Pining for a Brain Tumor

A new ad campaign from the Partnership for a Drug-Free America insists that "drug addiction is a disease"—no, wait, it's actually worse than a disease, because when you have cancer or AIDS, at least people recognize that you're sick and in need of treatment, and they're sympathetic. In a TV spot and a series of print ads (links to the right of the news story), shirtless addicts of various ages, sexes, and colors cut the line in front of Stan Marsh's dad, declaring they'd be "better off" if they had a brain tumor, cancer, AIDS, or heart disease. I suspect people with brain tumors, cancer, AIDS, or heart disease would disagree.

The Houston Chronicle reports that the "Hope, Help, and Healing" campaign, which is about to go national after being test-marketed in Houston and Cincinnati, grew out of research finding that "the public has a denial or lack of understanding about addiction as a chronic but treatable illness." Or maybe the public just disagrees with the contention that excessive use of psychoactive substances is a disease. As Thomas Szasz observes, one hallmark of a true disease is that people are not constantly insisting that it really is a disease. To its credit, the Chronicle quotes Stanton Peele and other critics of the disease model (and the war on drugs), noting that "some groups skeptical of the addiction-as-a-disease paradigm worry the partnership's message uses pseudoscience to oversimplify the complexities of drug use and addiction."

Leaving aside the scientific, conceptual, and moral issues, I'm not convinced that viewing addiction as a disease leads to less oppressive policies, as opposed to giving the war on drugs a kinder, gentler veneer by calling coercive re-education treatment instead of punishment. But let's take the Partnership for a Drug-Free America at its word: Addiction is a disease just like cancer or AIDS. Do police arrest people for having cancer or AIDS? Do doctors treat people for cancer or AIDS against their will? Are people with cancer or AIDS disqualified from various professions because the government refuses to license them? Until the partnership's prohibitionist propagandists start taking on these policies, I can't even give them credit for believing their own bullshit.

[via Luke Wilson at Rehabology]

Comments

[David]

Do doctors treat people for cancer or AIDS against their will?

What about that Starchild kid?

[the other Mark]

JFC, just learn a-discaprine. You all rack-a discaprine!

[David]

Do doctors treat people for cancer or AIDS against their will?

What about that Starchild kid?

[Ira Weatheral]

Does anyone think that these increasingly far out marketing strategies for the WoD mean the drug warriors are afraid their popular support is shrinking?

Or am I being too hopeful?

[John]

I hate the way the drug warriors always end up making war on personal responsibility. No one chooses to get AIDs or cancer or any other horrible disease. Suffering from those diseases is a tragedy in every sense of the word. No one makes anyone do drugs. Drug addicts choose to start and could choose to get treatment and quit if they want. Drug addiction may be a tragedy for the families and friends of the people affected by it, but it is not a tragedy for the addicts themselves. They made the choices that put them where they are.

If people want to get serious about legalizing drugs, then need to stand up for personal responsibility. The whole poor addict argument just feeds into the arguments for criminalization. If these people can't help themselves but be addicted, why on earth would we want to legalize the stuff and how can we not put the dealers away forever? That is where treating addicts as victims leads. If the argument is however that drug addicts have chosen to be where they are and are not victims of anything or anyone but their own poor choices, then you left wondering why the hell we are spending billions of dollars to jail people just to save them from themselves.

If anything libertarians ought to hate addicts. It is because of their dumb asses and irresponsible behavior that the rest of us have to pay for the drug war and are deprived of the opportunity to use drugs legally and responsibly. I really believe that the first step towards legalizing drugs is to stop portraying addicts as victims.

[Sphynx]

Jacob: Ad to the list or extend the licensing analogy - Does the State deny benefits (Pell Grants, Student Loans, etc.) based on secondary or tertiary symptoms of HIV/Aids et al. Just being arrested (or maybe convicted) of even a misdemeanor is enough to now for the State (Fed a/o states) to deny benefits it routinely grants to "worthy" citizens.

--------------------------

The above is not to be construed as support for goverment programs, just to point out the logical inconsitencies in State sponsored benefits programs.

[smacky]

"the public has a denial or lack of understanding about addiction as a chronic but treatable illness." Or maybe the public just disagrees with the contention that excessive use of psychoactive substances is a disease. As Thomas Szasz observes, one hallmark of a true disease is that people are not constantly insisting that it really is a disease.

QFT!

John,

I don't understand how anyone can view alcoholics as anything but despicable. (It's possible to feel pity for them, too, but it needs to be said that any pity should arise from the fact that they are choosing to make poor choices, for whatever reason -- much the same way someone can feel pity for someone who commits suicide -- and not from some so-called "disease" . Moreover, people with bad habits should be free to ignore any pity that other people have for them and destroy themselves as they see fit -- except without the support of taxpayer money.

