Thread: Addictions as disease

When Philip Seymour Hoffman died Huffington Post ran an article which quoted someone (I think Jamie Lee Curtis) talking about 'this terrible disease'. Now I know that modelling it as disease has been quite successful for the purposes of treatment however I absolutely think its wrong to call it a disease for a few reasons. But I absolutely do not believe that it is a disease and whats more I think its very harmful to call it one.
To my mind calling it a disease takes away people's control and makes them think they are going to be dogged by it for the rest of their lives. Cynical me thinks that addiction clinics like that situation just fine.
People give up their addictions by choice - usually after hitting rock bottom with some substances but it is still a choice they make which to my mind is the crucial factor in making it a behavioural issue rather than a disease. Whoever got rid of malaria, diabetes or shingles by choice?
I've had a couple of addictions in my time - I smoked 20/30 a day for about 25 years and gave up by choice about 8 years ago. I never even think about it now - even when people around me are smoking it doesn't worry me one bit. The same with other substances I have been addicted to - don't care, don't miss them, don't ever think about them.
Also contrary to AA doctrine there are many, many people who give up on their own without any help whatsoever - me being just one of them but also a couple of friends of mine too. I actually don't think it helps anyone to make them keep going to meetings and constantly reminding them of what they cant have.
Anyway - I voiced this opinion on HuffPo and apart from one or two voices of support most people have ranted and raged and I think would have had me executed if they could

So - what do you illustrious people think? Disease or not?

I don't really know but I tend to NOT view addictions as disease. Of course I'm no doctor so my "opinion" is just that. I also didn't feel sorry for Mr. Hoffman.

I think the "disease" model gets abused a lot, especially by groups like AA.
I think in a lot of cases drug abuse is more like self medication as user tries to compensate for other problems in their lives.
Like people who abuse alcohol because they are in pain and alcohol is actually an effective painkiller.
Maybe if drug treatment programs looked past the idea of the drug abuse being the disease and could look at what underlying causes existed there might be better outcomes.

That's one argument my wife and I have. One of her relatives is an alcoholic and when he gets drunk he changes from this nice guy into a monster, almost.

So, does alcohol turn a really decent person into an a-hole? Or is that person really an a-hole inside and the alcohol just lets the animal out for the evening?

It depends on the drug.

If it displaces a natural chemical in your body and forms a chemical dependence, it can be deadly to try to stop without help. Barbiturates are like this, and alcohol can be too. So can cocaine and most of the amphetamines. Cigarettes do this; they cause your body to use an alternative chemical pathway for what niacin ordinarily does for you. It takes your body months to get back to using niacin again, which is why people get twitchy; luckily it's not deadly to quit, but it is very, very difficult. Taking extra niacin didn't help either, any I was able to tell. After I while I was OK again and felt better. Opiate/opioid addicts have a particularly bad time; their bodies have stopped making endorphins, so for example when they eat, they don't get an endorphin rush, they hurt. Everything hurts. All the time. For a long time, until their bodies start making endorphins again.

Arguably, these are diseases. They are induced chemical problems in your body; we would call the body's reaction to either a pathogen or a toxic chemical a "disease;" these are just more subtle, but they're still body chemistry problems. They're still "diseases."

Originally Posted by Schneibster

It depends on the drug.

If it displaces a natural chemical in your body and forms a chemical dependence, it can be deadly to try to stop without help. Barbiturates are like this, and alcohol can be too. So can cocaine and most of the amphetamines. Cigarettes do this; they cause your body to use an alternative chemical pathway for what niacin ordinarily does for you. It takes your body months to get back to using niacin again, which is why people get twitchy; luckily it's not deadly to quit, but it is very, very difficult. Taking extra niacin didn't help either, any I was able to tell. After I while I was OK again and felt better. Opiate/opioid addicts have a particularly bad time; their bodies have stopped making endorphins, so for example when they eat, they don't get an endorphin rush, they hurt. Everything hurts. All the time. For a long time, until their bodies start making endorphins again.

Arguably, these are diseases. They are induced chemical problems in your body; we would call the body's reaction to either a pathogen or a toxic chemical a "disease;" these are just more subtle, but they're still body chemistry problems. They're still "diseases."

Agreed they induce chemical changes in body/brain and agreed that some substances are dangerous to quit alone but the decision to quit is still a decision. And I also agree that addiction does fit the medical definition of disease but the common understanding of what a disease is is different. Disease/illness is commonly understood to be something that happens to you and something that needs medication to cure and that's simply not the case with addictions. I also think it gives those who don't want to quit an excuse - something to hide behind. For example those that steal to fund their addiction can hide behind the 'its not me its this disease that makes me do it' plea.

A real addict tries to quit many times. I did with cigarettes.

Furthermore it is common practice to use other drugs to break an addiction. I used Chantix to quit smoking. It worked great. It was the only thing that did. For some people Wellbutrin works better.

You are making judgments you do not have the knowledge to make. You need to talk to a doctor if you want to get the straight scoop. They're all taught about it, because it is a risk of their profession; they have unquestioned access to drugs.

The tone of your post is quite unhelpful for people dealing with real emotional problems. It's quite hostile actually. I can see why people on HuffPo objected to it.

So then, is type two diabetes a disease?

Originally Posted by dan hunter

I think the "disease" model gets abused a lot, especially by groups like AA.
I think in a lot of cases drug abuse is more like self medication as user tries to compensate for other problems in their lives.
Like people who abuse alcohol because they are in pain and alcohol is actually an effective painkiller.
Maybe if drug treatment programs looked past the idea of the drug abuse being the disease and could look at what underlying causes existed there might be better outcomes.

What are the underlying causes?

Addiction is a disease. Clinical depression is a disease. They can be treated (made better) like both psychological and physical diseases. And you shove your *EXPLETIVE REMOVED*

I think the "disease model" for addiction is sort of appropriate, but not really helpful. Sometimes it is genuinely self-medicating. Back before we had any useful (forget predictable or reliable) psychoactive medications, cigarettes were often recommended to people suffering from anxiety - and especially conditions that we now call depression and/or PTSD after the 2 world wars. Alcohol was the only available analgesic for lots of people until the middle of last century.

A lot of people who drink too much or smoke or get addicted to other drugs are "self-medicating" to cope with horrible childhoods or specific traumas. Very often therapists have to deal with underlying emotional or psychological problems before the person is actually free to make the decision to give these substances up - and to stay away from them thereafter. They also need help with the physical consequences of the chronic poisoning they've subjected themselves to.

My suspicion about organisations like AA is that they use that model of the irresistibility of alcohol because, even though they allow people to talk about the problems they had before the addiction as well as the problems created by the addiction, they don't have any therapy or strategy for resolving any underlying or continuing problems. Just going over and over the fact that your parents beat you black and blue day in day out, as an example, doesn't help you really to deal with the genuine depression/PTSD/anxiety that underlies your self-damaging behaviours and your temporary escapes into an alcohol or drug induced fog.

Originally Posted by adelady

I think the "disease model" for addiction is sort of appropriate, but not really helpful. Sometimes it is genuinely self-medicating. Back before we had any useful (forget predictable or reliable) psychoactive medications, cigarettes were often recommended to people suffering from anxiety - and especially conditions that we now call depression and/or PTSD after the 2 world wars. Alcohol was the only available analgesic for lots of people until the middle of last century.

A lot of people who drink too much or smoke or get addicted to other drugs are "self-medicating" to cope with horrible childhoods or specific traumas. Very often therapists have to deal with underlying emotional or psychological problems before the person is actually free to make the decision to give these substances up - and to stay away from them thereafter.

