make people less happy and healthy is more important than rigidly defining these things.

  4. I would say “yes”, but with a caveat: addiction is not only a disease; there is a certain element of choice involved. We know that the brains of addicts respond differently to alcohol/drug stimulus than do the brains of non-addicts, so there is definitely a biological component to addiction. But we also know that addiction can be overcome through behavior modification, so there are clearly psychological/choice components as well.

  5. @ephymeris: It’s possible for something to be a disease while still be under the control of the afflicted individual to a degree. Diabetes is definitely a disease, but Type 2 is controllable in large part via diet and exercise (with the help of medication in most cases). The same is true of addiction. Calling it a disease, which it is because by the time addiction settles in, the brain no longer functions in an optimal way, in no way reduces the sufferer’s responsibility for the course of the disease.

    This is one of the major issues I have with AA, for example, in that they completely disempower the addict by convincing them that their disease is incurable and that only their “higher power” can do anything to truly help. It also doesn’t help that AA is quite ineffective and has some of the highest recidivism rates of all the treatment options short of “cold-turkey”.

  6. It isn’t a disease by any reasonable definitions and by classifying it as such, we shift our focus away from many of the known treatments and start looking for “cures”. One way I use to classify them is to take a person with an addiction (to alcohol, let’s say) and one with a disease like cancer, place them both in a room with armed guards and tell them that if they don’t stop drinking and don’t stop having tumours then they will be shot.

    Clearly in the case of alcohol, people can voluntarily refrain from drinking but no one can refrain from having cancer. This means that the causes, treatments and impacts of the two are very different.

    I find the whole attempt to label addiction as a ‘disease’ to be doubly strange given the popularity of the positive thinking movement which says that we can cure genuine disease by adjusting our thoughts when this is certainly false. However adjusting our thinking can genuinely affect the outcomes in addiction but instead people want to classify it as a disease which, as we know. means it is not anyone’s fault and can’t be affected through changes in thinking! It’s like people are in a rush to blame genuine victims while exculpating those who can actually cure themselves.

  7. @davew: I think Dave has it spot on.

    It depends on how you define disease. I think it’s difficult to really diagnose “addiction” therefore, it’s even harder to determine whether or not it’s a disease.

    I do not think it is a disease, but that is based on my personal loose idea of what I think a disease is. I think I am a potential addict, I think that my family is prone to excessively doing anything, therefore I am cautious with what I do and consume. Call me pompous, but I think most people with addictions bring it on to themselves from having no self control (key word is most)

  8. I’ve been talking with a friend a lot recently about mental health, largely because a friend of ours is crazy and doing damage to her family because of it. I think viewing addiction as a disease is wrong, but not wrong enough to be unuseful, which is part of why the idea persists.

    What it comes down to, either in psychosis or addiction, is personal responsibility. I’m bipolar; my ex insists that I’m also Aspergers, but I think I miss enough of the symptoms to really fit it. This, however, is not an excuse for inappropriate behavior. It is occasionally a reason, but the fact remains that, as an adult, I am responsible for my behavior. If the particular balance of brain chemistry that day dictates that I’m going to be short-tempered, I have a responsibility, as an adult, to take steps to minimize the impact of this on other people… and to apologize when my being bitchy and short-tempered results in me saying hurtful things or acting like an ass. It’s a humbling thing, having to say “I’m sorry I was such a jerk yesterday… you didn’t deserve that.” It’s a hard thing, not making excuses for your behavior… and resisting the urge to provide “reasons”, which are frequently excuses with less whining.

    The same applies to addicts. While they have a “disease” (I think “condition” is more accurate) that makes certain inappropriate behaviors more likely, they are responsible for their actions. Did you give into your addiction and blow the rent money on the ponies? It’s not your addiction that did that. It’s you. Give into your addiction and spend a weekend drunk off your ass and passed out on the stairs? Your addiction didn’t do that. You did. Defining addiction as a disease provides a useful toolkit for dealing with the issue, medically. It gets you thinking about chemical treatments that can reduce the symptoms. But it also has the corrosive effect of reducing the personal responsibility of addicts… providing them a “reason” that lets them hide from it.

