A neuroscientist who believes addiction is not a disease(theguardian.com)
theguardian.com
A neuroscientist who believes addiction is not a disease
http://www.theguardian.com/culture/2015/aug/30/marc-lewis-the-neuroscientist-who-believes-addiction-is-not-a-disease
90 comments
15+ years sober here, mostly through some recovery programs and a lot of AA.
Neither the "disease" model (which has connotations of communicability) nor the AA "allergy" model (there's something wrong with my body) make total sense. Rather than try to fit other terms into a procrustean bed, I just call it addiction. Everyone is different, but there are a lot of commonalities.
Given the amount of denial that is present in most cases of addiction, trying to fit it into other categories can make more room for rationalization and avoidance. "I clearly don't have a disease, I never caught it from anyone," someone might say, or "It's not an allergy, I don't break out in hives." And delay treatment that much longer.
I'm a firm believer in getting whatever help works for you. If that's Rational Recovery, great. If that means an AA meeting every day, great. Just get help. Get it earlier than you think you need it. Tell your boss (s/he probably knows something is up anyway, just not what). Drop in on a meeting [yeah, AA, I know]. Tell a friend. Tell your doctor. Make a call and get into treatment. Do something, because until you do that, nothing is going to change.
16 years ago I was without a job and essentially unemployable, on the verge of being homeless, drinking 750ml+ of hard liquor a day, and this close to offing myself to end the misery. Today I'm married, doing really, really well financially, am bringing up a kid, and have a 6100+ karma score on my non-throwaway HN account. Life is good :-)
Neither the "disease" model (which has connotations of communicability) nor the AA "allergy" model (there's something wrong with my body) make total sense. Rather than try to fit other terms into a procrustean bed, I just call it addiction. Everyone is different, but there are a lot of commonalities.
Given the amount of denial that is present in most cases of addiction, trying to fit it into other categories can make more room for rationalization and avoidance. "I clearly don't have a disease, I never caught it from anyone," someone might say, or "It's not an allergy, I don't break out in hives." And delay treatment that much longer.
I'm a firm believer in getting whatever help works for you. If that's Rational Recovery, great. If that means an AA meeting every day, great. Just get help. Get it earlier than you think you need it. Tell your boss (s/he probably knows something is up anyway, just not what). Drop in on a meeting [yeah, AA, I know]. Tell a friend. Tell your doctor. Make a call and get into treatment. Do something, because until you do that, nothing is going to change.
16 years ago I was without a job and essentially unemployable, on the verge of being homeless, drinking 750ml+ of hard liquor a day, and this close to offing myself to end the misery. Today I'm married, doing really, really well financially, am bringing up a kid, and have a 6100+ karma score on my non-throwaway HN account. Life is good :-)
Congrats on the sobriety. 11 years myself here on my non-throwaway account (don't hire me, then, we'll both be better off).
As for the disease model, and as a partial response to the comment sibling, it is my understanding that the disease model was cooked up specifically to address the "weak willed" label slapped on those that drink too much. If that's true, and I don't have a reliable source to back that up, it would fit well with AA's overall program. IOW, like other diseases, you don't have control over it (if you did, you'd quit), and it is not reflective of a base character flaw, etc.
I dunno, I don't get too hung up on it myself. As you said, get whatever help that fits your model of the world, but get help. I don't even buy into a lot of what AA touts, but simply sitting in a room with a bunch of other folks with similar struggles was a lot of what I needed. (Granted, for a lot of AA meetings "similar struggles" means "the court says I need this piece of paper signed".)
As for the disease model, and as a partial response to the comment sibling, it is my understanding that the disease model was cooked up specifically to address the "weak willed" label slapped on those that drink too much. If that's true, and I don't have a reliable source to back that up, it would fit well with AA's overall program. IOW, like other diseases, you don't have control over it (if you did, you'd quit), and it is not reflective of a base character flaw, etc.
I dunno, I don't get too hung up on it myself. As you said, get whatever help that fits your model of the world, but get help. I don't even buy into a lot of what AA touts, but simply sitting in a room with a bunch of other folks with similar struggles was a lot of what I needed. (Granted, for a lot of AA meetings "similar struggles" means "the court says I need this piece of paper signed".)
