Re: Addiction is a disease?
 

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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.

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Thats all just AA mumbo-jumbo.

Re: Addiction is a disease?
 

Discussions based around semantics are almost universally stupid.

Re: Addiction is a disease?
 

[ 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."

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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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

I've never heard anyone say that kindness is a disease, they call it a good habit.

Re: Addiction is a disease?
 

[ QUOTE ]
I've never heard anyone say that kindness is a disease, they call it a good habit.

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Shame it's not contagious, at least. In spite of the old saying.

[img]/images/graemlins/frown.gif[/img]

Re: Addiction is a disease?
 

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".

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

[ 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.

Re: Addiction is a disease?
 

[ 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.

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You can't compare treatment to non-treatment? Spoken like a true snake-oil salesman.

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Remission isn't a fault of current treatment problems, its an unfortunate barrier.

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Newspeak ???

Re: Addiction is a disease?
 

[ QUOTE ]
it often only takes one use to destroy everything the treatment has done, and this is universal for all forms of treatment

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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.

Re: Addiction is a disease?
 

[ 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.

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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?

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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?

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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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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."

Re: Addiction is a disease?
 

The dsm was created to have something to show insurance compaines in order to get paid

Re: Addiction is a disease?
 

I thought that, for example, alcohol dependence and alcohol abuse were in there but not alcohol 'addiction'

Re: Addiction is a disease?
 

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/

Re: Addiction is a disease?
 

Is there anything that happens to us/that we experience that does NOT have strong physical roots?

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease? (My experience)
 

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.

Re: Addiction is a disease? (My experience)
 

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."

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

[ 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.

Re: Addiction is a disease?
 

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...

Re: Addiction is a disease?
 

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 [img]/images/graemlins/smile.gif[/img]

Re: Addiction is a disease?
 

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!

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

[ 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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.

Re: Addiction is a disease?
 

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.