[Joe Majsterski]

I actually think the Partnership for a Drug Free America is fighting a rearguard action against changing opinions and moods about marijuana in particular. The latest commercials are now going on and on about how, "Well, yeah, okay, marijuana isn't DANGEROUS, but, um, see, it's just bad, because, you'll just sit around and do nothing!" Clearly, the health-risk issue has been swept aside, and now it's all about how demotivated you'll get. In my mind, this is an indicator that they're losing. People just don't think marijuana is that big of a deal. As for the rest, well, we've got a ways to go still.

[thoreau]

You know, I have a lot of sympathy for addicts who are trying to resolve their problems, and if they want to call it a disease, fine, call it a disease. Whatever.

But it's the only disease I'm aware of that you can treat by going to meetings. This makes it hard for me to cry a river for the people who insist that it's a disease and it isn't their fault. All of the other diseases require medications, surgery, radiation, physical therapy, and other things that run the risk of side effects.

Well, I guess that injury from secondhand smoke is a possible side effect of going to 12 step meetings.

[ChicagoTom]

I hate the way the drug warriors always end up making war on personal responsibility. No one chooses to get AIDs or cancer or any other horrible disease

Couldn't an argument be made that people who got AIDS from unprotected sex and people who got cancer from smoking or choosing to work in an asbestos plant qualify for :
"They made the choices that put them where they are."

Should we not treat them as having a disease or requiring treatment either, by your logic?

I'm all for personal responsibility, but that doesn't mean that everyone who chose to do something and then becomes addicted doesn't deserve treatement and help or is merely a victim if his/her own choices.

Some people get addicted, some people don't (hey -- look at that it is like a disease). Some people get cancer some don't.

To pretend that it is simply an issue of personal choices is a bit naive isn't it?

Using drugs isn't the "disease" -- the addiction is -- whether its addiction to sex, chocolate, cigs, alcohol, drugs or television -- and it is a health problem that people should get treated for.

I don't see a problem with treat drug addiction as a disease. I do have a problem with labeling it a disease and then throwing people with that disease in jail for it.

[Stretch]

As Mitch Hedberg said, alcoholism is a disease but it's the only one you can get yelled at for having.

[John]

Chicago Tom,

If it is a disease, perhaps that justifies not putting users in jail. But, it being a disease makes a pretty strong case that drugs should be illegal and that dealers should go to jail. If people can't help themselves but get addicted, how can we allow unscrupulous people to get rich by feeding their addiction and how can we do anything but make drugs less available in society?

[mk]

There is something one can do to treat one's own addiction. If that addiction is based on a physical dependence (emotional issues aside). That is to quit ingesting the addictive substance, go through the withdrawal and remain abstinent for the rest of your life.

I imagine many cancer and AIDS patients would love to have that course as an option, no matter how difficult it is.

[mediageek]

Addiction is bullshit.

[crimethink]

thoreau,

Well, by that standard, some mental illnesses are not diseases either, since not all of them respond to physical treatment. Of course, Szasz would respond, "Exactly!"

[mk]

Thoreau,
I recently ran across an old friend who told me that even most AA meetings are non-smoking now.

Truly, we are seeing the end of an era (or error).

[crimethink]

And it goes without saying that anyone who wishes they had a brain tumor instead of a drug addiction must be smoking crack. Err...you know what I mean.

[kohlrabi]

thoreau,

Do the meetings actually cure the disease, or do they help the person cope with it? Ie. they may still be addicted (diseased?) but not use.

[mk]

Crimethink,

I've said it many times before, thumb through the DSM-4 and you'll come away with a whole list of mental illnesses you never even knew you had. There is something for everyone in there.

I will say, however, that there are some people who are truly "ill" mentally. I work in MH and I see them every now and then. They need help, badly.

Still, a large number of the people we see have no real physical problems that I can see beyond the consequences of a lifetime of poor choices.

[Kwix]

mk,
So long as they still serve coffee every night and cake on "birthdays" I'm in.

[mk]

kohlrabi,

You got it. The meetings themselves are a kind of group therapy/pat on the back/ keep your chin up affair. AA is basically an abstinence support group.

Addiction isn't considered curable in that environment.

[ChicagoTom]

If it is a disease, perhaps that justifies not putting users in jail. But, it being a disease makes a pretty strong case that drugs should be illegal and that dealers should go to jail. If people can't help themselves but get addicted, how can we allow unscrupulous people to get rich by nfeeding their addiction and how can we do anything but make drugs less available in society?

Well we do it with alchol and society seems to have survived, no?

Also, I dunno what "it" is in your mind in the sentence "it being a disease makes a pretty strong case that drugs should be illegal ad that dealers should go to jail" In my view "addiction" is the disease, drugs themselves are not a disease...so I don't particularly see how it follows that dealers should be in jail and drugs criminalized.

Unless of course you are staking out the position that anything that has potential addictive properties should be illegal (gambling, drinking, smoking, etc)

If people can't help themselves but get addicted, how can we allow unscrupulous people to get rich by nfeeding their addiction and how can we do anything but make drugs less available in society?