  9. Hi there!

    [this is long. apologies]

    My Dad is an alcoholic. He hasn’t had a drink for twenty-four years, but he’s still an alcoholic. He gave up drinking when I was 16, and he now runs marathons. He’s 66 years old.

    He tends to think of his alcoholism as a disease. Not a physical disease, but a mental one. Often, when he speaks at AA meetings, he brings up the problems that John Nash had in “A Beautiful Mind” [spoilers follow]

    Nash wasn’t “crazy”, the way that most people understand “crazy”. He was a high functioning, fiercely intelligent, very “normal” guy, who happened to see people who weren’t there. He has a disease, and has learned to live with it.
    [end spoilers]

    My Dad knows, in the meatspace that is his brain, that he doesn’t need alcohol to be well-liked, to be funny, or even to “get him through the day”. What he DOESN’T know, is when to stop. If he broke down and said: “Okay, just this one drink”, that drink would turn into two, then four, then six. On one occasion, my dad reached for a cup of punch, not realizing that he accidentally took his friend’s cup, which had punch AND vodka. Now, that didn’t automatically put him on a spiral of drunken excess. He realized his mistake and spat out the rest of his mouthful. So it’s not like he’s doomed to slide all the way back to the gutter if he so much as touches alcohol.

    Now, I grew up in a household with a Father who drank to excess, and I definitely have half his genes. But I’m just not like him. I love a good glass of Jasper Newton Daniel’s Old No.7 Fine Tennessee Sippin’ Whiskey as much as the next guy, but I’ve never felt like I’ve NEEDED it. Back when I was 21, and just started legally drinking, I asked my Dad if it made him uncomfortable when I drink. He said to me: “I don’t worry about you”. When I prompted him for further explanation, he said: “I’ve seen you get up from a table in a restaurant and leave, with half a glass of wine still on the table. If you were an alcoholic, you’d HAVE to finish that glass”. It made me understand the alcoholic mode of thinking. It’s like a compulsive disorder.

    What my Dad -didn’t- say to me, is that he would be worried if my brother started drinking. My brother is straightedge. He doesn’t touch alcohol or drugs. He tries to lead a pretty ascetic life, and eats healthy. But my brother definitely has that alcoholic PERSONALITY. He’s very driven, he likes to be in control. He’s competitive. He has to be aware of what people are doing at all times. He can be obsessive about perfection and success. In fact, he’s probably straightedge because he’s just so driven to be “clean” at all times. Both my parents are convinced that if my brother ever started drinking, he’d be buying his vodka in bulk.

    I’ve noticed that a lot of Skeptic/Atheists have a subtle contempt for organizations like AA, who treat alcoholism as a “disease”, and insist on some kind of “prayer” or acknowledgement of a “higher power” to get you out of alcoholism. If I hadn’t grown up with one alcoholic, and one “potential” alcoholic, I would be against AA too. But I understand these organizations.

    The way that my Dad thinks, and the way that my brother thinks; are not like the way my mother and I think. If you told them that alcoholism was absolutely NOT a disease, and that by implication there was “nothing wrong with them”, their first thought would be: “Great! That means that I’m the one in control. That means that I can “fix” this. That means that I can just have one drink and be totally fine! Then of course I can have TWO drinks and still be fine, because I’M the one in control. There’s nothing wrong with me, and I am the one that controls how much I drink. No one ELSE can tell me how much to drink, so I can drink as much as I want!”.

    That’s just the way their minds work. I’ve seen it happen. Now my dad runs marathons, because he’s in control, and no one is going to tell HIM how far he can run. He’ll run to China if he wants to. You can’t stop him!” My brother is the same way with the things that he does. The “disease” isn’t the dependency, it’s the “control-freak obsessiveness have-to-prove-themselves” that’s the disease. The booze is practically a symptom.

    So if might very well NOT be any kind of real “disease”. But I don’t want my dad to ever feel like he doesn’t HAVE a disease. Because a disease is something that’s out of his control. That’s just the way I like it. [shrugs]

    — Craig.

  10. Treating it like a disease means we work to help the people who suffer and means more positive outcomes.

    What’s the alternative?

