They’re screaming it from the rooftops: “addiction is a disease, and you can’t stop it without medical treatment”! But why are they screaming it so loud, why are they browbeating us about it, why is it always mentioned with a qualifier? You don’t hear people constantly referring to cancer as “the disease of cancer” – it’s just “cancer”, because it’s obvious that cancer is a disease, it’s been conclusively proven that the symptoms of cancer can’t be directly stopped with mere choices – therefore no qualifier is needed. On the other hand, addiction to drugs and alcohol is not obviously a disease, and to call it such we must either overlook the major gaps in the disease argument, or we must completely redefine the term “disease.” Here we will analyze a few key points and show that what we call addiction doesn’t pass muster as a real disease.
Real Diseases versus The Disease Concept or Theory of Drug Addiction
In a true disease, some part of the body is in a state of abnormal physiological functioning, and this causes the undesirable symptoms. In the case of cancer, it would be mutated cells which we point to as evidence of a physiological abnormality, in diabetes we can point to low insulin production or cells which fail to use insulin properly as the physiological abnormality which create the harmful symptoms. If a person has either of these diseases, they cannot directly choose to stop their symptoms or directly choose to stop the abnormal physiological functioning which creates the symptoms. They can only choose to stop the physiological abnormality indirectly, by the application of medical treatment, and in the case of diabetes, dietetic measures may also indirectly halt the symptoms as well (but such measures are not a cure so much as a lifestyle adjustment necessitated by permanent physiological malfunction).
In addiction, there is no such physiological malfunction. The best physical evidence put forward by the disease proponents falls totally flat on the measure of representing a physiological malfunction. This evidence is the much touted brain scan[1]. The organization responsible for putting forth these brain scans, the National Institute on Drug Abuse and Addiction (NIDA), defines addiction in this way:
Addiction is defined as a chronic relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain – they change it’s structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.
The NIDA is stating outright that the reason addiction is considered a disease is because of the brain changes evidenced by the brain scans they show us, and that these changes cause the behavior known as addiction, which they characterize as “compulsive drug seeking and use”. There are three major ways in which this case for the disease model falls apart:
- the changes in the brain which they show us are not abnormal at all
- people change their behavior IN SPITE OF the fact that their brain has changed in response to repeated substance use jump to section
- there is no evidence that the behavior of addicts is compulsive (compulsive meaning involuntary) (point two addresses this, as well as some other research that will be presented) jump to section
This all applies equally to “alcoholism” as well. If you’re looking for information on alcoholism, the same theories and logic discussed here are applicable; wherever you see the term addiction used on this site, it includes alcoholism.
Brain Changes In Addicts Are Not Abnormal, and Do Not Prove The Brain Disease Theory
On the first count – the changes in the brain evidenced by brain scans of heavy substance users (“addicts”) do not represent a malfunctioning brain. They are quite normal, as research into neuroplasticity has shown us. Whenever we practice doing or thinking anything enough, the brain changes – different regions and neuronal pathways are grown or strengthened, and new connections are made; various areas of the brain become more or less active depending upon how much you use them, and this becomes the norm in your brain – but it changes again as you adjust how much you use those brain regions depending on what you choose to think and do. This is a process which continues throughout life, there is nothing abnormal about it. Here, Sharon Begley describes neuroplasticity: [2]
The term refers to the brain’s recently discovered ability to change its structure and function, in particular by expanding or strengthening circuits that are used and by shrinking or weakening those that are rarely engaged. In its short history, the science of neuroplasticity has mostly documented brain changes that reflect physical experience and input from the outside world.
So, when the NIDA’s Nora Volkow and others show us changes in the brain of a substance user as compared to a non-substance user, this difference is not as novel as they make it out to be. They are showing us routine neuroplastic changes which every healthily functioning person’s brain goes through naturally. The phenomenon of brain changes isn’t isolated to “addicts” or anyone else with a so-called brain disease – non-addicted and non-depressed and non-[insert brain disease of the week here] people experience neural adaptations too. One poignant example was found in the brains of London taxi drivers, as Begley and Jeffrey Schwartz pointed out in The Mind and The Brain. [4]
Is Being A Good Taxi Driver A Disease?
A specific area of the brain’s hippocampus is associated with creating directional memories and a mental map of the environment. A team of researchers scanned the brains of London taxi drivers and compared their brains to non-taxi drivers. There was a very noticeable difference, not only between the drivers and non-drivers, but also between the more experienced and less experienced drivers:
There it was: the more years a man had been a taxi driver, the smaller the front of his hippocampus and the larger the posterior. “Length of time spent as a taxi driver correlated positively with volume in…the right posterior hippocampus,” found the scientists. Acquiring navigational skills causes a “redistribution of gray matter in the hippocampus” as a driver’s mental map of London grows larger and more detailed with experience. [4]
So, the longer you drive a cab in London (that is, the longer you exert the mental and physical effort to quickly find your way around one of the world’s toughest to navigate cities), the more your brain physically changes. And the longer you use drugs, the more your brain changes. And indeed, the longer and more intensely you apply yourself to any skill, thought, or activity – the more it will change your brain, and the more visible will be the differences between your brain and that of someone who hasn’t been focused on that particular skill. So, if we follow the logic of the NIDA, then London’s taxi drivers have a disease, which we’ll call taxi-ism, that forces them to drive taxis. But the new diseases wouldn’t stop there.
Learning to play the piano well will change your brain – and if you were to compare brain scans of a piano player to a non-piano player, you would find significant differences. Does this mean that piano playing is a disease called Pianoism? Learning a new language changes your brain, are bilingual people diseased? Athletes’ brains will change as a result of intensive practice – is playing tennis a disease? Are soccer players unable to walk into a sporting goods store without kicking every ball in sight? We could go on and on with examples, but the point is this – when you practice something, you get better at doing it, because your brain changes physiologically – and this is a normal process. If someone dedicated a large portion of their life to seeking and using drugs, and their brain didn’t change – then that would be a true abnormality. Something would be seriously wrong with their brain.
Its not just physical activity that changes our brains, thoughts alone can have a huge effect. What’s more, whether the brain changes or not, there is much research which shows that the brain is slave to the mind. As Begley points out elsewhere, thoughts alone can create the same brain activity that would come about by doing things[2]:
Using the brain scan called functional magnetic resonance imaging, the scientists pinpointed regions that were active during compassion meditation. In almost every case, the enhanced activity was greater in the monks’ brains than the novices’. Activity in the left prefrontal cortex (the seat of positive emotions such as happiness) swamped activity in the right prefrontal (site of negative emotions and anxiety), something never before seen from purely mental activity. A sprawling circuit that switches on at the sight of suffering also showed greater activity in the monks. So did regions responsible for planned movement, as if the monks’ brains were itching to go to the aid of those in distress.
So by simply practicing thinking about compassion, these monks made lasting changes in their brain activity. Purely mental activity can change the brain in physiologically significant ways. And to back up this fact we look again to the work of Dr Jeffrey Schwartz[3], who has taught OCD patients techniques to think their way out of obsessive thoughts. After exercising these thought practices, research showed that the brains of OCD patients looked no different than the brains of those who’d never had OCD. If you change your thoughts, you change your brain physically – and this is voluntary. This is outside the realm of disease, this shows a brain which changes as a matter of normality, and can change again, depending on what we practice choosing to think. There is nothing abnormal about a changing brain, and the type of changes we’re discussing aren’t necessarily permanent, as they are characterized to be in the brain disease model of addiction.
These brain change don’t need to be brought on by exposure to chemicals. Thoughts alone, are enough to rewire the very circuits of the human brain responsible for reward and other positive emotions that substance use and other supposedly “addictive” behaviors (“process addictions” such as sex, gambling, and shopping, etc.) are connected with.
The Stolen Concept of Neuroplasticity in the Brain Disease Model of Addiction
Those who claim that addiction is a brain disease readily admit that the brain changes in evidence are arrived at through repeated choices to use substances and focus on using substances. In this way, they are saying the disease is a product of routine neuroplastic processes. Then they go on to claim that such brain changes either can’t be remedied, or can only be remedied by outside means (medical treatment). When we break this down and look at it step by step, we see that the brain disease model rests on an argument similar to the “stolen concept”. A stolen concept argument is one in which the argument denies a fact on which it simultaneously rests. For example, the philosophical assertion that “reality is unknowable” rests on, or presumes that the speaker could know a fact of reality, it presumes that one could know that reality is unknowable – which of course one couldn’t, if reality truly was unknowable – so the statement “reality is unknowable” invalidates itself. Likewise, the brain disease proponents are essentially saying “neuroplastic processes create a state called addiction which cannot be changed by thoughts and choices” – this however is to some degree self-invalidating, because it depends on neuroplasticity while seeking to invalidate it. If neuroplasticity is involved, and is a valid explanation for how to become addicted, then we can’t act is if the same process doesn’t exist when it’s time to focus on getting un-addicted. That is, if the brain can be changed into the addicted state by thoughts and choices, then it can be further changed or changed back by thoughts and choices. Conditions which can be remedied by freely chosen thoughts and behaviors, don’t fit into the general understanding of disease. Ultimately, if addiction is a disease, then it’s a disease so fundamentally different than any other that it should probably have a completely different name that doesn’t imply all the things contained in the term “disease” – such as the idea that the “will” of the afflicted is irrelevant to whether the condition continues.
People change their addictive behavior in spite of the fact that their brain is changed – and they do so without medication or surgery (added 4/18/14)
In the discussion above, we looked at some analogous cases of brain changes to see just how routine and normal (i.e. not a physiological malfunction) such changes are. Now we’re going to look directly at the most popular neuroscientific research which purports to prove that these brain changes actually cause “uncontrolled” substance use (“addiction”).
The most popular research is Nora Volkow’s brain scans of “meth addicts” presented by the NIDA. The logic is simple. We’re presented with the brain scan of a meth addict alongside the brain scan of a non-user, and we’re told that the decreased activity in the brain of the meth user (the lack of red in the “Drug Abuser” brain scan presented) is the cause of their “compulsive” methamphetamine use. Here’s how the National Institute on Drug Abuse (NIDA) explains the significance of these images in their booklet – Drugs, Brains, and Behavior: The Science of Addiction :
Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive signals. As a result, dopamine’s impact on the reward circuit of a drug abuser’s brain can become abnormally low, and the ability to experience any pleasure is reduced. This is why the abuser eventually feels flat, lifeless, and depressed, and is unable to enjoy things that previously brought them pleasure. Now, they need to take drugs just to try and bring their dopamine function back up to normal.
[emphasis added]
They go on that these same sorts of brain changes:
..may also lead to addiction, which can drive an abuser to seek out and take drugs compulsively. Drug addiction erodes a person’s self-control and ability to make sound decisions, while sending intense impulses to take drugs.
[emphasis added]
That image is shown when NIDA is vaguely explaining how brain changes are responsible for “addiction.” But later on, when they try to make a case for treating addiction as a brain disease, they show the following image, which tells a far different story if you understand more of the context than they choose to mention:
Again, this graphic is used to support the idea that we should treat addiction as a brain disease. However, the authors mistakenly let a big cat out of the bag with this one – because the brain wasn’t treated at all. Notice how the third image shows a brain in which the red level of activity has returned almost to normal after 14 months of abstinence. That’s wonderful – but it also means that the NIDA’s assertions that “Addiction means being unable to quit, even in the face of negative consequences”(LINK) and “It is considered a brain disease because drugs change the brain… These brain changes… can lead to the harmful behaviors seen in people who abuse drugs” are dead wrong.
When these studies were done, nobody was directly treating the brain of methamphetamine addicts. They were not giving them medication for it (there is no equivalent of methadone for speed users), and they weren’t sticking scalpels into the brains of these meth addicts, nor were they giving them shock treatment. So what did they do?
