View Full Version : Addiction is a disease?
craig r
12-07-2005, 04:28 AM
I decided to post this here instead of in OOT (which seems to be my new home). When people say addiction is a disease without a cure, do they mean this literally or is it metaphorical? I am not as concerned here with the "cure" part as I am the "disease" part. And I am not just talking about gambling addiction. I mean, all types of addiction. From my understanding all addiction is the same, even if the drug, food, type of sex, etc... is different.
craig
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When people say addiction is a disease without a cure, do they mean this literally or is it metaphorical?
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Both. I can't speak for all addictions, but scientists believe that alcoholics have a genetic predisposition toward their addiction. Whether this makes their alcoholism inevitable from birth is not known.
What is known is that no alcoholic is ever cured of his disease. There are no ex-alcoholics, only recovering alcholics. The only solution is to abstain.
Addiction is a disease.
When you see first hand what it can do to your family and people you know you will understand. People can become monsters and do things that they know are wrong and justify it with [censored] that only makes sense to them, they become posessed, they aren't even human, their mind is turned off and the drugs take over the conrols.
noggindoc
12-07-2005, 11:08 AM
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From my understanding all addiction is the same, even if the drug, food, type of sex, etc... is different.
craig
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This part is not exactly true. For example a heroin addiction is going to have different features than a sex addiction.
kyzerjose
12-07-2005, 11:55 AM
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From my understanding all addiction is the same, even if the drug, food, type of sex, etc... is different.
craig
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This part is not exactly true. For example a heroin addiction is going to have different features than a sex addiction.
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Aren't the underlying traits of an addictive personality pretty much the same though?
Obviously something that causes a physical addiction (drug) will present differently than a psychological addiction. (sex, gambling etc.)
I'd argue that certain individuals are wired to be addicts. Physical or psychological. Multiple addictions are not uncommon.
The American Medical Association identified addiction to alcohol as a disease. This is from one of the AMA’s publications:
“H-95.983 Drug Dependencies as Diseases
The AMA
1. endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice, and
2. encourages physicians, other health professionals, medical and other health related organizations, and government and other policymakers to become more well informed about drug dependencies, and to base their policies and activities on the recognition that drug dependencies are, in fact, diseases. (Res. 113, A-87)”
Forget the definition of “disease” in the sense that you can take a pill or shot to “cure” it. The effects of addictions are physical, mental and spiritual and require treatment of all three areas.
The “drug of choice,” alcohol, chemical drugs or sex, doesn’t seem to matter. The stories of addicts usually have commonalities.
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Obviously something that causes a physical addiction (drug) will present differently than a psychological addiction. (sex, gambling etc.)
I'd argue that certain individuals are wired to be addicts. Physical or psychological. Multiple addictions are not uncommon.
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There is a widely-held theory as to a gene that either triggers or allows an addiction. The hardwiring you mention. There is a lot of debate about the psychological side.
The physical damage, some think, leads to the psychological damage. Others think it's just the opposite. But, IMO, given enough time, they'll always be in accompaniment.
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This part is not exactly true. For example a heroin addiction is going to have different features than a sex addiction.
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Yes, there are subtle differences. But the overall effects seem to be the same.
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When you see first hand what it can do to your family and people you know you will understand. People can become monsters and do things that they know are wrong and justify it with [censored] that only makes sense to them, they become posessed, they aren't even human, their mind is turned off and the drugs take over the conrols.
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Substitute the word "drugs" with alcohol, gambling, sex, food, etc., and you can say the same thing. It's the addiction, not the means.
sternroolz
12-07-2005, 02:03 PM
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This part is not exactly true. For example a heroin addiction is going to have different features than a sex addiction.
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There are significant elements that make something like heroin different than other addictions. Your body rapidly develops a chemical dependency on heroin. Many people become addicated after one use. Almost everyone that uses heroing a few times becomes addicted and treatment is extraordinarly difficult....so much so that another dangerous and long term damaging drug, methadone, is used to allow people to sorta function because they cannot completely end the addiction.
So something like heroin is different because it is chemical based as well as emotion and mental based. Unlike sex addiction which is entirely emotional/mental.
CarlSpackler
12-07-2005, 04:52 PM
I won't comment on the other addictions you've listed, but I've studied drug addiction (this includes alcoholism) for over 12 years, and drug addiction is just as much a disease as AIDS and cancer. There is no cure for drug addiction, just like there's no cure for AIDS or cancer. For all practical purpose, one develops the disease of drug addiction the same way one contracts the HIV virus, by making one or more ignorant and irresponsible decisions (of course this excludes babies born with HIV or born with drug addiction i.e. crack babies, etc.).
Unfortunately, the money spent on research to cure/treat drug addiction is miniscule compared to the money spent on AIDS and cancer research. The most horrific thing of all with regards to drug addiction, is the war on drugs, which treats this disease as a crime rather than the massive health problem it is. Many drug addicts end up in prison or jail, and most get no treatment there. To make matters worse, drugs are readily available in prison/jail, and these drug addicts get the bonus of learning and being conditioned to be a violent criminal -- all because they have a disease.
Addiction may be a symptom of a disease, but I don't believe addiction itself is a disease.
EnderIII
12-07-2005, 10:09 PM
No, addiction is not a disease. This is not a widely held position, but seems clearly true.
Consider a disease such as cholera, which cannot be fixed by a choice of the person who has it. Contrast this with being addicted to cigarettes, which people fix by quitting every day. There seems be a significant and substantial difference between the two so much that the same word should not apply to both of them. I highly recommend the following website as a resource for this subject:
http://www.schaler.net/
So in answer to your orignal question, if they aren't using it metaphorically, they should be.
Anybody see last night's south park episode? They did a pretty good bit on this very topic....
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Anybody see last night's south park episode? They did a pretty good bit on this very topic....
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DAMN, beat me to it.
I cant say i totally agree w/ it, but it brought up some good points... and it was quite funny.
AlanBostick
12-08-2005, 06:37 PM
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This part is not exactly true. For example a heroin addiction is going to have different features than a sex addiction.
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Yes, there are subtle differences. But the overall effects seem to be the same.
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A heroin addict going through withdrawal experiences significant physical symptoms (chills, running nose, etc.). A so-called sex addict does not.
I'd be inclined to say that this difference was overt rather than subtle.
AlanBostick
12-08-2005, 06:51 PM
Not all addictions are created equal, then. I was hooked on cigarettes for a decade, finally quitting in 1988. I spent this past October in Biloxi, Mississippi, doing hurricane relief work. Everyone there smoked, and it was a high-stress situation. It wasn't long before I started smoking again, too.
Just before I boarded my plane home, I threw away what remained of my cigarettes. There is no room for smoking in my home life. I resigned myself to a week or two of misery until the nicotine fits passed.
To my complete surprise, they never arrived. I noticed when the effects of my last cigarette wore off, but I never felt any of the shaking and nervousness that I remembered from my many earlier attempts to quit.
N.B.: Some addiction and recovery experts would not describe my physiological dependence on cigarettes in my youth as an "addiction"; under a widely-used definition, for a condition to be an addiction it has to have an immediate negative impact on one's life, relationships, or work situation.
I find it foolish to say 'mental illness' or 'addictions' are diseases. What constitutes a mental illness or an addiction? Is it a lesion, an abnormal x-ray finding, elevated enzymes, tissue damage, insufficient insulin?
No, mental illneses and addictions are repetitive behaviors that are socially undesireable. The labels are a very convenient mechanism for both the 'sufferer' and the labeler. The person labeled wins because they are exonerated from personal responsibility. Instead of actively chosing to engage in undesired behaviors, the addict/neurotic is the victim of 'bad brain chemistry.' The labeler (such as a psychiatrist, psychologist, chemical dependency evaluator, social worker, medical doctor, drug company representative, parole officer) benefits because they have created a whole new class of clients needing assessment, treatment and diagnosis for these 'diseases.'
It's almost comical how many new 'diseases' are being evented each year. Look at the explosive growth of the DSM (Diagnosis and Statistical Manual of Mental Disorders) if you need proof. We are now being told that using too much caffeine, smoking, being shy, easily distracted, staying online for long hours, shoplifting, drinking, etc. are diseases. They are said to be the function of 'bad brain chemistry.' Every year we're told they're on the breakthrough of finding the cause of these pernicious disorders and disease. Of course, one is never found. It's called being HUMAN!
Why do think the advocacy groups were so hellbent on getting the AMA to call alcoholism a 'disease.' Because the label of disease conveys a lot of weight and exonerates the afflicted of responsibility. They no longer freely choose their behavior but are compelled to act in a certain way by virtue of 'brain chemistry disequilibrium.' There are financial incentives as well; think of the windfall created by labeling drug and alcohol abuse a disease. Insurance companies now are doling out billions to medically treat what was once thought of as merely immoral, sinful, neurotic, foolish behavior. And then there are billions spent on researching possible treatments.
My personal bias is seeking explanations that maximize free will. Rather than viewing chronic alcohol abusers as 'diseased alcohlics' I see them as individuals who make the foolish and self-defeating choice to persist in drinking large quantities. I believe that labels of 'mental illness' and 'addictive disease' do represent true diseases in the traditional sense. Rather, they describe problems in living.
I am not trying to say that chronic drinkers or chronic drug abusers do not suffer as a result of their behavior. Obviously, an addict can create real disease states by persisting in chronic use of intoxicating agents. I believe that we largely choose our behaviors and destinies. I believe that 'addictive disease' and 'mental illness' are metaphors for problems in living; not legitimate or verifiable diseases. Unfortunately, many people tend to underestimate their ability to actively choose their thoughts and behaviors.