That seems contradictory. If alcoholism is really a result of underlying emotional or psychological problems, once those problems are resolved, the alcoholic should in theory be able to return to moderate, social drinking like "normal" people, but I'll wager that rarely occurs, which to me suggests that susceptibility to alcohol addiction was the problem in first place. It may not be a level playing field, in the same way that some people can eat donuts and chips twice a day and never develop diabetes.

Among other reasons for suspecting it is a disease, or has a strong biological cause are 1) twin studies, and 2) the fact that you can breed strains of alcoholic mice. As far as I know, these are not depressed mice, or angry mice, or selfish, irresponsible mice. They are not socioeconomically oppressed mice, or involved in abusive relationships with a bad mouse spouse. These are just unlucky mice with the wrong genes.

Thanks for that.

I sort of thought about those things, but didn't want to write a dissertation. (My husband's family has some genetic propensity for this. It seems to be linked to those who also carry the haemaochromatosis gene. Fortunately, he has neither.)

Originally Posted by DianeG

What are the underlying causes?

That gets pretty complicated and the list would be long.
Some of the underlying problems people seek relief from are physical. Conditions like arthritis, neuralgia etc. Conditions that are often not recognized by their doctors. Often the person using the drugs has never even presented themselves to a doctor to complain because they simply think their condition is normal. All they know is that they feel better when they are stoned.

Other conditions can be social problems related to mental health, like depression, boredom, social isolation, abusive relationships, anxiety...
Again people often don't know they have a problem, do not get help and self-medicate instead. They think the problems they have are normal because they have suffered from them a long time but they know they feel better when stoned, even if it is only for a while. Some of these are the result of bad brain chemistry and can be treated more effectively with other drugs instead of what they are using.

So before assuming the addiction is the disease instead of a symptom of a disease it might be good to look a bit more at the person's life.
Just depriving somebody of drugs usually has no lasting effect if the reasons they are using the drugs are not addressed.
People sometimes just give up their drugs when conditions in their lives change, usually without it being a big decision, simply because they no longer need them.

Even the AA recognized this and their 12 step program is an attempt to adress some of these issues.
The American Psycological Association summarizes them into 6 steps because they consider the AA list redundant.

admitting that one cannot control one's addiction or compulsion;
recognizing a higher power that can give strength;
examining past errors with the help of a sponsor (experienced member);
making amends for these errors;
learning to live a new life with a new code of behavior;
helping others who suffer from the same addictions or compulsions.

Anyway that is my opinion of it and others are free to have their opinions too.

Some people dismiss cigarette addiction as "no big deal."

I beg to differ.

1. The success rate at quitting cigarettes is lower than for heroin. Heroin exceeds all other known drugs in this statistic.
2. The death rate for smoking is very high, and generally from heart disease, not cancer.
3. The recidivism rate, for starting smoking again, is higher than for heroin. Heroin, again, exceeds all other known drugs in this statistic.
4. Cigarette addiction is viewed as trivial. As a result support is almost impossible to get.

Originally Posted by DianeG

That seems contradictory. If alcoholism is really a result of underlying emotional or psychological problems, once those problems are resolved, the alcoholic should in theory be able to return to moderate, social drinking like "normal" people, but I'll wager that rarely occurs, which to me suggests that susceptibility to alcohol addiction was the problem in first place. It may not be a level playing field, in the same way that some people can eat donuts and chips twice a day and never develop diabetes.

Among other reasons for suspecting it is a disease, or has a strong biological cause are 1) twin studies, and 2) the fact that you can breed strains of alcoholic mice. As far as I know, these are not depressed mice, or angry mice, or selfish, irresponsible mice. They are not socioeconomically oppressed mice, or involved in abusive relationships with a bad mouse spouse. These are just unlucky mice with the wrong genes.

I think the fact that as many people quit drinking without any active intervention as quit because of intervention suggests it is not quite as simple as that.
If drug addiction was the great incurable disease as is usually presented then the numbers of people who stop on their own should be much lower than it is.
I think that there are not very many people going through standard drug treatment programs get their physical or emotional problems dealt with, mostly because very few treatment programs look beyond the addiction as the disease model.

Maybe the "genetic propensity" that is being bred into the mice is part of the brain chemistry problem. Some people actually process alcohol as a stimulant instead of as a depressant.
It is a genetic variation, but it does not explain why they want stimulation or depession instead of living without the drugs.

Originally Posted by dan hunter

Originally Posted by DianeG

That seems contradictory. If alcoholism is really a result of underlying emotional or psychological problems, once those problems are resolved, the alcoholic should in theory be able to return to moderate, social drinking like "normal" people, but I'll wager that rarely occurs, which to me suggests that susceptibility to alcohol addiction was the problem in first place. It may not be a level playing field, in the same way that some people can eat donuts and chips twice a day and never develop diabetes.

Among other reasons for suspecting it is a disease, or has a strong biological cause are 1) twin studies, and 2) the fact that you can breed strains of alcoholic mice. As far as I know, these are not depressed mice, or angry mice, or selfish, irresponsible mice. They are not socioeconomically oppressed mice, or involved in abusive relationships with a bad mouse spouse. These are just unlucky mice with the wrong genes.

I think the fact that as many people quit drinking without any active intervention as quit because of intervention suggests it is not quite as simple as that.
If drug addiction was the great incurable disease as is usually presented then the numbers of people who stop on their own should be much lower than it is.
I think that there are not very many people going through standard drug treatment programs get their physical or emotional problems dealt with, mostly because very few treatment programs look beyond the addiction as the disease model.

Maybe the "genetic propensity" that is being bred into the mice is part of the brain chemistry problem. Some people actually process alcohol as a stimulant instead of as a depressant.
It is a genetic variation, but it does not explain why they want stimulation or depession instead of living without the drugs.

Dan, as long as you keep denying and blaming you keep making it harder. Did you have an addicted parent? You seem to have a real problem about it.

Originally Posted by Schneibster

Dan, as long as you keep denying and blaming you keep making it harder. Did you have an addicted parent? You seem to have a real problem about it.

What are you talking about?

You're denying the physical mechanism of addiction that every doctor knows exists.

You obviously have an emotional problem with admitting there is more to it than just the person's own perfidity.

This is a science board, dan. Denying science isn't going to work out here very well.

Originally Posted by Schneibster

You're denying the physical mechanism of addiction that every doctor knows exists.

You obviously have an emotional problem with admitting there is more to it than just the person's own perfidity.

This is a science board, dan. Denying science isn't going to work out here very well.

Did you mean perfidy?

Originally Posted by dan hunter

I think the fact that as many people quit drinking without any active intervention as quit because of intervention suggests it is not quite as simple as that.
If drug addiction was the great incurable disease as is usually presented then the numbers of people who stop on their own should be much lower than it is.
I think that there are not very many people going through standard drug treatment programs get their physical or emotional problems dealt with, mostly because very few treatment programs look beyond the addiction as the disease model.

Maybe the "genetic propensity" that is being bred into the mice is part of the brain chemistry problem. Some people actually process alcohol as a stimulant instead of as a depressant.
It is a genetic variation, but it does not explain why they want stimulation or depession instead of living without the drugs.

I agree, there may well be differences in brain chemistry, and the compulsive "wanting" of alcohol after a period of use, is undoubtedly part of those differences in brain chemistry. My point was that I don't think alcoholism is a reaction to unfortunate circumstances. There are plenty of upperclass alcoholics who had happy childhoods, yet manage to drink themselves to death in the comfort of their own homes. It seems to cut across social economic lines, from the minister's wife, to the university professor to the big burly construction worker. And yet it follows a predictable pattern over time. I used to transcribe entire patient medical files into electronic form, and I was always amazed at how similar and predictable the medical histories of alcoholics were after five years, ten years, 30 years, if they continued to drink.

