Addiction is NOT a Disease???

This is a deeper topic than you're suggesting. The past twenty years of neuroscience have been putting a tighter and tighter box around what "free will" can be. Much of what we are and do is determined by our genes, and the rest is pretty much set in-utero (the primary environmental component). The next 5-10 years may add another 10-15% of variation, and we don't have much control over that, do we?

After age 10 we're pretty much on cruise control -- or so it seems.

So the contrarians aren't really arguing about addiction, they're arguing about the fundamental basis of responsibility. If all we are and do is determined by our genes and uterine residence, then what does punishment mean?

So they're arguments are nonsensical, but their anxiety is completely understandable. If our civilization survives I am reasonably certain that within 40 years our concepts of punishment and responsibility will be dramatically different.

You hit it on the nail. I often run into well-educated people who assert and insist addiction is not a disease. After scratching the surface to their assertion, they continue to deny it's a disease. I have to go to lengths in persuading that in fact it is.

I often point out if alcoholics lack self-control, or it's a matter of moral temperance, then mice are just as immoral, lacking in self-control, or self-indulgent as alcoholics.

A study involving breeding rats with the alcoholism gene demonstrated the following:

* Rats deficient in the CREB protein drank about 50% more alcohol than normal rats. They also showed more anxiety-like behavior in a maze test.
* These rats also showed a higher preference for alcohol over water compared with normal rats; yet they had similar preferences for sugar water -- indicating that the alcohol consumption was not related to taste preferences.
* These rats also displayed more anxiety than normal mice, which decreased when drinking alcohol. The anxiety-reducing effect of alcohol was not as great in the normal rats.
* Alcoholic rats had higher levels of the CREB protein in the central amygdala

The only rat I know that has higher morals and stronger self-control than of an average human is Splinter from TMNT.

I believe this is a matter of ignorance in the general public. Many people fight to educate the public. For example, just listen to radio talk show Loveline to just hear about Dr. Drew Pinsky M.D. expert advice on the matter. People who call in to the show struggle significantly from their disease. As he cites, "unlike any other disease, alcoholism is the only illness you need to convince patients they have." -- many from the public for that matter.

I would call alcoholism a compulsion - somewhere between a disease and a habit. A compulsion can be almost impossible to resist but people do resist them and I think Alcoholics Anonymous is a good example. I agree that people are predisposed to many health issues but to say everyone with a certain predisposition will always get the disease is obviously not true. The "National Institute on Drug Abuse and the vast majority of addiction specialists" may depend on federal funding and donations. These and other institutions may have a vested interest in making their particular issue seem as critical and dangerous as possible and threatening to middle-class people (or anyone with the money to donate or the time to write their Congressman.)

The definiton of the words "disease" and "disorder" are too ambiguous. Here you say: "It's a disorder, in other words, in which the brain is malfunctioning." Is a disorder the same as a disease?
I'm curious about the definiton of disease that Satel and Lilienfeld gave, which implies that the afflicted could not do anything to prevent the condition and could not "will" the disease away.

Dictionary.com defines "disease":
1. a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment.

So which definition is correct? In this case, doesn't it all come down to a classification? In some ways I feel "disease" is not quite fitting for alcoholism, but that is not to undermine the seriousness of the condition.

PS: "The only rat I know that has higher morals and stronger self-control than of an average human is Splinter from TMNT." Props to you.

Wow, that was kind of a bitter, petty response to a sober and professional disagreement with your article.

If we had, we would just have said "never mind."

How is this shallow sarcasm supposed to convince people that your point of view is correct?

Which is to say, it's kind of like picking your nose in public, evidently, except that it's more expensive.

Again, you turn to an attempt at comedy to respond to a serious critique. It's not impressive.

This clueless pair doesn't argue that the neurochemistry of an addict's brain is no different from that of a non-addict.

Calling two professionals "clueless" because they dared to disagree with you is simply juvenile.

And it goes on. "...gems of wisdom..." "...those who actually know something about it..."

Why not simply address where you disagree with them without the cattiness? Dismissing dissent like this by professionals who have a history of research and actually helping addicts control their behavior indicates a real lack of humility on your part. Your attitude suggests you have nothing to learn from experts who disagree with the experts you agree with.

Finally, suggesting that they consider addiction to be like "picking your nose" or "throwing your socks on the floor," or that "...the authors long for the days of Nancy Reagan's "Just Say No" campaign" is more than just unprofessional and juvenile. It's a dishonest way to debate and indicates an inability to constructively disagree with someone.

In which case, I suppose, it's good that you're a writer and not a scientist.

--All of what you say would be valid if the Slate article were not, in fact, clueless.
M.L.

Shame on the treatment center industry parasites that prey on and enable these people with the completely unproven concept of “addictive disease” and peddle their 12 step snake oil! Nearly two years ago I went to the finest treatment center in this city; following a double DUI accident. I found the center and the associated 12 step community an abysmal failure on the whole (a revolving door). It was the most unclean, negative, self-defeating, fear based thing I have ever been exposed to. This is to say nothing of the fact that many of the participants (if their appearance and behavior were any indication) were deeply troubled beyond any supposed addictions (watch the movie “Sherry Baby”). I have absolutely nothing to do with that anymore and I have been completely healthy without having indulged in any use of drugs or alcohol. I had been drinking for 30 years. So! Here I am, after having been told by two expert sources that I was an alcoholic. B.S.!!! I sell steel for a living and if you ask me if your dog needs a steel dog house or if they can get by with wood…. Guess what I would say? These must certainly be the same experts that had us believing “Pluto” was a planet! Afflictions? Yes. But there is no such thing as addiction! I am neither a religious man nor a Christian but what I know this. “There is something greater than the greatest of human weaknesses.” What a bunch of crap you treatment center head shrinkers are selling. Shame on you!