JeffreyREBT "Wherein I don't promise to make you rich without trying, or even trying very hard; I do promise to say things that will make you FEEL rich."
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I'd be inclined to say that this difference was overt rather than subtle.
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I was referring to the overall effects of, and damage done by addictions - psychological and spiritual. Of course physical withdrawal from dependence on a chemical substance differs from withdrawal from sex or gambling addictions. Sorry if I even implied that.
craig r
12-09-2005, 01:31 AM
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Addiction is a disease.
When you see first hand what it can do to your family and people you know you will understand. People can become monsters and do things that they know are wrong and justify it with [censored] that only makes sense to them, they become posessed, they aren't even human, their mind is turned off and the drugs take over the conrols.
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I don't understand how this makes it a disease. I am not saying that it isn't, but just because it changes a person into something they are not, does that necessarily make it a disease.
craig
p.s. I have experienced it first hand.
Craig, Alcoholism was defined/identified by the AMA as a disease because it met the criteria for their definition. For the life of me I can not find the list. The only one I remember is the one that I guess made the biggest impression on me - If untreated, the condition will cause/lead to death. (paraphrase?)
ezratei
12-09-2005, 02:38 AM
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I don't understand how this makes it a disease.
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A disease is a negatively abnormal (pathologic) change in the functioning of an organism. This change can be the result of any disease process (etiology). By this definition, alcoholism clearly is a disease.
Alcoholism runs in families and thus it is likely that certain individuals have a genetic predisposition towards the disease of alcoholism. No, they will not become alcoholics unless they start drinking but the same is true for many other diseases that have genetic predispositions but require environment stimuli to develop.
To those who have said that an alcoholic's behavior is "just part of being human" and therefore alcoholism is not a disease: do you claim that there is no biological basis for human behavior? And if there is, why can't these biological mechanisms be altered in a disease state (just like any other organ system) to produce abnormal effects?
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I find it foolish to say 'mental illness' or 'addictions' are diseases. What constitutes a mental illness or an addiction? Is it a lesion, an abnormal x-ray finding, elevated enzymes, tissue damage, insufficient insulin?
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Sometimes, any of these things other than "an abnormal x-ray finding" can cause mental illness.
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No, mental illneses and addictions are repetitive behaviors that are socially undesireable. The labels are a very convenient mechanism for both the 'sufferer' and the labeler. The person labeled wins because they are exonerated from personal responsibility. Instead of actively chosing to engage in undesired behaviors, the addict/neurotic is the victim of 'bad brain chemistry.' The labeler (such as a psychiatrist, psychologist, chemical dependency evaluator, social worker, medical doctor, drug company representative, parole officer) benefits because they have created a whole new class of clients needing assessment, treatment and diagnosis for these 'diseases.'
It's almost comical how many new 'diseases' are being evented each year. Look at the explosive growth of the DSM (Diagnosis and Statistical Manual of Mental Disorders) if you need proof. We are now being told that using too much caffeine, smoking, being shy, easily distracted, staying online for long hours, shoplifting, drinking, etc. are diseases. They are said to be the function of 'bad brain chemistry.' Every year we're told they're on the breakthrough of finding the cause of these pernicious disorders and disease. Of course, one is never found. It's called being HUMAN!
Why do think the advocacy groups were so hellbent on getting the AMA to call alcoholism a 'disease.' Because the label of disease conveys a lot of weight and exonerates the afflicted of responsibility. They no longer freely choose their behavior but are compelled to act in a certain way by virtue of 'brain chemistry disequilibrium.' There are financial incentives as well; think of the windfall created by labeling drug and alcohol abuse a disease. Insurance companies now are doling out billions to medically treat what was once thought of as merely immoral, sinful, neurotic, foolish behavior. And then there are billions spent on researching possible treatments.
My personal bias is seeking explanations that maximize free will. Rather than viewing chronic alcohol abusers as 'diseased alcohlics' I see them as individuals who make the foolish and self-defeating choice to persist in drinking large quantities. I believe that labels of 'mental illness' and 'addictive disease' do represent true diseases in the traditional sense. Rather, they describe problems in living.
I am not trying to say that chronic drinkers or chronic drug abusers do not suffer as a result of their behavior. Obviously, an addict can create real disease states by persisting in chronic use of intoxicating agents. I believe that we largely choose our behaviors and destinies. I believe that 'addictive disease' and 'mental illness' are metaphors for problems in living; not legitimate or verifiable diseases. Unfortunately, many people tend to underestimate their ability to actively choose their thoughts and behaviors.
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Yes, crazy people are just stubborn.
Do you really believe this crap? Here's a question for you - why do you think people make those bad decisions?
And another question - have you ever known a person with a serious mental illness? I mean severe psychotic/anxiety/dissociative disorders, OCD and schizophrenia and the like. And have you ever been close to someone with a relatively "minor" mental illness?
I'll be the first to admit the line can be hard to draw, and the DSM is a rather poor piece of work. I also think treatment recommendations have a tendency to be drug-heavy and questionable. But no such thing as mental illness? That's absurd.
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A disease is a negatively abnormal (pathologic) change in the functioning of an organism. This change can be the result of any disease process (etiology). By this definition, alcoholism clearly is a disease.
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This ignores the possibility that alcoholism might be a symptom of some other disease. This is an important distinction for two reasons. First, if someone is "cured" of alcoholism, but the underlying condition remains, the "true cause" may continue to have an undesirable effect. Second, if alcoholism can be viewed as a symptom then correct treatment may depend on the nature of the underlying problem.
An example would be sore throats. To treat alcoholism alone is like giving someone with strep a painkiller. It may eliminate the "problem" (temporarily), but the disease remains. Also giving a person antibiotics just because they have a sore throat is definitely not justified, because a number of things may result in a sore throat - treatment could include antibiotics, antihistamines, or just plain waiting it out (among other things).
Personally I believe the compulsive element of addiction exists in everyone. It's just a mechanical thing. An addict, to me, is usually someone with an emotional problem that they can only cope with using some specific behavior. The need to deal with this problem overrides any desire to stop the behavior, and that is where the addiction itself comes from. Addiction can be overcome by handling the original problem, thereby removing the "need" for the addictive behavior. (Physical addiction is something else, of course)
craig r
12-09-2005, 05:12 AM
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Craig, Alcoholism was defined/identified by the AMA as a disease because it met the criteria for their definition. For the life of me I can not find the list. The only one I remember is the one that I guess made the biggest impression on me - If untreated, the condition will cause/lead to death. (paraphrase?)
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I wasn't trying to claim it wasn't a disease, but that the person I quoted was not making a case for why it was a disease, just why it was bad.
I personally do think it is a disease.
craig r
12-09-2005, 05:18 AM
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A disease is a negatively abnormal (pathologic) change in the functioning of an organism. This change can be the result of any disease process (etiology). By this definition, alcoholism clearly is a disease.
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This ignores the possibility that alcoholism might be a symptom of some other disease. This is an important distinction for two reasons. First, if someone is "cured" of alcoholism, but the underlying condition remains, the "true cause" may continue to have an undesirable effect. Second, if alcoholism can be viewed as a symptom then correct treatment may depend on the nature of the underlying problem.
An example would be sore throats. To treat alcoholism alone is like giving someone with strep a painkiller. It may eliminate the "problem" (temporarily), but the disease remains. Also giving a person antibiotics just because they have a sore throat is definitely not justified, because a number of things may result in a sore throat - treatment could include antibiotics, antihistamines, or just plain waiting it out (among other things).
Personally I believe the compulsive element of addiction exists in everyone. It's just a mechanical thing. An addict, to me, is usually someone with an emotional problem that they can only cope with using some specific behavior. The need to deal with this problem overrides any desire to stop the behavior, and that is where the addiction itself comes from. Addiction can be overcome by handling the original problem, thereby removing the "need" for the addictive behavior. (Physical addiction is something else, of course)
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See, I thought this as well, that handling the original problem would prevent the "addiction". But, if you read the 12 steps (of any of the Anonymous groups), they make it seem that the problem is the alcohol, coke, etc... I don't know if I agree with these 12 steps. But, on the other side of that coin, if you get 100 truly happy people and get them to try heroin, how many of them would really "want" to do it again? I don't mean where they just think about it and then get over it in a day, but where they think to themselves "I have never felt this good before, I want to feel this again". Cocaine and Heroin are both very psychologically addictive drugs (not just from one time though). Don't you think that people want to have that same feeling again?
Also, why do a lot of people think that addiction is just getting the "fix"? There is much more to an addiction than just the actual high. The entire ritual is essential in the addicts mind.
craig
I'm not religious, so I don't have much respect for 12-step programs in general. The whole "you need a higher power to get better" thing puts it straight into the [censored] category for me.
I do think sometimes treating "just the symptom" isn't a bad thing. If someone is addicted to heroin, stop that addiction. On the other hand, if someone is addicted to the internet or the library or something, I don't it's such a major concern.
I've met some 12-step folks who had stopped their big addiction and still really had issues. Most of them seemed to have moved on to some other (relatively harmless) addictions afterwards. I was never close to any of these people however. I know that 12-step programs can really help with dangerous addictions, but I think they are only a first step.