Originally Posted by DianeG

There are plenty of upperclass alcoholics who had happy childhoods, yet manage to drink themselves to death in the comfort of their own homes. It seems to cut across social economic lines, from the minister's wife, to the university professor to the big burly construction worker. And yet it follows a predictable pattern over time. I used to transcribe entire patient medical files into electronic form, and I was always amazed at how similar and predictable the medical histories of alcoholics were after five years, ten years, 30 years, if they continued to drink.

I could type and type but what I am saying is actually nothing new.
If I gave a couple of links it might be easier.
Here is one from the PLOS Blog by Marc Lewis.
Marc Lewis, PhD is a developmental neuroscientist and professor of developmental psychology, recently at the University of Toronto (1989 to 2010) and presently at Radboud University Nijmegen in the Netherlands.

http://blogs.plos.org/mindthebrain/2...brain-disease/

A paper from AJOB at Taylor and Francis Online.
http://www.tandfonline.com/doi/abs/10.1080/21507740.2013.796328#.Ux6qnB8h4zC

also
http://www.indiana.edu/~engs/cbook/chap6.html


and of course, Wikipedia
Disease theory of alcoholism - Wikipedia, the free encyclopedia

Originally Posted by Schneibster

A real addict tries to quit many times. I did with cigarettes.

Furthermore it is common practice to use other drugs to break an addiction. I used Chantix to quit smoking. It worked great. It was the only thing that did. For some people Wellbutrin works better.

You are making judgments you do not have the knowledge to make. You need to talk to a doctor if you want to get the straight scoop. They're all taught about it, because it is a risk of their profession; they have unquestioned access to drugs.

The tone of your post is quite unhelpful for people dealing with real emotional problems. It's quite hostile actually. I can see why people on HuffPo objected to it.

How do you know I don't have the knowledge to make this judgement?

Originally Posted by Schneibster

You're denying the physical mechanism of addiction that every doctor knows exists.

You obviously have an emotional problem with admitting there is more to it than just the person's own perfidity.

This is a science board, dan. Denying science isn't going to work out here very well.

And you seem to make a lot of erroneous assumptions about the people on here too. Not every doctor in America is on board with the disease model of addiction either as you claim earlier - Stanton Peele, Theodore Dalrymple, Vik Watts to name a few.
Of course there is a physical change in the body with addiction - there is a physical change in the brain and body when you learn a new language, when you learn to play an instrument - there is a physical change in the brain and body when you do anything out of the ordinary. And that physical change becomes more of a reflex reaction the more you do it. As I said before I am not denying the physical changes.
However, none of that negates the fact that when people give it up they do so by choice. Nearly every ex-addicts story ends with something like 'I realised I had to change' or 'I hit rock bottom and I knew I had to give it up'. Addiction centres clearly don't work on treatment alone otherwise people wouldn't go back again and again because they have relapsed.
And I am not unsympathetic to the problems of addicts - I have been there - I tried to give up smoking about 30 times and eventually did it cold turkey because I had just had enough and made the decision to be an ex smoker.
Far from being unsympathetic I feel that calling it a disease actually takes away people's hope and makes them powerless and that is my main point here. I am not denying the difficulties or emotional turmoil or ruined lives - I am saying call it something else so that people understand they actually have some control over their own lives.

Originally Posted by LuciDreaming

call it something else so that people understand they actually have some control over their own lives.

A mental illness?

A little history lesson. Dr Benjamin Rush was a Renaissance Man who lived around the time of the American Revolution. He was a Founding Father of the United States, he attended the Continental Congress, he signed the Declaration of Independence, he was a physician, a writer, an educator, a humanitarian, an abolitionist, and more. He provided Lewis and Clark with the medical kit for their Corps of Discovery Expedition. You'll find his portrait in the logo for the American Psychiatric Association.



Anyway, during his time in history, the only significant addictive substance was, of course, alcohol. The common (and obvious) attitude toward alcoholism was that alcoholics simply drank too much. They would be okay if only they didn't drink so much. The prevailing attitude toward the solution to alcoholism was just have a drink or two and no more.

Along came Dr Rush, who did something quite extraordinary — he actually listened to what alcoholics had to say about their troubles with alcohol. The alcoholics told him that once they began drinking, they lost the willpower to stop. Rush came to realize that something in the alcohol caused them to lose control. He was the first person to develop the concept of addiction.

I've had several alcoholics tell me the same thing. They say that they simply cannot have one drink. It's not like not being able to eat just one Lay's potato chip. Unfortunately, unlike potato chips, alcohol is a psychotropic drug.

Interesting but why not just call it addiction and it doesn't resolve the fact that people eventually stop their addictions when they choose to.

Many (really most of the chronic diseases we suffer from in developed countries) have a strong lifestyle, or behavioral, component. Diabetes, heart disease, high blood pressure, kidney failure (usually due to either diabetes or high blood pressure). We usually have no problem in thinking of these as diseases, even though they are brought about, or at least aggravated, by the patient's decisions. Addictions and mental illnesses are no different. There are biological components involving neurochemistry, and behavioral components, the decisions the patient makes that aggravate or alleviate the disease. We know that many substances have a physiological addictive property, from rat and monkey experiements where the critter will repeatedly choose the addictive substance over food. They have no capacity for decision-making. Addiction is an illness, and a very complex one at that.

FWIW,
Clarissa

OK - that's fine Doglady - how about addressing the issue that people quit through choice? How did I come to quit smoking through choice after so many years and other substances previously?

I cant edit for some reason and want to change the first part because actually what you have said is not fine. Being so confident about people having 'no capacity for decision making' is part of the problem here. Why would you tell someone something like that - it absolutely robs people of being in control. And please explain how peoples capacity for decision making can spontaneously return when they do give up.

Before alcohol was ever invented there were no "addicts" that I've ever read about. So jumping forward to when alcohol was invented , not many people could afford it and few ever drank. Look at the Native Americans , as an example, they never had alcohol until the white settlers came and introduced it to them then they went crazy from drinking it. They never drank anything so they never were addicts but given the alcohol they soon did get addicted. To me, with that type of data I'd think alcohol is not a disease but rather a dependency on an external substance to make people feel "high".

Through time I do think that there are people who become dependent on any drug to either get stoned or to escape from their problems. Some of those people do have psychological problems which can be helped with therapy and other drugs that are used to control their problems. Many people have problems they can't figure out how to solve so they turn to drugs to hide them away but they always return. It is those people who become addicted many times and few seek treatment as they should always trying to thing they can handle those problems alone.

Originally Posted by LuciDreaming

I cant edit for some reason and want to change the first part because actually what you have said is not fine. Being so confident about people having 'no capacity for decision making' is part of the problem here. Why would you tell someone something like that - it absolutely robs people of being in control. And please explain how peoples capacity for decision making can spontaneously return when they do give up.

I didn't say you had no choice. This issue is more complex than that. There is a physical component to addiction. Animals in addiction experiments don't have the ability to choose - they don't have the degree of mental development and consciousness to choose. We do (for the most part). But the physical component of addiction makes that decision difficult to accomplish and maintain. Living without one's mood or mind altering substance is difficult. To deny this and just say it's a matter of choice denigrates all the suffering addicts go through who do succeed in quitting, even if it's only for a little time . It takes a lot of desire to overcome the pain of losing one's addictive substance. And then there's the issue of relapse. If one has spent their life numbing their feelings by getting high, they have to learn a whole new way of dealing with those feelings. Anxiety, anger, fear - all these are intense emotions and can send an addict or alcoholic back to using, IF they don't prepare for it and expect it.