I bet the success rate of parolees leaving "Rikers Island" (who live a crime free life) is higher than the success rate of those who leave these treatment centers.

All of what you say would be valid if the Slate article were not, in fact, clueless.

Ah, the old "is so!" argument. It's difficult to counter without resorting to the traditional response of "is too!"

I think the word "clueless" is constructively useless in a scientific disagreement. And I think it's obvious you're being emotionally reflexive when you use the word to describe the opinions of professionals who have spent years studying addiction and working to help people with addictions.

Damn, I blew my only joke. It should have said,

"It's difficult to counter without resorting to the traditional response of "is not!"

Forgive me, I have no editor.

LJM, you have to keep in mind this is a blog, and quite a well-written one at that. I like ML's style of writing because he keeps it light. If he had, as you seemed to suggest, kept it serious, it would have been boring. If I wanted to read a serious counterargument, I would pick up a scholarly journal. ML's little quips and analogies, like his stab at Nancy Reagan's campaign (which I think we can all admit accomplished nothing, with the exception of "Cartoon All-Stars to the Rescue"), make it interesting. Lighten up.

The comments of these two "Professionals" reminds me of two other non-sencical characters that were recently in the movies, if I am correct, there was even two movies made concerning these characters, they were "Dumb and Dumber". In some schools of thought about addiction as a disease concept, the behavioral portion that is first recognized by those around the addict and is the lasting impression that stays with the person. There is also decidedly a portion of the disease that is behavioral, and there are also portions of the disease that are physical and mental, as has been demonstrated many many times within the confines of Behavioral Sciences as well as Medical Science.
To disregard any of the evidence of addiction as a disease process is to effectivly mark oneself as only accepting "That which pleases me." But, isn't that a part of the addictive process too.

Elisabeth, I'm all for being light. I love light! I just think it's possible to respond to a disagreement (even in a light, funny way) without insulting the people with whom you disagree or misrepresenting their arguments. The fact that this is a blog doesn't really enter into it, as I think honesty and humility and objectivity are essential aspects of a disagreement (especially a scientific one), regardless of the forum.

I agree that ML has a good, informative blog here. But he's treating Satel and Lilienfeld with a snarky contempt best reserved for the likes of Kent Hovind and/or Jerry Falwell.

And while I agree that "just say no" was a disaster, the point is that it's dishonest to suggest that Satel and Lilienfeld supported that shallow method of drug education.

Addiction affects the brain chemistry. And continues to affect it after stoping. It has been shown that the brain will eventually start working properly again, after abstaining.

Love, adrenaline, smoking, etc, affect the brain chemistry. Shall we label them as diseases as well?

Labeling it as a disease allows the person to say, "oh, well it is not my fault, I have disease!". Thus differing responibity for there actions. It is a weak copout.

This concept of disease was started by a fraud, with the help of AA. The sarcasim of this article is amusing. And demonstrates the close mindedness of this culture. Indeed the close mindedness of this ORGINIZED RELIGION, As per the recent US Supreme Court ruling that sending an athiest to AA for rehabilitation is violating his constitution rights. As it is clearly a religious movement. And sad to say, like most religious movements, very close minded.

Every addict should know they have to build their own program of recovery. And since AA has a 5% retention rate, maybe it is not all it is cracked up to be. Maybe going to AA is just replacing one habit for another. Maybe there are other ways. Maybe there is valid research out there showing it is not a disease. Maybe being open minded is better than being close minded. Maybe I should stop being condesending and sarcastic.
James

Ps Check this site out for more logical info.
http://blogs.smh.com.au/radar/archives/2005/01/now_that_the_pa.html

During college (pursuing a psych degree) I studied psychopharmacology extensively. It is demonstrably true that addiction creates change in the operation of the brain, most commonly by reducing the number and sensitivity of dopamine receptors ('pleasure' receptors, though they're a lot more than just that). The question of whether or not addiction is a disease is not, however, dependent upon that fact. It is a question of how you define disease. It's semantics; and while that indication is usually used rhetorically as a way to minimize a difference between two positions, in this case it is very important because of our societal and personal reactions to the idea of disease VS. addiction. Typically, we assign little responsibility to individuals for the diseases that they have (there are exceptions such as emphysema, of course) and this in turn affects the way that they, personally, treat their condition. This is why I believe calling addiction a disease is a mistake. By calling it a disease, it removes the stigma of being addicted, makes medication the first line reaction, and destroys the cognitive dissonance that leads many addicts to seek treatment. As a society, we cannot give people the out of blaming their addictions on their genes or environmental factors. The cause of addiction is overuse of psychoactive substances. This is not to say that genetics don't play a role in determining susceptability, but no matter how maleable your brain might be you don't get addicted to heroin without sticking a needle in your arm. To call addiction a disease only validates the feelings of powerlessness that addicts feel. It undermines the fact that behavioral change is the only solution to their condition, and allows them to deny responsibility for their condition. Beating addiction is incredibly hard as it is, and the last thing drug counselors need is people coming to them with the belief that they have a disease which is beyond their control. If you believe your addiction is beyond your control to change, then you might as well be dead already because you're never going to do what you have to do to beat it.

While there is a predisposition linked to genetics and brain chemistry, a predisposition in and of itself is not a disease. Just like being predisposed to cancer does not mean you will get it, or that you have it. It just means you are more likely to get it. This predisposition does not constitute a disease. Someone with a predisposition to be an alcoholic can not become an alcoholic unless they start to drink, as opposed to other things like type-II diamebetes in which people can develpoe it even if they don't have a bad diet. So there is a fundemental difference between the predisposition to be an addict and actually having a disease.