That's a joke right? In this case I really dunno if you are being sarcastic. I assume you are, because I doubt you would state that with a straight face, but I can't really tell in the context of these last few posts.

[Stretch]

One has to wonder why surefire pills haven't been invented to block the physical desire for whatever addiction one has. As far as I'm aware, the only physical therapies for drug addiction involve a substitute drug or highly regulated doses of the target drug.

In my own experience, there is no doubt that I'm physically addicted to nicotine, but I find the "psychological addiction" much nastier to deal with. For example, if I'm in a siutation where I can't smoke for a protracted period of time, I may suffer from occasional nicotine pangs, but it's never really an issue. In certain cases I've gone days without smoking with no real ill effects. But put me in a situation where I can smoke freely and I will, especially if alcohol or coffee is involved. In short, there is absolutely a "disease" component, but it's minor compared to my free choice to smoke. Ultimately, I smoke because I want to and that's that.

[Mike Laursen]

Fuck these assholes! A friend of mine just found out he has a brain tumor. It's just about the scariest thing a person can be diagnosed with. The doctors might be able to buy him some time with some very nasty treatments, but he could end up as a vegetable.

[John]

I am only being half sarcastic. I don't believe addiction is a disease for even a moment. That said, if you take it as a disease, meaning people cannot help but be addicted if they are exposed to drugs, how on earth can you justify their legalization? You say that addiction not drugs is the disease. Put into another context, if sold a product that was gaurenteed to give a high percentage, say 25% of the people who used it terminal cancer, wouldn't their be a pretty good argument to make my product illegal? I think there would be and don't see any reason why drugs, if addiction truly is a disease, should be any different.

To put it bluntly, I don't see how you can be a whinny assed do gooder concerned about addicts who can't help themselves and still be for the legalization of drugs.

[John]

I am only being half sarcastic. I don't believe addiction is a disease for even a moment. That said, if you take it as a disease, meaning people cannot help but be addicted if they are exposed to drugs, how on earth can you justify their legalization? You say that addiction not drugs is the disease. Put into another context, if sold a product that was gaurenteed to give a high percentage, say 25% of the people who used it terminal cancer, wouldn't there be a pretty good argument to make my product illegal? I think there would be and don't see any reason why drugs, if addiction truly is a disease, should be any different.

To put it bluntly, I don't see how you can be a whinny assed do gooder concerned about addicts who can't help themselves and still be for the legalization of drugs.

[ChicagoTom]

Put into another context, if sold a product that was gaurenteed to give a high percentage, say 25% of the people who used it terminal cancer, wouldn't there be a pretty good argument to make my product illegal? I think there would be and don't see any reason why drugs, if addiction truly is a disease, should be any different.

There might (like banning the use of lead based paint) -- but in the context of personal choices people are allowed to make for themselves, I don't believe so, but based on your position I should assume you are in favor of banning cigs then, yes?

To put it bluntly, I don't see how you can be a whinny assed do gooder concerned about addicts who can't help themselves and still be for the legalization of drugs.

John, I just don't see how these two are mutually exclusive.

Just because some people get addicted, that doesn't mean that everyone who has the ability to use it responsibly should be forbidden from doing so. You agree with this, no?

And of those who do get addicted, they should be treated as a health problem instead of incarcerated as criminals or scufflaws.

It actually works rather well.

(And it's nice to see that anyone who has concern for the health of addicts is labeled a "whiny ass do gooder" --- who is whining here John? I want people to live free and be treated like responsible individuals with a health problem -- and you want people jailed and their choices taken away from them -- you are the worst of both worlds...a statist and a moralist)

[mk]

There are a large number of people who will have a terrible reaction to peanuts if they come into contact with them. They don't have any control over that apparently (I personally, am allergic to nothing so I can't speak from experience). Still, one can get peanuts "over-the-counter" at practically every grocery store. Some companies even market it to children!

Still, I would venture that most people with allergies don't necessarily think that other people shouldn't be able to have the occasional PB&J.

[thoreau]

kohlrabi has a point: They may still "have" the disease, but meetings can sure help them control it. You can't say the same for cancer.

If it is a disease, what kind of disease is it? Well, if one leaves open the possibility that not every instance of recreational use leads to physical addiction, then we could almost think of addiction as a type of allergy (figuratively speaking, not literally, since there is no immune response): Some people might be more susceptible than others with regard to certain substances. The people with the disease would be the ones who get physically addicted after consuming even small quantities of a substance, while the people without the disease either don't get addicted or require larger doses to get addicted.

I don't know if the response to certain drugs is really so heterogeneous over the population that we can really call different responses evidence of a "disease." If, for the sake of argument, there are people with an anomalously low threshold for physical addiction (as manifested by severe withdrawal symptoms when they no longer get the drug) then one would be led to two conclusions:

1) For some people, responsible use is indeed possible.
2) Irresponsible users are sick patients, not felons.

I'm not sure that the people who want to call it a disease really want to go down that road and reach those conclusions.