As far as the mental changes - addictive substances are psychoactive substances. They mess with the brain function. Studies have shown that there are subtle abnormalities in neurologic function in addicts, and these can last for up to six months after quitting the substance. Get rid of the addictive substance and the fog, confusion, and inability to make decisions all clear. Again, a biological action of the addictive substance that makes it hard to just 'decide' to quit. Were addiction just a choice, there would be no noticeable 'return' of decision making capacity once the substance was gone. Again, addiction is a very complex issue, with both physiological and psychological components. I applaud your quitting smoking. Quitting and staying quit takes a lot of work and is quite an accomplishment.

Clarissa

BTW, I'm not patronizing you LucidDreaming - I am a recovering alcoholic, sober for 11 years now. I've seen addiction from both sides - as an addict and as a physician trying to help other addicts gain control over their addiction. It's just not easy and straight forward.

Your answer to me implies that you haven't read my previous posts - I have never denied the suffering/anguish, physical or psychological components of addictions or the complexities of the issue. As I said before I have had a couple of addictions in my time - smoking was just one of them. What I am saying is that eventually what makes an addict give up is their choice to give it up and this to me is what negates the term disease.

Originally Posted by LuciDreaming

What I am saying is that eventually what makes an addict give up is their choice to give it up and this to me is what negates the term disease.

Granted, alcoholism is not the same as getting cancer, but there are behavioral components and choices in many diseases. The cancer patient either chooses to go through chemo or radiation or not. The diabetic either changes his diet and exercise habits or not. The schizophrenic needs a stable environment and social support and enough insight into his condition to keep taking the meds that alleviate his delusions. The problem with addiction and even things like depression, you're relying on the organ with problem to fix the problem.

When AA people talk about being "powerless over their disease," they don't mean they are helpless or unaccountable. If they truly believed that, they wouldn't bother trying any method at all. They are referring to the fact that is much more difficult to moderate use than to just abstain completely. And that is essentially what neuroscience suggests as well.

Originally Posted by DianeG

Granted, alcoholism is not the same as getting cancer, but there are behavioral components and choices in many diseases. The cancer patient either chooses to go through chemo or radiation or not. The diabetic either changes his diet and exercise habits or not. The schizophrenic needs a stable environment and social support and enough insight into his condition to keep taking the meds that alleviate his delusions.

That's a very different kind of choice. A person cannot just wake up one morning and choose to not have cancer and expect it to be gone without medical intervention. Whereas I decided one afternoon that I'd had enough of smoking and after a difficult few months I wasn't smoking any more.

Originally Posted by DianeG

When AA people talk about being "powerless over their disease," they don't mean they are helpless or unaccountable. If they truly believed that, they wouldn't bother trying any method at all. They are referring to the fact that is much more difficult to moderate use than to just abstain completely. And that is essentially what neuroscience suggests as well.

Then common sense would suggest that the AA should choose their words more carefully or not? I'm sorry but telling someone they are powerless over their disease is a ridiculous thing to do if what they actually mean is that abstention is easier than moderation.

I've yet to see any post that has convinced me the disease model of addiction is right.

Originally Posted by LuciDreaming

Originally Posted by DianeG

Granted, alcoholism is not the same as getting cancer, but there are behavioral components and choices in many diseases. The cancer patient either chooses to go through chemo or radiation or not. The diabetic either changes his diet and exercise habits or not. The schizophrenic needs a stable environment and social support and enough insight into his condition to keep taking the meds that alleviate his delusions.

That's a very different kind of choice. A person cannot just wake up one morning and choose to not have cancer and expect it to be gone without medical intervention. Whereas I decided one afternoon that I'd had enough of smoking and after a difficult few months I wasn't smoking any more.

Originally Posted by DianeG

When AA people talk about being "powerless over their disease," they don't mean they are helpless or unaccountable. If they truly believed that, they wouldn't bother trying any method at all. They are referring to the fact that is much more difficult to moderate use than to just abstain completely. And that is essentially what neuroscience suggests as well.

Then common sense would suggest that the AA should choose their words more carefully or not? I'm sorry but telling someone they are powerless over their disease is a ridiculous thing to do if what they actually mean is that abstention is easier than moderation.

I've yet to see any post that has convinced me the disease model of addiction is right.

Well, you're entitled to your opinion, but I think you're throwing the science behind it out the window. As I said above in a late edit, an alcoholic is relying on the organ with the problem to fix the problem, a bit of a Catch-22, although not impossible, as many people do manage to do it. But by your reasoning, no mental illness is a real disease, if the person who has it failed to seek help or wasn't successful.

Originally Posted by LuciDreaming

Originally Posted by Schneibster

A real addict tries to quit many times. I did with cigarettes.

Furthermore it is common practice to use other drugs to break an addiction. I used Chantix to quit smoking. It worked great. It was the only thing that did. For some people Wellbutrin works better.

You are making judgments you do not have the knowledge to make. You need to talk to a doctor if you want to get the straight scoop. They're all taught about it, because it is a risk of their profession; they have unquestioned access to drugs.

The tone of your post is quite unhelpful for people dealing with real emotional problems. It's quite hostile actually. I can see why people on HuffPo objected to it.

How do you know I don't have the knowledge to make this judgement?

Because no one who knows would act like that.

One of the downsides to NOT acknowledging the disease, or physiologic component, of the addiction, or mental illness, is to go back to the old blame and shame model that so many suffered from. 'You're a failure" or "you're just no good" was often heaped on addicts and the mentally ill. This attitude just forced them to hide their problems rather than try and keep trying to change.

You just quit, LucidDreaming. Great. Most people have a lot harder time of it. Perhaps the physical component of the addiction was not as big a part of your smoking habit as it is with some others. It isn't that hard for everyone. I have patients and friends that are able to quit just like that. But most can't. Most need to do a lot of work physically, socially, and psychologically in order to successfully quit and stay quit, from whatever addiction they have.

Originally Posted by DogLady

One of the downsides to NOT acknowledging the disease, or physiologic component, of the addiction, or mental illness, is to go back to the old blame and shame model that so many suffered from. 'You're a failure" or "you're just no good" was often heaped on addicts and the mentally ill. This attitude just forced them to hide their problems rather than try and keep trying to change.

Unfortunately the same blame and shame strategy shows up when people apply the addiction as a disease model, except instead of calling it a moral defect that religious conversion could cure they call it a genetic defect which can't be cured.
I don't see how that gains you very much.
What I said earlier was that it is important to look at the reasons people choose to get stoned and deal with those if you want to make a long term change.

Originally Posted by dan hunter

Originally Posted by DogLady

One of the downsides to NOT acknowledging the disease, or physiologic component, of the addiction, or mental illness, is to go back to the old blame and shame model that so many suffered from. 'You're a failure" or "you're just no good" was often heaped on addicts and the mentally ill. This attitude just forced them to hide their problems rather than try and keep trying to change.

Unfortunately the same blame and shame strategy shows up when people apply the addiction as a disease model, except instead of calling it a moral defect that religious conversion could cure they call it a genetic defect which can't be cured.
I don't see how that gains you very much.
What I said earlier was that it is important to look at the reasons people choose to get stoned and deal with those if you want to make a long term change.