    Treat it as a crime and end up with more people in jail? Put on our blinders and treat every case as a personal choice that exists in a vaccuum?

    Not all diseases are the same, and the comparison with cancer above is laughable. As if anything that’s not cancer can’t be called a disease.

    It seems like americans love to blame. They love to talk about people getting what they deserve. They love to look at people in a rough circumstance who have made bad decisions and spit on them, imagining it could never be them because they make GOOD decisions. They love to ignore their privilege so they can feel better about themselves for not being a drug addict. Those people are fucking assholes.

  11. I think a lot of the contempt for the “disease” label comes from the fact that we don’t have good, free, comprehensive treatment programs. AA is a joke, and offensive to people who want to beat their addiction without selling out their reasonable convictions. So, in america, we basically tell people they have a disease and let them loose. We don’t actually help them become responsible for controlling their disease (the diabetic example above was a good comparison), so the strong ones figure it out themselves, and the people who aren’t so lucky end up fucking up and not taking responsibility for it.

  12. I was going to disagree with tyro, but wasn’t looking forward to writing a lengthy explanation of why I think he’s wrong.

    Fortunately Craig (Draconius) wrote it for me…

    You can stand over someone with a gun and threaten to shoot them if they have a drink but that doesn’t mean they’re no longer an alcoholic.

    Yes addiction is a disease, a ‘disorder’ if you prefer, and it can be treated.

  13. Just a tangent note:

    @jjg.denis.robert said: Diabetes is definitely a disease, but Type 2 is controllable in large part via diet and exercise (with the help of medication in most cases).

    Type 2 diabetes can also be resolved surgically.

  14. Tough one. In some ways it very much acts like a disease – in some cases even like a hereditary one. In other ways, it’s not – few diseases are self-inflicted, while most addictions are started by the addict him-/herself.

    A common cause of addiction is self-medication. Pain can be treated by smoking pot or taking vicodin or oxycontin. ADHD and similar conditions can be treated with uppers like speed or cocaine, as can narcolepsy and fatigue-inducing syndromes and diseases. Depression can be held at bay with euphorisants. The list goes on – and where healthcare is inadequate or unavailable, it becomes the only option, if not a recommendable one. And the user becomes addicted, as a result of this self-medication. Is that self-inflicted? Was it really avoidable? That’s harder to say.

    Viewing it as a disease for purposes of treatment makes sense. Using that view to exonerate addicts of the actions they do that harm those around them, however, seems fallacious to me. In the end, we’ve got to own up to what we do, and even if something we weren’t in control of caused us to do it, own that we did it and take the consequences.

  15. I seem to recall from my brother’s going through rehab that there was a pretty strong component of personal responsibility and having to own up to the choices that you made and the things that you did, emphasis on YOU DID as part of the recovery process. The clear implication being that even though it’s a disease, you are still responsible for the choices that you made.

  16. @NoAstronomer: Disorder! That’s a better word for it. [nods]

    When I read these other responses, I feel like I’m arguing AGAINST the intelligent, skeptical argument. I … I don’t think it’s a disease either, but what I like about the words “disease” or disorder”, is that it defines the condition as something that’s NOT under your control. It’s the control issues that are the PROBLEM. :(

    (Which is also why they keep bringing God into it. It doesn’t matter if you think of God as JHVH, Allah, Buddah, a vague spiritual being, or even just a higher state of Universal Consciousness. The point is that YOU are not the center of the universe)

    If I can bore you all with another story about my Daddy:

    When my brother and I were little, and my Dad was still drinkin’; we almost got into a huge accident. We were going to my grandparents’ house for Thanksgiving. My brother, being 3, playfully grabbed the stick shift, and threw us into reverse while we were going 75 down the Garden State Parkway. We swerved into oncoming traffic, somehow missed everything (It was Thanksgiving, the roads were NOT empty) and wound up in a ditch on the side of the road, unharmed. The first thing to pop into my Dad’s head was: “Oh MAN, now when we get to my parents’ house, I can say: ‘I need a drink!’ and no one will question it!”.