As for me, being from a family with some current and former substance abusers, I'm happy to nod my head when they call it a disease, but call bullshit when they equate their disease with cancer. To the extent that it can be considered a disease, it is more like an allergy than a cancer.

[ChicagoTom]

To the extent that it can be considered a disease, it is more like an allergy than a cancer

Just curious....in your mind, what is the difference between a drug addict and a cig smoker getting lung cancer?

Why would the latter be considered a legitimate disease and not the former? In both instances poor choices the person made caused the consequences. Or are certain types of cancer a disease and others not so much?

It's not that I disagree -- I agree with a lot of your post. I just have a hard time seeing where the line is and what qualifies something to be on one side or the other of that line. It can't be just personal choice -- heart disease is a disease and although there is a hereditary aspect to it, personal choices play a very important role as well (diet and excersize). Alcholism also has a hereditary aspect as well, no?

[Kip]

Addiction is never a disease. Compulsion is the issue. Many/most people are weak and fail to control their urges. An addict wants to act like he CANNOT control himself, but of course he can, he just chooses not to. If you don't want to do something, and you find yourself doing it anyway, it's easy to excuse the choice by saying you are addicted. But you still made a clear choice. Weakness is the problem. Weakness is simply a characteristic, not a disease.

[Pi Guy]

IMO, there is no difference between a person who abuses drugs or alcohol, one who overeats to extreme obesity or undereats to anorexia, one who gambles until broke, one who runs up thousands of dollars on their credit card, promiscuity, masturbating five times a day, or any number of other extreme behaviors. I don't think that any of those are diseases at all. Instead, they simply indicate that the afflicted is not well-equipped to deal with the stress, resposniblities, or bad news that many others are more capable of taking in-stride.

Note that, in moderation, there really isn't anything inherently wrong with any of the actual addictions (legality aside) but, rather, it is the degree of excess of the addictive behaviors that creates the problem. It's the inability to take care of everyday life things - going to work and doing your job enthusiastically, communicating effectively with spouses and children, paying attention while behind the wheel, demonstrating respect for others in speech and behavior - that characterize the negativity of these so-called addictions. I suspect that that weakness could result from something innate (like a chemical imbalance) or external (say, child abuse), most likely, some combination of each.

In the end, if you're addicted to anything, you're capable of being addicted to everything. You just haven't tried everything yet...

[thoreau]

Chicago Tom-

I'm not saying it isn't a disease. I'm saying that it's a disease that can be managed purely by willpower, which is more than we can say for cancer.

The lung cancer probably could have been prevented with willpower, but once you get it you can't just will yourself to get better.

One thing that I think complicates this is that some people are assuming the word "disease" means "no more personal responsibility." It needn't be that way. To me, calling something a disease means that it is a problem with a biological component. That's it. That's different from assuming that "disease" is a "get out of responsibility free" card.

To put it in perspective, I'm sure we've all got at least one relative with an impressive list of ailments that constitute an excuse for everything under the sun. And, indeed, the impressive list of ailments may mean that it wouldn't be fair to expect this person to, say, fix the roof. But if that person tries to put too many burdens on everybody else, well, there's no dishonor in calling BS.

(That's not to say that calling BS would be a wise idea, of course. Doing so might be bad for your own health.)

[ChicagoTom]

If you don't want to do something, and you find yourself doing it anyway, it's easy to excuse the choice by saying you are addicted.

So then all the heroin users who go through withdrawl just aren't mentally strong enough?

Not that there aren't people who are weak and excuse their bad bahavior, but to paint with such a broad stroke basically denies the existence of physical addiction and withdrawl which have symptoms that are both tangible and recognizable.

[Russ 2000]

If I found out I had a brain tumor, I might start an alcohol habit.

If that addiction is based on a physical dependence (emotional issues aside).

IMO, most of the reason addiction is called a disease is to avoid dealing with emotional issues. Emotional problems are an even bigger target of stigmatization than having a disease. Even labeling things "poor choices" is a way to weasel out of empathy. Pitying someone's poor choices probably does nothing but encourage the poor choices to continue.

[grylliade]

It might also be that some people have a disease, and need to be treated, and some just need to make more responsible choices. My dad was an alcoholic for many years, and AA (or rather Overcomers Outreach, a specifically Christian version of AA) helped him to clean up. But I don't think he has a disease. He does, because that's the only way that AA allows alcoholism to be treated. I think that if dad were to drink, but not get drunk (or at least not get drunk often), he'd be okay. He doesn't have a disease, though not drinking is certainly better than when his behavior before he quit.

But there are also people who do have a disease, who can't quit without help, and who will never be completely well. It sure as hell isn't the same as cancer or AIDS, but it might be the same as, say, being bipolar or OCD. You can't help the behavior, and it affects your life negatively, but there are treatments to help you. Disease probably isn't the best word for it, but it's what we have to work with.