Leon, Good for you that you were able to quickly give up drinking after a double DUI accident! As for the treatment center, for which you were either placed in by the court system or checked yourself in to avoid judicial reprimand, are not all the same. See the movie "28 days"! As for me fortunately, I found the 12 step program to be a life saver. I am by no means am a scientist or researcher but, I can explain things from my own experience. I have found that alcoholism is not a "disease" over the obsession to alcohol it's an obsession and compulsion, as someone else already pointed out. Its seeing, observing and feeling everything differently. With the 12 program comes the lessons on how to live and accept life. For you dear sir, you may have experienced one bad treatment center but it doesn't qualify as an expert. Perhaps if you had spent 30 days in jail instead you would be less bitter. Speak not of what you obviously know nothing about. In fact, you may be what we "deeply troubled" 12 steppers call a "dry drunk". You may not be drinking but you still act like you are.

The percentage breakdown in the first post above is completely bogus. I just wanted to mention that.

Tom,

I am a recovering addict, and I don't think that you fully understand the program. In the steps, we begin by admitting that we are powerless over our addiction. This means that we recognize that we can never begin using our drug again, because when we do we are not able to control ourselves. So, because I admit my powerlessness, this does not mean that I am doomed to relapse (I'm not), it simply means that I can never use the drug again, or I will end up in a very bad place (a jail, an institution, or dead).

After making that admission of powerlessness, the rest of the 11 steps revolve around behavior modification (and make no . Go look them up, there is no 'snake oil' as some claim. They simply say that we should look beyond ourselves for help, make an honest assessment of our faults, admit to them, make amends to people we've hurt, and then help others.

So, saying that the addiction is beyond my control to change means that I am now prepared to recover from it, not that I might as well be dead.

--Very good comment, thank you for helping people understand.
M.L.

I think before you claim authority you should live with a loved one who is an addict. Observe their self destructive behaviour, have precious items stolen, lose friends and family members and get to watch them die. All of this can only be prevented by the addict themselves. Addiction is always continued by choice - no matter how tragic this is - because choice is the only cure. I'll bet my friend who has breast cancer would like to choose not to have it.

Tim,

You say that you're powerless over your addiction, yet you go on to outline a behavior modification plan that sounds a lot like taking control back over your life. I bet you avoid the places you used to drink. I bet you avoid hanging out with the people you used to drink with. I bet you try to avoid the situations and cues that inspire the need to drink. These are all actions that you take, clearly showing that you are not powerless. And lets be clear: the notion that addiction never leaves you is not medically true. Overuse of substances such as alcohol due change the chemistry of your brain, but to a large extent by ceasing the use of those substances your brain can repair itself. This is not to say that you can't cause permanent brain damage, because you certainly can. Long term PCP use can essentially make people schizophrenic. But in terms of ending the addiction, i.e. the physical dependecy upon a drug, that ends when your brain reverts to normal (or as close as it can get depending on the length and intensity of your use). If that were not the case, then you would never be rid of the symptoms of withdrawal. But you are, after a while, because you have beaten the addiction. Research has not yet concluded (to the best of my knowledge) the degree to which a prior addiction makes you susceptible to a future addiction, though admittedly there does seem to be some evidence that relapsing happens faster than your initial addiction. I hope that you recover fully and never relapse, but you should review your statement logically: if you truly believed that you were powerless over your addiction, then you would not be able to stop. Period. But you can. You can change your behavior. You can change your environment. You have the power. If you believe that power comes from God, so be it. But it is still you who performs the curative actions, and that is not powerlessness, but rather the complete opposite. You are taking control over your life and over your addiction and I hope you are completely successful.

I should point out that when I talk about addiction, I am talking only about physical addiction. Not all drugs are physically addictive, but that doesn't mean that people cannot become dependent upon them from a psychological perspective. Marijuana is a great example. It doesn't change the chemistry of your brain the way a drug like heroin does, but you can certainly become reliant on it to relieve stress and forget about your problems. Technically, it isn't addicitive because if you stop there is no withdrawal because you are not physically dependent. That doesn't mean that it isn't hard to live without it if you are a habitual user who has come to rely on it just to get through the day. That too can be a serious problem, but from a medical standpoint cannot be called a dependency. If you want to call addiction a disease, then only physical dependency would come close to qualifying.

An important note to take into consideration:

Addiction as defined is a biological disorder with a genetic basis. It is the continue use in the face of adverse consequences. Addiction is progressive in nature, lethal, and highly associated with denial; as published in JAMA 1992.

A interesting thing to point out about addiction is this whole issue about personal responsibility and free will--as cited by previous comments.

But please consider this;

The addiction process hijacks the brain and scrambles the priority system responsible for survival, water intake, food, run away from bad things, sex, and so on. The priority system sits underneath cognitive, language, and even conscious systems. It's beyond the realm of will power; it circumvents the drive for survival. Once addiction overwhelms the priority system, with it's messages of intake of chemical or destructive behaviors, the motivational drives that a healthy human being typically has, breaks down. Will power is a system too and can be broken. This impulse or drive is vastly powerful, and perhaps a reason why AA struggles to retain members; people are simply overwhelmed by the impulse.

The breakdown of the motivational system is demonstrated by profound distorted, wrapped thinking,irrational behaviors, distrusting judgment, roundabout rationalizations/justifications, and iron wall denial.

It's a real bad disease, a biological phenomenon. And yes, people do bad things in their disease in order to continue using. It's important to hold them accountable so they can see consequences to their addiction. Losing an important relationship or facing near death often helps people get into treatment; sometimes this is only way to overcome the broken drive system and for them to "get it"

What about the other side of it? The self-blame that addicts can experience by 'taking responsibility' can reduce self-esteem and serve to strengthen the addiction itself.

Tom's argument -against- removing the stigma of addiction actually left me feeling a bit upset. I think that blame and stigma for addictions are what PREVENT the public from caring about these issues. They PREVENT addicts from getting appropriate care and access to resources and they PREVENT consistently successful treatment. Stigmas lead to fear, shame and embarrassment-they also make it more difficult for someone to acknowledge their addiction and obtain treatment.