    That just sounds like a disorder to me. ;)

  17. My fiance has had struggles with alcoholism in the past, as has much of his family and I have learned more about alcoholism that I ever wanted to know. Labelling it as a “disease” is close, but not exactly right either. Addiction itself is less of a problem – in reality, it’s a symptom of a much larger problem.

    Addicts typically have traumatic pasts. Usually, there is some incident or situation that an addict has trouble dealing with. Some examples that I’ve heard: the death of a close friend or family member (particularly due to suicide), traumatic childhood due to abuse or neglect, poor parenting because the parents were also addicts.. They use alcohol or drugs to attempt to “forget” or “cover up” the trauma as an alternative to dealing with it. When they use alcohol to excess, they then do stupid things that cause even more pain and insecurity. The result is a person with incredibly low or non-existent self esteem. In the worst cases, some people don’t even feel that they’re worthy or capable of leading a normal life

    Curing alcoholism and drug abuse is not as simple as just developing willpower, owning up to your actions and stopping. Many alcoholics and drug abusers have such low self-esteem and such a terrible history that they find it nearly impossible to address the trauma and insecurities that led them to alcohol and drugs in the first place.

    I don’t know a single person who chooses to be an alcoholic or a drug user. I only know people who are struggling with feeling, memories, and emotions that they don’t know how to cope with other than to drown them in a bottle. Treatment only goes so far – you can teach a person to not drink, to analyze their actions and reactions, to assess their emotions. However, the biggest problem is that once people leave the supportive environment of a treatment center, they return to the same environment that got them in trouble in the first place. They go back to their drinking friends, or drinking family, and it’s only a matter of time before their willpower wears thin. Quitting an addiction requires a complete change of lifestyle, change of friends, and in some cases, abandonment of the people you love. You need to surround yourself with healthy, supportive people, and many people don’t have that. This is why so many people fail at treatment and fail at remaining sober. It takes commitment, not just on the part of the alcoholic, but on the part of their entire network to kick the habit. (you would be surprised how many people – including members of his own family – tried to get my fiance to drink again when he quit. It’s shocking how much pressure other alcoholics can exert on quitters. They do it because for every “drinking friend” they have, they can “justify” their own drinking as normal)

    My fiance was less of an alcoholic (in the sense that he didn’t need alcohol to get through every day) than a binge drinker, but the binging led to severe problems. He is now 4 1/2 years sober and loves every minute. In order to do this, he went through 6 months of treatment programs, left his parents house, reduced or eliminated contact with almost all of his drinking buddies, and continues to attend one-on-one counseling. On my part, for the first 2 years I kept my house totally free of alcohol, did not drink in his presence, and went with him to any family event where there would be alcohol so that he wouldn’t be the one sober person. I have wine in the house now, but the one condition for me having a glass of wine with my dinner is that he gets to have pop or dessert or some other treat. I never, ever get drunk (or even tipsy) around him.

    I think it’s wrong to treat alcoholism as a disease because it fails to recognize what drove the person to drink in the first place. I despise the viewpoint that alcoholics just need to “own up” to their actions, “take responsibility” or “try harder” to quit. Teaching alcoholics to quit drinking alcohol is easy. Helping them to deal with their past, their self-loathing, and their emotional trauma is much, much harder and these are the true causes of addiction.

  18. This is long I apologize.

    I think to answer this question it helps to step back from the addictions that involves a substance taken into the body (drug addiction, alcoholism, smoking) and look at addictions that are a result of behavior rather than substance abuse (gambling addiction, shopping addiction, hording).

    There are similarities and differences between the two types but I think disease may be the wrong word to use in either case; compulsion would seem to fit better. Calling it a disease would seem to imply that something is ‘broken’ and can be ‘fixed’; while this is true it is not as simple as prescribing the right drug or removing the offending substance. The reasons people fall into addiction are wide ranging and need to be addressed if the addict is to successfully ‘recover’ from the addiction. I used quotes there because recovery is the goal as opposed to finding a cure.