And none of this means that legalization isn't the answer to the problems posed. John, you asked how if you view addiction as a disease you can be for legalization. Well, for one thing, you might be aware that prohibition isn't working. If the justification for the WOD is the protection of addicts . . . well, it's failed. Considering all the other side effects of prohibition (the loss of civil rights, the destruction of inner cities, the militarization of police forces in the US, etc.), and considering that the response of prohibition is to lock up those considered sick (or force them into unhelpful rehab programs), then there seems to me to be no real alternative to legalization. In this case, the "cure" is worse than the disease. So that's at least one way that you can be for legalization while still viewing addiction (or some cases of it, at least) as a disease.

[mk]

I see your point Russ, but I was simply trying to isolate the physical side of the addiction equation, cellular adaptation and all that.

There are substances that, if abused, cause substantial physiological changes in a person. A late stage alcoholic will have wrecked his digestive system so much that they have a hard time digesting normal food. Things like that.

[ChicagoTom]

thoreau,

I agree that in general, some diseases are more serious than others. (Like cancer) But I dunno if I agree with :
I'm saying that it's a disease that can be managed purely by willpower

Most drug addicts go through a physical withdrawl and get physically sick. Many times sheer willpower is not enough. Look at smoking. How many people have failed to quit? Is it merely a lack of will power? There seems to be a lucrative market of products designed to help people stop smoking in various ways. Different people tend to have difference success rates with differnt products.

That leads me to believe that there is something more than merely willpower that will dictate whether or not one will successfully quit.

I used to smoke, but I quit cold turkey -- I never got nicotene headaches (withdrawl symptom)....but others have. Wouldn't that imply a physical component to the addiction in some people??

The fact that some people get addicted and others don't lead me to believe that there must be some physiological components that makes one more suseptible to addiction to certain substances than others.

To me, calling something a disease means that it is a problem with a biological component

And I believe that there is definately a biological component to drug addiction (as well as cigs and alcohol).

In my opinion, the fact that some people get addicted and others don't among people with similar sociio-economic environments leads me to believe that addiction is definately something that occurs in similar patterns like cancer or Down Syndrome, or many other diseases diseases who seem to occur rather randomly or by chance.

One thing that I think complicates this is that some people are assuming the word "disease" means "no more personal responsibility."

I don't think calling something a disease removes personal responsibility -- but it does mitigate it somewhat. People who are diagnosed with something definately have a personal responsibility to change their lifestyles once diagnosed (diabetics have to change their diet etc) but before you are diagnosed -- is it really all your fault?

And how does one diagnose addiction? The only way to diagnose it is after the fact -- once you've gotten addicted. Granted you made the choice -- but if you made it thinking you could use it responsibly and you realize that you are addicted...On the other hand, once you've recognized yourself as an addict, I believe you do have a responsibility to try and clean up.

[mk]

Alcohol, once digested, becomes something that is metabolised in the same way that corn syrup is.

See, it all comes down to the corn syrup.

[grylliade]

Addiction is never a disease. Compulsion is the issue. Many/most people are weak and fail to control their urges. An addict wants to act like he CANNOT control himself, but of course he can, he just chooses not to. If you don't want to do something, and you find yourself doing it anyway, it's easy to excuse the choice by saying you are addicted. But you still made a clear choice. Weakness is the problem. Weakness is simply a characteristic, not a disease.

And how, exactly, are you supposed to develop that willpower from nothing at age forty or fifty? To say that it's weakness is just begging the question. How do you get rid of that weakness? It's easy to criticize from the sidelines, when you're the kind of person who has (or has developed) that kind of discipline. You might realize that the problem is that you're making the wrong choices, but when you've tried time and again to stop making those choices and failed, is the answer to just keep on trying again and again? There's something to be said for persistence, but . . . well, Dr. Phil isn't wrong when he says that insanity is doing the same thing over and over again and expecting different results.

The question is how to help those people to make good decisions. If it were as simple as just making good decisions, if it were actually in their power to choose wisely instead of poorly, it would already have been done. It's hard, even if it is your own fault. I can say, "I'm responsible for starting using, but I cannot, of my own volition, stop using what I'm addicted to. Help me." That's taking responsibility for my own decisions. Disclaiming responsibility for having started would be victimization. Admitting you victimized yourself is rosponsibility.

[Maurkov]

John, you can also be in favor of legalization from a harm reduction perspective. A product that kills 25% of users is bad, but a government policy that kills 50% of users is worse.

[Harry Palm]

"...masturbating five times a day, or any number of other extreme behaviors."

Five? I think you meant fifty.

Five - ha ha ha...

[smacky]

People who are diagnosed with something definately have a personal responsibility to change their lifestyles once diagnosed (diabetics have to change their diet etc) but before you are diagnosed -- is it really all your fault?

What about people with a predisposition to certain behaviors and/or a family history of a problem/disease? If a person is aware of this predisposition and/or history, aren't they guilty of ignoring these facts?

If it were as simple as just making good decisions, if it were actually in their power to choose wisely instead of poorly, it would already have been done. It's hard, even if it is your own fault.