These methamphetamine addicts were court ordered into a treatment program (whose methodology wasn’t disclosed in the research) which likely consisted of a general mixture of group and individual counseling with 12-step meeting attendance. I can’t stress the significance of this enough: their brains were not medically treated. They talked to counselors. They faced a choice between jail and abstinence. They CHOSE abstinence (for at least 14 months!) – even while their brains had been changed in a way that we’re told robs them of the ability to choose to quit “even in the face of negative consequences.” [5]
Even with changed brains, people are capable of choosing to change their substance use habits. They choose to stop using drugs, and as the brain scans above demonstrate – their brain activity follows this choice. If the brain changes caused the substance using behavior, i.e. if it was the other way around, then a true medical intervention should have been needed – the brain would’ve needed to have changed first via external force (medicine or surgery) before abstinence was initiated. They literally wouldn’t have been able to stop for 14 months without a real physical/biological medical intervention. But they did…
Substance Use Is Not Compulsive, It Is A Choice
In his classic book Addiction & Opiates, Alfred R Lindesmith PhD explained the requirements of reliable scientific theories explaining the causes of things such as heroin addiction:
…a genuine theory that proposes to explain a given phenomenon by relating it to another phenomenon must, in the first place, have clear empirical implications which, if not fulfilled, negate the theory.
If the theory is that neural adaptations alone cause uncontrolled behavior, then this proposition can easily be shown to be false. I demonstrated above that in the midst of having fully “changed” or “addicted” brains, people do indeed stop using substances, so essentially, it is case closed. But the depths to which the brain disease theory of addiction can be negated go even further, because the basic theory of addiction as representing uncontrolled substance use has never been explained. Explanation of the mechanism by which substance use happens without the individual’s consent is conspicuously missing – yet such explanation is a necessary part of such a theory, as Lindesmith writes (again in Addiction & Opiates):
…besides identifying the two types of phenomenon that are allegedly interrelated, there must be a description of the processes or events that link them. In other words, besides affirming that something causes something else, it is necessary to indicate how the cause operates to produce the alleged effect.
“Here Comes the Bogey-Man” by Goya, circa 1799
There doesn’t seem to be any explanation or evidence that substance use is involuntary. In fact, the evidence, such as that presented above, shows the opposite. Nevertheless, when the case for the disease is presented, the idea that drug use is involuntary is taken for granted as true. No evidence is ever actually presented to support this premise, so there isn’t much to be knocked down here, except to make the point I made above – is a piano player fundamentally incapable of resisting playing the piano? They may love to play the piano, and want to do it often, they may even be obsessive about it, but it would be hard to say that at the sight of a piano they are involuntarily driven by their brain to push aside whatever else they need to do in order to play that piano.
There is another approach to the second claim though. We can look at the people who have subjectively claimed that their substance use is involuntary, and see if the offer of incentives results in changed behavior. Gene Heyman covered this in his landmark book, Addiction: A Disorder of Choice[3]. He recounts studies in which cocaine abusers were given traditional addiction counseling, and also offered vouchers which they could trade in for modest rewards such as movie tickets or sports equipment – if they proved through urine tests that they were abstaining from drug use. In the early stages of the study, 70% of those in the voucher program remained abstinent, while only 20% stayed abstinent in the control group which didn’t receive the incentive of the vouchers. This demonstrates that substance use is not in fact compulsive or involuntary, but that it is a matter of choice, because these “addicts” when presented with a clear and immediately rewarding alternative to substance use and incentive not to use, chose it. Furthermore, follow up studies showed that this led to long term changes. A full year after the program, the voucher group had double the success rate of those who received only counseling (80% to 40%, respectively). This ties back in to our first point that what you practice, you become good at. The cocaine abusers in the voucher group practiced replacing substance use with other activities, such as using the sports equipment or movie passes they gained as a direct consequence of abstaining from drug use – thus they made it a habit to find other ways of amusing themselves, this probably led to brain changes, and the new habits became the norm.
Long story short, there is no evidence presented to prove that substance use is compulsive. The only thing ever offered is subjective reports from drug users themselves that they “can’t stop”, and proclamations from treatment professionals that the behavior is compulsive due to brain changes. But if the promise of a ticket to the movies is enough to double the success rate of conventional addiction counseling, then it’s hard to say that substance users can’t control themselves. The reality is that they can control themselves, but they just happen to see substance use as the best option for happiness available to them at the times when they’re abusing substances. When they can see other options for happiness as more attractive (i.e. as promising a greater reward than substance use), attainable to them, and as taking an amount of effort they’re willing to expend – then they will absolutely choose those options instead of substance use, and will not struggle to “stay sober”, prevent relapse, practice self-control or self-regulation, or any other colloquialism for making a different choice. They will simply choose differently.
But wait… there’s more! (Added 4/21/14) Contrary to the claims that alcoholics and drug addicts literally lose control of their substance use, a great number of experiments have found that they are really in full control of themselves. Priming dose experiments have found that alcoholics are not triggered into uncontrollable craving after taking a drink. Here’s a link to the evidence and a deeper discussion of these findings: Do Addicts and Alcoholics Lose Control? Priming dose experiments of cocaine, crack, and methamphetamine users found that after being given a hit of their drug of choice (primed with a dose) they are capable of choosing a delayed reward rather than another hit of the drug.
Three Most Relevant Reasons Addiction Is Not A Disease
So to sum up, there are at least two significant reasons why the current brain disease theory of addiction is false.
- A disease involves physiological malfunction, the “proof” of brain changes shows no malfunction of the brain. These changes are indeed a normal part of how the brain works – not only in substance use, but in anything that we practice doing or thinking intensively. Brain changes occur as a matter of everyday life; the brain can be changed by the choice to think or behave differently; and the type of changes we’re talking about are not permanent.
- The very evidence used to demonstrate that addicts’ behavior is caused by brain changes also demonstrates that they change their behavior while their brain is changed, without a real medical intervention such as medication targeting the brain or surgical intervention in the brain – and that their brain changes back to normal AFTER they VOLITIONALLY change their behavior for a prolonged period of time
- Drug use in “addicts” is not compulsive. If it was truly compulsive, then offering a drug user tickets to the movies would not make a difference in whether they use or not – because this is an offer of a choice. Research shows that the offer of this choice leads to cessation of substance abuse. Furthermore, to clarify the point, if you offered a cancer patient movie tickets as a reward for ceasing to have a tumor – it would make no difference, it would not change his probability of recovery.
Addiction is NOT a disease, and it matters. This has huge implications for anyone struggling with a substance use habit.
References:
- 1) NIDA, Drugs Brains and Behavior: The Science of Addiction, sciofaddiction.pdf
- 2) Sharon Begley, Scans of Monks’ Brains Show Meditation Alters Structure, Functioning, Wall Street Journal, November 5, 2004; Page B1, http://psyphz.psych.wisc.edu/web/News/Meditation_Alters_Brain_WSJ_11-04.htm
- 3) Gene Heyman, Addiction: A Disorder of Choice, Harvard University Press, 2009
- 4) Sharon Begley and Jeffrey Schwartz, The Mind And The Brain, Harper Collins, 2002
- 5) Links to the 2 methamphetamine abuser studies by Nora Volkow:
http://www.jneurosci.org/cgi/content/full/21/23/9414
http://ajp.psychiatryonline.org/cgi/reprint/158/3/377
Important Notes from the author to readers and especially commenters:
On “badness” or immorality:
Please do not attribute to me the idea that heavy substance users must be “bad” or “immoral” if they are in fact in control of and choosing their behavior. I do not think this. I think that at the time they’re using, it is what they prefer, given what life options they believe are available to them – and I don’t think it’s my job to decide what other people should prefer for themselves, and then declare them bad if they don’t live up to my vision of a “good” life. That’s what the disease recovery culture does, de facto, when they present the false dichotomy of ‘diseased or bad’. To say that addiction is chosen behavior is simply to make a statement about whether the behavior is within the control of the individual – it is not a judgment of the morality of the behavior or the individual choosing it.
On willpower:
Please do not attribute to me the suggestion to “use willpower.” I have not said that people should use willpower, nor do I think it’s a coherent or relevant concept in any way, nor do I think “addicts lack willpower” or that those who recover have more willpower, nor, and this is important, do I believe that a choice model of addiction necessarily implies willpower as the solution.
“Addicts” do not need extra willpower, strength, or support, to change their heavy substance use habits if that is what they want to do. They need to change their preference for heavy substance use, rather than trying to fight that preference with supposed “willpower.”
On compassion:
Please don’t accuse me of not having compassion for people who have substance use problems. You do not know that, and if you attack my motives in this way it just shows your own intellectual impotence and sleaze. I have a great deal of compassion for people with these problems – I was once one such person. I am trying to get at the truth of the nature of addiction, so that the most people can be helped in the most effective way possible. I don’t doubt the compassion of those who believe addiction is a disease, and I hope you’ll give me the same benefit of the doubt. I assure you I care and want the best for people – and I don’t need to see them as diseased to do so. When you see someone who’s gotten themselves into a mess, don’t you want to help, even if it’s of their own making? Why should we need to believe they have a disease to help them if the mess is substance use related? I don’t get that requirement.
Some Agreement I’ve Found From Addiction Researchers (added 6/10/14)
I began working out my understanding of the brain disease model back in 2005 as I started working on a book about addiction; published this article in 2010; and was happy to find in 2011 when I went back to work with Baldwin Research that they had arrived at a similar conclusion. The way they stated it amounted to “either everything is addiction, or nothing is” – referring to the fact that the brain changes presented as proof of addiction being a brain disease are so routine as to indicate that all behavior must be classified as addiction if we follow the logic.
I was also gratified to have found a neuroscientist who arrived at the same conclusions. I think Marc Lewis PhD and I may disagree on a few things, but it seems we may see eye to eye on the logic I presented above about such brain changes being routine, and thus not indicative of disease. Check what he wrote in 2012 for the PLOS Blog, Mind The Brain:
every experience that has potent emotional content changes the NAC and its uptake of dopamine. Yet we wouldn’t want to call the excitement you get from the love of your life, or your fifth visit to Paris, a disease. The NAC is highly plastic. It has to be, so that we can pursue different rewards as we develop, right through childhood to the rest of the lifespan. In fact, each highly rewarding experience builds its own network of synapses in and around the NAC, and that network sends a signal to the midbrain: I’m anticipating x, so send up some dopamine, right now! That’s the case with romantic love, Paris, and heroin. During and after each of these experiences, that network of synapses gets strengthened: so the “specialization” of dopamine uptake is further increased. London just doesn’t do it for you anymore. It’s got to be Paris. Pot, wine, music…they don’t turn your crank so much; but cocaine sure does. Physical changes in the brain are its only way to learn, to remember, and to develop. But we wouldn’t want to call learning a disease.
….
In my view, addiction (whether to drugs, food, gambling, or whatever) doesn’t fit a specific physiological category. Rather, I see addiction as an extreme form of normality, if one can say such a thing. Perhaps more precisely: an extreme form of learning. No doubt addiction is a frightening, often horrible, state to endure, whether in oneself or in one’s loved ones. But that doesn’t make it a disease.
I think that quote is very important, because it highlights neuronal changes that occur in the same region implicated in addiction (whereas the examples I presented earlier in the article represented some other regions).
In a brilliant paper titled “The naked empress: Modern neuro science and the concept of addiction”, Peter Cohen of The Centre for Drug Research at University of Amsterdam, states that:
The notions of addiction transformed into the language of neurology as performed by authors like Volkov, Berridge, Gessa or De Vries are completely tautological.
He essentially argues that Volkow et al take for granted that heavy drug and alcohol use is uncontrolled, identify neural correlates, and present them as evidence of uncontrollability. Yet they don’t do so with other behaviors, and he provides plenty of examples. He notes that they start with assumptions that certain patterns of behavior (e.g. heavy drug use) are uncontrolled, and others are controlled – based purely on cultural prejudices. He accurately identifies addiction as a learned behavior, or as routine bonding to a thing, and then expresses something very close to my thesis presented above (that all learned/intensely repeated behaviors result in “brain changes”).