Ummm, it allows the proper sort of psychotherapy and drug therapy to be applied.

As far as why people get stoned, might as well ask why people drink. Lots of perfectly normal people do and have no problem. Some people have legitimate reasons-- and legally permitted ones-- for taking barbiturates or morphine or amphetemines. Not every use of a drug is an addiction.

Originally Posted by DogLady

One of the downsides to NOT acknowledging the disease, or physiologic component, of the addiction, or mental illness, is to go back to the old blame and shame model that so many suffered from. 'You're a failure" or "you're just no good" was often heaped on addicts and the mentally ill. This attitude just forced them to hide their problems rather than try and keep trying to change.

You just quit, LucidDreaming. Great. Most people have a lot harder time of it. Perhaps the physical component of the addiction was not as big a part of your smoking habit as it is with some others. It isn't that hard for everyone. I have patients and friends that are able to quit just like that. But most can't. Most need to do a lot of work physically, socially, and psychologically in order to successfully quit and stay quit, from whatever addiction they have.

I did wonder when someone might suggest that my addictions couldnt be 'proper addictions' like other peoples because I was able to quit them...... And you are assuming I didnt have a hard time and thats not true either.

Once again - no-one is trying to blame or shame people for not managing to quit or denying the difficulties.

A recent study here has shown that when offered financial incentives people are much more likely to stop smoking and stay stopped - I was wondering how that fits in with the disease model? Offering financial incentives an effective way to encourage healthier lifestyles, researchers claim - Health News - Health & Families - The Independent

Originally Posted by dan hunter

Unfortunately the same blame and shame strategy shows up when people apply the addiction as a disease model, except instead of calling it a moral defect that religious conversion could cure they call it a genetic defect which can't be cured.
I don't see how that gains you very much.

Do people with incurable peanut allergies feel defective and ashamed?

Allergies are not usually considered as diseases by most people, but if you wanted to start labelling allergies as genetic defects and diseases the eugenicists would likely support your claim and call for the elimination of people with allergies.

dan, that seems to be what you're doing with people who are addicted.

Originally Posted by Schneibster

dan, that seems to be what you're doing with people who are addicted.

No, you are just showing that you failed to understand what has already been said again.

Perhaps I missed it, but has anybody bothered to offer a precise, broadly accepted definition of disease. If not, I suggest you are all farting in the wind.

Why no sorrow ? He had it coming ? Not saying he didn't, but ...you know ..."it tolls for thee", sort of thing. Or did you just not like him ?

Originally Posted by PumaMan

I don't really know but I tend to NOT view addictions as disease. Of course I'm no doctor so my "opinion" is just that. I also didn't feel sorry for Mr. Hoffman.

Originally Posted by John Galt

Perhaps I missed it, but has anybody bothered to offer a precise, broadly accepted definition of disease. If not, I suggest you are all farting in the wind.

The medical definition is as follows - 'a disorder of structure or function in a plant, human or animal, especially one that produces specific symptoms or affects a specific location and is not simply a direct result of physical injury'.
Far from farting in the wind as you so eloquently put it my argument has never been the definition - in fact I think somewhere I have pointed out it fits the medical definition. What I have said is its unhelpful to call it a disease because it gives people the idea that they have no control over stopping it. When in fact the only way that people stop is when they make the choice to stop.

What is a disease? I doubt if there is such a thing as an agreed definition. This report examines the question.

What is a disease?

Originally Posted by LuciDreaming

Interesting but why not just call it addiction and it doesn't resolve the fact that people eventually stop their addictions when they choose to.

I agree with you to some level, however, in the way that addiction is defined we are addicted to a lot of things, even food. Why do we seem to handle somethings better than others. My take is owing to knowledge of ones being and adjusting to the right quantity.
Some stimulants move the nerve system stronger than others, the question is where do we stop since each body is different?

Originally Posted by Stargate

I agree with you to some level, however, in the way that addiction is defined we are addicted to a lot of things, even food

No.
"In the way that addiction is defined" food does not apply for most people.

Originally Posted by dan hunter

Originally Posted by Schneibster

dan, that seems to be what you're doing with people who are addicted.

No, you are just showing that you failed to understand what has already been said again.

You called for the eugenic elimination of drug addicts. I was completely clear on what you said. It's not very commendable.

Originally Posted by Schneibster

Originally Posted by dan hunter

Originally Posted by Schneibster

dan, that seems to be what you're doing with people who are addicted.

No, you are just showing that you failed to understand what has already been said again.

You called for the eugenic elimination of drug addicts. I was completely clear on what you said. It's not very commendable.

Go reread what was said between post #41 and #42.
I am not a fan of eugenics and you must be an idiot to think I am.

Originally Posted by dan hunter

Originally Posted by Schneibster

Originally Posted by dan hunter

Originally Posted by Schneibster

dan, that seems to be what you're doing with people who are addicted.

No, you are just showing that you failed to understand what has already been said again.

You called for the eugenic elimination of drug addicts. I was completely clear on what you said. It's not very commendable.

Go reread what was said between post #41 and #42.
I am not a fan of eugenics and you must be an idiot to think I am.

You said it. Do you now disown it?

Originally Posted by Schneibster

Originally Posted by dan hunter

Originally Posted by Schneibster

Originally Posted by dan hunter

Originally Posted by Schneibster

dan, that seems to be what you're doing with people who are addicted.

No, you are just showing that you failed to understand what has already been said again.

You called for the eugenic elimination of drug addicts. I was completely clear on what you said. It's not very commendable.

Go reread what was said between post #41 and #42.
I am not a fan of eugenics and you must be an idiot to think I am.

You said it. Do you now disown it?

Whatever.
You are not worth my time or effort.
Have a nice day.

Sorry, I deal with facts. Next time bring some.

Originally Posted by dan hunter

What is a disease? I doubt if there is such a thing as an agreed definition. This report examines the question.

What is a disease?

Agreed - with the current 'accepted' medical definition of disease pregnancy fits the bill nicely. Besides its the common widely accepted definition of being something acquired or something that happens to an individual through no fault of their own that does the damage.

Originally Posted by Stargate

Originally Posted by LuciDreaming

Interesting but why not just call it addiction and it doesn't resolve the fact that people eventually stop their addictions when they choose to.

I agree with you to some level, however, in the way that addiction is defined we are addicted to a lot of things, even food. Why do we seem to handle somethings better than others. My take is owing to knowledge of ones being and adjusting to the right quantity.
Some stimulants move the nerve system stronger than others, the question is where do we stop since each body is different?

Also agreed - currently there is no understanding of how some substances lead to addictions and others don't. I myself had one drink of alcohol and never bothered again but other substances reeled me in very quickly. Since all addictions hijack the dopamine system I think it would be safe to assume as you say that some substances/activities excite dopamine receptors more than others which in itself doesn't qualify as a dysfunction of the dopamine system. And as you say even sugar has addictive properties.

To my mind the very fact that addictions vary from person to person and substance to substance or behaviour to behaviour also puts the disease model into question and in my opinion I also think the individuals biome plays a part.

Originally Posted by LuciDreaming

To my mind the very fact that addictions vary from person to person and substance to substance or behaviour to behaviour also puts the disease model into question and in my opinion I also think the individuals biome plays a part.

Where does one put the claims of sex addiction, food addiction, gambling addiction etc?
I simply can't imagine all the "isms" that people are claiming to be diseases and starting 12 step groups to deal with are really diseases in and of themselves.

Originally Posted by LuciDreaming

I smoked 20/30 a day for about 25 years and gave up by choice about 8 years ago. I never even think about it now - even when people around me are smoking it doesn't worry me one bit. The same with other substances I have been addicted to - don't care, don't miss them, don't ever think about them.

