Monthly Archives: November 2016

#Addiction ‘Disease’ #Recovery

Recovery?The concept of addiction as a ‘disease’ rumbles on ad infinitum and (allegedly ) there is “a growing body of scientific evidence” to support and quantify both sides of this often heated debate. In my opinion, a lot of the argument falls into the same puerile and petty squabbles which I referred to recently in The Malignancy of 12v4 Bickering.

I say this because, the process tends to promote and support generalised methods for dealing with individuals on individual journeys towards recovery. In some parts of the world (particularly the USA), there is probably a pressing need to formally categorize addiction as a disease, if only to make recovery support more widely available to more people. Again, that social/professional penchant for convenient labelling and boxing off  issues presents unexpected or unforeseen impacts and outcomes. The most prominent of these being; categorizing addiction as a disease provides excuses for some people who tend towards an ambivalent view of the responsibilities for their recovery.

Although the ‘disease’ label might fit well for some, in particular the American addiction treatment industry or, the popular 12-step fellowships recovery model (also perhaps more prevalent in the USA), it doesn’t sit particularly well on this side of the pond. Provision of ‘an excuse’ for some, who latch on to anything that supports their personal belief – “my addiction is not my problem, I am ill” – is often counter productive, especially within more secular programmes like SMART recovery. It’s not a good message to offer anyone who is making a choice to do battle with their addictions, in my opinion.

There is good reason to ask whether addiction actually is a disease. If it is, then we might expect it to have a specific cause or set of causes, an agreed-on repertoire of treatment strategies, and a likely time course. We might wonder how the disease of addiction could be overcome as a result of willpower, changing perspectives, changing environments, mindfulness or emotional growth… Neuroscience is a young discipline, and the distinction between brain development and brain pathology remains muddy (The Guardian)

Like many debates, despite the topic and irrespective of any academic prowess of the protagonists on either side; most individuals will decide on which side they wish to reside sue to their own underlying (often hidden) assumptions and reasons.

Is addiction really a disease? …it’s “a chronic relapsing brain disease” according to the American National Institute on Drug Abuse. This definition, born of the marriage between medicine and neuroscience, is based on the finding that the brain changes with addiction. It’s a definition that’s been absorbed and disseminated by rehab facilities, 12-step programmes, policy makers and politicians. (The Guardian)

Historical, national, social and economic factors can and do also come into play when people pledge their personal allegiance to a particular argument. Although the issues surrounding addictions have worldwide similarities, there are also significant historical and socio-economic differences between the USA and the UK. The distinct and fundamental differences (currently) between health-care and addiction treatment services on opposite sides of the pond have a major impact on thinking.

Why it’s wrong to call addiction a disease: Apart from being scientifically baseless, the disease model undermines hope, fails to end stigma and doesn’t always get addicts the help they need. (The Guardian)

Cynically, or even from a social science point of view, it would be crass to disregard the fact; health care in the USA is a massive and lucrative industry, where service users are obliged to pay handsomely at source for their care and treatment. Whereas in the UK (currently) the health-care and treatment we require/receive is mostly free at point of delivery. That is not to say addiction doesn’t have undoubted negative impacts of scale on the public purse, on both sides of the North Atlantic.

However, a common impact on how we actually deal effectively with recovery is the social (and medical) stigma attached to addictions treatment. But even that has different tonal content and connotations in the two nations discussed here.

Rethinking how we talk about addiction: People with substance use disorders and other mental health issues face greater stigma than those with other illnesses. Many of the addiction-related terms widely used in our society—even in the addiction field—retain an implicit moral judgment and subtly frame drug problems as transgressions worthy of punishment. (Dr Nora Volkow – Director, ANIDA)

The above shows that this relevant and important stigma factor is now being recognised (in the USA) and rightly so, it has a significant impact on how we effectively deal with addictions. This however is something that has been mostly true in the UK for some time now, at least since the so-called ‘recovery agenda’ previously promoted by our government and public health bodies several years ago. It would appear that finally, we have all moved on from the punishment to support models of recovery, that has to be a good thing. The so-called ‘war on drugs’ has not only been unsuccessful and expensive, it has failed our society. But despite us having thankfully moved on apace, the ‘disease’ arguments still remain.

Two huge benefits of the disease concept are frequently touted by Volkow and others. First, addicts need treatment, and if we don’t define addiction as a disease, they won’t get the help they require. Second, addicts don’t deserve to be scorned or denigrated: they have a disease, and we don’t put people down for being sick. (Marc Lewis – The Biology of Desire: Why Addiction Is Not A Disease)

OK, I have no medical qualifications so I couldn’t possibly argue for (or against) the “chronic relapsing brain disease” diagnostic theory / assumption. Unfortunately perhaps, from a point of fuelling those ongoing arguments, this assumption has now been afforded even greater credence post publication of the USA Surgeon General‘s report ‘Facing Addiction in America‘ (see Key Findings: The Neurobiology of Substance Use, Misuse, and Addiction). But even that has to quantify the ‘evidence’ claims – “Well-supported”: when evidence is derived from multiple rigorous human and nonhuman studies; “Supported”: when evidence is derived from rigorous but fewer human and nonhuman studies.

Several studies have shown that a belief in the disease concept of addiction increases the probability of relapse. And that shouldn’t be surprising. If you think you have a chronic disease, how hard are you going to work to get better? (Marc Lewis – The Biology of Desire: Why Addiction Is Not A Disease)

It’s always worth remembering a known saying; “medicine can be an imprecise science” – working out the best treatment for a particular individual patient often relies on a doctor’s experience and intuition. Increasingly today, we have a tendency to group individuals under particular labels. Something that allows ‘professionals’ (and society) to conveniently group them in one particular box or another. This is often born out of time, financial and even political constraint factors which in turn, wrongly have a consequent and significantly negative impact upon how we provide public services.

The jury in my particular head is still out on the addiction disease theories however; I would agree that there are obviously many psychological factors involved in anyone’s addictive behaviours. Factor in some economic and social issues, along with criminal justice system involvements or childhood trauma and experiences and it’s obvious; addictions are a mental health issue and mental health issues can and do create/support addictive behaviours… it’s another one of those so-called chicken and egg debates again!

Which side you wish to sit on the disease debate is your choice… much like that choice you have and can make to make to do something about your addiction!

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