The problem of course is that probably all learning produces temporary or lasting ‘change in neural systems’. Also, continuation of learned behavior may be functional in the eyes and experience of the person but less so in the eyes of the outsider. Who is right? We know of people remaining married in spite of-in the eyes of a beholder- a very bad marriage. Who speaks of lasting ‘neural change’ as the basis of the continued marriage? But, even when a person herself sees some behavior as counter functional, it is not necessarily seen as addiction. It may be seen as impotence, ingrained habit or unhappy adaptation. It all depends on which behavior we discuss, not on the brain.
The great points contained in this article would be done an injustice if I tried to sum them up here, so check it out for yourself at The Center for Drug Research University of Amsterdam. As with Marc Lewis, I suspect that Peter Cohen and I might have some substantial disagreements about the full nature of addiction and human behavior in general, but I think we at least agree that the changes in the brain of an “addict” do not necessarily represent disease, and more likely represent a routine process.
Writing in 2013 for the journal Frontiers In Psychiatry, esteemed behavioral and addiction researcher Gene Heyman pointed out something so painfully obvious that we don’t even take notice – no causal link has ever been found between the neural adaptations caused by excessive substance use and continued heavy use. That is, correlation is not causation:
With the exception of alcohol, addictive drugs produce their biological and psychological changes by binding to specific receptor sites throughout the body. As self-administered drug doses greatly exceed the circulating levels of their natural analogs, persistent heavy drug use leads to structural and functional changes in the nervous system. It is widely – if not universally – assumed that these neural adaptations play a causal role in addiction. In support of this interpretation brain imaging studies often reveal differences between the brains of addicts and comparison groups (e.g., Volkow et al., 1997; Martin-Soelch et al., 2001) However, these studies are cross-sectional and the results are correlations. There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug.
Did you get that? Let me repeat the words of this experienced researcher, PhD, and lecturer/professor from Boston College and Harvard who, in addition to publishing scores of papers in peer reviewed medical journals has also had an entire book debunking the disease model of addiction by Harvard University press (I say all of this about his credentials so that I can hopefully STOP getting commenters who say “but you’re not a doctor, and what are your credentials wah, wah, wah,……” here’s a “credentialed” expert who essentially agrees with most of what I’ve written in this article – so please, for the love of god, save your fallacious ad hominems and appeals to authority for another day!)- he (Gene Heyman PhD) said this, as of 2013:
There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug.
And this was in a recently published paper in a section headed “But Drugs Change the Brain”, in which he continued to debunk the “brain changes cause addiction” argument by saying:
There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug. For example, in a frequently referred to animal study, Robinson et al. (2001) found dendritic changes in the striatum and the prefrontal cortex of rats who had self-administered cocaine. They concluded that this was a “recipe for addiction.” However, they did not evaluate whether their findings with rodents applied to humans, nor did they even test if the dendritic modifications had anything to do with changes in preference for cocaine in their rats. In principle then it is possible that the drug-induced neural changes play little or no role in the persistence of drug use. This is a testable hypothesis.
First, most addicts quit. Thus, drug-induced neural plasticity does not prevent quitting. Second, in follow-up studies, which tested Robinson et al.’s claims, there were no increases in preference for cocaine. For instance in a preference test that provided both cocaine and saccharin, rats preferred saccharin (Lenoir et al., 2007) even after they had consumed about three to four times more cocaine than the rats in the Robinson et al study, and even though the cocaine had induced motoric changes which have been interpreted as signs of the neural underpinnings of addiction (e.g., Robinson and Berridge, 2003). Third [an analysis of epidemiological studies] shows that the likelihood of remission was constant over time since the onset of dependence. Although this is a surprising result, it is not without precedent. In a longitudinal study of heroin addicts, Vaillant (1973) reports that the likelihood of going off drugs neither increased nor decreased over time (1973), and in a study with rats, Serge Ahmed and his colleagues (Cantin et al., 2010) report that the probability of switching from cocaine to saccharin (which was about 0.85) was independent of past cocaine consumption. Since drugs change the brain, these results suggest that the changes do not prevent quitting, and the slope of [an analysis of epidemiological studies] implies that drug-induced neural changes do not even decrease the likelihood of quitting drugs once dependence is in place.
Read the full paper here – it’s an amazingly concise summary of the truths about addiction that contradict many of the accepted opinions pushed by the recovery culture – Heyman, G. M. (2013). Addiction and Choice: Theory and New Data. Frontiers in Psychiatry, 4. doi:10.3389/fpsyt.2013.00031
Why Does It Matter Whether or Not Addiction Is A Brain Disease?
When we accept the unproven view that addiction and alcoholism are brain diseases, then it will lead us down a long, painful, costly, and pointless road of cycling in and out of ineffective treatment programs and 12 step meetings. You will waste a lot of time without finding a permanent solution. When we examine the evidence, throw out the false disease concepts, and think rationally about the problem we can see that addiction is really just a matter of choice. Knowing this, we can bypass the rehabs, and find the true solution within ourselves. You can choose to end your addiction. You can choose to improv your life. You can choose to stop the endless cycle of “recovery” and start living. You don’t need to be a victim of the self-fulfilling prophecy that is the brain disease model of addiction. There are alternative views and methods of change which I hope you’ll take the time to learn about on The Clean Slate Addiction Site.
There are many different ways to argue against the brain disease model of addiction. I have only presented 3 basic arguments here. But beyond just addiction, many modern claims of “brain disease” are fatally flawed, in that they are founded on the logically impossible philosophical stance of psychological determinism. From this standpoint, any evidence of any brain activity is immediately interpreted as a “cause” of a particular mind state or behavior – with no regard for free will/the ability to choose one’s thoughts and thus behaviors. If you understand the impossibility of psychological determinism (or “epiphenomenalism”) then you’ll take all such claims with a grain of salt. For a detailed examination of this issue, see the following article: The Philosophical Problem with the Brain Disease Model of Addiction: Epiphenomenalism
How To End Addiction, Substance Dependence, Substance Abuse, Alcoholism, and General Drug and Alcohol Problems (updated 11/4/2015)
Due to the fact that most conventional rehab and addiction treatment programs follow the false belief that addiction is a disease, they are generally not effective at dealing with these problems – so I really can’t ethically recommend any “treatment” programs other than a run of the mill detoxification procedure if you feel you may be experiencing physical withdrawal symptoms – you can find that through your local hospital or emergency room; by asking your primary care doctor; or by calling 911 if you feel your life is in danger due to withdrawal (beware that withdrawal from alcohol and some prescription drugs such as the class known as benzodiazepines can lead to fatal seizures). But what comes after detoxification is simply personal choices, and treatment programs actually discourage productive personal choices by attempting to control people and feeding them nonsense such as the disease theory and idea of powerlessness.
If you want to end or alter your own substance use habits you need to make the choice to do so. Many readers will object to this answer as flippant, cruel, out of touch, et cetera. I realize this, but I chose to change, and in reality everyone who moves beyond problematic substance use chooses to change as well.
There is too much to unpack within what people believe is contained in the statement “choose to change.” I have tried to address some of that here in the past, but I realize this article is not the place to do that. This article’s scope needs to remain limited to the question of whether or not addiction is a disease.
My conclusion is that addiction is freely chosen behavior, and that the person who continues heavy substance use despite mounting costs still sees heavy substance use as their best viable option at the time they’re doing it – even though they recognize many costs and downsides. Choosing to change then, really means that they rethink whether heavy substance use is their best viable option. The only way I know to come to new conclusions is to re-examine the issues methodically, and this may often mean gathering new information and perspectives. Thus, the help that can be given to troubled heavy substance users is information. Helpers can provide accurate information that troubled people can use to change their perspective and come to believe they have better viable options than continued heavy problematic substance use.
I endeavor to give accurate information here that will help people to understand that change is possible, and that they are not doomed to a lifetime of addiction. Hopefully, this helps them on their way to believing in better viable options.
About this article:
I originally published this article on September 25, 2010. I have since added some significant supporting work I was able to find over the years, and those additions are noted. Some other minor edits from the original article are not noted.
Author
Hi, I’m, Steven Slate, the author of this post and of all content on this website. Yes, I was what you would call an “addict.” If you want to know more about me, go to the About page. If you want quotes from PhDs and such (as if I haven’t given enough here already) go to my Quotes From Experts About Addiction page. Please be civil in your comments, and many of your angry comments may already be answered on my FAQs page, so maybe check that out before you scream at me.
and …….
An important study led by University of New Mexico psychologist William Miller found that two critical factors predicted relapse for those treated for addiction problems: “lack of coping skills and belief in the disease model of addiction.”
It’s all in how you perceive and look at. One person says its a disease, and it liberates them to seek out the necessary treatment, just like any other disease and hopefully the world stops heaping unrealistic, unfounded in reality shit on them about their addiction. Another person hears it’s a disease, and becomes helpless and goes on as usual just like any other disease, got to die of something, may as well enjoy myself with a drink, a hit, a smoke, a Big Mac It happens all the time. It is not proof that its not a disease. Its a cognitive processing and behavioral response to reality problem. Financial interest in disease model?…what a twisted, cynical, paranoid assumption is that? No, just experienced in the disease treatment model. Personally, I live at the poverty level. Lead the horse or ass to water… bye bye.
And, experienced with all other disease models working in medical hospitals for a broad spectrum understanding of all diseases and how they work. If we follow your line of reasoning, your own support of anti-disease, must mean you have some financial interest in, let’s say insurance companies that don’t want to cover addiction treatment because its “not a disease.” That will really help people recover, right? Or a political lobbyist for insurance companies who don’t want to offer insurance coverage, for as one legislator put it “When you don’t take care of your body, you shouldn’t get insurance” which will include things as he mentioned diabetes (again being ignorant of diabetes much like yourself and addiction), and opens the door to heart attacks or cancer or anything else that might have some element of “choice,” or how about accidents, you didn’t wear a seatbelt, or a motorcycle helmet, well no coverage for you big boy. Keep it up boys, just doing great, sooo smart!
Idiots who are “disease-theory” advocates would do well to START with getting a MEDICALLY-ACCEPTED DEFINITION of what “disease” IS (the gibberish you cited as a “reference from Hazeldon-Betty Ford did NOT HAVE EVEN THAT!), THEN they can attempt to state how addictive “BEHAVIOR” meets a “disease” criteria! I am still waiting to see this happen. Even American MD’s aren’t stepping up to attempt this, and they’ve been to American MEDICAL SCHOOLS! “Disease theory” advocates really ought to focus their efforts instead as to HOW the VOLUNTARY, WILLING, AND KNOWING BEHAVIOR of an addict’s ingestion and acquisition of a drug is somehow a “disease”. They can’t do that either! Or how a drug winds up IN-VOLUNTARILY INSIDE the user (as a real medical disease DOES!). This is NOT HARD TO PROVE. But the complete LACK OF IT re-enforces the only logical conclusion. Addiction to any drug, is and remains, a CHOICE!
Addiction to some drugs, especially morphine, and/or heroin, is not always a choice. Example, and there are many others: The American civil car (1861-65), where many hundreds of thousands more suffered horrific injuries and debilitating illnesses during their terms of service in the Union or Confederate Armies. The pain and suffering endured by soldiers on both sides was immense. Doctors and surgeons attached to both armies sought to ease the misery of sick and wounded soldiers by prescribing millions of doses of a recently-discovered wonder drug, morphine. To ease the pain and suffering, doctors in the Union Army alone issued more than 10 million doses of morphine during the war.