For the other question, I think only a person who has experienced addiction can understand what it's really like. Most people just look at the behaviors they can see, and from the outside looking in I think a focus on "getting the fix" makes sense.
craig r
12-09-2005, 05:48 AM
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I'm not religious, so I don't have much respect for 12-step programs in general. The whole "you need a higher power to get better" thing puts it straight into the [censored] category for me.
I do think sometimes treating "just the symptom" isn't a bad thing. If someone is addicted to heroin, stop that addiction. On the other hand, if someone is addicted to the internet or the library or something, I don't it's such a major concern.
I've met some 12-step folks who had stopped their big addiction and still really had issues. Most of them seemed to have moved on to some other (relatively harmless) addictions afterwards. I was never close to any of these people however. I know that 12-step programs can really help with dangerous addictions, but I think they are only a first step.
For the other question, I think only a person who has experienced addiction can understand what it's really like. Most people just look at the behaviors they can see, and from the outside looking in I think a focus on "getting the fix" makes sense.
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In the "A" group's defense, the "higher power" doesn't have to be God or a god, it just has to be something that you believe in "bigger than yourself". This could be as "simple" as something like family. I think one reason they stress this is because an addict lives in a very selfish and narrow view of the world (so do a lot of non-addicts, but in a different way). So, without going into whether the "A" groups are good or bad, I just wanted to clarify that about them.
I guess the best example of how being an addict probably isn't just about getting a fix are smokers. It isn't just the "high" that nicotine creates, but the actual process of getting the cigs, opening the pack, hand to mouth, the nicotine entering the body, the high experienced, the comedown, and then the system repeates. If it was just the "high" then i think they would make the gum stronger (yes I know some get addicted to the gum as well, but I think it is obvious why they would). I don't really see how the Meth addict is any different. In fact, meth isn't nearly as physically addictive as nicotine (either is coke for that matter; in fact, don't they compare heroin as the closest physcial addiction to nicotine?). So, physical reasons for craving Meth can be ruled out a bit. But, the other parts, just like with smoking, really can't.
craig
p.s. I didn't know this until the other day, but if you took a heroin addict and an alcoholic and dumped them on an island with food, shelter, etc..., but no way for them to get the drug and no way for them to kill themselves, that the heroin addict would live, but the alcoholic would possibly die. I was under the impressiont that a smack addict had to have heroin or would die from physical withdrawal.
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an addict lives in a very selfish and narrow view of the world (so do a lot of non-addicts, but in a different way).
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....And it's an incredibly thin line between the two.
Ian
noggindoc
12-09-2005, 10:46 AM
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I find it foolish to say 'mental illness' or 'addictions' are diseases. What constitutes a mental illness or an addiction? Is it a lesion, an abnormal x-ray finding, elevated enzymes, tissue damage, insufficient insulin?
No, mental illneses and addictions are repetitive behaviors that are socially undesireable. The labels are a very convenient mechanism for both the 'sufferer' and the labeler. The person labeled wins because they are exonerated from personal responsibility. Instead of actively chosing to engage in undesired behaviors, the addict/neurotic is the victim of 'bad brain chemistry.' The labeler (such as a psychiatrist, psychologist, chemical dependency evaluator, social worker, medical doctor, drug company representative, parole officer) benefits because they have created a whole new class of clients needing assessment, treatment and diagnosis for these 'diseases.'
It's almost comical how many new 'diseases' are being evented each year. Look at the explosive growth of the DSM (Diagnosis and Statistical Manual of Mental Disorders) if you need proof. We are now being told that using too much caffeine, smoking, being shy, easily distracted, staying online for long hours, shoplifting, drinking, etc. are diseases. They are said to be the function of 'bad brain chemistry.' Every year we're told they're on the breakthrough of finding the cause of these pernicious disorders and disease. Of course, one is never found. It's called being HUMAN!
Why do think the advocacy groups were so hellbent on getting the AMA to call alcoholism a 'disease.' Because the label of disease conveys a lot of weight and exonerates the afflicted of responsibility. They no longer freely choose their behavior but are compelled to act in a certain way by virtue of 'brain chemistry disequilibrium.' There are financial incentives as well; think of the windfall created by labeling drug and alcohol abuse a disease. Insurance companies now are doling out billions to medically treat what was once thought of as merely immoral, sinful, neurotic, foolish behavior. And then there are billions spent on researching possible treatments.
My personal bias is seeking explanations that maximize free will. Rather than viewing chronic alcohol abusers as 'diseased alcohlics' I see them as individuals who make the foolish and self-defeating choice to persist in drinking large quantities. I believe that labels of 'mental illness' and 'addictive disease' do represent true diseases in the traditional sense. Rather, they describe problems in living.
I am not trying to say that chronic drinkers or chronic drug abusers do not suffer as a result of their behavior. Obviously, an addict can create real disease states by persisting in chronic use of intoxicating agents. I believe that we largely choose our behaviors and destinies. I believe that 'addictive disease' and 'mental illness' are metaphors for problems in living; not legitimate or verifiable diseases. Unfortunately, many people tend to underestimate their ability to actively choose their thoughts and behaviors.
JeffreyREBT "Wherein I don't promise to make you rich without trying, or even trying very hard; I do promise to say things that will make you FEEL rich."
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You're working with a pretty limited understanding of the human condition if you seek only explanations that attempt to "maximize free will." I mean come on the whole "addiction is people making bad choices" thing is so old and played out. That is primarily a religious/moral argument that is not particularly helpful in explaining or helping anything.
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See, I thought this as well, that handling the original problem would prevent the "addiction". But, if you read the 12 steps (of any of the Anonymous groups), they make it seem that the problem is the alcohol, coke, etc... I don't know if I agree with these 12 steps.
craig
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This is not entirely true. The First Step of AA reads "I am powerless over Alcohol", reflecting the fact that the original 12 steps were written in the 1930s, a time before the disease concept had been fully realized in the treatment of addiction when medicine and society viewed chemical dependency as a moral defecency, . About 20 years after the steps were originally written they were adapted to the treatment of drug addiction by members of AA who were attempting to create a new fellowship that would become Narcotics Annonymous. In this adaptation, the first step reads "We are powerless over addiction..."; NA seeks to treat the disease of addiction, not the dependency upon a specific substance. Identification as an addict in reference to membership in the NA fellowship is all encompasing and does not differentiate between substances.
Greetings,
Thank you for the replies to my perspective on labels of 'mental illness' and 'addictive diseases.' First of all, let me respond to a poster who replied:
"Yes, crazy people are just stubborn. Do you really believe this crap? Here's a question for you - why do you think people make those bad decisions?"
The poster starts off with a personal attack, completely irrelevant to the truth value of my premises. Whether or not my idea seems counterintuitive, unexpected, socially unacceptable, incredible, silly, contrary to popular opinion does not matter. Ironically, he/she professes that people afflicted with 'mental illness' or 'addictive illness' have real diseases then he refers to them as 'crazy?' I wouldn't call somebody with cancer or diabetes 'bizarre or zany.' I wonder why he would chose this socially stigmatizing description for helpless victims of "true diseases."
Ok, now you ask me why people make bad decisions. First of all, what you consider 'bad' will hinge on your value system as to what constitutes 'bad.' Lets assume 'bad' means resulting in undesireable consequences. Here is my basic answer. People make bad decisions because people are inherently flawed creatures prone to doing stupid things. More specificially, people's behaviors are a function of their beliefs about things. For example, lets assume I believe that I must have the approval of everybody I meet. Let assume you indicate you don't approve of me and my goofy ideas regarding "mental illness." What is the likely result? I will likely have a negative cognitive-emotive consequence in light of my belief about needing universal approval.
You see, I believe people and things do not disturb us; rather we disturb ourselves by believing they CAN disturb us. I belief we needlessly disturb ourselves (often in very severe ways) by allowing inflexible and irrational ideologies to guide our thinking. You are not depressed because you lost your job; you are depressed because you believe losing your job is all-important.
"And another question - have you ever known a person with a serious mental illness? I mean severe psychotic/anxiety/dissociative disorders, OCD and schizophrenia and the like. And have you ever been close to someone with a relatively "minor" mental illness?
I'll be the first to admit the line can be hard to draw, and the DSM is a rather poor piece of work. I also think treatment recommendations have a tendency to be drug-heavy and questionable. But no such thing as mental illness? That's absurd."
BTW, I will risk subjecting myself to the psychoanalytic fallacy and confess I have been diagnosed with a 'mental illness.' Specifically, panic disorder, OCD, Aspergar's disorder and bipolar disorder. In my early twenties I was involuntarily committed and have met hundreds of people with both brain diseases and problems in living.
I used to buy into the medical model of mental illness and felt like a hopeless victim of brain chemistry disequilibrium. It was very empowering when I stumbled upon Rational Emotive Behavioral Psychology. REBT enabled me to appreciate the role my goofy and rigid ideologies played in perpetuating my own self-defeating behaviors and irrational ideas (which many call 'mental illness').
I personally think labels of mental illness are not helpful for most people. Many people become the personification of their 'disease' and capitulate, assuming a victim role. Also, labels of mental illness are stigmatizing and hurt people in terms of employment, education, social advancement, and consitutional rights. Generally, I don't think people are served well by these labels.
I never stated that I believed brain disease didn't exist. Now that would be a difficult position to defend. To reiterate, I don't believe 'mental illness' literally exists. To say a mind is all is analogous to saying society is disease; an abuse of language. The mind a hypothetical construct, a concoction, an invention, a means of explanation. True disease like diabetes has a concrete referant.
JeffreyREBT 'Wherein I don't promise to make you rich without trying; or even trying very hard; I do promise to say things that will make you feel rich."