James made an interesting comment when he said: 'Maybe going to AA is replacing one habit for another.' I think this statement hints to addiction being a lot deeper than simply a case of a one-off addiction to alcohol, for example. Too many other factors come into play-our genes being one of them.

I have no special expertise in the behavioral sciences. My knowledge stems only from reading and one-on-one work with addicts. I have trained and volunteered as a person-centered counsellor for around 6 years. This is an ace blog entry though and I'm curious to read more from those who are experienced in the field, whether from personal experiences or academia.

Tom,

Again, you misunderstand.

I am powerless over my physical reaction to alcohol when it is introduces to my body. If were to go to a bar after work and have a drink, I may just go home afterwards like a normal person, or I might wake up in Tuscon three days later. I honestly don't know which. That is what I mean by powerless. The physical disease of addiction is defined by the medical community as an allergy for this very reason (an allergy is defined as an abnormal physical reaction to a substance). I do not perform any 'curative actions' because I am not (and will not be) cured - any more than a diabetic 'cures' him/herself by injecting insulin.

I am not, however, powerless over whether or not i choose to have that first drink. That is where the behavior modification comes into play. Yes, I avoid people, places and things that could cause me to take a first drink.

Parents of children with nut-butter allergies also avoid keeping Skippy around the house so that the kid does not become tempted and kill himself. Furthermore, just because the kid is not currently choking or displaying some other physical symptom does not mean that the allergic condition has disappeared. The same is true for me. I have detoxed from alcohol quite a while ago, and I currently show no signs of withdrawal. My addiction, however, is still there waiting for me.

As for the God thing, let me clear something up. AA and the other step programs welcome the religious, the agnostic, and the atheists (it's none of your business which one I am). A 'Higher Power' or 'God' is defined by each individual member and there is no litmus test over how one defines it. If you feel that it is your family, nature, the weak electromagnetic force, Krishna, L. Ron Hubbard, the Socratic Method, or the community of people that love and support you - doesn't matter. The only thing that I need to understand about God/Higher Power is that it is NOT ME.

David's comments are well said. I do have one comment on the genetics issue, however. Genetic basis only refers to susceptibility to addiction. Almost anyone can get addicted, its really a question of how much of a drug it takes to get your brain to change. Take cocaine. Cocaine is essentially a dopamine analogue, and when you use it your brain is in essence flooded with dopamine. Your brain 'knows' how much dopamine should be floating around, and if you continue using cocaine and overloading it then your dopamine receptors will eventually downgrade their sensitivity, and the total number of receptors on a given neuron will also decrease. As this process continues, you need ever greater amounts of the drug just to feel normal. When you quit, your brain remains in an altered state and your natural levels of dopamine production cannot satisfy your needs. Then you get horrible withdrawal symptoms. The rate at which your brain adjusts is most likely due to genetics. However, the drug use is what causes the addiction, not genetics.

Actually, marijuana addiction has been reported to be harder to treat than heroin. And if you do go through withdraw, it should be in supervision of medical staff because detox of marijuana, for some, can place a person into deep depression, and possibly suicide. Oh withdraw is very real.

Marijuana withdraw is associated with paranoia,irritability, depression, and anxiety. Addicts then in turn, use more to self-regulate these symptoms. However, it only accelerates the break down. So often addicts would switch to alcohol or drugs like speed or crystal meth.

True it does not change the brain chemistry like heroin does, but it does end up massaging the same reward system that heroin does.

Not all people with an genetic predisposition for addiction,will be addict to marijuana. For some it may not work for them. For those it does work, it's POW, a big bang of euphoria, typically after three times or more with the drug.

Tim,

I don't know who told you or where you read that addiction is classified as an allergy, but that is not true. The medical community as a whole doens't classify addiction as a disease, hence all the debate. In any case, the allergy example is not a valid comparison. Allergies are abnormal reactions on the part of the immune system to foreign agents. Typically, its an overreaction on the part of histamines (hence all the swelling). Alcoholism is not like that. Your immune system doesn't react to alcohol. Being addicted does nothing to change that. Physical addiction is a result of brain change, and like I said most of that is reversible. From a medical standpoint, you could go have a drink and your brain wouldn't immediately revert to the addicted state. Not that I am suggesting you do. From a behavioral standpoint, taking that one drink could easily as you say put you back on a hopelessly destructive path. I just want to be clear though that any reaction you have is at this point behavioral and not medical. That's why I object to the disease terminology. If you're using addiction in a more expansive way to include behavioral reactions to alcohol, then you're absolutely right. I'm only arguing from a purely psychopharmacological point of view. I certainly wouldn't want you to test it and destroy your life again.

P.S. Diabetes is a really bad comparison to alcoholism, because you cannot ever reverse the physical deficiences that come from having diabetes, whereas your brain can largely repair itself from alcoholism. In many ways its the opposite: physically speaking, an alcoholic drinking is a lot like a diabetic taking insulin: both are trying to relieve physical suffering by ingesting a substance that replaces one their body has stopped producing naturally. Insulin for diabetics, GABA receptors with alcohol (it's more complicated than that, but who really wants to get into it?). The only difference is that not all diabetics are responsible for their condition, while all alcoholics are.

Dave:

Marijuana addiction is possible through the dopaminergic system in the same way that sex or food addiction is. I suppose I should have been clearer in my statement: Marijuana affects canabanoid receptors, which show no upgrading or downgrading of response due to stimulation by THC. But your point is well taken: you can get addicted to anything if it becomes so pleasure creating that it causes a downgrading of receptor # or sensitivity in the dopaminergic system. Sorry for getting so technical.

Tom:

Although a bit technical for me, I buy it.

Tim:

Well written comment that illustrates the 12 step process. Thanks for helping people understand better how it works.