While morphine certainly did ease the immediate suffering of sick and wounded Civil War soldiers, the highly-addictive drug also created a generation of addicts among Civil War veterans. The sad figure of the morphine-addicted, disabled Civil War veteran could be encountered in just about any American town in the late nineteenth century. The problem got so bad that the most commonly used term for drug addiction was “The Army Disease.” Accurate statistics for the period are hard to come by, but historians believe that as many as 200,000 to 500,000 Civil War veterans suffered from morphine addiction, in some cases for decades after the war ended in 1865.
The same thing happened in Vietnam, the longest war in American history – thus far. Some 40,000 Vietnam veterans came back from the conflict as heroin addicts – many of these soldiers didn’t make a choice to use drugs when severely wounded, they were injected into them by doctors to ease the pain and suffering before and after surgery, and after they returned to the USA for further treatment. They became addicted to drugs (were addicts).
Perhaps one could say that once their wounds healed and the suffering eased, that continuing to use drugs so they wouldn’t become sick in withdrawals, was a choice, but was it really? The fact remains, these soldiers, while laying on a stretcher unconscious, or close to it, did indeed, have drugs pushed “inside their body involuntarily.” Many of these war wounds were horrific, and required weeks and months of treatment with morphine – the soldiers became addicted.
There is other examples of people ingesting drugs not by their own choice, but the above should suffice.
What is the truth of it? Sometimes intentionally and sometimes not, often directly and often through circumstance, the American government is the greatest cause of drug addiction at home. And war is its conduit. Call it a choice, call it a disease – call it whatever you want if that turns your knob, but the real issue is, this crisis is not going to stop anytime soon – only get much worse.
Have a good day, folks…
First I would respectfully point out that dependence is not addiction. Second I would also point out that in reference to the Vietnam War, only 5% of the vets who came back ‘addicted’ to heroin actually continued to have an addiction to it.
And just calling it whatever you want, is not going to help the issue. Helping the issue would actually start by understanding what addiction really is and by doing away with the idea that it’s an incurable brain disease; which its obviously not.
Just my two cents.
The rage in this post is characteristic of extreme denial, like your whole worldview is contingent on making other people feel solely responsible for destructive patterns of behavior. That’s probably your own addiction.
It’s like calling OCD “a choice.” It isn’t a choice if the odds are overwhelmingly slanted in the favor of one in each step of the decision process. It’s more like an organic and self-building propensity. Personal destruction obtained in pursuit of one hobby or habit is abnormal, no matter what we can say about neurochemistry in our primitive time.
Shame nor blame rarely ever work, for obvious reasons, Mr. “atheism is part of my identity.” That puts you in some juvenile company.
there was a choice in the beginning for most addicts, but at some point, you lose your choice. Your hedonic set-point raises for pleasure and the survival sensors of your brain put the drug above other survival aspects (such as: Food, Water, Shelter, and sex). This is called a Amygdala Hijack. https://www.youtube.com/watch?v=Lr-T6NAV5V4
So I agree at some point it was a choice, but Willpower cannot power you through any “Choice”. 12 step programs call it Powerlessness and the unmanagability to get out of feelings. If you have not ever lived in an addiction, you probably have no clue what so ever.
Disproving the “No choice after some point” is easy. Give a non-addict a barrel of drug injected apples. If there is really “no choice” then without knowing what said person is addicted to, said person will seek out Heroin.
What the person will actually seek out is apples. Operant conditioning, the withdrawal symptoms generate negative reinforcement to eat a new apple.
People yell “it is the substance” but behavioral psychologists would know that the persisting behavior after the withdrawal symptoms are finally over will be the eating of apples, not the use of a particular drug. The person never knew s/he was ingesting an addictive drug, the behavioral modification to continue using the drug was never taught.
You have obviously never been addicted to opiates or opioids before…it’s not just the onset of withdrawal symptoms that keeps the addict going back for more. The truth is actually much darker. Drugs, for a lot of addicts, provide a way to escape the insanity and utter catastrophe of existence. As I’ve heard Jordan Peterson say, and I agree with this sentiment: The question is not why do people take drugs. The real question is why do people NOT take drugs ALL the time? Only a person who has truly thought through the conundrum of human existence will understand that statement. I know the debate here is about whether or not addiction is a choice or a disease, and I have to say that I find this debate to be shallow, and slightly inane. It’s obvious that addiction is both choice and disease (or disorder of physiological and psychological origin if you don’t like the word disease). Addiction is a result of the interplay of human free-will and the deterministic nature of our genetic, cultural, environmental circumstances. I never intended to get addicted to opiates but, lo and behold, I did! I was able to get off of opiates through a combination of medication (Gabapentin and Clonidine) and sheer suffering. It was both a physiological and psychological struggle for me and in this way, the remedy mirrors the etiology. This debate is silly and the addicts don’t really give a damn what our prognostications are regarding the future of addiction treatment…all they care about is the very real suffering that is part and parcel of their everyday lives. Just my two cents.
And yet, you do care whether addiction is considered a disease or not, or else you wouldn’t be reading and commenting on this article. It’s not as if this website is the New York Times – it’s a tiny niche website about a niche topic that you really need to search out in order to end up here.
I really do get sick of these “who cares?” falsely incredulous comments.
Let me give you a real clear answer on why the average person doesn’t take drugs all the time: because they haven’t bought into the false romanticized views about drugs taking away all the pain of living and such.
I bought that stuff at one point, and that’s why I ended up living in a crackhouse shooting up heroin and cocaine around the clock. To stop doing that, I had to realized drugs were nothing near as good as we think they are when we are “addicted.”
Best,
Steven Slate, author of this article and website.
My sentiments exactly Mantra. I lost two sons to addiction. Both raised in a Christian home and made professions of faith. Both had rehab. Both were great kids. Very athletic and great grades. The genetic component of addiction in our family is so strong that I preached abstinence from the time that I felt they could understand. My dad and both of my husbands parents were alcoholics. I have 2 brothers who are both addicts. Many nieces and nephews as well.
The access that young people have today to drugs is unbelievable. And addiction is touching every area of life. It does not discriminate. Lower to upper class families all affected. Easy access, like easy access to food and sugar, yet we lable obesity as a disease. Diabetes a disease? Most diet changes “cure” diabetes.
You’ll never know how desperately an addict wants a “cure” unless you’ve watched someone you love go through it or experienced it yourself. Judge not lest ye be judged. I know where my boys are and have the hope of seeing them again yet everyday I live with the what if, if only, if I would have…. found a cure.
Awesomely posted Papa! I think we have the “same anti-disease model” library! I have a few more books though, with titles referred from the old “Orange-Papers.org” site.
I agree, addiction isn’t real. playing video games is more addictive. And I have epilepsy, so I have been told to take pills twice a day for a genuine brain disorder. These pills do nothing but alter my mind, while the doctor doesn’t say how. He says they might help the seizures, he enforces addictive behavior in a twelve year old because he thinks they stop seizures, while agreeing with the de-moralizing and bastardizing of everyone else who enjoys using drugs. Meanwhile, my seizures haven’t been less frequent. I was frustrated, I didn’t like these drugs. So I looked into medical marijuana, and now I smoke marijuana regularly instead of every once in a while with friends. It is genuinely the best drug I ever took for seizures. I wouldn’t want anyone slicing my brain, as that can severely damage it, and so can electroshock.
Repetitive behavior is common in humans, especially repetitive behavior that people enjoy or that help us survive. Drugs have a kind of half and half kind of status. On the one hand people enjoy them, use them in ceremonies, claim them as medicines. On the other hand some have limits, where you genuinely dislike using them. For instance, I don’t enjoy drinking because I don’t like puking and it’s a seizure trigger, but if I’m acting silly or weird, people will jump to “Are you drunk?” on the internet because due to the religious nature of the drug laws, alcohol is accepted while other drugs like peyote, magic mushrooms, have been demonized because they have Native American belief attached. There’s also smoking ceremony.
Lately I’ve gotten obsessed with the drug issue because I think that drug prohibition is just an injustice, punishing people violently for drug use is wrong. Meanwhile claiming that racist and violent consequences are unintended is ridiculous given the history, that so much of this demonization comes from religious prejudice and claiming the drug to be somehow connected to the target that is nonwhite, claiming the drug has side effects of white women rape, was a common way to convince people to demonize a drug. To claim that they have real goals that are important when white women rape certainly can’t be proven.
Really, addiction is just as ridiculous, only it’s trying to be more inclusive, they realized people wanted a less racist government, but they doubled down on racism with the drug war and they didn’t want people to be aware, they wanted to pretend they’re “liberal” that they are so against drugs only because of how bad they are for you, so despite overwhelming evidence to the contrary, they claim their morality justified in prohibiting drugs, when actually, I think of them as immoral, them as bad and deserving of judgement for treating people badly simply because of their habits, even though they weren’t hurting anyone else.
Meanwhile, it’s just a punishment that is far too extreme for the thing done, which is just, basically, being me when you don’t have to be, hanging out. If you want to try reading my stories that I’ve written about this issue, they are science fiction political satire, Mary Jane Adventures, about a marijuana plant that comes to life and kills all the prohibitionists with robots. My point is, that a war on drugs, is that ridiculous. Also I felt like killing all these people but I figured I should do it in spirit. I posted them online on toomuch89.deviantart.com in my gallery. Along with my paintings.
Drugs are less addicting than video games? You are clearly not educated. In a genetically predisposed child, their prefrontal cortex, chemical balance, and more is significantly abnormal at birth. Many children do not realize until they become injured or ill at a later age, and are prescribed opiates/benzos/painkillers (me at my first dental visit, age 14), or thier parents have them take stimulants for nonexistent adhd (me as well age 10). Their brain tells them they need more, while normal brains tell them to stop, or overwhelm them, or cause discomfort. Now, in an addictive child/teen/adult, many are normal people, doing legal things. Some have their first drink. They suddenly realize how good they feel, and instantly obsess/plan on when they do it again. I am the first child in my family to break an addiction. My grandpa, my father, all dead. Do you think addicts WANT to admit they are sick? After quitting do they want to shake, sweat, vomit or have seizures? Many try quitting on their own. Addiction clouds you and tricks you into thinking you dont have a problem. I didnt KNOW i was an addict until i woke up in a hospital after waking up after a heart attack at age 19. Im 22 now, first year med school, but i must continue therapy if i want to stay clean. Its no different than vetting lung cancer from smoking, diabetes due to overeating, or heart disease DUE to an outside cause. It is STILL a disease, just like smomong related lung cancer is still a disease. Both are deadly. Temptation is on tv. Magazines. Internet. College. Highschool. Work. Just because you could control your use, you arent an addict. Just be mindful, informed, and realize theres more to it than what you think it is. Most of us think were fine until we end up where i did. In stage 3 heart disease. Taking what my doctor prescribed and not being physically able to stop.
Do not be arrogant and such a holier than thou snob!
ADHD exists. Basic medical knowledge would confirm this, and the use of stimulants (also known as caffeine by Adults) has been shown to help people with ADHD function.
The use of a small amount of oxycodone does not instantly make you addicted, those drugs do NOT change your brain permanently due to a small amount of use. Only by you voluntarily conditioning yourself to become an addict, do you become an addict. Operant Conditioning, for someone with so much hubris you fail to factor in Nurture and are going straight to “It isn’t my fault, it is all nature”
Research, the only people who like the disease model are the Addicts, because it helps them deny that they’re addicts.
Addiction does NOT trick you into thinking you do not have a problem, you trick yourself, you make excuses for the behavior and you rationalize it away.
This can be seen at all levels of human functioning, not just addiction. Speeding is heavily rationalized as “okay until you are caught”. You see it in politics, you see people rationalizing that they do not have a ‘weight problem’ but society has a ‘perception problem’ (yes, I did just pull that out). Rationalizations are what we use to justify our choices and hide the truth from ourselves.
So what was the reason for all those relapses BEFORE the disease model of addiction?