Good for you, random internet person, good for you.
Do you think the disease model implies more some kind of genetic/environmental slant, as opposed to a 'weak character'. I think what the disease model is putting forward is that something outside of your control led to your addiction rather than something you're supposedly meant to have control over, that is to say your decisions and will.
Thanks for posting this.
edit: And I just remembered, the clinical/medical label used is actually "illness", not disease...
Do you think the disease model implies more some kind of genetic/environmental slant, as opposed to a 'weak character'. I think what the disease model is putting forward is that something outside of your control led to your addiction rather than something you're supposedly meant to have control over, that is to say your decisions and will.
Thanks for posting this.
edit: And I just remembered, the clinical/medical label used is actually "illness", not disease...
Are you sure about the latter? Wikipedia believes that "disease" means "any condition that impairs the normal functioning of the human body":
https://en.wikipedia.org/wiki/Disease#Terminology
Illness, they say, refers to the patient's experience of the disease. A person with a disease might not feel ill, and a person who experiences illness might not have a disease.
https://en.wikipedia.org/wiki/Disease#Terminology
Illness, they say, refers to the patient's experience of the disease. A person with a disease might not feel ill, and a person who experiences illness might not have a disease.
>it could easily be called, "doesn't pay attention when the teacher wants syndrome,"
This is a common misunderstanding. My experience with ADD is that it's not just "doesn't pay attention to what someone else wants"; it's "I can't pay attention to what I want to pay attention to".
And yeah, I do think that ADD has some beneficial effects as well. Syphilis can sometimes attack the nervous system in ways that create permanent elevated mood. I don't think that makes syphilis "not a disease".
This is a common misunderstanding. My experience with ADD is that it's not just "doesn't pay attention to what someone else wants"; it's "I can't pay attention to what I want to pay attention to".
And yeah, I do think that ADD has some beneficial effects as well. Syphilis can sometimes attack the nervous system in ways that create permanent elevated mood. I don't think that makes syphilis "not a disease".
It's both. Certainly there are those who legitimately suffer from the condition, as you put it, but there a greater amount of young boys who are misdiagnosed by teachers with no legitimate experience over the ability to diagnose besides: "he's a distraction to my classroom".
This characterizes Zimbardos more recent work on "The Demise of Guys" where you can learn an overview about it here[0]
The great issue is the vast amount of boys being misattribute with the condition, from predominately female teachers.
I was one of those boys, but I was one of the few lucky ones who's father is a doctor and never had me prescribed medicine I didn't need. I ended up excelling in upper school.
[0] http://www.ted.com/talks/zimchallenge?language=en
This characterizes Zimbardos more recent work on "The Demise of Guys" where you can learn an overview about it here[0]
The great issue is the vast amount of boys being misattribute with the condition, from predominately female teachers.
I was one of those boys, but I was one of the few lucky ones who's father is a doctor and never had me prescribed medicine I didn't need. I ended up excelling in upper school.
[0] http://www.ted.com/talks/zimchallenge?language=en
Hi! As someone also diagnosed with ADD I know what you mean. But that's still a control relationship, whether it's the teacher controlling me or me controlling myself to do something dull.
I don't know about you, but I've never had any problem focusing on anything I found interesting; even in high school 12-hour coding marathons were easy for me. In one of Hallowell and Ratey's books they talk about how a better name for it would be "Attention Inconstancy Syndrome". But we have the name because in our industrial model of education teachers expect controllable students, and so see our difference as a deficit.
All humans have limited attention spans, and different people have different limits. The problem for me wasn't my difference per se, but the expectation that I conform to patterns of behaviors that work for others. Now that I'm an adult and can define my own life, I'm no longer a "problem", just different.
I don't know about you, but I've never had any problem focusing on anything I found interesting; even in high school 12-hour coding marathons were easy for me. In one of Hallowell and Ratey's books they talk about how a better name for it would be "Attention Inconstancy Syndrome". But we have the name because in our industrial model of education teachers expect controllable students, and so see our difference as a deficit.
