Addiction is a disease?

[SheetWise]

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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 ???

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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.

[DCWildcat]

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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.

[DCWildcat]

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]

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]

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]

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

[bkholdem]

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