More Liberal/Leftist political bullshit from David Love !!!!
Complete repudiation of David Love’s nonsense from Huffpost
It was 1971 and the Vietnam War was heading into its 16th year when two congressmen, Robert Steele from Connecticut and Morgan Murphy from Illinois, made a discovery that stunned the American public.
While visiting the troops in Vietnam, the two congressmen discovered that over 15 percent of U.S. soldiers had developed an addiction to heroin. (Later research, which tested every American soldier in Vietnam for heroin addiction, would reveal that 40 percent of servicemen had tried heroin and nearly 20 percent were addicted.) The discovery shocked the American public and led to a flurry of activity in Washington, which included President Richard Nixon announcing the creation of a new office called The Special Action Office of Drug Abuse Prevention.
The office was created to promote prevention and rehabilitation of drug addictions and also to track and research the paths of addicted servicemen and women when they returned home. It was this last part, the tracking of returning soldiers, that led to some surprising insights.
Lee Robins, one of the researchers in charge of tracking the veterans, found that when the soldiers returned to the United States only 5 percent of them became re-addicted to heroin. In other words, 95 percent eliminated their addiction nearly overnight. [1]
This finding completely contradicted the patterns of normal addiction. The typical heroin cycle went something like this: an addicted user would enter a clinic and get clean, but once they returned home, the re-addiction rate was 90 percent or higher. Nearly every heroin addict relapsed. The Vietnam soldiers were displaying a pattern that was exactly the opposite.
What was going on here? And, perhaps more important, what can it teach us about changing our own behaviors, building better habits, and breaking bad ones?
How Addictions Get Shaped
Here is what happened in Vietnam: Soldiers spent all day surrounded by a certain environment. They were inundated with the stress of war. They built friendships with fellow soldiers who were heroin users. The end result was that soldiers were surrounded by an environment that had multiple stimuli driving them toward heroin use. It’s not hard to imagine how living in a war zone with other heroin users could drive you to try it yourself.
Once each soldier returned to the United States, however, they found themselves in a completely different environment. Not only that, they found themselves in an environment devoid of the stimuli that triggered their heroin use in the first place. Without the stress, the fellow heroin users, and the environmental factors to trigger their addiction, many soldiers found it easier to quit.
Compare this situation to that of a typical drug user. The individual picks up a bad habit at home, goes to a clinic to get clean (e.g., somewhere devoid of all the external stimuli that drive their habit), then return to their old environment with all of their old triggers surrounding them, and somehow hope to quit their bad habit. It’s no wonder 90 percent of typical heroin users became re-addicted once they return home — they are surrounded by all of the things that caused them to get addicted in the first place.
Papa nick
Those things they were surrounded by didnt cause them to be addicted. Lots of people in worse conditions dont become addicted.
Although I think that in certain cases of abuse where the abused tries drugs etc they are going to have to look at that abuse in some kind of therapy etc.. but for you to say an environment causes someone to use drugs, is strange. Or at least what if the environment a person in increases their risk of using drugs? Or drinking? And what if they have a terrible experience because of it, but continue to use? Why do some people continue ue to use and sine dont? Could it be because they have a disease? It is it lack of will power? Are you going to say then that a man from the ghetto who works his way into the NBA and throws it all away over drugslacked will power? Well then how did he get into the NBA and out of the ghetto? Seems like it would have taken a lot of will power.
Theres no shame being an alcoholic or addict. It’s just an illness and means you just have to give up drugs and alcohol. Can you do that?
The commonly accepted idea of addiction as a brain disease is almost entirely without scientific basis. We have more than enough diseases without inventing new ones to relieve us of moral responsibility to deal with the complexity of the human condition. We must elimnate the destructive mindset that all deviant behavior is a disease.
SECOND!
It is not almost entirely without scientific basis. It is not a case of it being a total or almost completely moral issue. Not all people who drink alcohol or take drugs are or become addicts. They are able to use in a controlled or quasi-controlled manner…their consequences are ones that they can live with. People ceasing their usage does not mean that addiction does not exist. Not everybody is or becomes an addict. There are predisposing factors, genetically, physiologically, psychologically, socially, environmentally that determines who becomes addicted and who has more trouble stopping their addiction. It pleases you to continue to look down on people struggling with alcohol and drug addiction from a lofty, holier than thou place. You continually make the false conclusion that addiction as a disease excuses people from responsibility, when in reality, admitting an addiction and working a treatment program produces the most personally responsible people on the planet. They work their butts off and face demons you’d hide from under your bed. And then they go out there and help others who are struggling. You know nothing about it. It is evident from everything you post.
Thank you for this ❤️
I lost two sons to addiction. One in May of 2015 and the other in November of 2015. 6 months apart. They were 25 and 31. I watched them both cry , beg, and pray for a way out. The mind is a powerful thing. And that is what they could not escape. I went to many drug classes trying to understand this because at first I believed it was a choice and my response was “ just stop”. I watched them try. I watched them struggle. They both went to rehab. I now know the affect of heroin on the brain and escape and sobriety is rare.
Also, sobriety achieved also leads to times of remission, and times of relapse, like many diseases. An addict can be sober for months or many years, and then relapse again. Its a part of the disease process. Sobriety from a former user does not mean they are not addicted.
I never get times of remission from my diabetes, endometriosis or tachycardia. I have to take boatloads of meds (i.e. drugs) to manage them for the rest of my life. I take “drugs” to treat my sickness. Addicts use drugs to feel good. It does not matter if a disease has flare ups or is static. Even if there are times that I don’t feel the symptoms as much, it doesn’t mean the underlying physical abnormality/disease isn’t there. I can’t choose not to be diabetic. While I am sympathetic to the struggle of addiction, people can and do get sober. My grandfather was a raging alcoholic. When he decided to stop drinking, he stopped and it was for the rest of his life. Addicts can choose to stop using, even if they still at times intensely desire to use. Whereas, I desire nothing more intensely than to be healthy, but I don’t have a choice as to whether I’m sick or not. Every day I have to watch what I eat, test my blood sugar, take multiple medications including an injectible, exercise, and even then it is hard to control my blood sugars. I will likely have to do that the rest of my life, and yet I still have to worry about losing a foot or my kidneys not working anymore. There is no rehab where I can “get off diabetes”. My pelvic disease has caused me to try 6 kinds of birth control, an IUD, Lupron injections with the largest needle you ever saw, surgery and medication that works but negatively affects my blood sugar control. I have to consider oophorectomy. This is likely from genetics, exposure to toxins in utero. Conflating addiction with disease is an affront to people who suffer from real diseases that they had no part in making and have poor options for treatment. I understand that addicts want to change the perception of addiction to one they feel will erase stigma and blame. I agree that it is unfortunate that society has stigmatized and blamed addicts that need help, but it will muddy the waters between understanding the difference between having a medical condition and an addicted condition. Russell Brand was on a talk show a few days ago and referred to addiction as a disease, but then went on to say that anything can be an addiction. Not to mention he was promoting his new book, Freedom from Addiction or some-such title. So, you can get freedom from addiction? I can’t get freedom from diabetes. There are no times that I can eat whatever I want, how much I want. It is such a burden that I can never, ever be free of. There is no rehab for diabetes or endo. To be sick is to never be free. That is my definition because I live it every day. I remember when I was young and didn’t have disabling diseases and I remember how free I felt. It is a depressing burden to know whatever you do, you will never be free of the grip of your disease. Being sick means never forgetting you’re sick. I had pelvic pain last night; I had to take a muscle relaxer to stop the spasms. I had low blood sugar about an hour ago and it came on fast. My body never lets me forget or choose not to be like this.
Benzodiazepine addict who was prescribed it by a doctor. The doctor cuts them off. Their seizure threshold is lowered, they have tachycardia, hallucinations and possible psychosis. They experience obsessive suicidal thoughts and seizures. They have a fever, vomit and diarrhea every few minutes and extreme restlessness, along with stomach and leg pain. They experience a grand mal seizure and die. People that want to take drugs get high. Addicts have to take drugs to feel normal. Most addicts have some sort of mental illness, over 50%. Generally they take drugs to minimize their symptoms. Schizophrenia is not curable either. The largest needle you ever saw? How about 90% of your veins collapsing or getting abscesses drained? Permanent psychosis. Type I or type II diabetes? Type II is usually the result of a poor diet, should we blame them for it? How about the people with such bad necrosis you can see down to the bare bones on their arms? The 13 year old girls that turn tricks to fat old men just for enough money to cop a hit who risk being raped or murdered? Does that sound like the kind of life you choose? Addicted to percocet? Have to worry about your liver shutting down or CNS depression leading to death? Deviated septum, pulmonary edema, cardiac arrest, kidney failure, neurotoxicity, circulatory collapse. You can be free from addiction but your body and mind will never be the same. If someone loses an arm from an untreated abscess it doesn’t just grow back when they get off heroin. No one starts out trying to be an addict. A lot of the time it starts with a prescription for pain or anxiety and when it runs out people experience rebound pain and rebound anxiety, as well as withdrawal symptoms that have been fatal at therapeutic doses. Everyone should exercise daily, no one should eat whatever whenever they want and lots of women get IUD’s. I don’t see a difference between how painful it would be to lose a foot to diabetes or to an abscess, I don’t see how one is more righteous than the other, either way you lose a foot. Since addiction and addiction related issues are dealt with by doctors, medication and nurses and diseases are also treated by doctors, medication and nurses it doesn’t matter what you call it, its still dealt with by medical staff in a medical setting. Consider yourself morally superior if you want but it isn’t going to change anything. Pain is pain.
G –would illness be a better word for you to understand what addiction is? As far as remission what we really have is a reprieve. We recover but we are never cured. Have you ever seen an addict in active addiction? Then have you seen the same person sober? Not all diabetics do what they need to do to maintain healthy blood sugar. Why? Why dont addicts do what they need to do to maintain recovery? Because it’s an illness that needs to be recovered from and then maintained.
I saw a guy pass out and go into a diabetic coma. That was how he found out he had diabetes. We saved his life. He recovered. But I think he had to do certain things to maintain that recovery otherwise he would relapse into his former state of coma and probably die. Its the same with the addict.
As usual, DEP has her — “Perception is Reality” — head up her butt. She is a classic example of how years of damaging indoctrination can absolutely destroy one’s ability to use reason and logic and how it can lead to an extreme emotional imbalance brought on by Cognitive Dissonance.
In DEP’s world, denial rules supreme. In the field of psychology, cognitive dissonance is the mental discomfort (psychological stress) experienced by a person who simultaneously holds two or more contradictory beliefs, ideas, or values.
But there is hope for DEP. Emotional imbalances occur when a person is not coping with life effectively – whether it is due to stress, depression, anger, feelings of negativity and so forth. It is important for DEP to balance these emotions to avoid further problems. Treatment for emotional imbalances includes exercise, meditation, creative expression, relaxation, herbal medicine, massage, acupuncture, Ayurveda, aromatherapy, reflexology, counseling, and homeopathy.
Now, MORE RESEARCH SOURCES
Harvard psychologist Gene Heyman on why drug or alcohol addiction is not a disease, but a matter of personal choice
By CHARLIE GILLIS in Maclean’s Magazine June 1, 2009
Gene M. Heyman, Ph.D.
Boston College and Harvard University
“Addiction: A disorder of choice.”
At the heart of Heyman’s analysis is a startling view of choice and motivation that applies to all choices, not just the choice to use drugs. The conditions that promote quitting a drug addiction include new information, cultural values, and, of course, the costs and benefits of further drug use. Most of us avoid becoming drug dependent, not because we are especially rational, but because we loathe the idea of being an addict.
Heyman’s analysis of well-established but frequently ignored research leads to unexpected insights into how we make choices—from obesity to McMansionization—all rooted in our deep-seated tendency to consume too much of whatever we like best. As wealth increases and technology advances, the dilemma posed by addictive drugs spreads to new products. However, this remarkable and radical book points to a solution. If drug addicts typically beat addiction, then non-addicts can learn to control their natural tendency to take too much.