It is as simple as making good decisions. Yes, it is hard. Life is hard. Then again, I don't want to pay for others' lack of discretion.

The question is how to help those people to make good decisions.

Good parenting is a good start.

[MainstreamMan]

Not that I will sway any here, but I think those who oppose the description of addiction as a disease do not have a very sophisticated sense of the meaning of the word or the attribution.

From American Heritage: Disease--

"A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms."

Some of the reasons stated above for why addiction is not a disease fit with one or many of the features included in this definition.

Those who drink to excess due to stress in a way that makes them identifiable based on that behavior can be said to have a disease in their behavioral-cognitive (decision making) system, for instance. If that definition can be agreed upon between people reliably, it can be used to determine why these people differ from others in this meaningful way.

A recent review of the issue:

"Over the last several years, considerable evidence has accumulated on the reliability and validity of modern definitions of alcohol dependence and abuse/harmful use. The evidence comes from studies conducted in clinical samples, general population samples, and samples of participants and their relatives in genetics studies, and not only from U.S. samples but also from samples assessed in many countries around the world. The evidence is very consistent regarding the classification of alcohol dependence (Hasin et al. 2003). This diagnosis, as represented in DSM?III?R, DSM?IV, and ICD?10, has consistently been shown to be reliable and valid. Based on the evidence, investigators can use this category in their research with a high degree of confidence."

Indeed, alcoholism as a disease category is more reliable than many conditions that would be slam-dunks as diseases in most discussions

Autism stands out as one to consider.

Once you get past an idea that a disease is something you can treat with a pill, then the definiton makes sense.

[Larry A]

This argument is silly because it focuses debate on the wrong question. Regardless of whether addiction is a disease or a poor lifestyle choice, incarceration does more harm than good.

[Doctor Duck]

wonder why surefire pills haven't been invented to block the physical desire for whatever addiction one has

Coming soon. Rimonabant, to be marketed by the makers of Ambien as 'Acomplia', has been through testing as a diet drug with a unique mode of action. The smart money says that it will be prescribed 'off-label' for all sorts of addictive behaviors.

You read it here first. Um, unless you read it somewhere else already.

[M]

http://www.rational.org/

........................................that is all
Ye know on earth, and all ye need to know.

[Russ 2000]

smacky,

Good parenting is a good start.

I tend to agree with that, but it's so simple it is too often ignored. If good parenting is a good start, then bad parenting is logically an enabler of self-destructive behavior.

But some people (not me) consider bad parenting an excuse. If that denail isn't enough of a roadblock, there are enough people who DO consider bad parenting an enabler that insist on taking useless, extreme measures to combat bad parenting - like fomenting hatred of bad parents (rather than trying to simply understand them) or Children's Health advocates looking to prosecute, fine, and incarcerate parents for relatively benign transgressions like smoking in the house or letting the kid take a candy bar to school.

[grylliade]

It is as simple as making good decisions. Yes, it is hard. Life is hard. Then again, I don't want to pay for others' lack of discretion.

Well, yeah. But what's wrong with people asking for help with getting themselves out of their own bad decisions? I'm not suggesting that treatment be paid for out of the public purse, just that saying that addiction is a disease isn't entirely wrong. Again, it's easy to criticize others for bad choices when you yourself have been largely able to avoid those bad choices; but when you've made bad decisions your entire life, that's all you have practice with. You make good decisions by making good decisions, and learning how to avoid the seduction of taking the easy way out. But that's easier said than done. Sometimes people need help to make that first good decision, and there's nothing wrong with giving them help to do so, if they ask for it.

Look, there seems to be the same trap here that people often fall into. It's either "addiction is a disease, and addicts are victims," or "addiction is a choice, and addicts are weak and stupid." Maybe both are wrong, and the truth lies somewhere in between. I'm arguing that addicts aren't weak and stupid, they're just trapped in a cycle of bad choices. Granted that that cycle of bad choices was put into place by their own decision; when they want out, do we refuse help and tell them to lie in the bed they made? Or maybe, just maybe, we can realize that everyone has their own demons to face, and this is theirs, and give them help. We don't have to absolve them of responsibility for their choices.

People are largely (if not entirely) products of their genes and environment. If I have never been taught to exercise my willpower in such a way as to overcome my weaknesses, how do I learn late in life? It's doable, and some people can even do it on their own, with no one else's help. But that doesn't mean that every person will be able to, nor does it mean that they should. If people can quit on their own, with no external help, more power to them. But if they can't, what are they supposed to do?

Good parenting is a good start.

Yeah, no shit. Doesn't do me much good if I'm a fifty-year-old addict to tell me that my parents should have done a better job. Well, obviously. But, again, where do I go from here? The answer to a plea for help isn't, "You shouldn't have gotten yourself into this mess." Again, no shit. But I can't exactly change the past. All I can do is start from where I am now.