PokerAmateur4
12-09-2005, 11:55 PM
[ QUOTE ]
[ QUOTE ]
When people say addiction is a disease without a cure, do they mean this literally or is it metaphorical?
[/ QUOTE ]
Both. I can't speak for all addictions, but scientists believe that alcoholics have a genetic predisposition toward their addiction. Whether this makes their alcoholism inevitable from birth is not known.
What is known is that no alcoholic is ever cured of his disease. There are no ex-alcoholics, only recovering alcholics. The only solution is to abstain.
[/ QUOTE ] I didn't read past here but...
This can't be true I don't think, such a universal statement. While wise as a rule for any, can't some alchoholics drink just a few beers or what have you later in their recovery?
I apologize for offending you, that wasn't my intent. (well, maybe a little bit just to shake things up)
Personally I think the "mind" is really an abstraction of brain interactions that we can't mechanically describe (belief, memory, emotion, etc). But even if we do away with the term, I don't see how something like addiction fails to qualify as indicative of disease.
I assume a "belief" has a neurochemical existence here and that there is therefore some concrete referent. We just can't describe it in physical terms because it can only be identified through behavioral symptoms. Also many mental illnesses seem to be independent of belief - they are "brain diseases" as you say. A number of mental illnesses have also been show to have a strong biological component through twin studies, etc.
I disagree with you on certain points, but I don't think most of them are relevant to the topic. If you agree that mental illness is a problem (and not something that is just willed away magically) then I suppose whether we call it an actual "illness" is just semantic.
The thing I do take issue with is your claim that the labels don't help. It's easy to see where this is true, of course, but I think they do more good than harm. Being able to put a name on your problems can make them much less intimidating. A person who has "x disorder" knows he isn't alone, knows he can't be expected to just "buck up and deal with it," and knows that there is help out there for him. Treatment is also more efficient with categories and labels - most labels are based on strong symptomatic correlations, and while the labels themselves may not have any real accuracy, identifying those correlations seems like a clear step forward in understanding and treating the problems.
I don't think it's realistic to think that a single treatment will be effective for every problem. Do you believe that REBT is an effective cure-all? If not, how can we create alternative treatments without using labels and categories?
Greetings,
And I wasn't offended in the least. In fact, I generally choose not to let anything 'offend' me. First of all, I have read your definition of the mind. If my understanding is correct, you basically believe the mind is the brain in motion. And the reason the mind construct is important here has everything to do with volition and free will. The disease theory proponents often argue free will has been thoroughly sabotaged and annihilated by the 'disease process.' They are not referring to the kidney or the spleen as the cause of alcoholism; they are referring to the mind construct. Alcoholics Anonymous argues in their twelve steps, "Admitted we were POWERLESS over alcohol; that our lives our lives had become unmanageable." Ironically, they also hold this seemingly irrational and contradictory position that they can be 'restored to sanity' if they 'come to believe a power greater then themselves can restore them to sanity.' As you can see, they are arguing alcoholism is a problem of belief (as I argue as well, just differently). They believe the prescription for stopping chronic alcohol abuse is belief in God's ability to remove "character defects." I think AA's philosophy is hogwash. I think the prescription for stopping chronic alcohol abuse is thinking more rationally through disputing and changing irrational beliefs .
I am still trying to discover which mental illnesses are independent of belief. Isn't mental illness really just a problem of irrational belief and subsequent deviant behavior? I assume you are thinking of more severe 'mental illness' like schizophrenia. Most people call this a mental illness and I call it brain disease. And yes, there is some convincing proof that it's a serious disease. For example, schizophrenics are abnormal responders on EDA. Also, there is the enlarged fourth ventricle theory, PET scan findings, etc.
Let me lastly address your point that belief has a neurochemical existence and is therefore the concrete referant. Doesn't EVERYTHING have a neurochemical existence. We might assert almost all human behavior is the product of "mental illness" if we believe brain chemistry abberation is the culprit. Does your brain chemistry not deviate from its usual course when you engage in different activities? Are you then mentally ill sometimes and not at other times. What constitutes an ideal brain chemistry profile? For example, assume I lose a significantly large amount of money on a hand of poker (or win a large amount). Wouldn't my brain chemistry change from its equilibrium point and therefore be in an abberant state. Would I be temporarily mentally ill until my brain chemistry re-orients itself? Can you see where this reductionism leads?
And your point about labels. Are labels useful? Well, I assume they are used as a means of facilitating communication. The utility of the DSM-IV is that it affords behavioral health professionals a common language. Uniform language helps conduct research and acquire compensation from insurance companies. A common language would seemingly be necessary for the purposes of assessment, treatment and research of behavioral problems. I do not deny this. However, labels also can lead to negative consequences such as stigma and discrimination. Also, the labels can result in clients capitulating and assuming a victim or sick role.
Lastly, let me briefly address the efficacy of REBT and its utility in treating 'mental illness' and addictions. I don't believe I can emphasize enough the proven utility of REBT and CBT in general. The founder of REBT, Albert Ellis, pioneered cognitive behavioral therapy. The meta-analytic studies show a consistent advantage for CBT over all other forms of psychological talk therapy and even medication for most mental illness (excluding psychotic disorders) and behavioral health problems. You might have noticed the decline in popularity of psychoanalysis. This is because psychoanalysis is being replaced by electic therapy and cognitive behavioral therapy, which generally produce more desireable results in a shorter period of time.
While REBT might be useless in stopping command hallucinations it might help a schizophrenic or somebody with a psychotic disorder deal more effectively with other challenges posed by their disease. I believe REBT and CBT (cognitive behavioral therapy) will generally improve the lives of those who apply this therapeutic approach.
JeffreyREBT "Wherein I don't promise to make you rich without trying, or even trying very hard; I do promise to say things that will make you FEEL rich."
I suppose with that distinction between mental illness and brain disease, I can agree. I do think brain disease can increase the risk of addiction, however. Also sometimes it is very difficult to make that distinction.
Going by dictionary.com disease is "A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms." So I would say if your belief structure could be considered "pathological" it would qualify as an illness. Personally I would say that any set of beliefs that causes harm to an individual can be considered a disease.
I believe that people who choose to treat themselves as victims will choose to treat themselves as victims, whether or not they have a convenient label. Many of these people do use labels as excuses, but I think they would assume victims roles regardless. In my opinion they want to believe they are victims, and they will use any tools at their disposal to reinforce that belief. I don't think the label itself is actually causing harm. My view on the stigma surrounding mental illness is similar - I think the stigma was actually stronger before the labels, and now that mental illness is coming to be understood that stigma is diminishing.
With regard to CBT, I agree that it is effective, but I also think it's limited. Other approaches to treatment are also very effective, and in some cases necessary. Group therapy, medications, humanistic therapies, and even treatments like ECT have their place. Labels help determine which treatment to administer when. Even cognitive behavioral therapies aren't universal. For example, patients with borderline personality disorder don't respond all that well to REBT - but they do respond well to dialectical behavioral therapy, a different CBT which takes the specific diagnosis into account.
Addictions to things that are not physically addicting (cocaine, sex, gambling, etc.) are totally for pussies with no self control and most likely a cry for help.
Being serious,
Capo
craig r
12-12-2005, 03:57 AM
So, nicotine, alcohol, heroin, and benzos are the only drugs not for "pussies"? Those who do a few bags of smack a day are not crying for help, but those who snort 3 eight balls a day are?
craig
[ QUOTE ]
Addictions to things that are not physically addicting (cocaine, sex, gambling, etc.) are totally for pussies with no self control and most likely a cry for help.
Being serious,
Capo
[/ QUOTE ]
Alex/Mugaaz
12-12-2005, 08:11 AM
Hey guys, south park covered this last Wendsday, just a heads up.
All I'm saying is that if someone is "addicted" so something NOT ADDICTIVE then they are bitches.
SNOWBALL138
12-12-2005, 02:38 PM
[ QUOTE ]
When people say addiction is a disease without a cure, do they mean this literally or is it metaphorical?
--------------------------------------------------------------------------------
Both. I can't speak for all addictions, but scientists believe that alcoholics have a genetic predisposition toward their addiction. Whether this makes their alcoholism inevitable from birth is not known.
What is known is that no alcoholic is ever cured of his disease. There are no ex-alcoholics, only recovering alcholics. The only solution is to abstain.
[/ QUOTE ]
Thats all just AA mumbo-jumbo.
SNOWBALL138
12-12-2005, 02:40 PM
Discussions based around semantics are almost universally stupid.
noggindoc
12-12-2005, 04:28 PM
[ QUOTE ]
Greetings,
Thank you for the replies to my perspective on labels of 'mental illness' and 'addictive diseases.' First of all, let me respond to a poster who replied:
"Yes, crazy people are just stubborn. Do you really believe this crap? Here's a question for you - why do you think people make those bad decisions?"
The poster starts off with a personal attack, completely irrelevant to the truth value of my premises. Whether or not my idea seems counterintuitive, unexpected, socially unacceptable, incredible, silly, contrary to popular opinion does not matter. Ironically, he/she professes that people afflicted with 'mental illness' or 'addictive illness' have real diseases then he refers to them as 'crazy?' I wouldn't call somebody with cancer or diabetes 'bizarre or zany.' I wonder why he would chose this socially stigmatizing description for helpless victims of "true diseases."