Tim writes

"As for the God thing, let me clear something up. AA and the other step programs welcome the religious, the agnostic, and the atheists (it's none of your business which one I am). A 'Higher Power' or 'God' is defined by each individual member and there is no litmus test over how one defines it. If you feel that it is your family, nature, the weak electromagnetic force, Krishna, L. Ron Hubbard, the Socratic Method, or the community of people that love and support you - doesn't matter. The only thing that I need to understand about God/Higher Power is that it is NOT ME."

And this works for the athiest how?
How is an athiest to believe in a higher power that is not me, if he does not believe in a higher power to begin with?
Thus the US supreme court ruling about 12 step being deeply religious.

James

It should also be noted (if it hasn't already) that AA's success rate is roughly the same as that for people who attempt to end addiction without any support at all.

In terms of a "higher power," I think that for some individuals, the notion that they don't have the power to end their addiction on their own is actually disempowering (if that's even a word). For people with spiritual inclinations, however, it might be just the thing they need.

Since every addict is an individual, I think there are probably a lot of effective ways of ending addiction, based on each individual's particular needs.

Tom

"The only difference is that not all diabetics are responsible for their condition, while all alcoholics are."

1. What possible difference does this make?
2. Addicts are in fact not always responsible for their situation. There are children born addicted because of the mother's drug consumption. Also, I've known quite a few people who have become addicted to medication due to over-prescription or poor medical oversight.

I fully admit that I am responsible for the consumption of alcohol that led to my addiction, as are the majority of addicts. This fact, however, does not provide any evidence one way or another as to the classification of chemical addiction as a disease. People infected with HIV, or who suffer from heart disease at a young age may also be responsible for their condition. Do these become 'lesser' diseases because of that (or perhaps they are not diseases at all. You seem much better informed).

Addiction is a disease.

For years psychologists/psychiatrists unfamiliar with addiction patients have been trying to "dumb down" this text book definition. To make light of this disease and call it a habit is disgraceful. Satel and Lilienfeld should be removed of practicing any type of medicine and get their own head examined. These two clearly suffer from ego issues of their own and the insecurity of not being able to treat those who suffer from these so called "habits."

I have experienced first hand the pain/suffering addiction has inflicted upon others. A disease is something that we are born with and forced to live with. No one chooses to become an addict, much like no one chooses to have diabetes or a food allergy. But if you are dealt that hand in life, you do have a choice to live without the agents which can destroy you.

I pray to god that we can unite in this world together to fight these battles of ignorance and defamation. What we need is love, compassion and hope that those who live with addiction continue to fight for the right to live!!!

"And this works for the atheist how?
How is an atheist to believe in a higher power that is not me, if he does not believe in a higher power to begin with?
Thus the US supreme court ruling about 12 step being deeply religious."

A higher power is to be interpreted by the patient by to mean beyond themselves. If the patient is an atheist, than they can interpret a higher power to mean their family, significant other, their childhood role-model, mother nature, or the AA group themselves--anything that higher beyond themselves that could be more powerful than themselves.

I must admit, initially, I was suspect of that part of AA recovery process. But let me float a theory: perhaps, accessing a spirituality inside the patient could lend itself to accessing certain emotional systems that could aid in bypassing the broken drive order of the brain, and provide pathways towards recovery.

Here is a quote by Jack Marx. Jan 1, 2005
http://blogs.smh.com.au/radar/archives/2005/01/now_that_the_pa.html

That AA is a religious movement is a truth so self-evident it’s a wonder debate still exists. References to “God” – a proper noun always – appear in The Big Book 136 times, with a further 348 references to “Him”. Prayers ride on language more suited to the King James Bible than a manuscript from post-Volstead New York:
"God, I offer myself to Thee - to build with me and to do with me as Thou wilt. Relieve me of the bondage of self, that I may better do Thy will…Thy Power, Thy Love, and Thy Way of life. May I do Thy will always!"

Chapter Four, entitled "We Agnostics", goes to pains to reassure the “anti-religious” that the higher power need only be “God as you understand him”, then very clearly refers to agnosticism as “prejudice”, experienced pre-recovery by the authors who “often found ourselves handicapped by obstinacy” before “casting aside such feelings” to become “open-minded on spiritual matters”.

But hey, I am far from an athiest. But I am also not christian, so maybe that says something.

What ever floats your boat. You could say I use some of the steps in my own recovery. Or you could say it just looks like I do, cause I practise spiritual principles from a different belief structure.

The point being, AA will not work for everyone. 95% of people to be frank. Why? The disease concept, powerless concept, denial, higher power, to name some of the major points.

James

As already stated in various ways, the underlying & apparantly intractable argument seems to be a quasi-theological one: genetic predispostion vs. choice. On this point I think that the Slate writers make a very common-sense & usable distinction: that disease should be understood as "afflictions that are neither brought on by sufferers themselves nor modifiable by their desire to be well."

Does this mean that some people can't be more or less predisposed than others to addiction or say, obesity? Of course not. Nor does it imply that we should not feel sympathy & compassion for addicts, or that pharmaceutical interventions can not help them with their problem. It also does not mean that human choice doesn't affect the course of physiological diseases like heart disease or diabetes; of course it does. But choice alone cannot CURE Huntington's Disease or Alzheimer's. However, countless former addicts DO eradicate their 'disease of addiction' through behavioral changes alone.

Once again, we open the debate up to a semantic turf war, as the disease-proponents might simply argue that addiction is never cured but only goes into "remission." But this line of medicalizing is only persuasive if you grant Lemonick et al the right to indiscriminately widen the definition of disease to include virtually any constellation of behaviors that appear to deviate from preconceived models of normalcy, which are of course incredibly relative culturally & historically-speaking. Such broad definitions risk losing credibility by their arbitrary & omnivorous quality, like the definiton of "disability" to some hardcore disability rights advocates, which makes no qualitative distinctions between paraplegia, Down's Syndrome, anencephaly, mental illness, and persistent vegetative state.