All humans have limited attention spans, and different people have different limits. The problem for me wasn't my difference per se, but the expectation that I conform to patterns of behaviors that work for others. Now that I'm an adult and can define my own life, I'm no longer a "problem", just different.
> My experience with ADD is that it's not just "doesn't pay attention to what someone else wants"; it's "I can't pay attention to what I want to pay attention to".
So kids with ADD can't concentrate for hours on, say video games or other interests?
So kids with ADD can't concentrate for hours on, say video games or other interests?
A kid might focus for hours on video games, while telling himself he really needs to write that paper for class tomorrow. Maybe you could say his id is in control of focus, not his ego.
Doesn't that describe pretty much everyone? Or maybe I have ADD as well...
If you're curious, I found the books by Hallowell and Ratey helpful. One of them contained a self-assessment quiz. It's meant to be descriptive, not diagnostic, but it was very useful to me in seeing the pattern. Here's a web version:
http://www.drhallowell.com/blog/adhd-self-assessment-quiz-2/
http://www.drhallowell.com/blog/adhd-self-assessment-quiz-2/
No that's mischaracterizing what I think the parent intended.
It's not "I can't focus on anything" but "I often have problems focusing on things I _want_ and try to focus on".
It's not "I can't focus on anything" but "I often have problems focusing on things I _want_ and try to focus on".
Most people, if they could actually choose what they're able to sustain focus on, would not choose video games or other forms of idle entertainment. Wouldn't you rather do something that brings some lasting value to your life?
Since video games are designed to capture attention at the expense of all other qualities, they're like a last refuge for people who want to have the experience of really getting into something, but don't have the focus control for something more substantial.
Since video games are designed to capture attention at the expense of all other qualities, they're like a last refuge for people who want to have the experience of really getting into something, but don't have the focus control for something more substantial.
Unless your comment also applies to novels and films I suspect you haven't got a clear idea about what games are.
It also applies to films and to a lesser extent, novels. Of course, some truly great games provide more than just temporary entertainment, and the same applies to TV shows.
Yikes, what a terrible parallel when we're talking about the unhelpful connotations of infectiousness when the word disease is brought up.
As an ex-heroin addict, I agree. I also agree with the author/scientist who was interviewed in the article; my personal addiction was far more behaviour based than it was a disease. Becoming an addict takes practice and choices, and it was taking responsibility for that, along with a great support system from my family and governmental medical help that helped me break the 6 year cycle. As of today, I've been clean for three years. That said, N=1, and from others I used to associate with (many who are no longer with us), the disease model makes more sense.
Basically, I think addiction is complex, and any one way of thinking about it will likely miss a lot.
Basically, I think addiction is complex, and any one way of thinking about it will likely miss a lot.
There was a study suggesting that what we call Schizophrenia is really 8 separate conditions with similar symptoms.
That is probably how most mental disorders are.
http://www.cnn.com/2014/09/16/health/schizophrenia-eight-dis...
That is probably how most mental disorders are.
http://www.cnn.com/2014/09/16/health/schizophrenia-eight-dis...
> what we call Schizophrenia is really 8 separate conditions with similar symptoms
I don't think we'll be able to say for sure how many different conditions there really "are". There may not even be such a number.
I don't think we'll be able to say for sure how many different conditions there really "are". There may not even be such a number.
Oh, definitely. Many things have complicated relationships to behavior like that. When I talk to friends with chronic diseases like Celiac's or diabetes, they spend a lot of time thinking about behavior, choices, and responsibility in ways similar to my recovering addict friends.
Congrats on being clean 3 years, by the way. That's an enormous accomplishment, especially with something so socially stigmatized as heroin.
Congrats on being clean 3 years, by the way. That's an enormous accomplishment, especially with something so socially stigmatized as heroin.
I'd never heard of the hunter vs farmer hypothesis. But, it's very interesting. A disproportionate number of my friends and I, although intelligent, had lifelong difficulties with ADHD, bipolar disorder, and substance abuse (as did many of our parents). We always used to ponder and hypothesize, as kids (in the 80s / 90s), that we just weren't built for modern life and that our recent ancestors were probably nomadic hunter gatherers. We felt like our bodies and minds truly were trying to push us to escape, to run wild in the forest.