After 25 years? It occurred to me to wonder what took you so long? You seem intelligent enough and if it was a mere "choice", why didn't you throw down the pack in horror as soon as you read the surgeon general's warning? "You mean these things cause cancer? Christ! Why didn't anyone tell me!" Cigarettes don't even impair consciousness. It should have been a no-brainer.

Originally Posted by LuciDreaming

Also agreed - currently there is no understanding of how some substances lead to addictions and others don't. I myself had one drink of alcohol and never bothered again but other substances reeled me in very quickly. Since all addictions hijack the dopamine system I think it would be safe to assume as you say that some substances/activities excite dopamine receptors more than others which in itself doesn't qualify as a dysfunction of the dopamine system. And as you say even sugar has addictive properties.

To my mind the very fact that addictions vary from person to person and substance to substance or behaviour to behaviour also puts the disease model into question and in my opinion I also think the individuals biome plays a part.

I don't understand. The fact that it varies from person to person doesn't seem like evidence that it is not biological. Not everyone gets lupus. Not every one gets osteoporosis or type II diabetes, even when they have the same environment or make similar life style choices. Coronary artery disease runs in families. Not every one is allergic to peanuts. I am unlikely to develop sickle cell anemia. Etc.

Originally Posted by dan hunter

Originally Posted by LuciDreaming

To my mind the very fact that addictions vary from person to person and substance to substance or behaviour to behaviour also puts the disease model into question and in my opinion I also think the individuals biome plays a part.

Where does one put the claims of sex addiction, food addiction, gambling addiction etc?
I simply can't imagine all the "isms" that people are claiming to be diseases and starting 12 step groups to deal with are really diseases in and of themselves.

That people misuse "addiction" doesn't make all addictions invalid.

And as a matter of fact, I see this misuse of "addiction" as problematic for exactly that reason. Such things are called "habits," not "addictions." An addiction is a physical matter of an induced abnormal chemical deficiency; in almost all cases the addictive agent itself creates the deficiency that drives the addiction. Food is merely a necessity of life, like water or air. These are not induced. Nor are they abnormal. As a result they are not "addictions."

Originally Posted by dan hunter

Where does one put the claims of sex addiction, food addiction, gambling addiction etc?
I simply can't imagine all the "isms" that people are claiming to be diseases and starting 12 step groups to deal with are really diseases in and of themselves.

Each is a compulsive behavior driven by one part of the brain that is in conflict with the wants, intentions and rational insight of another part of the brain.

It's interesting that people treated with a dopamine agonist medication for Parkinson's disease sometimes spontaneously develop a gambling addiction with no prior history or interest in gambling. The compulsion goes away if the treatment regimen is changed.

Originally Posted by DianeG

It's interesting that people treated with a dopamine agonist medication for Parkinson's disease sometimes spontaneously develop a gambling addiction with no prior history or interest in gambling. The compulsion goes away if the treatment regimen is changed.

Whoa.

Originally Posted by DianeG

Each is a compulsive behavior driven by one part of the brain that is in conflict with the wants, intentions and rational insight of another part of the brain.

It's interesting that people treated with a dopamine agonist medication for Parkinson's disease sometimes spontaneously develop a gambling addiction with no prior history or interest in gambling. The compulsion goes away if the treatment regimen is changed.

OK, I give you a point on that, Frequency of New-Onset Pathologic Compulsive Gambling or Hypersexuality After Drug Treatment of Idiopathic Parkinson Disease

http://www.pdf.org/en/spring05_Gambling_Sex

but it just brings us back again to my point that the behaviours are symptoms of the disease instead of disease in and of themselves.

Originally Posted by dan hunter

Originally Posted by DianeG

Each is a compulsive behavior driven by one part of the brain that is in conflict with the wants, intentions and rational insight of another part of the brain.

It's interesting that people treated with a dopamine agonist medication for Parkinson's disease sometimes spontaneously develop a gambling addiction with no prior history or interest in gambling. The compulsion goes away if the treatment regimen is changed.

OK, I give you a point on that, Frequency of New-Onset Pathologic Compulsive Gambling or Hypersexuality After Drug Treatment of Idiopathic Parkinson Disease

Gambling, Sex, and…Parkinson's Disease? - Parkinson's Disease Foundation (PDF)

but it just brings us back again to my point that the behaviours are symptoms of the disease instead of disease in and of themselves.

That's right. The chemical deficiency is the disease.

Originally Posted by dan hunter

but it just brings us back again to my point that the behaviours are symptoms of the disease instead of disease in and of themselves.

I don't know what you mean by that.

Originally Posted by DianeG

Originally Posted by dan hunter

but it just brings us back again to my point that the behaviours are symptoms of the disease instead of disease in and of themselves.

I don't know what you mean by that.

Then maybe we need to follow John Galt's suggestion and find a mutually agreed upon definition of disease.
My point is that a lot of these behaviours being called disease are symptoms (signs).
As you know, and would likely be quick to point out, a lot of diseases can produce the same symptom.

Maybe we should accept addiction is a disease and stop abusing people who have it and start treating them.

Duh.

My point is that a lot of these behaviours being called disease are symptoms (signs).

Symptoms are not the same as signs of illness. Generally speaking, symptoms are things that we can see or feel for ourselves - facial pallor, an ache in a joint, a sore throat, palpitations, itchy eyes.

Signs are things that medical people observe as measurements - pulse, temperature, blood pressure, response (or lack of it) to certain stimuli, the colour of body parts. The symptoms that a patient reports may seem to have nothing to do with what a doctor detects from standard signs. Though many experienced doctors can identify a diabetic just by the facial pallor or someone with thyroid disease from similar simple observations. But they wouldn't act on that without confirming by testing.

Originally Posted by dan hunter

Then maybe we need to follow John Galt's suggestion and find a mutually agreed upon definition of disease.
My point is that a lot of these behaviours being called disease are symptoms (signs).
As you know, and would likely be quick to point out, a lot of diseases can produce the same symptom.

Okay, I think I know what you mean now.

But whether we say compulsive consumption of alcohol is a sign/symptom of an underlying neurochemical disorder, or that the neurochemical disorder is the biological mechanism behind the disease of alcoholism, I don't know if it matters all that much. There's supposedly 140 million alcoholics world wide according to Wikipedia. They seem to have a condition with a common set of symptoms and a statistically predictable outcome. There are genetic links, and possible physiological mechanisms such as differences in GABA receptors. In twin studies, identical twins form biological parents who were alcoholics were both more likely to become alcoholic regardless of whether their adoptive parents were alcoholic or not. Conversely, twins from non-alcoholic biological parents were no more likely to become alcoholic than the general population or one another, even if one ended up raised by an adoptive alcoholic parent. To me, these things satisfy the criteria for disease or disorder, rather than life style choice or learned behavior.

So where does binge drinking fit into your model?

Originally Posted by dan hunter

So where does binge drinking fit into your model?

I'm not really sure, but I agree that there could be more than one mechanism behind it, and some studies say there are different subtypes of alcoholics. I certainly wouldn't classify every college student who drinks more than they intended to at a frat party on Saturday night as an alcoholic, even if that happens with some frequency.

On the other hand, there does seem to be people in a binge drinking subtype who find that every time they consume alcohol, they end up in jail, or a fight, or getting physically removed from an establishment. There is something kind of abnormal about that. They are some times described as "Jeckyll and Hyde" type drinkers, in that their personality seems to shift radically and quite aggressively under the influence, compared to other people who more or less just become stupider versions of themselves.

