Addiction is a disease?

[bkholdem]

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]

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

[DCWildcat]

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]

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]

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]

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]

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]

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]

[ 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.