Lemonick appears to take delight in condescendingly disparaging their argument as if the Slate authors were arguing for intelligent design. In fact, psychiatrists & psychologists are probably better gatekeepers than physicians and pathologists for creating useful classifications & distibnctions between behavioral disorders and brain diseases that carry behavioral symptoms (like schizophrenia). And, yes, I realize that there are underlying reward-seeking mechanisms that can eventually alter an addict's brain chemistry, but unlike the paridigmatic "chicken & egg" dilemma, it appears obvious that the behaviors produce the chemistry and not vice versa.

Wow!! Everyone sure seems to have done their homework with regards to their positions on addiction classification. Lots of fancy words and quotes on the "latest statistics." Perhaps someone could explain to me that with all the apparent experts out there why we are still witnessing very low success rates in recovery for addicts regardless of the treatment they are committed to.

Many of the responses I've read above have sadly shown me, as with much North American society, how people become so quickly focused on fueling their own intellectualism and misguided arrogance at the expense of what the real issue is.

Matt: If by "the real issue," you mean focusing on more successful treatments and higher recovery rates, then you may also be missing the point of this particular forum. The question of whether addictions are more effectively treated through behavioral interventions vs. pharmaceutical ones (or some effective combination of the both) is hardly a trivial matter. Nor is it idle intellectualism to ponder the potential economic effects or such reclassifications (addiction, obesity as diseases vs. lifestyle choices) vis-a-vis health insurance, Medicare, and the like.

Perhaps you'd like to take a crack at your own (rhtorical?) question: why do YOU think the success rates so low?

I find it interesting that virtually no one in this forum has yet commented on the effects of our consumption-driven, media-laden society, where we willingly bombarded ourselves for hours at a time with images of alcohol consumption, easily obtainable sexuality, and wealth without effort. No small wonder that anti-depressants are the most popular prescription drug in the U.S., which also happens to be one of the most affluent societies in human history. Apparantly lots of reasons for people to destructively pursue the oblivion of addictions to assuage their depression.

Matt: An expert has knowledge and experience in the field with regards to available research and treatment options. It's not synonymous with curing the condition. If I was addicted to -insert substance- and went to an expert, I would be doing so with the impression that the expert has extensive information and experience to treat my condition and can thus provide the best treatment given the current knowledge base. The fact that success rates are low speaks to the numerous unknowns, challenges and complexities of addiction.

p.s. -waits for you to share what the real issue is-

This is sort of off the subject, but bear with me.

When President Bush said 'America is addicted to oil', did he really mean addicted or highly dependent?

You'll have to ask Bush what he meant. While you're at it, give him a swift kick in the arse for his recent antics over stem cell research.

Why would I kick Bush? I don't care about him, stem cell research, or politics in general. Money is more important than politics. What good is freedom if you are poor? Money can buy freedom. Freedom can't buy money.

So am I addicted to money?

James

I'm aware that this probably won't get through to you, but here goes nothing -

AA was founded, and the Big Book was written in the 1930's in the United States. So yes, the language in the text reads as biased to the Judeo-Christian system of belief (i.e. God as a white dude with a beard sitting on a throne controlling the world). The style of writing can be a bit antiquated and even off-putting at first.

The intention of the program, however, is to be inclusive of everyone, regardless of their religious belief (or lack thereof). In fact, we open each meeting with the phrase "the only requirement for AA membership is a desire to stop drinking" and we mean it.

I have never seen anyone kicked out of a meeting, ostracized, or even looked at sideways for calling themselves an atheist, saying that they don't believe in god, or are even having trouble understanding the concept of a higher power. It simply does not happen, in my experience. In fact, and honest admission of belief/non-belief is always welcome - especially since we alcoholics tend to have a problem with honesty. AA is not a religious program, it is a spiritual one (and each member can define spirituality in the manner they see fit). This has been the case since it's inception. Those who disagree have, in my opinion, not spent enough (or any) time around or in the program.

Also, I could care less what the Supreme Court's opinion of the matter is, as well as Jack Marx's (whoever he is).

Hi Tim,

I am not out to bash 12 step. Nor endorse it. It is what it is.

How would the words "spiritual program" sit with an athiest? The answer seems obvious to me.

Not believing in spirituality or god, or not believing in powerlessness, are huge road blocks for some entering 12 step. And some try out of desperation, because there seems to be no other ways. As only a handfull of treatment centres are not 12 step based.

You seem to say that AA can and should work for everyone. That they are either in denial, or have not given it a shot. This seems like a very illogical statement.

One cannot help but see similarities in fanatical religious movements, claiming theirs is the only way to heaven.

If someone says AA did not work for them, and considering that would be 95% of people who try it, could there not be something valid to there statments? If the medication I took only had a 5% success rate, would I be wrong in looking for other medication? Or maybe I am just in "denial".

As I said everyone must build there own program. Sad to say that there is not much out there except 12 step. Lots of 12 step bashers who would have you buy there book though.

To each his own. Would it be surprising to say that I attend the odd 12 step meeting? Imagine that!

James

Mr. Lemonick: Perhaps you'd like to respond to Wm. Salletin's latest piece on obesity.

http://www.slate.com/id/2171214/

--I'll take a look, but I don't want to get into the habit of critiquing each Slate story that comes along.
M.L.

James,

'Spiritual Program' sits just fine with me, and I have been non-religious my entire life. In fact, I know quite a few atheists in the program. You may refuse to believe that this is possible, but there it is.

From Webster's Dictionary:
Athiest
Pronunciation: 'A-thE-ist
Function: noun
: one who believes that there is no deity

I, and many in AA would define ourselves by this criteria. If you have concocted your own definition that gets you through the day, then more power to you.

AA, and any program based on the AA model, does not require that members believe in a deity. Period. So, atheists are, and always have been, more than welcome.

Also, you put words in my mouth when you say that I claim that AA can and should work for everyone. I have never, and would never, claim that to be true. I can only say that it works for me, and I know that it has worked for millions of others.