Ironically, sometimes the "crazy drunks" recover the fastest, because it doesn't take 30 years for them to figure out that drinking is not like playing the piano - they are unlikely to get any better at it with more practice.

So are we basically agreeing on what I said in post #3 or are we still at odds there?

I'm not sure, lol.

I think it is a disease with a biological mechanism, but I don't think it's incurable, any more than type II diabetes or depression is. I even agree with Lucidreaming, that wanting to quit, deciding to quit, is absolutely necessary. I'm just not sure that "wanting it" or the intensity of sincere desire, guarantees success, if the person does not make other changes that make abstaining easier or more likely.

A former surgeon general under Clinton, David Kessler, wrote a book about compulsive eating. His advice in breaking any addiction was: 1) don’t prime 2) don’t cue and 3) don’t increase the reward value of the substance.


That’s essentially what neuroscience says:
Don’t prime – it’s easier for most alcoholics to quit than try to moderate their use, because every drink reawakens and strengthens the conditioned neural pathways.
Don’t cue – avoid people and places positively associated with alcohol. That sounds ridiculously simplistic, but there are reams and reams of reproducible scientific studies that show that people’s decisions in all sorts of matters are strongly influenced by environmental cues, even though every one of us is absolutely convinced that all of our own personal choices are freely made for completely logical reasons.
Don’t increase the reward value - stress, conflict, frustration, anger, resentment, guilt, boredom, all increase the reward value of alcohol. A lot of the “spiritual” advice in AA, or psychological support from therapists, is really aimed at reducing those triggers as much as realistically possible, not making the person more saintly.

Probably the biggest obstacle in over coming addiction or understanding it in others (or even changing less detrimental habits) is that we simply don't like to believe that our brains have anything in common with a lab rat's. We like to think we are free agents, with the same level of freedom or control at all times, and that our behavior and beliefs are stable from one moment to the next, and not significantly influenced by circumstances we find or place ourselves in.

It's funny how so many discussions about human behavior ultimately turn into weird philosophical discussions of free will.

Free will....Well that is a different topic all together.

I think there are points that we still disagree about and that is OK.
At least we understand each other's point of view a bit better.
I am going to leave this thread now because I have said everything I wanted to about it.

Originally Posted by DianeG

Originally Posted by LuciDreaming

I smoked 20/30 a day for about 25 years and gave up by choice about 8 years ago. I never even think about it now - even when people around me are smoking it doesn't worry me one bit. The same with other substances I have been addicted to - don't care, don't miss them, don't ever think about them.

After 25 years? It occurred to me to wonder what took you so long? You seem intelligent enough and if it was a mere "choice", why didn't you throw down the pack in horror as soon as you read the surgeon general's warning? "You mean these things cause cancer? Christ! Why didn't anyone tell me!" Cigarettes don't even impair consciousness. It should have been a no-brainer.

Nice... a bit of sarcasm with your response - I dont recall being anything but polite to you but hey ho. Firstly I enjoyed smoking and although I tried to give up a few times when it started going up in price my heart wasnt quite in it so my attempts failed.

What you are roundly ignoring is that when I eventually did give up it was down to choice and this is the case with the majority of people. They hit rock bottom and they realise they cant go on as they are any more or they dont and end up being addicts forever. I dont know of any successful attempts to quit any addiction that have been instigated by others although those people probably do exist.

I apologize if my remarks sounded sarcastic. I only meant that amount of time involved for that choice suggests some kind of struggle, between the part of you that saw it as clearly benefitial to stop, even dangerous not to, and some other part of you that was reluctant to give it up, for whatever reason. I suspect too, that the choice had made many times before, and every bit as sincerely. The interesting question is how people maintain their commitment to a change like that, past the craving phase, and over many years, and why others don't.

Originally Posted by LuciDreaming

Originally Posted by DianeG

Originally Posted by LuciDreaming

I smoked 20/30 a day for about 25 years and gave up by choice about 8 years ago. I never even think about it now - even when people around me are smoking it doesn't worry me one bit. The same with other substances I have been addicted to - don't care, don't miss them, don't ever think about them.

After 25 years? It occurred to me to wonder what took you so long? You seem intelligent enough and if it was a mere "choice", why didn't you throw down the pack in horror as soon as you read the surgeon general's warning? "You mean these things cause cancer? Christ! Why didn't anyone tell me!" Cigarettes don't even impair consciousness. It should have been a no-brainer.

Nice... a bit of sarcasm with your response - I dont recall being anything but polite to you but hey ho. Firstly I enjoyed smoking and although I tried to give up a few times when it started going up in price my heart wasnt quite in it so my attempts failed.

What you are roundly ignoring is that when I eventually did give up it was down to choice and this is the case with the majority of people. They hit rock bottom and they realise they cant go on as they are any more or they dont and end up being addicts forever. I dont know of any successful attempts to quit any addiction that have been instigated by others although those people probably do exist.

With cigarettes that's all that's required.

Your mistake is assuming other things are just as easy. They're not.

And Schneibster your understanding of addictions comes from where exactly? Engineering or astronomy? And again you make unfounded assumptions and obviously haven't read my previous posts or you would know that smoking has not been my only addiction. Your mistake is in assuming that giving up smoking is easy - it isn't and I don't need references to qualify that.


Diane G - could I clarify my statement within your post #60 to show you how I came to this conclusion? Because all addictions hijack the dopamine system it doesn't seem likely that the addiction arises from a 'faulty' dopamine system otherwise it would logically follow that an individual would become addicted to any substance/activity that employed it. I feel there is a much stronger behavioural/environmental component involved which is supported by people being much more able to quit their addictions if they avoid friends/places they associate with their addictions. Like Dan I suspect we are much more in agreement about things than disagreement.

The problem I have is that the language we use around these things is very important - people need to be enabled to give up, empowered if you like (although I don't like that word because its used too much). Calling it a disease seems to me to take that away and as I said in my first post it affords the opportunity to hide behind it - as in 'I cant help drinking I have a disease' etc.. It seems to allow people to feel they are victims and victims generally don't feel that they can alter their circumstances. To my mind change always comes from within and having the strength to make that change doesn't generally come from using language that implies helplessness.

Originally Posted by LuciDreaming

Diane G - could I clarify my statement within your post #60 to show you how I came to this conclusion? Because all addictions hijack the dopamine system it doesn't seem likely that the addiction arises from a 'faulty' dopamine system otherwise it would logically follow that an individual would become addicted to any substance/activity that employed it. I feel there is a much stronger behavioural/environmental component involved which is supported by people being much more able to quit their addictions if they avoid friends/places they associate with their addictions. Like Dan I suspect we are much more in agreement about things than disagreement.

The problem I have is that the language we use around these things is very important - people need to be enabled to give up, empowered if you like (although I don't like that word because its used too much). Calling it a disease seems to me to take that away and as I said in my first post it affords the opportunity to hide behind it - as in 'I cant help drinking I have a disease' etc.. It seems to allow people to feel they are victims and victims generally don't feel that they can alter their circumstances. To my mind change always comes from within and having the strength to make that change doesn't generally come from using language that implies helplessness.

Well, that’s a good point about the dopamine system, but you would still have to explain things like twins studies that show there is a percentage of the population who are more likely to become alcoholics regardless of environment, or why studies show that differences in a the GABA alpha2 receptor gene are linked to alcoholism. The differences aren’t absolute – for example one study showed a gene variant present in 90% of alcoholics but also 49% percent of controls, but that difference is still quite significant. I am not saying people are helpless or unaccountable, only that it’s by no means a level playing field.