    Since everyone is giving the anecdotal reasons behind his or her thoughts I’ll add mine. My dad no longer drinks, he stopped about 25 years ago out-of-the-blue, cold turkey. He says he is an alcoholic but I’m not sure he fits the most popular definitions that I have heard; he drank a lot (about a 12 pack each night) but it didn’t disrupt his life in a big way (that I saw anyway, I was a self-absorbed teen however), he and my mother would binge on the weekends (not uncommon in this area of the country), and he never hit bottom. I am glad he quit and I would never try to tell him he should drink again but I don’t believe he was an alcoholic; that doesn’t make what he did less remarkable since there was obviously a compulsion at work there.

    Treating addiction as completely in the control of the addict is not right either and it can lead to things like the current ‘war on drugs’ and what is happening in the drug courts throughout America as showcased on this weeks This American Life in which Ira Glass shows how Judge Amanda Williams is using overly punitive methods to deal with drug offenders and is ending up with worse results because of it.

    It’s not an easy question, but I do wish people would stop laughing at addicts like Charlie Sheen; sure he’s bug nuts crazy but it’s really more sad than funny.

  19. Clearly some people have a body chemistry or personality that predisposes them to alcohol sensitivity and alcohol abuse. The notion of disease is a construct in some sense but addictions are unique in that they require an outside substance to facilitate the full spectrum of the illness/disorder/whatever. I think you can try to make an analogy with diabetes; but in the end a diabetic has a punky pancreas and his/her circumstance is totally (juvenile onset) out of their control. Put a diabetic in an environment with no insulin and they die, put an alcoholic in an environment with no alcohol and they cease meeting the DSM IV criteria for being an alcoholic. So I guess I’m in the disorder camp.

  20. Addiction is a disease with with varying degrees of personal responsibility and susceptibility.

    Whether it can be cured or not doesn’t make it a disease. There are plenty of deceases that are curable, incurable, curable for some…

    The fact that it is tied to behavior doesn’t stop it from being a disease. Life style choices often start the disease process. Calling it a disease doesn’t remove blame or personal responsibility.

  21. @here_fishy:

    You seem to fall squarely in the “nurture” camp when it comes to the causes of alcoholism. You mentioned trauma several times. While I agree that trauma may be the case for some, I think heredity has a whole lot to do with it! I think nature trumps nurture in this case.

    But damn it, that’s no excuse! For all of us who have had to live with an alcoholic parent(s) it is small comfort. If you a have disease, disorder, problem, syndrome or whatever you want to call it….just do what you have to do to help yourself you selfish sons of bitches so you can take care of the kids you decided to have.

    Uh, guess you touched a nerve.

  22. I think the problem stems from disease or not disease, and I fell into it.

    When you say something is a disease most people automatically think of a physical ailment; while addiction is a disease it is a brain disease, something that we as humans seem to have a problem defining or dealing with.

  23. @Laika: It does seem like I touched a nerve. And I don’t disagree with you – I feel that there is some hereditary component as well, and I can’t understand how alcoholic parents can do that to their children either. I’m just saying that it’s a lot harder than many people believe to quit an addiction because it’s not as simple as removing the alcohol (or drug). You have to deal with all of the stimuli (hereditary or not) that prompt people to drink, and some people never get the courage to confront those issues because of the pain involved.

    Having children can be an incentive to stop, but it can also be an added stressor. I definitely feel for the children of alcoholics – you can’t do anything about who you were born to except strive to be different and hope that your parents get the help they need.

  24. Is depression not a disease because some people are helped by behavioral modification therapy?

    I think some people go too far with the “personal responsibility” angle. I can understand Laika’s viewpoint. I’ve been on the receiving end of abusive addictive behavior. My stepdaughter was a junkie. Heroin sucks. But blame is a trap. It doesn’t help anyone.

    Some people are genetically predisposed to addictive behavior. Some people choose to use a substance or engage in a behavior that results in a physical addiction. Sex addiction caused by dopamine dependence can be as debilitating as a degenerative brain disorder, and may or may not be resolved by behavior modification.

    I just want to remind people to be careful about the blaming, especially if you have never been or known an addict–a real addict who continued addictive behavior despite its destructive outcome. It’s not productive. It is not a tautology that everyone is responsible for their own behavior.

  25. I have alcoholics in my family too, though only one recovering (my dad).

    I see it pretty much the same way as I see my asthma — I can’t get rid of my asthma, but I can manage it. Just like my dad manages his alcoholism.