Ok, now you ask me why people make bad decisions. First of all, what you consider 'bad' will hinge on your value system as to what constitutes 'bad.' Lets assume 'bad' means resulting in undesireable consequences. Here is my basic answer. People make bad decisions because people are inherently flawed creatures prone to doing stupid things. More specificially, people's behaviors are a function of their beliefs about things. For example, lets assume I believe that I must have the approval of everybody I meet. Let assume you indicate you don't approve of me and my goofy ideas regarding "mental illness." What is the likely result? I will likely have a negative cognitive-emotive consequence in light of my belief about needing universal approval.
You see, I believe people and things do not disturb us; rather we disturb ourselves by believing they CAN disturb us. I belief we needlessly disturb ourselves (often in very severe ways) by allowing inflexible and irrational ideologies to guide our thinking. You are not depressed because you lost your job; you are depressed because you believe losing your job is all-important.
"And another question - have you ever known a person with a serious mental illness? I mean severe psychotic/anxiety/dissociative disorders, OCD and schizophrenia and the like. And have you ever been close to someone with a relatively "minor" mental illness?
I'll be the first to admit the line can be hard to draw, and the DSM is a rather poor piece of work. I also think treatment recommendations have a tendency to be drug-heavy and questionable. But no such thing as mental illness? That's absurd."
BTW, I will risk subjecting myself to the psychoanalytic fallacy and confess I have been diagnosed with a 'mental illness.' Specifically, panic disorder, OCD, Aspergar's disorder and bipolar disorder. In my early twenties I was involuntarily committed and have met hundreds of people with both brain diseases and problems in living.
I used to buy into the medical model of mental illness and felt like a hopeless victim of brain chemistry disequilibrium. It was very empowering when I stumbled upon Rational Emotive Behavioral Psychology. REBT enabled me to appreciate the role my goofy and rigid ideologies played in perpetuating my own self-defeating behaviors and irrational ideas (which many call 'mental illness').
I personally think labels of mental illness are not helpful for most people. Many people become the personification of their 'disease' and capitulate, assuming a victim role. Also, labels of mental illness are stigmatizing and hurt people in terms of employment, education, social advancement, and consitutional rights. Generally, I don't think people are served well by these labels.
I never stated that I believed brain disease didn't exist. Now that would be a difficult position to defend. To reiterate, I don't believe 'mental illness' literally exists. To say a mind is all is analogous to saying society is disease; an abuse of language. The mind a hypothetical construct, a concoction, an invention, a means of explanation. True disease like diabetes has a concrete referant.
JeffreyREBT 'Wherein I don't promise to make you rich without trying; or even trying very hard; I do promise to say things that will make you feel rich."
[/ QUOTE ]
Jeffrey,
I'm happy that cognitive behavioral ideas and techniques have been helpful to you. It sounds like many of the principles have helped you to overcome a few rather significant mental disorders (or whatever we'd like to call them I don't want to get into the semantics debate right now). Obviously one characterstic of both Asperger's and OCD is rigidity. And it sounds like REBT has helped elucidate some of the rigidity in your thinking. But I think if you'll use what you've learned you will see that your thinking continues to be rigid in some areas. Interesting that someone with two diagnoses that tend to involve rigid and overly concrete thinking would say that he doesn't "believe" in mental illness because it has no solid or observable referent like diabetes. You sound like an infomercial for REBT. It has been shown to be effective, no doubt. There is solid research backing for this approach. However, meta-analytic studies have shown many forms of therapy to be effective. REBT is not the only effective way to do therapy (I know you didn't say that specifically don't worry).
It also sounds like the issue of "labels" for mental disorders brings up personal issues for you because you were diagnosed with several. Again, I ask you to try to see that these labels are helpful in certain situations. I agree, they can sometimes be damaging. But they were created for reasons and many of them are helpful. The field of psychology and psychiatry would be crippled without the use of these "labels." Clinical research for both therapy and medication would be nearly impossible without labels or diagnoses. This in and of itself is a strong argument for the need for diagnoses as even the treatment you advocate so much for (REBT) would not exist without it. I could go on but this is already too long winded.
From what I hear, withdrawal is the pussy part. I have spoken with quite a few physical addicts, and the universal consensus has been that it's much much harder to handle the psychological element.
If you want to call addicts bitches, that's your prerogative. But to claim that it's somehow different based on whether the substance is physically addicting is pure ignorance.
The lack of knowledge (ignorance) of a lot of the posters in this thread is apparent to anyone who has ever been addicted to something or directly involved with someone who has. They're not stupid. They just don't have any firsthand knowledge.
I've never heard anyone say that kindness is a disease, they call it a good habit.
[ QUOTE ]
I've never heard anyone say that kindness is a disease, they call it a good habit.
[/ QUOTE ]
Shame it's not contagious, at least. In spite of the old saying.
/images/graemlins/frown.gif
The most current research on addiction, from a neuroscience perspective, is that many of the addictions that you consider to be non-physical in nature (gambling, sex, etc.) actually do have strong physical roots.
That is to say-- the neurochemical responses of a gambler when gambling is very similar to that of an alcoholic or drug addict.
So in fact--- gambling or eating or any of these other complusive behaviors which you consider to be only for "bitches", appear-- at least at the moment-- to have the same components (physical and pyschological) as those types of addictions reserved for "men".
SheetWise
12-13-2005, 08:29 AM
If you're going to do any serious research into addiction or addictive personalities, you're going to have to add a study of spontaneous remission. I think you'll find it's responsible for "curing" more people than any of the "treatment" programs for drugs/alcohol/sex etc. (one reason it's rarely mentioned by those invested in the "treatment" industry, such as AMA). You'll also have to look at the methodology for determining "success" and use it as a guideline for selecting a control group to make a comparative analysis, since very few studies supply their own control groups (with good reason, if they're looking for funding). Most of what is accepted as "fact" in the disease/cure model, such as the idea that addicts cannot use their drug of choice responsibly or recreationally, should be seen as what it really is -- good advice, not science.
DCWildcat
12-13-2005, 03:31 PM
[ QUOTE ]
If you're going to do any serious research into addiction or addictive personalities, you're going to have to add a study of spontaneous remission. I think you'll find it's responsible for "curing" more people than any of the "treatment" programs for drugs/alcohol/sex etc. (one reason it's rarely mentioned by those invested in the "treatment" industry, such as AMA). You'll also have to look at the methodology for determining "success" and use it as a guideline for selecting a control group to make a comparative analysis, since very few studies supply their own control groups (with good reason, if they're looking for funding). Most of what is accepted as "fact" in the disease/cure model, such as the idea that addicts cannot use their drug of choice responsibly or recreationally, should be seen as what it really is -- good advice, not science.
[/ QUOTE ]
It's a huge ethical breach to have a control group in an addiction setting. Two groups addicted to heroin, and we withold treatment for one group? No. The best you can do is attempt different treatment measures over a huge sample of addicts and measure the relative success of them. In other words, you can compare the relative success of treatments, but you can't compare treatment to non-treatment.
Remission isn't a fault of current treatment problems, its an unfortunate barrier. Treating any addiction is difficult because (depending on the addiction) it often only takes one use to destroy everything the treatment has done, and this is universal for all forms of treatment.
SheetWise
12-13-2005, 04:52 PM
[ QUOTE ]
It's a huge ethical breach to have a control group in an addiction setting. Two groups addicted to heroin, and we withold treatment for one group? No. The best you can do is attempt different treatment measures over a huge sample of addicts and measure the relative success of them. In other words, you can compare the relative success of treatments, but you can't compare treatment to non-treatment.
[/ QUOTE ]
You can't compare treatment to non-treatment? Spoken like a true snake-oil salesman.
[ QUOTE ]
Remission isn't a fault of current treatment problems, its an unfortunate barrier.
[/ QUOTE ]
Newspeak ???
[ QUOTE ]
it often only takes one use to destroy everything the treatment has done, and this is universal for all forms of treatment
[/ QUOTE ]
I hear this all the time, but I find it very hard to believe. What is the precise justification for this? How is the "destruction" of the treatment results measured and defined?
It seems likely to me that what really happens is that the addict goes back to his old patterns of behavior. This may be seen as a complete regression by some clinicians, but I don't see any reason to believe so.
DCWildcat
12-14-2005, 04:27 AM
[ QUOTE ]
It seems likely to me that what really happens is that the addict goes back to his old patterns of behavior. This may be seen as a complete regression by some clinicians, but I don't see any reason to believe so.
[/ QUOTE ]
That doesn't make sense. A heroin user seeks treatment for his addiction, gets treatment, and starts abusing heroin again. How can that not constitute a complete regression?
[ QUOTE ]
I hear this all the time, but I find it very hard to believe. What is the precise justification for this? How is the "destruction" of the treatment results measured and defined?
[/ QUOTE ]
How is this in any way difficult to measure? Addiction has a strict APA definition that all clinicians follow. If the subject regresses and fits the criteria of a diagnosis of addiction, then he has regressed, and has effectively destroyed all of the work of his treatment.
DCWildcat
12-14-2005, 04:42 AM
The answer to this question is very simple, and it's a matter of definition. The most widely acknowledged defintion is that of the APA (found in the DSM), which is used by all psychologists. The criteria for meeting a diagnosis for addiction include a physical symptoms.
All forms of addiction require some sort of physical symptoms, including both dependency (subject must experience withdrawal effects) and tolerance (needing increased amounts for same biochemical activity). I think most people would agree that if someone has a problem that results in noticeable physical symptoms, it can be classified as a disease. Thus, addiction is a disease.