Is it the only way to stop drinking? Nope. And nobody ever claimed that it was - even Bill W. If someone finds a method of achieving sobriety that works (12 step or not) then they should hang onto it for dear life and not let anyone talk them out of it. The survival of the addict is the only important issue.

The 5% statistic gets kicked around quite a bit (and is constantly quoted as if it were an unassailable truth). Where does this come from? Does it mean that only 5% of alcoholics who have ever tried AA for any length of time (even one meeting) succeed in attaining long term sobriety? If that is the case, then I believe that the statistic is probably too high - .005% is more like it.

The whole point of the program is that it has to be adopted permanently. I can't expect to go to 1, 5, 60 or 90 meetings and expect to dust myself off and say 'Well, I'm fixed, then' and go off on my merry way.

And, no, it is not surprising that you attend an occasional meeting. Your knowledge of the program seems just deep enough to suggest that you probably stop by once in a blue moon.

From webster

spiritual
3 entries found for spiritual.
To select an entry, click on it.
spiritual[1,adjective]spiritual[2,noun]spiritual bouquet

Main Entry: 1spir·i·tu·al
Pronunciation: 'spir-i-ch&-w&l, -i-ch&l, -ich-w&l
Function: adjective
Etymology: Middle English, from Anglo-French & Late Latin; Anglo-French espirital, spiritual, from Late Latin spiritualis, from Latin, of breathing, of wind, from spiritus
1 : of, relating to, consisting of, or affecting the spirit : INCORPOREAL
2 a : of or relating to sacred matters b : ecclesiastical rather than lay or temporal
3 : concerned with religious values
4 : related or joined in spirit
5 a : of or relating to supernatural beings or phenomena b : of, relating to, or involving spiritualism : SPIRITUALISTIC
- spir·i·tu·al·ly adverb
- spir·i·tu·al·ness noun

Anyways, believe what you want. It dont make much difference to me. And vice verca I imagine.

Seems to me, the more shaky and unsure someone is, the more fervently they will hold on to something. Eyes closed, jaw clenched, hearing nothing but their own heartbeat, with a deathlock on their belief structure. Must be a crappy way to live, one day at a time. Just an observation.

James

"Seems to me, the more shaky and unsure someone is, the more fervently they will hold on to something. Eyes closed, jaw clenched, hearing nothing but their own heartbeat, with a deathlock on their belief structure. Must be a crappy way to live, one day at a time. Just an observation."

Wow. You must have gone to some _really_ crappy AA meeting to have developed a resentment this strong. But then again I'm the zealot, Right?

Anyhoo. I'm dropping off of this, too. Thanks for the back and forth, James. My wife and kid are away for the week, and this kind of thing actually helps keep my head clear when I'm on my own.

Shaky, unsure, but still happily among the 5% (at least for today).
Tim

Yeah, sorry bout the one day at a time thing. I aint having a very good day.

This kind of dialoge has always helped me too. Take care, thanks for playing with me.
James

Early in life I observed the obvious: people who chose to smoke wasted money, couldn't stop, and either they or their loved ones developed lung problems. People who drank got into unsavory sexual behaviour and fights, and wasted money. Like my dad, they beat and cheated on their wives and didn't feed their kids. My college friends who did drugs dropped out of school and became thieves and bums with mental illnesses and burned out brains. So I CHOSE, out of my own free will, not to copy those 3 negative behaviours, and boy, am I GLAD! I had lung surgery twice from second hand smoke, was beaten, cheated on, molested, raped, drugged secretly by others twice, neglected, malnourished, and underpriveleged. Still, I CHOSE not to let any of those events become a permanent crutch or excuse. Pardon me, but in my humble opinion, addiction begins with one little choice, and expands from there. It's neither genetic, environmental, nor contagious. You can choose.

Sally Satel responds:

Below are the links to the SLATE article (note that the controversy is over the term "brain disease") and one to a expanded article on the same topic.

http://www.slate.com/id/2171131/fr/flyout

http://www.american.com/archive/2007/july-august-magazine-contents/the-human-factor-2

--Sally Satel MD

From the Time article: "By the time I reached my late 20s, I'd poured down as much alcohol as normal people consume in a lifetime and plenty of drugs--mostly pot--as well."

Perhaps the author is not a neutral observer in all of this? If successful biological treatments do become available, I wonder whether the author would approve of involuntary administration of such treatments since the addiction disease, as he so aptly puts, affects areas of the brain involved in judgment, and presumably, free-will decision making.

Be careful what you wish for.

--Point taken, but I can't really endorse the idea of NOT developing treatments because they might be used inappropriately. It isn't done with szhizophrenia medications outside of hospitals, so perhaps your fears are unnecessary.
M.L.

Sally,

I've always been puzzled by the argument that success in AA helps to dispel the idea that addiction is a disease (as in your article).

Most of those in AA (from my experience) believe that they have a disease, and also take the personal dimension of substance abuse seriously.

I find no conflict here, and am more than a bit confused by the arguments of those who do.

--Thanks, Tim. I was trying to make exactly this same point.

Ooh - and if you didn't know, many in the medical profession actually believe AA does not think of addiction as disease ENOUGH. This is because AA believes that addiction is also a moral and religious failing (yes they do - you have to actually read through the Big Book to find this out).

Also, there really is no research validating the effectiveness of AA. AA itself only counts its successes after people actually drop out of the program. Talk about cooking the data!

--You have to read through the Big Book intelligently. If and when you do, you'll see why most of what you say above is wrong. Your second paragraph, by contrast, makes no sense at all.
M.L.