    AA can be pretty stupid, but it worked okay for him; I think mostly because it gave him a place to talk and listen to other people who have the same problem. That always seemed to be the only real point to it that I could see.

  26. All of the comments here are excellent but I tend to agree most with @Mark Hall and @mikerattlesnake.

    I feel strongly that addiction (whether you call it disease or something else) should be treated as a medical problem and not as a legal problem.

    The so called War on Drugs has had a huge negative impact (and whenever a dumb idea takes on in the US it seems the world follows suit).

    A more enlightened approach such as used by the Netherlands could be a lot more beneficial e.g. in reducing organised crime and even potentially reducing funding for the Taliban.

    I would like to see an evidence based approach and a proper comparative costing of the two opposite strategies.

    Of course, hell will freeze before any politician is brave enough to act.

    $0.02

  27. The compulsion to do things that end up being self-destructive is an evolved trait. Usually those things are adaptive in the short term but maladaptive in the long term.

    Calling it a “disease” is not always accurate because there might be nothing “abnormal” going on.

    For example, anaphylaxis is the extreme immune response that you get when exposed to the right antigen, such as lipopolysaccharide from bacteria. Inject LPS into the blood stream and people exhibit anaphylaxis. Anaphylaxis can kill you in a few minutes. It can also save your life. If you were living “in the wild”, and had bacteria in your blood stream, you would need an extreme immune response to have even a small chance of surviving. That is why evolution configured organisms to exhibit things like anaphylaxis. Evolution configured humans to minimize the sum of death/non-reproduction from too wimpy an immune response (death from infection) and from too strong (death from anaphylaxis).

    Is anaphylaxis a “disease”? Not really, but if you go into anaphylaxis from a bee sting, you need treatment or your immune response might kill you.

    I think that most of the disorders of addiction relate to maladaptive stress responses. When you are being chased by a bear, your physiology induces a feeling of euphoria so that you can run and not get tired. It is not that you are not consuming metabolic resources, you are. Your body is becoming “fatigued”. You don’t feel the fatigue because your body has also induced the delusion that you are not tired and that you feel great. Your body does this so you will keep running away from the bear, even if your muscles start to die from ischemia. In a non-euphoric state, dying muscle hurts like hell.

    The control system that triggers euphoria in a near death metabolic state has to be triggered only in true emergencies, otherwise organisms would put themselves into that euphoric state and risk death for no benefit. I think that is what produces the euphoria of autoerotic asphyxiation, the runner’s high, the euphoria of near death experiences, and also the euphoria of stimulant drugs of abuse.

    Euphoria is a complex feeling, it has to have a complex regulatory system. That regulatory system is triggered by near death metabolic stress. Stimulant drugs of abuse just trigger that regulatory system too.

    Once that euphoria is triggered, your physiology adapts so that it can be triggered again more easily.

    It is really hard to not trigger euphoria if you have something that will trigger it. Is the inability to not trigger euphoria a disease? I don’t think so.

  28. I can’t help but wonder if the issue of whether addiction is a disease is how “addiction” is perceived in our culture. We have a tendency to dichotomize everything (to the point that everyone is an unwitting expert in the false dichotomy fallacy), so that a disease is out of our control, and addiction is in our control, and there is nothing in between.

    Because addicts find great difficulty ceasing their addictive behavior, it is easier to unburden themselves of the responsibility of altering that behavior and blame an outside force: the disease. Non-addicts (a general population, not meant to be all) see addiction as being completely within one’s control, and if only addicts used enough will power, they could quit. Also, diseases are perceived as coming from a fully outside source. We’re more likely to assume an addict “got himself into that situation.” Thus we’re more likely to pity and help someone who was undeservingly afflicted than someone we see as bringing about his or her own ruin.

    It takes a little knowledge of psychology to perceive it for what it is, but if you lack it, let me assure you: This is bullshit.