DCWildcat
12-14-2005, 04:43 AM
You must understand that there are no normative statements about diseases in the DSM. Somehow, people cloud the issue of addiction with normative statements, usually with some sort of moral/religious/philosophical mumbo jumbo behind it.
If a doctor diagnoses a broken arm, he diagnoses it as a broken arm. It isn't dependent on how it got broken. It's just broken. Similarly, if someone fits the criteria of DSM, he is an addict. It does not matter if he was unlucky and "fell" into an addiction, or he "deserved it" because of self-abuse. He's just an addict, period, just like someone who broke their arm.
So when people make statements like, "well, you can be addicted to alcohol, but not gambling. You can't be addicted to gambling," they're flat wrong. If you fit the criteria of an addiction you have one. Period.
That's about what I thought. "Success" is defined entirely based on specific short-term symptoms. There is no real consideration of the long term, no differentiation between relapse and regression, and no value placed on benefits (or costs) of the treatment that may be unrelated to the original symptoms.
This is not how most medical doctors work. Now, I think there are some valid concerns with medical doctors and their approach as well (particularly in that they often fail to consider the psychological costs of treatment), but they do try to consider all the effects of a treatment before administering it. They recognize that the body is a single system, and if they screw with one part of that system it may affect other parts too. They understand that some treatments may involve occasional relapses, and that in some cases results may not be clear for some time. And they do take care to understand the mechanics of the problem - how the arm has broken is relevant, its angle and specific state is relevant, and a clear understanding of the structure of the arm is critical. A doctor will also check for any possible complications of the broken arm.
Most importantly, if I have a broken arm my doctor is not going to cut it off. Sure, I wouldn't have a broken arm any more, so my symptoms would be resolved. In fact, I would be sure never to break that arm again. But no medical doctor is likely to recommend such a treatment based on that criterion alone. I don't consider typical psychologists to be quite so discerning.
Also, regarding your DSM comment - psychologists use the DSM out of necessity. I would be surprised if you could find a single professional who has no qualms with it. All psychologists use it, but not so many actually agree with it. It's a highly controversial document that does more to keep psychologists of varying schools of thought "on the same page" than to document the actualities of mental illness.
DCWildcat
12-17-2005, 06:54 PM
That's a very well thought out post. I admit I don't know the ins and outs of diagnosing addiction, but I imagine there's a least some steps taken that ameliorate some of what you discuss.
As for DSM, yes, it's a controversial document. It is, however, necessary. What people don't understand is that the criteria for meeting diseases is, to a large extent, arbitrary. The symptoms chosen are chosen for some reason, but it tends to be the opinion on the psychologists working on the area. However, it is edited and revised constantly to fix those errors. Making such a manual is necessary to be able to consistently diagnose and treat patients. It's an absurdly difficult process, too.
Greetings,
I just thought I'd address a couple of points since I last read this thread. First of all, I think we should briefly discuss the clinical approach to diagnosis. Clinicians are notorious for producing diagnosis that aren't very valid nor reliable. The personal bias of the clinician comes into play, which isn't surprising since they have their own backgrounds, areas of expertise, financial motivations, ideologies, etc.
There is a term used by mental health practicioners known as the 'diagnostic creep.' Basically, what happens is that clinicians overdiagnose a patient to ensure they can get compensated for services rendered. This can be used for the patients benefit (who otherwise wouldn't receive treatment) or to line the pockets of the clinicians. An example of the 'diagnostic creep' would be labeling a patient who has dysthymia with major depression. It would be very difficult if not impossible to prove the clinician was doing anything wrong. The language of the DSM is so vague, the science is so primative, and reliability and validity of mental diagnosis is so lacking that it would nearly impossible to prosecute offending clinicians.
In fact, if you open up the DSM you will notice that what seperates one diagnosis from another might be only one or two different behaviors. And terms like 'depressed mood' are so subjective. It's not like there's a dipstick for measuring serotonin levels. It has been joked that psychiatry is 90% percent speculation and 10% guesswork.
I also wanted to comment on relapse in alcholism and drug addiction. One of the worst features of AA, in my humble opinion, is their philosophy of relapse. In AA, not having a relapse is all-important. Clients get the message that they are precisely one drink away from complete destruction. They use a system of medallions to reward complete abstinence. After certain intervals of time, the medallion changes and with it one's status in the group. If a person has one relapse, they lose all of their medallions and have to start from scratch. Their belief is that alcholics can NEVER have a drink again or they will absolutely, positively fall into an abyss of destruction.
I think this argument is completely fallacious. All you have to do is find a few heavy drinkers who now occasionally have a drink. Heck, I can use myself as an example. When I was in my teenage years to early 20's it is fair to say I drank heavily. I was diagnosed alcoholic and briefly attended AA. Ok, now in my current life I rarely drink (partially because of migraine headache I only drink on vacations). When I'm on vacation I will have a beer or a gin and tonic. I have been on approximately five vacations in the last decade so I may have consumed just under a dozen drinks (total). According to the AA model, I should be currently getting drunk almost every day (if not every day) and spiraling out of control. The last time I drank in Semptember of 2003 should have ignited a hopelessly destructive alcohlic binge. Well, it didn't.
As mentioned previously, I'm not a fan of this model. It think it represents a rigid and irrational ideology, not anything close to a valid argument. My personal example is one counterexample, and there are many others. In fact, I think their ideology of the all-importance of complete abstinence is DANGEROUS. If a person remains abstinent and has one slip up, they have completely relapsed and start from scratch. There isn't much distinction between a couple of beers and a couple weeks of drinking till black out. The AA member, having a minor relapse, now has a perfect justification for returning to chronic and heavy drinking. What difference does it make when a minor relapse is total relapse and your medallions must be discarded?
I think rigid ideologies generally are self-defeating, dangerous, and undesireable. I think it's more important to get people to think more rationally about their drinking and other self-defeating behaviors. I'm sure there are some alcoholics who are well-served by the AA (or other complete abstinence) models. But complete abstinence is not absolutely, positively the only way to treat those who drink excessively.
"Poor me, poor me, pour me another drink."
Jeffrey REBT "Wherein I don't promise to make you rich without trying, or even trying very hard; I do promise to say things that will make you FEEL rich."
bkholdem
12-18-2005, 03:16 AM
The dsm was created to have something to show insurance compaines in order to get paid
bkholdem
12-18-2005, 03:18 AM
I thought that, for example, alcohol dependence and alcohol abuse were in there but not alcohol 'addiction'
bkholdem
12-18-2005, 03:21 AM
If you want an interesting and amusing perspective on the dsm go get a subscription to the journal of polymorphous perversity
http://www.psychhumor.com/
bkholdem
12-18-2005, 03:25 AM
Is there anything that happens to us/that we experience that does NOT have strong physical roots?
DCWildcat
12-18-2005, 03:44 AM
1) Only psychiatrists can prescribe medicine.
2) Most insurances don't cover mental health. None did when the DSM came out. DSM was created to satisfy psychologists and lawyers at first...I'm not sure where you're getting your argument about the DSM having to do with getting paid.
3) Clinician's diagnoses really aren't as subjective as they're being made out to be. In some cases, the diagnoses are more replicable than doctor's diagnoses.
Soxx Clinton
12-18-2005, 04:57 AM
I am an ex-boozehound. I got physically dependent on it and it sucks. Physical withdrawal is unbelievably painful. It is sort of like a combination of extreme panic like anxiety (someone chasing after you with an axe) combined with flu-like physical symptoms.
Before I was ultimately sent to the hospital, I tried to quit several times on my own. My symptoms started within a few hours of my last drink, included hearing and seeing things that weren't there, the severe anxiety as mentioned above, inability to eat, constant vomiting, etc. etc.
Ironically the only thing that made it go away if 4 or 5 drinks, after which I would be as calm as a cat lolling in the sunshine.
Once the symptoms start, it is UNBELIEVABLY tempting to get rid of them by simply doing the only you know that works (ie. have a few drinks). In fact, the whole situation is so horrifying that it all but becomes a necessity. This is the overpowering urge that is really meant by the term "craving" in severe dependency. Getting high is not the point anymore- just being normal for a few minutes more is. If this is lack of willpower then so be it. Anybody who has been through it will pretty much laugh at the question, "why don't you just suck it up and quit".
Anyway, after being in the hospital for a week, and gradually detoxing with barbs, it took about a month for me to feel normal again.
The problem with definitions as I see it is that there are a lot of idiots who drink too much and cause problems the same way people overdo it with credit cards or call in sick too much out of laziness. Then there are people who are just exploding with the actual physical reality of chemical dependence.
Perhaps I was irresponsible in the early stages, or perhaps I have a inherited disease. I have no idea. But for me, at some point, the "addiction" or whatever you want to call it became very real, immediate, and horrifying to the extreme.
Anyway, the idea of ultimately becoming a social drinker again or teaching myself "willpower" is silly. Obviously my intent is total abstinence for obvious reasons.
As for AA I found it helpful for the first few months, more so because people there were coping with the same sort of wreckage that I was (money, legal, family etc.) and it helped to be around people who knew how it felt and what was going on. I think the religious elements of the program are a shame and I ultimately quit going because of that.
Thanks for the fabulous post,
I'm sorry to hear about your miserable experience with alcohol dependence. You do an excellent job articulating the misery of physical dependence on alcohol. And yes, there exists a distinction between psychological addiction, physical addiction, and simply being intoxicated and acting deviant. As you mentioned, cold turkey withdrawl from alcohol can be extremely unpleasant, dangerous and possibly fatal. It's harder to stay clean from a drug when you become physically ill without it. Obviously, medical treatment is warranted.