Okay, here's an analogy. Say that I find that I need to lift a two-hundred-pound weight off of my legs, through my own choices. I find that I can't do it. If I ask you to help me, is the best response really, "You should have been working out"? Well, maybe I should have, but I didn't. Now I kind of need your help. Now, if time and again, you find me in the same situation, and I have never developed the strength to lift the weight, it's becoming apparent that it's a character flaw. And sometimes people just need to be left under the weight. But, if after helping me lift the weight, I ask for help in not getting in that situation again . . . is that weakness? I don't know how to not get in that situation to begin with, so I want help from someone who does know. That's just common sense.

[smacky]

Okay, here's an analogy. Say that I find that I need to lift a two-hundred-pound weight off of my legs, through my own choices. I find that I can't do it. If I ask you to help me, is the best response really, "You should have been working out"? Well, maybe I should have, but I didn't. Now I kind of need your help.

That's a very poor analogy. Drinking and drug problems aren't comparable to a two-hundred pound weight on your legs. A better comparison would be you adding one-pound weights on to your legs eventually until it starts to hurt, and then continuing to place one-pound weights onto the pile that is already there, and asking other people to "help" you figure out how to get the painful mass of weight off of your legs as you continue to add one-pound weights onto yourself.

But, if after helping me lift the weight, I ask for help in not getting in that situation again . . . is that weakness? I don't know how to not get in that situation to begin with, so I want help from someone who does know. That's just common sense.

Yes, it is character weakness at the very least. If someone can't figure out to slowly and incrementally put down the cigarettes/alcohol/drugs, they are dumber than the bag of crack rocks they are holding, and it ceases to be my problem. You can only tell a person so many ways. I see how voluntary support groups might be helpful, though, to people who are lacking a real-life social net of concerned friends/family, and I think they are a positive step.

[beloml]

"And how, exactly, are you supposed to develop that willpower from nothing at age forty or fifty?"

Ummm . . . by not going out and buying, and then using, drugs?

[Robert]

"One has to wonder why surefire pills haven't been invented to block the physical desire for whatever addiction one has."

When treatments are discovered that do that in animals, their mode of action turns out to be one of the following:

(1) Make the animal stupid or confused, so the animal has trouble learning what it likes, or learning how to get it.

(2) Decrease the animal's motivation to do anything. The animal is either so euphoric it has no further desires, or so dysphoric it despairs of acting on any desires -- hard to tell.

"To put it bluntly, I don't see how you can be a whinny assed do gooder concerned about addicts who can't help themselves and still be for the legalization of drugs."

You can't. The best the whiny assed do gooders can do is to opine that addicts not be punished, but they certainly aren't for allowing drugs to be sold to potential addicts.

Robert

[uncle sam]

If it is a disease, perhaps that justifies not putting users in jail. But, it being a disease makes a pretty strong case that drugs should be illegal and that dealers should go to jail. If people can't help themselves but get addicted, how can we allow unscrupulous people to get rich by feeding their addiction and how can we do anything but make drugs less available in society?

Ah the conundrum of prohibition. This logic, which at first seems quite reasonable, is exactly the opposite of what should be done.

That last thing you want to do with someone who is chemically addicted is to make them desperate for sources of relief.

The prohibition of addictive substances makes them quite expensive (which drug warriors perversely like to crow about), thus rewarding those who are willing to disobey the law to make a profit.

Drug prohibition, like most government policies produces perverse results.

[Ruthless]

Why no comment on the image?
If it had been cropped lower, would it have been a "costume malfunction"?
I mean, is the image supposed to be Janet Jackson "after drugs"?

Drugs don't make one ugly, after all.
Look at the ongoing "comeback" of Kate Moss.

[Jim Walsh]

My mother died in 1998 from a brain tumor. It was a slow, messy process; the worst part was watching her gradually lose control of her ability to think and communicate.

So go ahead, you richard-cranial types over at the ONDCP: ask me if I think that strung-out chick in the PSA would be better off with a brain tumor.

Go ahead, ask me.

[jackl]

Is "addiction" a disease or is just a "poor choice" by the irresponsible and weak willed, as some of you doubtless shining models of probity who have offered your smug condesention?

("Good parenting". Yeah, why didn't I think of that?!! /slaps head/. Like no kids with good parents ever went bad...guess that prodigal son stuff is just a bible story.)

Or is "addicition", rather, a dessert topping or floor wax or a meaningless bumper sticker slogan, an Oprah & Dr. Phil made up pop-psych thing, or a cleverly made up authoritarian thought crime, like some Soviet dissident imprisoned as a mental patient because he couldn't make it as a normal Comrade Getalong in the "worker's paradise" ?

Perhaps the real issue is Prohibition. End prohibition and you wouldn't have this argument anymore. Just like any third world drugstore, like Mexico when the cruise ships dock, you can go into a pharmacia and get your percocets you crave without doctor shopping and the government nanny state of the USSA. Without sending your maid out to the parking lot, like "addict" Rush Limbaugh, poster child of conservativism.

