Friday, January 13, 2006

The disease model of addiction: a response to Psyton

I'm disinclined to agree with Psyton's dismissal of the disease model of addiction in that there absolutely is a genetic component to problems like alcoholism. As LRC illustrates, some families have this more than other families.

Also, alcoholism and drug addiction tend to be comorbid with mental illnesses. If a schizophrenic finds that when he drinks he doesn't hear voices so much, I can imagine drinking every day would become attractive. Similarly, cocaine has some of the same properties stimulants like Ritalin do. People with Attention Defecit Disorder can find that really attractive.

I don't know that its at all funny that poor people are more likely to be addicts. Poor people are also more likely to have faced many of life's most depressing experiences, so that something some people use to escape depression might be more of an issue isn't a big shock.

Plenty of diseases have a personal responsibility component. In fact, I would venture to say ALL mental illnesses do. Are you going to listen to your paranoid fantasies when a coworker looks at you funny? If you're so depressed you can barely get off the couch, are you going to go to work anyway? I'm thinking that Psyton knows a guy who finds it very difficult not to get upset in certain circumstances that wouldn't necessarily upset other people and I doubt Psyton would call this person's efforts to keep from getting too upset a personal responsibility issue alone. Those are disease questions, but they are personal responsibility questions too. In short, personal responsibility can be harder for some people than for others and addiction is one of the things that can make it harder.

My issue with Frey is that he is claiming he overcame addiction by willpower ALONE and that is a lie.

If the breast cancer analogy is too far out, perhaps I can make a more reasonable comparison if I say that it is equivilent to him saying "Yes, I had clinical depression, but I just forced myself to cheer up and that worked fine! So people shouldn't go to a psychologist when they are depressed, they shoudl just suck it up like I did!" when he never had clinical depression at all.

The sheer level of scumbaggery still makes me shake my head.



Chalicechick said...

I'm sure there are addicts who take such an attitude, but most of the ones I've known have taken more personal responsibility than that. To take a more common example, lots of fat people have genetic components to their size, but I've never met one who denied that eating was the major part of the issue.

But in my opinion, denying to addicts that they do have a reason for being susceptible isn't doing them any favors. Because it is harder for them. And if you tell them their problems come from their own weakness alone, that seems like a recipie to give up.

Saying, "this is especially hard for you because of this other problem (be it mental illness, psychological addiction to the drug or what have you) and here's what we can do about the other problem..." seems like an excellent beginning to actually helping somebody.

Or as Jimmy Breslin put it lightly "When you stop drinking, you have to deal with this marvelous personality that
started you drinking in the first place."

Of course it takes willpower to overcome alcoholism just as willpower can be helpful in overcoming some of the effects of mental illness. But for most people it is going to take more.

Treating it as "you have a disease" rather than "you're just weaker than everybody else" seems like a more reasonable approach.

Diseases can be overcome. Congenital weakness of spirit, not so much.

Chalicechick said...

This seems like a stupid question, but I'm going to ask it anyway.

If quitting by sheer willpower is the best solution for everyone, how come all the unhappy addicts in the world haven't fixed themselves? I mean willpower convenient and free and you can start any time?

Seems to me like some people have quit drinking through willpower, a lot more have quit drinking with AA (and the first thing AA teaches is that you're powerless over your addiction), some people need more specialized disease-focussed approaches, some people never find an approach that works and drink themselves to death.

Willpower is a component of all of them, but I'm not sure why you would think it is the total solution for everyone when so much evidence, anecdotal and otherwise, exists to suggest otherwise.

I mean "Addiction is totally the addict's fault for being weak. If they can't fix themselves through willpower, then they are too weak and they should be stonger. Because strong people don't need drugs" is a Dr.-Laura-like tautological approach that sounds logical in theory, but I seriously doubt it helps many people in the real world.


LaReinaCobre said...

I don't know if drug or alcohol addiction is a disease, but the way I see it, the approaches to overcoming addictions are varied and useful. They are useful because not all people are addicts for the same reasons. They are useful because there is no single recipe for breaking the grip of addiction. Multiple models are needed.