Regarding bipolar disorder, you might enjoy reading Jameson's "Touched With Fire". She looks at the family trees of Romantic poets and how so many of the creative ones struggled, and how they had relatives that were thoroughly troubled in a way that made them unproductive. It's a great look at creativity as a double-edged sword.
> it could easily be called, "doesn't pay attention when the teacher wants syndrome," or "is not interested in your boring trivia syndrome".
"Doesn't fit into modern modes of domination and unquestionable authority" syndrome.
How many diseases are "isn't productive under capitalism and is therefore less useful to society" syndrome?
There is a presumption that we treat people the way we should treat people (we being society in the abstract, of course). Well yeah, if you take that as a premise then the only conclusion you can make is that people who cannot participate in society effectively for their own benefit and the benefit of others are sick!
How many diseases are culturally specific, both geographically and historically? Depression is on the rise in many countries. Are people getting sicker, or is society becoming more inhospitable?
If drug addiction is perceived as a symptom of a sick society, suddenly the logic of treating it is completely different.
"Doesn't fit into modern modes of domination and unquestionable authority" syndrome.
How many diseases are "isn't productive under capitalism and is therefore less useful to society" syndrome?
There is a presumption that we treat people the way we should treat people (we being society in the abstract, of course). Well yeah, if you take that as a premise then the only conclusion you can make is that people who cannot participate in society effectively for their own benefit and the benefit of others are sick!
How many diseases are culturally specific, both geographically and historically? Depression is on the rise in many countries. Are people getting sicker, or is society becoming more inhospitable?
If drug addiction is perceived as a symptom of a sick society, suddenly the logic of treating it is completely different.
The definition of all mental disease is completely based on social norms, a mental disease is just something which prevents you from behaving in a way certain people deem 'normal'. People like Szasz have posited it as a method for social control, where psychiatrists are proxies for authoritarian state power. I think if you asked Nietzsche he would say it's a natural response to the death of god; people look for something else to worship, and it's capitalism/obedience, and people who don't believe in it need help much in the way heretics of old were deserving of our help and pity to find God. Now instead of priests we look to psychologists, the priests of our new religion.
If you need evidence simply look at homosexuality; this was a mental disease while society didn't accept gay people (being gay made it impossible to live a "normal" life in society). Now that we think being gay is just fine it's no longer a disease. Nothing medical changed, ergo the definition was not in essence a medical one.
If you need evidence simply look at homosexuality; this was a mental disease while society didn't accept gay people (being gay made it impossible to live a "normal" life in society). Now that we think being gay is just fine it's no longer a disease. Nothing medical changed, ergo the definition was not in essence a medical one.
[deleted]
"If drug addiction is perceived as a symptom of a sick society, suddenly the logic of treating it is completely different."
Couldn't agree more (see my post elsewhere in this thread). I think the campaign against addicts (drug war) was indeed started from the 'isn't useful to capitalist society' angle, but now addicts, at least in the US but I'm sure pretty much everywhere else, are actually what bring massive profits to capitalist society through our government's prosecution and persecution of them. While it probably was not the intended result for most prohibitioners when they started the drug war, the war itself has created a whole new multi-billion dollar industry and front for many capitalists, especially the manufacturers of weapons, law enforcement, etc.
Society, at least in the US, refuses to look at itself as the source of the problem because it enjoys the problem. Much of society has benefitted from persecuting and prosecuting drug addicts and the inevitable supply lines that are caused by the existence of a black market. Police, military, politicians, and other beneficiaries of all these billions (trillions over time) refuse to ever acknowledge there is a problem because that would mean the end of their nice perks, the end of the pina colada machines in the police station, the end of the fun SWAT raids, the end of selling so many assault rifles, tanks, and other death equipment that doesn't belong in civilian police hands.
Damn straight addiction would be treated differently if it was seen as what it really is: a symptom of an incredibly sick society that no longer cares about its members and values profits above all else, including all human life, even that of its own citizens.