I laud your efforts at staying clean. Also, my experience with twelve-step groups (including AA) parellels yours. I just couldn't get around the all-important higher power element of the program. One man suggested I make my car my higher power! I'm an agnostic and found it impossible to believe a higher power could "restore me to sanity." The logic of the twelve steps seems dubious at best. I'm supposed to hold the position of absolute powerless while believing I have the power to stop with the help of some nebulous higher power. It just doesn't logically follow. The twelve steps seem steeped in Christianity and I think it probably has better utility for a religious person.
I do think some heavy alcohol abusers can moderate their drinking, even after being detoxed for physical addiction. Furthermore, I think many treatment programs get blasted unfairly for producing poor results. I think a reduction in drinking/drugging in and of itself warrants some positive appraisal. In your case, you have found complete abstinence to be ideal. I wish you continued success in your plight to completely abstain and better your life.
JeffreyREBT "Wherein I don't promise to make you rich without trying, or even trying very hard; I do promise to say things that will make you FEEL rich."
thehotspur
12-19-2005, 03:50 PM
I'm a poker player who happens to be a psychologist whose area of expertise is addiction. The disease model of addiction is 60 years old and has been shown in the intervening years to be incorrect. It is still promoted by the fellowship groups like AA, NA, and GA but these are not groups of scientists and their ideas are not based on current thinking or research findings. Where this model is promoted from within the medical establishment it is due partly to professional competitiveness with psychology, and partly ignorence of non-medical models and research.
I'm going to paste below a section of something I wrote about this general issue not too long ago, it may be of some interest to some of you.
Unfortunately, yet understandably, the field of addiction has historically been embroiled in the causality debates not only of nature versus nurture, but even determinism versus free will. The erosion of will in addiction is most famously exemplified by the seminal work of Jellinek with problem drinkers in the 1940s. He defined the move from heavy use to addiction as being characterised by “loss of control”:
“The drinker has lost the ability to control the quantity once he has started…
He is not aware that he has undergone a process which makes it impossible for him to control his alcohol intake.” (Jellinek, 1952)
And so began the popularisation of the belief that addictive behaviours were not just decisions, but were necessitated by conditions of addiction. How Jellinek’s “loss of control” theory became applied to illicit drugs is strange, given that a proper reading of his initial work indicates that it only applies to quantities of alcohol intake rather than instances of it. So the concept of loss of control became extended to the “choice” to take alcohol, heroin or crack cocaine, and because of the lifestyles which are sometimes needed to sustain it, entire lives were now “out of control”.
But is this loss of control in addiction a valid concept? Let us first look at the proposed mechanism of the subversion of will in addiction, and the empirical evidence for it.
Essentially the medical model holds that addiction follows a progressive course in which the substance alters / interacts with biochemistry to produce tolerance, withdrawal, and craving which cause the addict to lose control over their addictive behaviour (Doweiko, 1999). This precludes the possibility of addicts consuming in moderation, or in altering their consumption level in response to other variables. But the evidence hasn’t supported this.
In respect of alcohol, Davis in 1962 after a long term follow up on alcoholics showed that some of them did in fact demonstrate moderation in their drinking. Cahalan and Room in 1974 also found that alcoholics didn’t necessarily lose control over their drinking behaviour, and both studies downplayed the supposed relationship between physiological characteristics and control of drinking. An interesting study by Cohen et al in 1971, demonstrated that alcoholics could moderate their quantity of alcohol intake when there were rewards available (in this case better living conditions) to do so. They concluded that “substantial evidence that loss of control following the first drink is not inevitable” (p.144)
That the relationship between consuming the addictive substance and craving more of it is largely a non-physiological phenomenon has been established by various studies. Merry in an article in the Lancet in 1966 entitled “The Loss-of-Control Myth” reported a study in which alcoholics who were unaware that they were consuming alcohol reported no cravings for more. Even more than this, studies by Engle and Williams (1972) and by Marlatt et al (1973) demonstrated than alcoholics evidenced increased desire for alcohol when they were told they had consumed some when in fact they had not.
Thus we can see that their “loss of control” was not a physiological phenomenon, but rather a psychological phenomenon. In respect of drugs, Robins et al in 1975 studied returned Vietnam veterans and found that most of those who had used heroin in Vietnam had given up taking it, and that there was a high proportion of recovered addicts who used heroin occasionally without becoming readdicted. They concluded:
“It does seem clear that the opiates are not so addictive that use is necessarily followed by addiction nor that once addicted, an individual is necessarily addicted permanently” (p.961).
This independence from physiological determinacy is even evidenced in rat studies. Alexander et al in 1980 reported that, given a richer environment, morphine addicted rats chose not to consume the drug, whereas caged rats consumed up to sixteen times as much.
The danger of the strong determinacy models of addiction, whether it be the original Jellinek disease model, later medical models, conditioning models, or other psychosocial or psychodynamic models which de-emphasise volition is that they create expectancies and act prescriptively. Thus, as Schaler in his book “Addiction is a Choice“(2000) puts it very simply -
“The more people believe in their ability to moderate their consumption of drugs and alcohol, the more likely they will be to moderate.” (p.37)
So where does this leave us in terms of freedom of action? On one side of the scale we have the strong deterministic models and on the other side we have the libertarian position as exemplified by a quote from Schaler (2000)- “Addiction doesn’t mean you can’t control your behaviour. You can always control your own behaviour.”(p.119)
But there seems to me to be a very great gap between establishing that addiction doesn’t necessitate compulsion, and claiming that all behaviour is freely volitional. In between the poles of determinism and libertarian free will we have compatibilism. That is a recognition that things are determined but we still have free will. Yes our addictive behaviours are functions of our decisions, but our decisions are also functions of our conditions, both internal and external. Thankfully the field of addiction has now come to recognise the necessity of applying a biopsychosocial model to explain the causal factors of addiction (although with the health psychology profession still in its infancy it may take some years for its force to be fully felt). But what also requires a biopsychosocial analysis is the ability of the addict to exercise and marshal their personal will.
Soxx Clinton
12-20-2005, 03:41 AM
All of that is very well and good if we are talking about those sorts of decisions that are made before physical dependence has set in. Once the physical imperatives set in then all bets are off.
In other words, I think the academic understanding therefore of "Loss of Control" is poorly defined and switches contexts mostly because the people studying it haven't personally experienced it. Once loss of control happens on a physical basis it is very real, not psychological at all, and nearly gains the imperative of a survival instinct.
Soxx Clinton
12-20-2005, 03:50 AM
Furthermore, I think in many studies, you may not be looking at a homogenous group. What way do you have of seperating real physical addicts from the types of sociopaths who flunk out of college because they played to much Xbox? I have met plenty of "alcoholics" in and out of AA who I realized had not experienced real physical dependence at all but had been diagnosed and participating in "recovery" more from social consequences (DUI's. etc.) then from physical suffering.
thehotspur
12-20-2005, 08:50 PM
Why do you think that physical dependence necessarily implies loss of control? You say:
"Once loss of control happens on a physical basis it is very real, not psychological at all"
I don't have a concept of any complex behaviour such as drinking alcohol, taking drugs, or gambling as being outside psychological control. Physically needing something in order not to suffer does not mean that one has lost control. Surely the fact that people can and do quit addictions, or that they don't give in on a particular day is evidence of this. AA, NA, and GA propagate rubbish unfortunetly, and addicts like to hear that they had no choice, that they were in the grip of a disease.
DCWildcat
12-21-2005, 11:13 PM
[ QUOTE ]
Furthermore, I think in many studies, you may not be looking at a homogenous group. What way do you have of seperating real physical addicts from the types of sociopaths who flunk out of college because they played to much Xbox?
[/ QUOTE ]
You really don't think shrinks can distinguish between these groups? Clinical psychology programs are harder to get into med school these days, and hese folks have PhD's for a reason.
(rant) More people doubt psychology than perhaps any other scientific field, though its results are often more reliable than those of physicists, doctors, and virtually all fields of social science. This is because they insist on an emphasis on empirical validity not seen in other fields (probably out of necessity). Yet while people admit they don't know anything about higher level physics or economics, many seem to think they understand human behavior to a much greater extent than they do. Maybe this is why soo many people question every single finding in psychology, but simply accept findings in other sciences much more readily.
Psychology is 90% bull sh!t and 10% common sense. Psychoogists, as a group, do more harm than good in society (although they don't do much of either, really). But those who freely prescribe SSRI (anti-depressants) based on some cock-e-mamy theory that a "chemical imabalance" is the cause of the depression are truly irresponsible and are lackeys for big pharma... who are the real villains... (Sorry to hijack the thread). Addictions are funny things. Not a one size fits all question. Different people get addicted in different ways. AA, NA, and GA are not complete rubbish for everyone. They are quite correct and effective - for some. Clearly not for others...
thehotspur
12-23-2005, 03:02 PM
Psychologists don't and indeed legally cannot prescribe medication. Although my replying to a post that includes the term "cockamamy" (or a funny attempt of it) means that I think my head need examining /images/graemlins/smile.gif
12AX7
12-24-2005, 12:01 AM
Well this is an interesting topic. What brought it on?
Anyways, Yes I agree. Many things labelled disorder may, or may not be. Further, to say they are all caused by "brain chemical imbalances" leads to some interesting questions. Ones that should really be answered before handing out mind altering chemicals and stigmatizing people with the "disorder" label.