Addiction Is a Choice
October 01, 2002 | Addiction, Alcohol Abuse
By Jeffrey A. Schaler, PhD
Scientifically, the contention that addiction is a disease is empirically unsupported. Addiction is a behavior and thus clearly intended by the individual person. What is obvious to common sense has been corroborated by pertinent research for years
The person we call an addict always monitors their rate of consumption in relation to relevant circumstances. For example, even in the most desperate, chronic cases, alcoholics never drink all the alcohol they can. They plan ahead, carefully nursing themselves back from the last drinking binge while deliberately preparing for the next one. This is not to say that their conduct is wise, simply that they are in control of what they are doing. Not only is there no evidence that they cannot moderate their drinking, there is clear evidence that they do so, rationally responding to incentives devised by hospital researchers. Again, the evidence supporting this assertion has been known in the scientific community for years
The vast majority of research methods create false statistics through confirmation bias. The only real evidence most people have is personal experience. Addiction clearly isn’t a disease to someone who has gone through it. Social science is flawed and will never be able to explain reality because everyone is extremely different from one another. There is no mean or median explanation for everyone to solve a societal problem together. Without the community effort (neighbourly love) that has died off since we were children, problems caused by people making choices in their lives will become a worse situation than it is. Research will not solve it.
To all friends who are (temporarily) addicted to substances and to all my fellow EX-drug abusers and EX-problem drinkers please remember this:
1) We are not now–and never have been- powerless over substances. Nor are we powerless over “people, places, and things” as juvenile 12 step groups preach ad infinitum.
2) WE don’t have-and never have had – a brain disease that causes addiction. That’s a ridiculous proposition mainstreamed by Nora Volkow who reinvented the disease theory of addiction as a function of neuroscience and positioned herself as the international go-to source on addiction.
Neuroscience’s chronic brain disease model has produced no useful diagnostic or treatment tools for addiction, even as it expands endlessly before us. Natural recovery from drug addiction and alcoholism is the norm, often without abstinence, completely undercutting the “chronic, relapsing brain disease” meme.
Several studies have tracked people who developed alcoholism or drug addiction, following them for decades. In one such study, Kenneth Sher found that “people mature out of addictions at all ages.” In another, Madeline Meier reported that “relapse does not appear to be as ubiquitous as one might expect based on estimates from clinic samples ” This leads Meier to “the view that alcoholism, in most cases, represents a changeable habit rather than a brain disease.”
3) We are not now-and never have been- spiritually deficient. This again is the fantasy land childish nonsense propagated by 12 step groups in order to subjugate and control their members. The (so called spiritual) 12 steps are used to convince millions, when they are at their most vulnerable due to personal crises, that the 12 steps are God’s latest revelation, above and beyond Christianity and other religions.
In absolute sincerity about their SPECIAL KNOWLEDGE of God, members put the groups above scientific scrutiny and intellectual analysis.
4) We are not now-nor have we ever been- VICTIMS of a genetic inheritance that predestines us to be addicts.
So stop whining and take responsibility for your actions.
We don’t have a brain disease and we’re NOT POWERLESS.
In truth, we have power beyond measure…. It is the pleasure of the weak-minded and brainwashed to try to take our power from us.
Don’t allow this!
In the interest of putting a STOP to the perpetuation of the “disease theory”, I e-mailed President Trump, and asked him to FIRE Norma Valkow (who may have some “medical degree” from MEXICO!), due to her NOT being licensed to practice IN the U.S.A.! NIDA needs to be eliminated from the federal budget as long as she is the head of it! That agency is WASTING taxpayer dollars as long as one of these idiot “disease-theory” advocates is the head of it!
I hope that Trump and Congress will take a MEAT-AXE to this agency until it actually starts RESEARCHING SCIENTIFIC SOLUTIONS to addiction!
Lmfao, you now expect all Americans to have American degrees or they don’t count.
Your brain is haywire, bro. We should research know-nothings like you.
Hi, i’m christopher hannah from orlando florida. my son grew from taking spice to becoming an addict to “flakka”.he goes insane acting like a zombie. looking possessed.Destroying properties of our neighbors and slamming his body on my husband’s car. seeking to devour or destroy anything that comes his way. we had to lock him inside his room till he tries to get a hold of himself. whenever he feels like taking them he steals from me or sells some of my property.this made him move with bad peers. this got my husband and i worried and disturbed knowing his state of mind. fortunately i came across a testimony of a mother who had similar issue with her husband until he got prayed for by diviner peterson of newgracefoundation. i also contacted him for prayers. now my son is doing fine in less than a week after he got prayed for by diviner peterson. he is totally free from flakka and spice. i’m so glad and urge anyone facing similar or any problem at all to also contact him for prayers via email address:newgracefoundation@gmail
Diseases are things like malaria, Parkinsons. Addiction is a result of poor choices and refusal to take responsibility for one’s actions. To tout it as a “disease” is the equivalent of enabling by any other means and is a disservice to junkies and drunks.
You know, the psychologist saying, what we see in others exists in us. You are describing yourself Papamick, because you don’t know me enough to make those assertions. With an MS degree, my critical thinking skills are always at the forefront, and fully balanced in the emotions department. What you are failing to grasp is that not all people who use chemicals are addicts. Diagnosing includes three categories, substance USE, substance ABUSE, and substance DEPENDENCE. There are objective diagnostic criteria for each. There are reasons people recover from addiction, either they were not addicted in the first place or they worked their program, but are in high likelihood for further relapse. Just like any disease if you don’t do what you are supposed to do, diabetes, heart disease, cancer, etc. You do not understand and are stuck on powerlessness and have ignored explanations about it. You don’t like AA support group’s use of higher power or powerlessness? Fine, while it has shown successful results for millions, go on and head on off to other “logical” approaches, nobody cares, but that does not change the disease model of addiction which is not dependent on AA, they are two different things entirely. Trump is hardly likely to take a stand over the disease of addiction, he saw his own brother destroyed by the disease of addiction.
Oh my goodness, Dep, u really need to get off this site!!
Classic challenge to the “loss of control” myth:
Loss of control drinking in alcoholics: An experimental analogue.
Marlatt, G. Alan; Demming, Barbara; Reid, John B.
Journal of Abnormal Psychology, Vol 81(3), Jun 1973, 233-241
Presented 2 groups of 32 male 23-65 yr old non abstinent alcoholics and social drinkers with an ad-lib supply of either alcoholic or nonalcoholic beverages in a taste-rating task. Ss were assigned to 1 of 2 instructional set conditions in which they were led to expect that the beverage to be rated contained alcohol (vodka and tonic) or consisted only of tonic.
The actual beverage administered consisted of either vodka and tonic or tonic only. Results show that instructional set is a significant determinant of the amount of beverage consumed and post task estimates of the alcoholic content of the drinks. The actual beverage administered did not significantly affect the drinking rates of either alcoholics or social drinkers. Loss-of-control drinking, in the form of increased consumption by alcoholics who were administered alcohol, did not occur during the drinking task. Results are discussed in terms of implications for treatment and for the conception of alcoholism as a disease. (Psyc INFO Database Record (c) 2016 APA, all rights reserved)
The results showed that for both alcoholics and social drinkers, subjects who expected to sample a drink containing alcohol drank almost twice as much beverage as those who expected to receive only tonic, regardless of the actual presence or absence of vodka in the drink. The findings provided a challenge to the, disease model theory of loss of control and opened the door to cognitive-behavioral treatment programs for alcoholism designed to modify expectancies and to teach behavioral coping skills to prevent relapse.
Doesn’t “The Sober Truth” ALSO have a study like the one above? Or maybe its in Dr. Doddes’s first book, “The Heart of Addiction”!
What the **** do you think this is proving? All this blindfold taste test (not a study in any sense) suggests is that both social drinkers and alcoholics desire alcoholic drinks. If all you have are a handful of cups, those are going to disappear.
Did the alcoholics beat up the researchers and look for their stash?
Most pointless research ever.
Some people place research above everything even if it’s a bunch of biased hogwash.
If anyone watches Pleasure Unwoven they will be able to understand why addiction is a disease. Your brain stops working properly. Please watch this and become more educated before just accepting everything posted on the internet.
IT is not a disease!!!!! If u have any common since U would see that!!
I don’t think you truly understand what is exactly meant when the WHO labeled addiction a disease. It should be illegal to post fraudulent websites such as this, you know, biased bullshit. I see that you’re a Trump voter, I now understand why you don’t believe in science.
You see that I’m a Trump voter??? Where the heck do you see that? LOLOL
Are all substances linked to substantially similar degrees of dependency?
No?
There goes the choice theory.
Your FAQ doesn’t state what substance you were addicted to. Please elaborate because while cocaine and speed are fairly easy to quit Fentanyl and Xanax are not. Since stopping benzo use immediately can trigger life-threatening seizures. Barbiturates can cause death for the same reason. Weed is barely a drug and you can’t really get physically addicted to MDMA or mushrooms. So what exactly were you “addicted to” IV heroin and coke? Straight fentanyl? Or Vicodin Adderall, and cigarettes? Have you ever had any firsthand experience in withdrawing from high potency intravenous opiates cold turkey (after at least 8 months) or immediate cessation of benzodiazepine treatment? You seem to be oversimplifying a complex issue. It really doesn’t matter if it is a disease or not, hospitals still have to treat it. When someone is seizing from benzo withdrawal it is a major medical emergency, disease or not it is a public health issue. Most people can’t afford to drop everything and use mommy and daddy’s cash to go to a fancy rehab especially if they’re living on the streets. I know many IV users and am an ex-addict myself. How many times a day were you shooting up and what? I was doing 90mg of Dilaudid, IV cocaine, Fentanyl and “oxycontin” (probably also fentanyl) and I’m prescribed 2mg of clonazepam daily. The class of drug really affects the body’s response to withdrawal. Cocaine, speed, meth take it or leave it. You can sleep it off in a week even if you’ve been going hard. Clonzepam is much more difficult to get off of and can kill you. So what is it you were using? I can’t seem to find it on here which makes me doubtful of your premise. Also what is up with the taxi analogy? Entirely unrelated red herring argument.
“there is no evidence that the behavior of addicts is compulsive (compulsive meaning involuntary)”
First, compulsive does not mean involuntary, and nowhere in medicine or related research has anyone suggested that addiction of any type is an autonomic function.
If addiction treatment is considered medical, and it is (not to mention that it is mandated to be covered by medical insurance), then people in medicine absolutely do say that addiction is involuntary. The evidence of this is directly observable to anyone who’s attended addiction treatment, and anyone who’s heard those who work in this field spout off about it.
Are you telling me that this doesn’t essentially say “involuntary???:
You do know that diseases such as an STD which has the word disease in it, was received by a choice. How about the fact that sugar triggers cancer cells, because we all have cancer cells in our bodies, it’s just a matter or maintaining healthy habits and no over stressing or over exercising. Diabetes can also be triggered by over indulging sugar. We are in a heroin epidemic where innocent people are dead because Purdue Pharma told them OxyContin had an extremely low risk of addiction, misrepresenting their drug, then when it was too late, even school teachers or younger children were prescribed the drug for post surgery pain relief and became addicted. I’m pretty much just speaking about opioids and heroin because it does things to a person…making family and friends feel hurt and pain in there hearts because drugs can consume a person, heroin addicts and opioid victims are people who once they have crossed a line have lost their soul, that’s how different this drug can make someone. I pray no one has to deal with this but when you watch someone you love fight for survival but fail over and over and feel hopeless that the drug was won, you will see how similar is to cancer. You have to watch as they suffer and you know you can’t do anything, just sit there and hope for another day with the one you love. I understand you were just writing thoughts but in all honesty opioid addiction is a disease, the leading cause of deaths for people between 28 and 50. If we don’t help the people because of a choice they made that consumed them, then maybe we are the ones with the real disease!