You "conservatives/libertarians" who have posted about "personal responsibility" here are really confused. Real personal responsibiity is you use what ever drugs you want and are responsible for what you do. Fake responsibility is the government telling you can't use such drugs at all...it's not a matter of your choice...because you will get "addicted" and get a "disease" which will cause us to imprison you, ruin your future employability as a felon, and take your property. Hmmmmm.

[cliff]

What is wrong with the prohibitionists? Comparing a genuine life threatening disease (cancer, heart disease, etc) to a problem largely created by thier own policies is outright absurd and IMHO certifiably insane. I lost my wife after a 2 year struggle with heart disease. She would've gladly traded her problem with someone that happens to use drugs.

Her condition was ultimately fatal, a drug user can choose to quit or not. The stigma from the prohibs policies is the reason that people have to hide their drug use. The growth of the drug testing industrial complex is proof that most drug users are pretty normal people and are pretty good at managing thier drug use and lives. If drug use was immediately recognizable, then drug testing would not be neccessary.

That's right! That's what the prohibs want you to think, that all responsible use is abuse and all users are addicts, diseased filthy addicts. More insanity.

[kevrob]

If addiction is something over which an untreated addict has no control, it isn't wise to criminalize drug use. I've proposed what ought to be done with drunk or stoned lawbreakers on a previous H&R topic. Drug users who don't break other laws ought to be left unmolested.

I don't know if the disease model is the best description for addiction. There is a physiological component, as it has been shown that some people have genetic markers that identify them as more prone to, say, alcoholism. Trouble is, I don't think there is a dependable test one can take to warn you about that. When people start drinking at 21 (or 18, or younger) they don't know if they will be doomed to alcoholism, or not. Joe College can indulge in the worst sort of frat-boy behavior such as binge drinking to the vomit-point, but later in life moderate his behavior and be a never-more-than-two-beers kind of guy for the rest of his life. His old college roomie Jack may find, when time comes to straighten up and fly right, that he "can't." These two guys react to alcohol differently, and that is partially down to physical difference, so if it's not a disease it is at least a "condition."

There's also supposed to be a psychological component to addiction. Joe may not have the "addictive personality" that Jack has. Counseling and/or support groups may be a perfectly sane response to a psychological problem.

I don't trust my general knowledge of these elements when applied to the other, illegal, drugs. There is so much propaganda and spin - One hit of crack and you can be addicted! - that I have several bags of salt ready when I read about the subject.

As several commenters with harsh personal experience have noted, ONDCP is rude and cruel to analogize addiction to less avoidable and more immediately fatal diseases.

Kevin

[Paul]

I always dress warmly-- you know, for the weather-- that way I won't catch Alcoholism.

[Paul]

But seriously:

I lost my wife after a 2 year struggle with heart disease. She would've gladly traded her problem with someone that happens to use drugs.

I'm sorry to hear that, cliff, and that about sums it up. I'll trade a brain tumor for a coke addiction any day of the week. I can beat the coke addiction.

[Paul]

A better comparison would be you adding one-pound weights on to your legs eventually until it starts to hurt, and then continuing to place one-pound weights onto the pile that is already there[...]

Yeah, and while everyone around you keeps telling you "quit putting those goddamned wieghts on your leg because eventually, you won't be able to get up".

Sorry, peeps, but addiction is not waking up one morning with a 200lb weight on your leg. It's a process of choices and actions and consequences stemming from choice and action that gets you there.

We can debate how much, when and if addicts get help, but you didn't 'catch' your addiction. Oh, and I can tell you from experience that society is overflowing with help for addicts. It's just that addicts are what's known as a generally 'uncooperative' group. Often times they have to hit rock bottom before they're ready to accept help.

To take the 200lb analogy further, it's like what smacky says, you keep putting one pound weights on your legs-- and then when you have 150 pounds and you're offered help, you say "fuck off" and continue putting weight on your legs. Then at 175lbs, you're offered help again (probably by a social worker in an emergency room that you're in because of an abcess or some such thing) and you say "fuck off" and leave A.M.A. Then at 200lbs you ask for help again, and when you're told what you need to do, you say "fuck off" and leave again, A.M.A. Then, six months later when you have 250lbs on your legs, you're again in the E.R.... and so it goes.

The above vignette brought to you courtesy of daily events in a real emergency room.

[Bobster]

...If you don't want to do something, and you find yourself doing it anyway, it's easy to excuse the choice by saying you are addicted...

Does going to work count?

[jackl]

I'm sure if you do your sampling and analysis of "addicts'" behavior from an emergency room, Paul, you're going to see quite a skewed sample, dontcha think? That's pretty much the same as what you'll hear from cops too. I don't base my opinion on physicians (totally) on how they behave at the country club bar either.

[cliff]

Does going to work count?

Comment by: Bobster at August 11, 2006 05:58 AM

Yes, you are hopelessly addicted to work and you must seek counseling.

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