For example, if you say there's a brain chemical imbalance... er... ummm... how did you establish what in balance is? How did you establish then, that an imbalance was present?
Like many legal issues, the extremes are clear right? Insanity in its extreme forms are clearly visible. The big question is, where is the line between disorder and simple human variation, or what may be refered to as excentricity. Or even evolution?
And what of cultural impact. Kill your enemy and fry them up for dinner here in the USA, you are criminally insane. *Don't* do that in some tribal cultures and you're insane, right? LOL!
Anyway, I'm all for much stricter definitions and diagnosis than what presently passes. The big childhood ADD debate comes to mind.
I think the questions I posed above should be answered and further, that methods of screening out false positives should be given some thought.
For example, someone who is fastidious about dirt and crud. Obsessive, or someone who is clearly aware of physical reality.
An example of this jumped out at me the other day.
I was at a new Bashas. A food chain. There was a little display with sterile wipes. It said, "To clean the basket handles and child seat area for your protection, The Management".
However, had you gone to another grocery store with your own wipies... someone might label you an OCD sufferer, right?
So anyway, yeah, I try to bear in mind doctors are "health care provider" not trained scientists/researchers.
As an aside, I believe some sources state modern Psychiatry was dying on the vine until a point in the 70's when the APA got in bed with the drug companies.
You really want an eye popper, go study the history of the "ice pick lobotomy" and just what was going on a scant 50 years ago.
The science of the mind is still very embrionic. I do believe it might have been Einstien that said the only thing the brain will never figure out is itself. LOL!
RIDGE45
12-25-2005, 03:03 AM
Craig~
I didn't read any of the other posts so I appologize if anyone has covered any of what I say.
Anyway, I am majoring in Neuroscience (basically the science of brain, nervous system, and pscyhology) and know quite a bit about addiction.
So onto to the good stuff...
Essentially addiction results from a reward pathway in a certain part of the brain (at least most addictions...especially drug). Basically when you perform a behavior (eating, sex, GAMBLING, etc), take a substance (again food, drugs, etc), if affects the amount of chemicals (called neurotransmitters) which result in increased stimulation of what has been deemed the "reward pathway" in the brain. Since this is pleasurable for a person they behavior that causes becomes addictive. (For example lab rats will endure intense pain to recieve drugs of addiction liek cocaine because the reward is so great).
From a more non-science background addiction is formed through reinforcement or conditioning. A certain behavior results in a good feeling so it becomes addicting. Gambling is a particularly strong reinforcer because the reward (i.e winning money, etc) can not be predicted. Thus, the person feels compelled to play until they get the feeling (winning) again, and afterwards want to feel it so bad that they continue.
As far as addiction as a disease, it's looked at a disease because it results from chemical changes in the brain, and because it is something that has to be "cured". It's hard to quite anything you are "addictied" to cold turkey. The more that is understood about the chemical/biological mechansims of addiction that more it is looked at as a "disease" rather than a mental weakness because it is soemthing that in a way has to be cured. Also, some people are more succeptible to addiction (addictive personalities).
Sorry is this doesn't make sense...PM if you want more info, and/or want me to point you in the right direction of more information.
SheetWise
12-25-2005, 03:32 AM
[ QUOTE ]
I didn't read any of the other posts ...
I am majoring in Neuroscience ... and know quite a bit about addiction.
[/ QUOTE ]
If you do, it's not reflected in your post. Reading the posts might actually help you direct your 'quite a bit' of knowledge. Who knows, there may even be a 'bit' you missed.
thehotspur
12-26-2005, 04:21 PM
Isn't it a remarkable coincidence how often addicts with an "unbalanced neurochemistry" happened to have been abused when young, screwed over, or had a lousy life. These neuroscientists who reduce human behaviour to meaningless chemistry (which the very top experts in the field even admit is just a metaphor) bring very little to the party other than their pharmaceutical backers who want to apply existing drugs to addicts.
SheetWise
12-26-2005, 11:53 PM
I agree. I'm sure orgasm causes "chemical changes in the brain" as well, yet I've never seen it viewed as a disease requiring a cure -- while the recognized pharmacopeia boasts several compounds designed to enhance performance of an act which invariably leads to the same outcome.
RIDGE45
12-27-2005, 04:35 PM
Your post is extremely misguided...
Any psychologist, scientist, etc. who claims depression RESULTS from a chemical imbalance is an idiot. Psychologists use SSRI's because they work...they do not believe that the face they work explain the causes of the depression.
An SSRI selective blocks the reuptake of a chemical called serotonin (SSRI = selective serotonin reuptake inhibitor). This happens to help the symptoms of depression (but causes some nasty side effects....weight gain, etc.). When SSRI's were first discovered many hypothesized that depression must then be a result of a serotonin "imbalance". This has sense been proven, for the most part, false. It is just that that lower levels of serotonin are associated with depression and SSRI's help the symptoms of depression.
It would be like claiming headaches are caused by a lack of aspirin since aspirin "cures" headaches. This is not the case but one can not refute that aspirin helps headaches...same goes for SSRI's and depression.
Your post is uneducated. You attack a field, and a theory, that you obviously know nothing about. It is sad that people stubbornly stick to their OPINIONS of psychology, mental illness and treatment with little regard for what has been discovered, and what is being discovered, through research. Scientists, and psychologists alike work tirelessly to prove/disprove the theories of psychology through studies (both behavioral and scientific) in order to convince uniformed, biased skeptics like yourself that psychology is real.
I challenge you to research the field of psychology and neuroscience. Do not let the actions of a few bad pscyhologists/scientists cause you to ridicule a whole field that is helping society cope/deal with such diseases as alzhiemers, addiction, aging, strokes, etc, etc, etc.
RIDGE45
12-27-2005, 04:42 PM
Physical addiction could be indeed labeled a disease.
You show me a full blown alcoholic that has quite cold turkey. You can't do it because your body is dependant on alcohol. The withdrawl is unbearable, and the only thing that helps it?? You got it...alcohol.
Do you think you have enough "will power" or psychological control to not have alcohol when you are seeing, feeling, and hearing things that do not exist?
There comes a point in alcohol addiction where you can not psychologically overcome/control the urges to drink because your body can not function normally or feel normal without alcohol.
I am not saying AA, etc. are the best choice but you can not just decide to quite drinking one day if you have been an alcoholic for years. You need serious help and aid to succeed, and not die.
I equate it to being starved and having food in front of you...there is only so long you will be able to wait until you will eat that food.
RIDGE45
12-27-2005, 04:46 PM
There are different kind of addictions or dependancies such as Physical Depedancy or Pyschological Dependancy. Just because something isn't physically addictive doesn't mean you can't become dependant/"addicted" to it.
RIDGE45
12-27-2005, 04:47 PM
Nice post.
thehotspur
12-27-2005, 08:36 PM
Ridge I'm glad you feel so confident as an undergraduate to attack the ignorence of others. Of course this arrogance tends to be limited to undergraduates. I had lost it by the time I received my Phd in psychology. Of course if you bothered to take the time to read the whole thread ans see my earlier post you would know that, but you were too busy being authoritative in that cute undergraduate way. Anyway I wish you luck in your education, I hope you go beyond chemistry to actual psychology.
Not as misguided as you think. 90% bullsh!t and 10% common sense was obviously tongue in cheek. The point is that SSRI's are very dangerous, very overprescribed, and those PSYCHIATRISTS who prescribe them freely to treat "depression" or "bi-polar" behavior are irresponsible and harmful to society. And they most definitely ARE lackeys for big pharma, who most definitley ARE the real villains when it comes to the massive amounts of SSRI's and other so-called "anti-depressants" and "mood stabilizers" that are being consumed every day by unsuspecting kids, parents, and young adults. These drugs are doing FAR more harm than good, the big pharmaceuticals KNOW this is true, yet they promote them aggressively anyway, because they are very profitable. It's disgusting and it needs to change.
SheetWise
12-28-2005, 12:00 PM
[ QUOTE ]
You show me a full blown alcoholic that has quite cold turkey. You can't do it because your body is dependant on alcohol.
[/ QUOTE ]
You will find thousands of examples -- but you have to open your eyes to find them.
TomBrooks
12-28-2005, 02:53 PM
[ QUOTE ]
I find it foolish to say 'mental illness' or 'addictions' are diseases.
The labels are a very convenient mechanism for both the 'sufferer' and the labeler.
The person labeled wins because they are exonerated from personal responsibility.
The labeler...benefits because they have created a whole new class of clients needing assessment, treatment and diagnosis for these 'diseases.'
We are now being told that using too much caffeine, smoking, being shy, easily distracted, staying online for long hours, shoplifting, drinking, etc. are diseases.
There are financial incentives ... Insurance companies now are doling out billions to medically treat what was once thought of as merely immoral, sinful, neurotic, foolish behavior.
My personal bias is seeking explanations that maximize free will.
[/ QUOTE ]
There has been a trend in the USA in the last 40 years or so to reduce emphasis on the responsibility of an individual. Governments have taken on more responsibility to take care of adult persons who are financially unsucessful on their own. Companies who sell consumer products are bear a greater responsibility for their products with less emphasis on responsibility on an individual who chooses to use, misuse, or take risks with the product.
The downside to the individual is that this tends to reinforce the idea that an individual has less control and power over their lives than they really do. People have the power to make choices in their life. Realizing and excercising that power that tends to liberate, enrich and bring happiness and prosperity into a person's life. Denying or reducing that belief tends to have the opposite effect.
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