Hi Laura,
I am well aware that people make choices that result in acquiring diseases. The method by which a disease is acquired is not the issue here. I have never said that people choose to acquire addiction. Many people seem to assume that’s my argument, but it is not, and I even have a section on my FAQs page explaining that this is not my argument although it’s kind of absurd that I should always have to remind people what I am not saying. What I am saying, is that there is no disease to be acquired – that there is no state of involuntary substance use that one can catch, develop, or otherwise enter into. I am saying that what we call addiction is fully voluntary behavior. I suggest you reread the article if your takeaway is that I’m saying people choose to get addicted. No one is addicted in the popular sense of the term.
Your comments also seem to suggest that you see my writing as an argument against helping people with substance use problems. On the contrary, I have actually written this in order to help people with substance use problems. I had a very bad heroin use problem, and as long as I believed the misinformation I was taught in treatment programs about being diseased and in for a lifelong struggle against addiction, I continued to struggle and problems became exponentially worse. When I rejected the idea that I was addicted, I was finally able to deal with my problems and make the choice to change. If you look at the homepage of this website, you’ll find a link to my TEDx Talk where I explain this a bit further. I view problematic substance use as the result of a highly developed preference, and the feeling of being “addicted” as a learned interpretation of that preference – a sort of social contagion that overcomplicates the problem. The way to fight a social contagion is with facts. Here is the fact that substance users need to know: they are not using substances against their will, and they can choose differently.
Best,
Steven Slate, Author of this website
Laura… I agree with you. By making this comparison, you make certain preferences of one sickness, ailment, disease over the other. Many cancers and diabetes and joint disease is caused by negative behavior. We may find one day that they all are. What benefit is it to argue choice over disease when everything is the effect of choice?
Hi Brenda,
The point of the disease model of addiction is that substance users cross a point where they lose the power to choose. Whether or not this is the case has MASSIVE implications for how to address substance use problems. The alternatives are clear, and very different:
1) If we assume the substance user has lost the power to choose, then they must somehow be coerced to stop – either by medicine on a neurological level, or coerced by being locked up in jails.
OR
2) If we assume they retain the power of choice, then we can provide them with help that allows people to make better choices – information, ideas, awareness of other options.
If it’s not a disease, and we approach it with medicine, then we won’t have much of an affect on their choices. It’s like hooking jumper cables up to your dead car when the problem is really that the car is out of gas. Seeing how addiction treatment doesn’t raise rates of success at conquering substance use problems above the rates of success for people who don’t receive treatment, I think the medical approach is playing out like our little car analogy.
So, it’s pretty simple to see that whether or not to approach it as a disease is a debate with very REAL consequences for troubled people.
Best,
Steven Slate
So,addiction is a disease,as some say.My question is,if addiction is a disease,why is psuedoscience used in the treatment?
Exactly what benefit do people get by childishly claiming to have a fake brain disease called addiction? I can understand the benefit to LPC’s, treatment industry counselors and 12 step cultists—$$$$$$$$$$$—- but I can not fathom the reason for folks who abuse substances to claim it’s a disease. Is it stigma avoidance? Is it attention seeking? Is it to escape accountability so that they can keep using?
I’ve thought about this a lot Mick, and there are many reasons. It does help to deal with stigma on a personal level. In some cases it could be conscious malingering, but I think that more often than not we’re persuaded to genuinely believe it. They make a convincing case for the disease of addiction, and it’s easy to believe it when everything in your life is in shambles, and your behavior and desires appear to be so irrational. The disease model explains the apparently unexplainable: that people want to do things that will clearly end badly.
I would submit that “irrational” behavior and desires are not unexplainable though. The explanation is that we are human, we do not come into this world with a clear cut instruction manual or inborn knowledge of how to thrive. To make all the best decisions all the time – to be a fully rational actor – is a ton of work (and I would say ultimately impossible). Life involves a ton of trial and error. That is being human. Until we can accept that fact, we’ll continue to buy into nonsense like the disease model of addiction.
Personally, I have been at peace (for 15 years now) with the fact that I made some bad decisions and developed some strong desires for a style of substance use that didn’t serve me well as a result of being a normal human being. I am at peace with the fact that I will continue to go through trial and error in other parts of life too because I am human. I will sometimes want things that aren’t that great for me in the long run, and that is okay. I will make choices that aren’t optimal, and that is okay. It just means that I am human, and life is a constant challenge, but each challenge can be learned from, reducing future challenges. The minute you start to think your struggles/challenges/failings are stable defects within you is the minute you freeze in place, or even move backwards in life (as I did while believing I had a disease called addiction).
I also believe, as I think was suggested by your comment (“attention seeking”), that sometimes people like being victims. I’m sure this was some part of why I bought into the disease model of addiction. It takes a ton of pressure off of you, and gives you a meaningful struggle. Victimhood is a status symbol now in our culture. Victims are seen as having more moral worth than “privileged” non-victims. Being born a privileged white guy like me is boring, but if I have the affliction of addiction to battle, I gain prestige, and it makes any accomplishments I make in my life more significance, more value. Like “Hey, I achieved this despite having the disease of addiction!” as opposed to “I achieved this because I was born privileged and so it has no meaning!” This value brought by victimhood will incentivize many people to hold onto the disease of addiction.
Let me ask you this, have you ever injected meth? It is 30-100 times stronger then anY orgasm you would get from sex, would you be able to give up sex for the rest if your life? I highly doubt it. Try quitting something that is the paragon of pleasure when you couldn’t even give up sex in your life, if you had the choice. Go ahead and pretend your better than somebody you veiw as attention seeking or lacking in responsibility of action. Addicts may choose to use drugs but they don’t choose to have the chemical imbalances and shortages the come from the drug wether using for the first time or the 100th. But it only takes one time to fundamentally change everything you thought you knew about life and addiction. Trust me I was ignorant just like you but as soon as I felt the pure ecstasy and nirvana at age 21 I realized how pathetic and wrong it is to think addiction is something less then profound. But you would sell your soul and your mother if you experienced a big syringe of it, even if you didn’t choose to use it and you were forced instead. Next time you think you understand something you better have the first hand experience cause without that your the worst kind of fool – a fool who thinks himself wise.
It’s curious that you compare addiction to cancer or diabetes when we know in that many cancers and diabetes and other ailments are often the effect of negative behaviors. A person eats high fat, sugary, highly processed foods and gets colon cancer, breast cancer, diabetes. A person smokes and gets lung cancer. A person overeats and burns out their knee and hip and back joints. I’m not sure how you say addiction is that different. By all accounts every ailment is an effect on something gone awry; many that we have no control over, but many that we do. It could be argued that cancer and diabetes and other ailments are also a choice.
Brenda, in case you missed it in your initial reading of the article, the critical point is NOT about the genesis of a condition. Whether it is acquired through one’s behavior or not has nothing to do with whether or not it is a disease. A disease is characterized by the fact that it cannot be removed by an effort of the mind or will. Usually, a disease will also involve some form of physiological dysfunction, but this is not always the case. To recover from a disease will require either the passage of time and/or medical intervention of some form. If I contract a bacterial infection, this is a disease. It will not be ameliorated through good thoughts, prayer, or meditation. I will need time to recover, and possibly a course of antibiotic medication. Whether I brought it on myself (ate food I knew had spoiled, for example) or got sick through no fault of my own (stabbed by a mugger’s rusty knife) is absolutely immaterial. What matters is that once the disease manifests, it is not directly under the control of the sufferer.
Addiction doesn’t follow this pattern. While a cancer sufferer doesn’t wake up one day and say “I think I’ll continue to have cancer today”, that is exactly what habitual drug users do. Each time they use drugs, they choose to do so. They say “I think I’ll go get high today”.
The critical point here is that one cannot simply choose to no longer have a disease. It is certainly possible to increase your chances of acquiring a disease by your choices. Smoking drastically increases your risk of lung cancer, though there are long-term heavy smokers who never get the disease. However, for those that do, they cannot simply choose to get better. In order to be cured, they need some form of medical intervention, be it chemotherapy, radiation therapy, a lung transplant, or something of that sort.
Contrast this with another type of condition brought on by life choices. I’m a little overweight, and I take full responsibility for this. I don’t exercise as much as I should, and I eat too much junk. However, I am not ‘diseased’. I can make different choices and lose weight, and in general improve my fitness level. This is much the way I see ‘addiction’- a series of poor choices (by conventional standards) that have lead to a state that others (and possibly the ‘addict’ as well) will find undesirable. However, it does not require outside intervention to ‘treat’. It only requires a shift in behavior. Behavior described as ‘addictive’ is simply habitual behavior. It is not involuntary, compulsive, or symptomatic of disease.
Physical dependence is an entirely separate issue. It is possible to have physical dependence on a substance where there is no strongly-formed habit, or a habit in the absence of physical dependence. Conflating physical dependence with habit is one of the many disingenuous things proponents of the disease model do in order to convince people their model is accurate.
The thing about science is that any properly-formed hypothesis or theory needs to be falsifiable. This means that there needs to be some conceivable situation that would disprove the theory or hypothesis. In the disease model, where it is asserted that an ‘addict’ cannot recover without medical intervention, this potential situation would be the case where a person labeled as addicted recovered without such help.
Imagine I had a theory that all (not most, but ALL) crows are black. You try to disprove my theory by presenting me with a crow that isn’t black, perhaps an albino specimen. However, I cleverly point out that, since a crow is BLACK, what you have presented isn’t a crow at all. After all, the definition specifies the bird must be black, so you cannot be presenting a crow. This means I don’t have to amend my theory (ie, “MOST crows are black”) or admit to being wrong. I can simply stick my fingers in my ears and close my eyes, and my worldview is preserved. This isn’t honest, and it’s certainly not science.
If the proponents of the disease model were honest, they would discard (or at least amend) their theory when confronted with these cases. Instead, they pick the dishonest tactic of dismissing any data that doesn’t fit their theory. Subjective accounts on the part of addicts, seeking to justify their behavior by calling it ‘compulsive’ or ‘involuntary’ are given credence (because we know addicts NEVER EVER lie), but conflicting cases are called ‘anomalies’ (much like spontaneous remission of cancer) or simply dismissed outright (“Oh, they weren’t REAL addicts if they beat it by themselves- it’s INVOLUNTARY behavior, after all”- see the ‘No True Scotsman’ fallacy).
You can identify a behavior as addiction by its involuntary nature, and you know it’s involuntary because that’s the sort of behavior characterized by addiction. WTF? Even many people WITHOUT a grounding in formal logic can see this as the circular reasoning that it is, so it stuns me that well-educated people still promote this model. Call me cynical, but I think most who promote it due so out of self-interest. There are those who stand to make money (doctors, rehab clinics, and prisons- and don’t even get me started on the logic of labelling a behavior as ‘involuntary’ and then locking someone up for it). There are the users themselves, who feel relieved if they can delude themselves into thinking their behavior is not their fault. There are the families of users, particularly users who fund their habit through theft and other crime, who would rather think of their loved ones as ‘sick people’ rather than ‘bad people’. There is also the vast juggernaut that is political correctness, and the knowledge that it will steamroll any who dare suggest that an alcoholic or junkie is just as responsible for their life choices as the rest of us.
If you’re still convinced that ‘addiction’ merits the label of ‘disease’, let me propose a thought experiment. On the one hand, we have Alice, who has just been diagnosed with advanced breast cancer. Whether she went in for regular screenings or not, and whether you believe her lifestyle choices contributed to her disease are moot points. The fact remains, she has cancer, a bona-fide disease. On the other hand, you’ve got Bob. Bob has a long-term heroin habit, and has long since given up any attempt to hide it. He fits the stereotypical image of a street junkie. He’s skinny, because even when he’s got money for food, he can seldom keep it down. He’s missing several teeth. He does whatever it takes to get money for his next fix, whether that means turning tricks, panhandling, or theft.