After reading a few more comments, actually, AA IS a religious program. You actually have to read through the Big Book FULLY to find this out. Initially you get the sense you don't have to be any particular religion or even believe in God but halfway through you find out the real attitude - basically, that those who don't believe in God will change their mind anyway after a while. This is so condescending its unbelievable. And legally requiring people to attend AA has been successfully challenged many times in court because of the religious nature of the program. If you don't believe in God or a "higher power" the whole thing just doesn't make sense. Plus the 12 steps were based on a the Oxford group - a Christian fundamentalist organization. Pretty much word for word.

OK - one more point and I will stop. After reading Senator Biden's comments I have to comment. I like Biden, by the way, but he seems really ignorant on the topic. He says that the use of the term "abuse" is pejorative. WHAT? What planet is he on? Everyone who abuses alcohol, for example, has a brain disease? This would mean that the majority of the U.S. population, and even moreso if they've been to college (college students are more likely to abuse alcohol compared to their non-college going cohort)have had the brain disease of addiction because of their risky use of alcohol. Yes, risky use of alcohol qualifies as abuse, compared to dependence which is a NEED for alcohol. They are different, and thankfully only in a small percentage of cases does someone who abuses alcohol end up with dependence.

You can do all the studies you want but until you go through it how can you determine it is a diesease or not. Yes, I'm a addict and I have problems with drugs. But I took drugs for pain not for enjoyment. Now with this addict I work through it with help of God, Family and Friends.Do we need more rules with prescription drugs? I dont think so because there is people out there really in pain and can't get it because there doctors think they will be addicted to it. No one deserves to be in pain. So taking drugs to get high is wrong and it just makes it worse for the ones who really really need it. I know because I have friends who have medical problems who will need drugs the rest of there life and so will I. Walk in somone shoes for one day before you judge. Judging is for God to do. Not someone with opinion who knows nothing about the topic.

Robin Williams said: "You can do all the studies you want but until you go through it how can you determine it is a diesease or not."

I do not have to smoke crack cocaine to know that it is not a desired drug to be used. You are drug addict who is physically and mentally dependent on drugs to make you "feel normal". You are not in true pain. You should just admit that youm cannot imagine a life without drugs and that you will resort to any illegal, immoral, and incomprehensible activity in order to fulfill the next high. Judging is for me to do because I know what I am talking about.

I've never seen a journalist argue his point with such anger. It's as if he can't open his mind to the possibility that we as a culture may be mistaken in characterizing compulsive behavior as a disease. I accepted the disease model for years, and I accumulated a handful of clean years, though I chose to use drugs and alcohol again and struggled. I came to the realization that, for me, the 12-step/disease model actually hinders my success, and that I got clean in the first place not because I attended AA meetings, but that I chose not to drink or use drugs. For me, AA after relapsing was a horrible atmosphere that encouraged me to continue this loop of thinking: Why did I relapse? Because I'm an alcoholic. Now, I don't use those words. I'm not an alcoholic or an addict. I'm a person who has made some terrible choices. It's up to me to stop making choices that are detrimental to my health and happiness, not to mention the health and happiness of those who love me. This line of thinking makes much more sense to me. But I also don't want to negate the experiences of those who choose the 12-step route. That's a matter of personal choice, too, and if that choice helps one to choose not to abuse alcohol or drugs, then it's a good choice. In terms of journalistic balance, however, I think it would behoove this Newsweek writer to have looked at the credible research of those who have done vigorous studies into the idea that the abuse of alcohol and drugs is a choice, and talked to experts such as Stanton Peele and Jeffrey Schaler. But I'm throwing rocks at a glass house. Only a year ago, out of ignorance of the wealth of information from anti-disease model researchers, I may have written the story Lemonick and Park wrote. In fact, in my own book, Dixie Lullaby: A Story of Music, Race and New Beginnings in a New South, which came out in 2004, I wrote that I suffered from the disease of addiction -- as though there was no other way of looking at it. Time moves on and theories are challenged. It's up to us journalists to keep up, keep an open mind and admit that, in our reporting, we may have overlooked a nook or cranny.

--You've never seen a journalist argue his point with such anger? You either don't read a lot, or you're seeing my words though a very bizarre filter. Time moves on and theories are challenged. But the challenges have to stand up to scrutiny. If and when the alternate-theory guys make much headway, we'll revisit the topic.
M.L.

Oops. I inadvertently referred to Michael Lemonick as a "Newsweek writer." I apologize for the error.

OK, Michael, you got me there. I was being a bit disingenuous. I certainly have seen journalists react angrily -- I've reacted angrily myself. What startled me was the intensity of the anger: the name-calling, the wholesale refusal to even consider the other side of this debate. Frankly, it reminded me of how I reacted the first time someone gently suggested to me that there may be other ways of looking at the problem of drug and alcohol abuse. It frightened me, pissed me off. Then, when I began researching the topic, I found much debate within credible scientific circles.

Just because the authors have bought into the hopeless, worthless, unscientific conclusions that keep people in their bad habits and make expensive rehab centers rich, doesn't mean the rest of us have to buy it.

Has anyone raised the question why the problem is growing and not shrinking, even when AA and other like groups have been growing like wildfire since the govt adopted their flawed un-science as an excuse for caring?

Its because the "treatment" doesnt work because its not treating anything.

There is no arguing against the science of addiction, but to call it a disease is wrong. Addiction is more like an allergy - a physiological and psychological reaction to something. Do you think there would be alcoholics if there was no alcohol? The brain reacts to something that is good (a drug) and tells itself to continue using this thing. But it turns out this thing is heroin and it is bad in the long-term. Addiction is not a result of a lack of self-control, nor is it a disease. It is something else. I am an addict, so I can speak from experience when I say that addiction is a limited choice, but a choice nonetheless. There are things we as addicts can do in order to prevent relapse. Example: When I walk down the street and see a bar, I know it is a bad idea and DECIDE not to go in there. If I actually had walked in that bar, I might have been at the point of no return and went ahead and got a drink, but I didn't because I made the CHOICE not to put myself in that position. It's that simple.