I suppose where we differ is whether the disease model implies total helplessness. I don’t know of any addictions counselor or MD who ever told a patient “There is nothing you can do to stop, and nothing we can do to help, so you might as well go home and keep on drinking.”

The concept of being “powerless over alcohol” isn’t about abstaining as much as it is about the inability to moderate use. Ironically, it is the patient’s belief in his own level of mental control and autonomy that is his undoing. The therapist presents him with all the evidence of problems his drug use has caused over the years – relationship problems, social embarrassment, legal and financial problems, etc. And yet the patient often clings to the belief that, while that was true in the past, in the future it will be different. He can still use, but prevent these other things from occurring, if he really tries. He will make a rule to stop at two drinks. He will only drink on Fridays. He will switch to wine or beer. He will not get into an argument with anybody. He will never get into an auto if he’s had a single drop. He will only drink socially, or he will only drink at home, where he can’t get into trouble. And yet, the outcome is always the same, he eventually resumes his same level of use or actually increases it, and encounters many of the same consequences.


So in my opinion, one benefit of the disease model is that it helps convince the patient – “look, there is something biologically different about you, you are not going to be able to consume alcohol like other people no matter how hard you try to ‘drink responsibly.’ Your best strategy is to abstain.” But more importantly, I think the disease model is supported by the scientific evidence, and the patient has the right to the most accurate scientific information about his condition that we have. We no longer withhold the prognosis or likely outcome from cancer patients because we worry they will give up hope and abandon treatment, even if that sometimes happens. They are still entitled to that information, regardless of how they respond to that information.


The likelihood of quitting and staying stopped is not necessarily related to the intensity or sincerity of the desire to stop, in my opinion. Many alcoholics and addicts wake up literally every morning thinking “I’m never doing this again. I have to stop before it kills me. I can’t live this way,” and yet are unable to follow through with that choice if they don’t do other things that make that more likely to happen. The purpose of medical intervention or grass roots programs like AA is to help the patient make those changes, change routines and habits associated with use, avoid environmental cues, and weaken the neuropathways between craving and use, while strengthening other neuropathways -essentially, play one part of the brain against another part. Some people probably do figure out how to do this all on their own, and recover without assistance, but if we can help others with this process before they ruin their lives, I think it’s better than expecting each person to reinvent the wheel, so to speak.

Originally Posted by LuciDreaming

And Schneibster your understanding of addictions comes from where exactly?

My psychologist.

My problem was PTSD from having heart attacks. He says the old myth about having to hide the process is only true about some types of problems. For mine it was useless; I was better off knowing the plan. What he did was emotionally reinforce the things I was doing right and tell me I was OK. It's called "cognitive therapy," though you shouldn't expect your experience would be like mine. I had easily identified problems that I knew to bring out and discuss with him. He said I was "easy money." My treatment was all him reassuring me emotionally and interacting with me to convince my subconscious I was OK.

I was good with that. He made me confident which was what I needed.

It was the support I needed to not go back to my cigarette addiction. Worked great, not only kept me off cigarettes but helped me get better after mourning not being able to smoke them any more. Worth every nickel, and only covered for 20% by the bullshit insurance banksters. Saved my freakin' life, and saved the insurance banksters a lot of money, not that they're grateful, greedy $%&*^$s.

We talked about addictions; how could we not? I was quitting cigarettes.

Sorry dude he knows way more than you. I learned a lot; and avoided some predictable problems because of what he told me.

Not to mention I've gone to friends who became addicts' funerals. My understanding is personal. I saw them decide to die.

He may know more than I do (then again he may not) - it doesnt follow that you do just by dint of knowing him. Your posts are contradictory see #5 and #78. I have no respect for someone who demands strict standards of others without adhering to them himself - you venture your opinions as though they are fact - how about you supply some supporting references for your comments.

Whilst your understanding may be personal mine comes from a BSc and ongoing education in clinical neurology (and a personal element too).

He does. He treats all the doctors and nurses and their spouses on the Monterey Peninsula. He's the best. That's how I chose him. Money was no object and it cost me plenty.

Sorry but when you disagree I figure he knows what he's talking about and you don't.

And actually you're the one who's advancing opinions-- about addiction-- as facts. This is another classical ratfxxking. Accuse your opposion of X then do it yourself. Typical conservatardian attempted mind manipulation that only works on stupids.

Get therapied and wake up.

I worried if I was addicted before I got help. I was lucky; I'm not. I'd gotten rid of all my addictions before I worked with him. He told me what an addiction is, and I could understand and acknowledge what he said was true. It has helped me avoid getting re-addicted again, and to recognize the danger signs and avoid problems. It's some of the most useful advice I've ever received.

None of it is even remotely like what you're saying about not needing or getting help or how if you do you're "weak" or "bad." Nor is your policy of eliminating such help likely to reduce addictions; in fact it's more likely to promote them by making people feel worthless. They're addicted and you can't fix it. Sorry, we can, but you convincing them we can't makes them go kill themselves. Sorry but you are not helping.

There is help. There are people who care. Please don't let these self-righteous cigarette quitters discourage you. There are people who understand reality. Do not despair because you meet these idiots. There are those of us who understand, care, and are trying to get them eliminated from positions where they can hurt people like you.

Originally Posted by Schneibster

He does. He treats all the doctors and nurses and their spouses on the Monterey Peninsula. He's the best. That's how I chose him. Money was no object and it cost me plenty.

Sorry but when you disagree I figure he knows what he's talking about and you don't.

And actually you're the one who's advancing opinions-- about addiction-- as facts. This is another classical ratfxxking. Accuse your opposion of X then do it yourself. Typical conservatardian attempted mind manipulation that only works on stupids.

Get therapied and wake up.

Well - I havent advanced anything here that isnt accepted knowledge about addictions - my disagreement has always been about terming it a disease and I have provided names of other doctors that also think that. In post #15 you argue that giving up smoking is extremely hard and some waffle about heroin and cigarette rates of recidivism - references please - and then in post #78 you allude to it being easy to give up and again in post #83 you make a case for how hard it is.

What would I get therapy for?

Originally Posted by Schneibster

I worried if I was addicted before I got help. I was lucky; I'm not. I'd gotten rid of all my addictions before I worked with him. He told me what an addiction is, and I could understand and acknowledge what he said was true. It has helped me avoid getting re-addicted again, and to recognize the danger signs and avoid problems. It's some of the most useful advice I've ever received.

In post #81 you state your psychologist told you you are 'easy money' and you seem to think thats good somehow.... To me that means he took your cash without you actually needing his help - a charlatan in other words.

Originally Posted by Schneibster

None of it is even remotely like what you're saying about not needing or getting help or how if you do you're "weak" or "bad." Nor is your policy of eliminating such help likely to reduce addictions; in fact it's more likely to promote them by making people feel worthless. They're addicted and you can't fix it. Sorry, we can, but you convincing them we can't makes them go kill themselves. Sorry but you are not helping.

Please provide the post numbers where I have stated that getting help is a sign people are weak or bad or where I have stated help should be eliminated. Where have I tried to convince people they cant be helped?

Originally Posted by Schneibster

There is help. There are people who care. Please don't let these self-righteous cigarette quitters discourage you. There are people who understand reality. Do not despair because you meet these idiots. There are those of us who understand, care, and are trying to get them eliminated from positions where they can hurt people like you.

Who are you talking about? You seem very confused. I dont smoke and havent done for about 5 years or so. I dont know what you mean by 'people like me' either.