Along comes Charlie. Charlie kidnaps Alice and Bob, and locks them in his basement. He and his associates monitor them by closed-circuit television to make sure they don’t injure each other or commit suicide. He provides them with food, drink, comfortable beds, television, and numerous other comforts and diversions, including a nice big stash of heroin that either of them can use. He tells them that he will check on them in two weeks, and test them for their respective diseases: Alice will receive a biopsy, and Bob will receive a drug test. If Alice tests positive for cancer, her husband and daughter will be tortured and killed. If Bob tests positive for heroin, his parents- who have stood by him despite his lifestyle- will likewise be tortured and killed.
At the end of the two weeks, Alice’s biopsy provides the expected results, and she gets to watch a video of the torture and murder of her loved ones. What do you think will happen to Bob? If his test comes back clean, does that mean his addiction doesn’t meet the criteria for a disease?
get em brenda
This is a well thought out and referenced article. I may have missed it, but I never read where you referenced people born of addicted parents and the effects on the brain, neurons, transmitters, and synapsis. Here’s the definition of disease: https://www.merriam-webster.com/dictionary/disease
Addiction can be a disease.
You are spot on David. By the traditional definition of “Disease” as defined by dictionaries from medical to the literary, addiction is a disease.
Brenda Writes: “It could be argued that cancer and diabetes and other ailments are also a choice.”
Folks, it would be difficult to find a comment more ignorant and foolish than this one from Brenda
you’re wrong.
A person who tans excessively has a high chance of getting skin cancer. How did they get it? From not protecting their skin from UV light.
Type 2 diabetes is a condition derived from poor eating habbit of eating high sugar foods causing the pancreas to not be able to regulate sugar levels and can be reversed in most cases by eating properly.
Cloged arteries and heart valves is caused by eating fatty foods.
All choices.
This article reads like a personal vendetta. Who are you helping with your commentary? Or are you just trying to fuel a debate?
First, you need to consider the broader definition of disease — “a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.” Are you simply arguing semantics? If instead of brain “disease,” we called it a brain “disorder” would you stop judging those who need help? There is plenty of legitimate evidence to explain what happens to the brain under the influence of drugs and alcohol if you do your homework.
Second, no one chooses addiction, and no one is calling addiction a disease to give sufferers an excuse to continue abusing drugs or alcohol. On the contrary, understanding addiction as a brain disease helps us recognize and help sufferers who want to overcome their addiction. That’s where choice and humanity come in — the choice to get help and humanity to provide it.
Finally, if you want to be taken seriously, you need to be less one-sided and misleading. Unlike addiction, cancer has long been understood as a disease and is sometimes caused by choice. If we follow your logic, perhaps we should we stop treating people with lung cancer because they chose to smoke? Or skin cancer because they choice to be in the sun too long?
So, nice rant, but what, exactly, is your point?
I’m going to cut and paste a part of the article you may have missed (re: your comment “If instead of brain “disease,” we called it a brain “disorder” would you stop judging those who need help”:
-Steven Slate
I’d also like to respond to this comment of yours:
Where exactly did I express such logic? Don’t bother looking, because you won’t find it. My logic is not that people make choices that result in acquiring the disease of addiction. My logic is that the behavior we call addiction is fully freely chosen at every level. Incidentally, I also addressed this on the FAQs page of this site.
I expressed my utter disagreement with the logic you falsely attributed to me on my FAQs page. There is no brain disease that compels you to use drugs that can be acquired. That is what this article was about. So I am completely uninterested in any theories of how a nonexistent disease is acquired. Here’s a little excerpt from my FAQs page:
Please stop attributing ideas to me which I clearly did not express.
Good day,
Steven Slate
Finally:
My point is that substance use is freely chosen even in the people society has labeled as addicts or alcoholics, and people can choose to change it if they see fit. They don’t have to believe in a fake disease that will lead them into a fight against a bogeyman.
I don’t say this to put anyone down. I like drug users. I don’t think drug use is inherently bad. And I can’t stand to see people misled into believing their behavior is involuntary.
-Steven Slate
The point people are trying to make against you is that if you haven’t been an addict yourself then you don’t understand it very well. I have been an addict and I understand it was my choice to begin doing drugs and MY CHOICE to stop them. Nobody else can define you or label you with their collective ideas. I have been an addict, but it was never a disease.
Well that message didn’t go where I wanted it to go
I tend to think of “addiction/the habit of using opioids or other drugs” as a choice. This should be obvious by use of the word “habit.” My main issue however isn’t specifically with the idea of “addiction/the habit of using opioids or other drugs” in isolation. My issue is that the idea that consuming drugs/alcohol regularly and in high quantities is a disease that requires rehab and working the 12 Steps is what I have a problem with.
I think the perception that using high and regular doses of opioids is a disease cured by going to 12 Step rehab with 12 Step meetings for life afterwards is what is the single greatest contributor to the opioid epidemic. I think we can trace this happening to Obama Care–as well intended as it might have been. This is because with Obama Care the poor (and those that regularly consume high doses of opioids often are poor) could have insurance pay for rehab so more people than ever before were going to rehab. Which, if AA and 12 Step worked, would mean a drop in those who had a problematic habit of consuming opioids, especially one that killed them. But that is not what we see. Instead, we see a slight delay in-between the period when more people are going to rehab and more people are dying from OD and with use even higher still.
Because there is so much money to be made by stockholders in rehabs, it is attractive to come to the conclusion that Big Business and the government (if one believes that Big Business runs the government, which I believe) is vested in the disease model. It becomes more abhorrent when one takes into consideration that having a drug illegal necessitates the idea of rehab even more, just as owning prison stock (which supposedly Jeff Sessions, our Attny General does) also makes money for the rich by destroying lives by either sending those caught with an illegal substance (who don’t necessarily have a problematic relationship with the drug) into both prison and rehab, and the first destroys lives and the second seems likely to lead to OD.
This methodology is more subtle than in the Philippines, but it isn’t more moral.
No one said anything about substance use, what you are questioning is addiction. Right? No one questions cancer as being a disease they just do their best to get it treated even when the treatments are not working they don’t say, “See it’s not a disease because the treatments don’t work.” Drugs are a symptom like food, nicotine, sugar, sex, gambling etc. You made an argument that cancer is not a choice but it is a choice to eat unhealthy foods, smoking cigarettes or stand out in the sun, and not exercise etc. Those are choices and contributing factors to getting cancers and other diseases.
“From their, it is entirely a voluntary process which must be freely chosen by the individual in order for any change to take place.”
I think you mean “From there, it is entirely a voluntary process….”
I disagree with you but everyone is entitled to their own opinion.
You got me! I made a spelling/grammar error, and citing this is enough of a counterargument to invalidate this entire post. Looks like I’m gonna have to shut down my website now and move on to other things, forever trying to escape the shame of my error. Maybe I can change my name and hair color, and find some isolated village off the grid where I can build a new life for myself. Wish me luck! 🙁
Steven Slate
I think you meant to post this comment on a different page – Sleazy Tactics Used To Full Dramatic Effect in Kevin McCauley’s ‘Pleasure Unwoven’: The Choice Argument
Everyone is entitled to make a snarky nit-picky response to a blog post in the comments section of a completely different blog post.
Thank you for your TEDx talk. And for your website. Really thought provoking.
It takes a lot of guts to go out there and voice your beliefs…your experience and research. I appreciate your dedication and hard work.
Steve,
I wonder what your thoughts about compulsory treatment are. I have seen this method to not only be highly ineffective but to be immoral as well. I say ineffective due to the abysmal success rates, and I say immoral because of the way behavior modification techniques are being used on clients. Not that BM isn’t useful but when it’s being used without the client’s knowledge or consent it becomes manipulation. I believe it was Skinner who wrote about this.
My question is this. If the disease concept is on the up and up then why is there such a dishonest presentation of it? And why are some of the techniques used in treatment so immoral and even cruel sometimes? Do the ends really justify the means?
What are your thoughts on this?
This was an interesting read. I’m actually a recovering alcoholic, and by no means have a closed mind on why I am the way I am. From my personal experience I can try and shed some light on my addiction to alcohol. Now, I’m not sold on the “disease” label, but I am however a believer in the “allergy” (phenomenon of crave) that I experience when I drink alcohol. When I drink, I always drink until I am drunk. I could have a full intention to just have 2 beers, and the next thing I know I am closing down the bar at 2 AM with god knows how many I’ve had. I have tried and tried, and tried again to be a “responsible” drinker, but I fail miserably every time. I have battled this addiction for the last decade, and have made some terrible decisions , and I absolutely hate alcohol. Yet, I still crave and romance the idea of drinking. It’s an unexplainable obsession. It’s an exhausting condition. It truly seems unexplainable unless you experience what I am trying to explain. I am not here to say addiction is a disease, or a choice, and frankly I don’t care what you want to label it. All I know is that I would truly give anything to not be the way I am. The only thing that seems to help is the fellowship of Alcoholics Anonymous, because it’s a place you can go where other people can truly identify with your experiences with alcohol, and its a fellowship that has proven to keep people abstinent .
Hi CD,
I’m glad you liked the article, and took the time to share what you go through. Is your craving/obsession something you experience on a daily level regardless of whether you’ve had alcohol that day – or only at times after you’ve had that first drink? Thanks in advance for taking the time to answer.
Steven Slate
Hi Steven,
Yes this obsession is always there. The strength of the obsession varies of course, and the fellowship of AA is what helps me manage this obsession. Now anything can trigger the obsession, such as: stress, work, relationships, happiness, success etc. Now, if I pick up a drink, it will eventually lead me to get drunk. I had just had a relapse after over a year of sobriety. I had a glass of champagne on NYE, and thought I am either going to be able to mange drinking this time or its going to lead right where I left off. And that is the definition of insanity, to do something over and over again expecting a different result. I have tried and failed to manage my drinking a thousand times. Within a month, I was drinking gross amounts and blacking out. That is the phenomenon of crave, the allergy. Picking one up and not being able to stop. It’s not a choice, it goes beyond will. Now picking up that initial drink was the obsessive thoughts building up in my head over a few months, because I had stopped going to AA, and had no support system that kept me sober. I am not a spokesperson, and am just here to say that is the only thing that seems to keep people sober. Im not much of a believer in the “Higher Power” and spiritual side of AA. But by just going to meetings to share, and listen to fellow people’s daily life situations that experience this same obsession, and keeping in contact with those people on a daily basis, is what helps me not pick up a drink, or act on those obsessive thoughts.
You see, no one picks up a drug or a drink and says, hey lets battle addiction the rest of our lives! I think it is in direct correlation with mental health. And before we seek a doctor, we find solace in a drink or drug. Yes it is our choice to pick up that drink or drug to begin with, but I know that no one who suffers from addiction, active or in recovery, want to continue using.
I love how you were talking about how the brain scans were totally normal, and then you go on to say that people change their behavior despite the fact that their brain function was altered.. you realize that the brain scans were showing that their brains weren’t normal, and that their function was altered… You contradicted yourself and you sound like a f****** idiot, you have no idea what we go through and the changes that we have to deal with on a daily basis not to mention the struggle of staying sober and not going back out to that hell. That compulsive hell… With me I couldn’t stop once I started, from the very beginning when I was 13 up until when I stopped at age 20. And I was only able to stop because I was going to die, and had to get help, and thank God for Bill W. You may think you know what you’re talking about, try living it first before you go making a fool out of yourself with speculation. Also I guess when someone has diabetes that’s just how they are and it’s totally normal for them, same with cancer right? I mean when you’re stupid as f*** it’s just how you are and I guess there’s no changing that huh? You amuse me with your speculation…