I am not an addict, but my biological father was for some time (he is now born again). His mother was a gambling addict. Knowing that this is in my history, I acknowledge that there is a possibility that I may have a personality that is easily inclined towards compulsive or addictive behavior. I am very careful not to use alcohol thoughtlessly. I also grew up in a religion that outright prohibiits alcohol and drug consumption.

I don't know that it's inevitable that anyone will become a drug addict based on biology. However, I have heard many Native Americans refer to alcohol as "poison" for their people. Perhaps some substances are worse for some groups of folks more than others (like 70% of african americans being lactose intolerant).

In any case, I believe we learn - more than anything - how to cope with things from the people around us. If people around are coping with the problems in their life through addiction (be it alcohol, sex, gambling, drugs), this probably has a greater impact on us than anything. Then again, we're back to the nature vs nurture argument.

I just say, find whatever correction method works best for you. How one gets over the addiction is not that important to me. We're UUs after all - many paths, and all.

Anil Yadav said...

Treatment of alcoholism takes place in two steps: detoxification and rehabilitation. Detoxification involves helping a person to stop drinking and ridding his or her body of the harmful (toxic) effects of alcohol.

Detoxification and Withdrawal

Detoxification is often difficult because a person's body becomes accustomed to the intake of alcohol. When alcohol is no longer available, the body goes through a period known as withdrawal. The ease and success of withdrawal depends on the person's prior drinking habits. The amount of alcohol consumed on a regular basis and the length of time the person has been drinking determines the difficulty of the withdrawal process. Mild withdrawal symptoms may include nausea, achiness, diarrhea, difficulty in sleeping, excessive sweating, trembling, and anxiety. These symptoms often disappear in less than a week. Patients going through a mild withdrawal usually require no medical attention other than observation to see that their symptoms do not become worse. An individual who has been dependent on alcohol for a long period of time may experience more serious withdrawal symptoms. Such symptoms include fever, increased heart rate, high blood pressure, seizures, and hallucinations, which may take the form of delirium tremens (DT). A person suffering from DT has uncontrollable shaking, panic attacks (see panic disorders entry), and severe hallucinations. DT usually begin about three to five days after the patient's last drink and may last up to a week. During this time, the patient must be monitored. Patients going through serious withdrawal generally require medical attention. For example, they are often given sedatives to avoid the potentially life-threatening consequences of high blood pressure, rapid heart rate, and seizures.


Rehabilitation may involve the use of both medications and recovery programs. Some chemicals act as a deterrent to drinking because when they interact with alcohol they produce nausea, vomiting, and other unpleasant physical effects. One drug that has been used with some positive results is disulfiram (pronounced di-SUL-fuh-ram; trade name Antabuse). Drugs by themselves are often not very effective, however, since they do not deal with some of the reasons that may have contributed to a person becoming an alcoholic. Recovery programs help alcoholics to understand why they abuse alcohol and to find ways to avoid drinking in the future. Some of the most effective rehabilitation programs involve peer groups in which recovering alcoholics meet regularly and provide support for each other. Perhaps the best known of these groups is Alcoholics Anonymous (AA). The AA recovery program is based on a 12-step model. These steps include the need to recognize the destructive power that alcohol has over an alcoholic's life, the damage that alcoholism has done to others involved personally or professionally with the alcoholic, and the need to turn to a higher power for help in overcoming the problem.

Alternative Treatment

The lives of alcoholics and those around them are quite stressful. Whether stress leads to alcoholism or is a direct result of alcoholism is up for debate. In either case, stress-relieving therapies may help a person avoid alcohol consumption. These therapies include massage, meditation, and hydrotherapy (water therapy). The harmful physical effects of alcoholism can also be treated by alternative therapies. Vitamins and mineral supplements, for example, can be used to treat malnutrition. The herb known as milk thistle is thought to protect the liver. Other herbs, such as lavender, skullcap, chamomile, peppermint, and yarrow, are believed by some to help an alcoholic through withdrawal. Acupuncture (a Chinese therapy technique where fine needles puncture the body) has also been recommended to decrease withdrawal symptoms and to prevent a return to drinking.

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