    With some exceptions*, our memories and patterns of behavior—even the behavior of our thinking patterns—are neither liquid nor set in stone, but are rather something in between. As we learn a new behavior or pick up a new habit, we have an initial experience, then another, then another, and so on. With each new experience, the associations we make with that particular action or thought are reinforced. These associations can be broken, although it is much harder than their initial creation. You’ll have had a sense of this feeling if you’ve ever tried to break a bad habit. For addicts, the associations made with their addictions are exponentially stronger and more difficult to break.

    Breaking addiction does take will power, but will power is not enough to sustain an addict through withdrawal. It takes social support and intrinsic motivation, and sometimes it takes a change of environment and medical assistance.

    (Let me make it clear that this is an oversimplified example of addiction. Severe physiological addictions, such as those created by methamphetamines, take much more than a few interventions and will power to overcome.)

    A disease, however, does not begin by choice, and will power isn’t part of it’s cure. By that I mean, an addict can choose not to pick up a drink or a needle (although the choice might be very difficult, it is there); a diseased person can’t choose not to have a new lesion today.

    No, addiction is not a disease. However, that does not mean we should withhold the help that addicts desperately need to overcome their circumstances.

    *e.g., OCD, chronic depression, anterograde amnesia, etc.

  29. Wow, this is just one of those topics where some skeptics are so ennamored with their own skepticism that they miss the goddamn big picture (see also: abortion debates where people spend hours trying to pin down the point that a fetus becomes a person [of course always pre-birth…] while ignoring the core issues of consent and ignoring the simplest conclusions).

    It wouldn’t matter if addiction shared ABSOLUTELY NO superficial characteristics with another disease (which is not the case). It is irrelevant that you can’t come up with a proper disease analog to compare it to. The point is that it has predictable patterns that can be assessed and treated LIKE a disease, and that doing so is more effective than any other form of dealing with the problem.

    Everything else is just semantic wankery.

  30. I believe addiction is the symptom. Some cases it may be caused by disease, in others it may be just poor lifestyle choices.
    Arguing about how to classify it feels like a false dichotomy to me. Different people drink in different ways and for different reasons.

  31. An addiction is an addiction. Applying another label is only as useful as that label’s ability to foster effective treatment modalities.

    The disease model has a much the best track record so far. None of the disease model treatments that I am aware of absolve the addict of responsibility. To the contrary, all of the effective ones recognize personal responsibility as a key element in the treatment.

    Arguing that the disease model does not hold the addict responsible is a strawman.

    In the work I do with street addicts, those who are not aware of their own responsibility are few and far between. It’s not that they will not accept responsibility, it’s that they do not have the physical, social, or emotional resources to take effective responsibility.

  32. Let’s also not forget that an addiction involves not just the individual with the addiction, but everyone in that person’s life. You have to treat the entire situation if you are to have hope for a full recovery.

    Also, I’d like to say that from what I can tell everything that is being said here is true, at least to some extent, about substance addictions, but I’m not sure it applies as strongly to behavioral addictions. Let’s not forget that behavioral addictions are no less real but are sometimes harder to define. There seems to be a very strong componant of trauma involved in these types of addictions (with genetic predisposition perhaps playing a smaller role), almost to the point of substance and behavioral being two very different, but equally real, types of addiction.

  33. @mrmisconception:

    I am under the impression that the majority of substance abusers do in fact have trauma, i.e., child abuse, sexual abuse, etc., in their backgrounds? Is that still currently the thinking on this issue, or has that been, so to speak, debunked?

    Also, is it not true that the chemical processes within the brain are similar between substance abuse and behavioural addictions? I mean, don’t both processes involve dopamine inducing/inhibiting brain functions?

    Do we have any psychologists or other sciencey professionals here who can clarify?

  34. @John Greg: Your impression is correct. Victims of trauma have much higher incidence of drug abuse and even other health problems. Some forms of stress and trauma does some very powerful things to people, things that never go away. If you have never been a victim of trauma, it is very difficult to appreciate how life-changing that experience can be.

    There is a lot of thought that much of drug abuse amounts to self-medication to cope with previous adaptations to trauma that are now maladaptive.

    It is pretty clear that drug addicts have a pretty crappy life. So crappy, that if you tried to impose that lifestyle on them, it would be declared cruel and unusual punishment.

    I think the stimulant drugs of abuse change the “discount rate”, to use a term from economics. The discount rate is what is used to value goods and services in the future compared to goods and services in the present. The present value of something is always higher than the future value. A dollar now is worth more than a dollar a year from now. That difference is the discount rate.

    One way of thinking about what stimulant drugs of abuse do is that they make the discount rate very high, and in the limit infinite, so that current experience is infinitely valued over future experience. This is why (I think) drug addicts are willing to use HIV infected needles to inject drugs. The present experience of injecting the drug is so valuable that the future experience of HIV is negligible. It is a completely rational choice given an infinite discount rate.

    My hypothesis is that the state of stress is what regulates the “discount rate”, and makes it infinite when you are running from a bear. That is why you can endure any damage and in the limit run yourself to death. Living in the moment and escaping from the bear is infinitely valuable compared to having a body that is not damaged.

    I think this is why one strategy of negotiation is to put your opponents under a lot of stress. If they have a higher discount rate than you do, they will value near term gain higher than you will and you can strike a better deal for yourself in the long term.

    This is why the “war on drugs” will never succeed. It is not possible to deter drug abuse. The lives that drug addicts choose for themselves are worse than anything that the criminal justice system could impose on them. It is not possible to deter someone who has an infinite discount rate. Avoiding future punishment is of negligible value.

  35. Addiction may or may not be a disease, but how is it that the religion called AA came to be the main way we deal with a “disease?” There is zero scientific basis for the 12 steps which simply say we should pray away our addictions. There are evidence based methods out there like SMART Recovery which encourages self empowerment and does not believe we are powerless. Further it is a myth that we must define ourselves as “in recovery” for the rest of our lives. Most people who quit an addiction do so using our own inner strengths. I reject the idea that quitting without joining AA means I am a “dry drunk” I am just as legitimately sober as someone who attends meetings 7 days a week. There is no difference between abstinence and sobriety. One step is all that is necessary.
    My opinion that AA is a religion is one that is shared by a number of courts who declared that because of the religious nature of AA it is a violation of church/state separation to order people to join AA.
    I encourage people to check out the blog called Stinkin-Thinkin where people discuss why AA does not work. Also look at The Orange Papers to find some interesting facts about why the 12 steps are such a failure for so many.

  36. @John Greg: and @daedalus2u: I’m not sure your comment is accurate.

    Victims of trauma have much higher incidence of drug abuse and even other health problems.

    This is a comment on trauma victims but not all addicts are trauma victims.

    @daedalus2u: I think you are over thinking it. I don’t disagree with your “discount rate” analogy but addicts don’t weigh choices they only choose the object of their addiction. Many are unaware of the consequences of their actions and many have been convinced that they simply aren’t true.

    And then there are the annoying people who seem to be able to use without sign of addiction at all. I work in film (were I deal with a lot of addicts) and there is always one or two people who seem to be able to do as much blow as they want and have no noticeable side effects. I’ve seen a few people get in too deep because they assumed they were doing as well as the guy next to them.

    Also not all addicts suffer, I worked for one guy who was fine during the day but every night he was rolling on E and raving it up with his friends. He lived a happy, carefree life, he was just stoned for half of it.

    It’s easy to assume every addict has a problem outside of the addition itself but I don’t buy that. Sometimes people use drugs because they are fun and some times it’s hard to control how much fun you have. It’s no different than people who eat too much McDonald’s, they aren’t feeding away their trauma, they just like the Macs.

  37. Disease: 1. a disorder or abnormal condition of an organ or other part of an organism resulting from the effect of genetic or developmental errors, infection, nutritional deficiency, toxicity, or unfavorable environmental factors; illness; sickness. 2. any harmful condition, as of society. (Random House Webster’s College Dictionary 2000)

    Addiction: dependence on or commitment to a habit, practice, or habit-forming substance to the extent that its cessation causes trama.

    SO…if I were debating the issue as an attorney or something…if every dictionary has the same definition…and I hope they would. Then addiction is a disease. Break the question down to it roots to get the answer. Yeah there are going to be emotions involved, bias positions and of course bending and twisting of words.

    ADDICTION is a DISEASE and not only that but probably the Americans MOST DEADLY DISEASE.

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