Couldn't agree more (see my post elsewhere in this thread). I think the campaign against addicts (drug war) was indeed started from the 'isn't useful to capitalist society' angle, but now addicts, at least in the US but I'm sure pretty much everywhere else, are actually what bring massive profits to capitalist society through our government's prosecution and persecution of them. While it probably was not the intended result for most prohibitioners when they started the drug war, the war itself has created a whole new multi-billion dollar industry and front for many capitalists, especially the manufacturers of weapons, law enforcement, etc.
Society, at least in the US, refuses to look at itself as the source of the problem because it enjoys the problem. Much of society has benefitted from persecuting and prosecuting drug addicts and the inevitable supply lines that are caused by the existence of a black market. Police, military, politicians, and other beneficiaries of all these billions (trillions over time) refuse to ever acknowledge there is a problem because that would mean the end of their nice perks, the end of the pina colada machines in the police station, the end of the fun SWAT raids, the end of selling so many assault rifles, tanks, and other death equipment that doesn't belong in civilian police hands.
Damn straight addiction would be treated differently if it was seen as what it really is: a symptom of an incredibly sick society that no longer cares about its members and values profits above all else, including all human life, even that of its own citizens.
>How many diseases are "isn't productive under capitalism and is therefore less useful to society" syndrome?"
We tend to call those "crimes".
We tend to call those "crimes".
Just like drug possession and use? :3
Every institution of power has its own designator of "bad" that justifies dehumanization. Police: Crime. Medicine: Disease. Military: Terrorism (nowadays). Religion: Heresy. etc. We should not be surprised when they overlap.
Every institution of power has its own designator of "bad" that justifies dehumanization. Police: Crime. Medicine: Disease. Military: Terrorism (nowadays). Religion: Heresy. etc. We should not be surprised when they overlap.
Your point about the disease hypothesis is flawed because one of the main questions asked during diagnosis is "does this affect your day to day living? How much?"
I think that changes treatment choices, but I don't think it changes diagnosis. Plenty of people with cancer aren't affected by it (yet), but that doesn't mean they wouldn't be diagnosed with the disease.
DanBC is talking about the diagnosis of addiction (or indeed most mental illnesses), not diagnosing any disease.
For example, a patient would likely not be diagnosed with an anxiety disorder if symptoms did not have a marked effect on their day to day living.
This means that the disease model can not be said to be a tool used to enforce normative cognition or behavior, but a model to help decrease suffering.
For example, a patient would likely not be diagnosed with an anxiety disorder if symptoms did not have a marked effect on their day to day living.
This means that the disease model can not be said to be a tool used to enforce normative cognition or behavior, but a model to help decrease suffering.
Could you perhaps point me to a link? When I look at Generalized Anxiety Disorder, I don't see that one:
https://en.wikipedia.org/wiki/Generalized_anxiety_disorder#D...
"Excessive" is normative, there. And Oppositional Defiant Disorder seems quite clearly designed to enforce normal behavior:
https://en.wikipedia.org/wiki/Oppositional_defiant_disorder
And there are scads of articles critical of the way ADD is treated in the US, and specifically critical of how the diagnosis and medication are used to create classroom compliance. A teacher friend once substituted in a classroom where every single child was on medication. Given that the disease prominence is circa 10% and not all kids are on medication, either she should have bought a lottery ticket or there was some other factor than strict medical necessity going on there.
https://en.wikipedia.org/wiki/Generalized_anxiety_disorder#D...
"Excessive" is normative, there. And Oppositional Defiant Disorder seems quite clearly designed to enforce normal behavior:
https://en.wikipedia.org/wiki/Oppositional_defiant_disorder
And there are scads of articles critical of the way ADD is treated in the US, and specifically critical of how the diagnosis and medication are used to create classroom compliance. A teacher friend once substituted in a classroom where every single child was on medication. Given that the disease prominence is circa 10% and not all kids are on medication, either she should have bought a lottery ticket or there was some other factor than strict medical necessity going on there.
That's the problem with attempting to use Wikipedia as an authoritative expert source: it's not, and it's not what it attempts to be.
The part about marked effect on the life of a would-be patient would not be explicitly stated amongst DSM diagnostic criteria, as it is not a symptom of the illness in question, but rather something most mental illnesses have in common (i.e. a large part of the reason for viewing mental disorders as illnesses). However, the second sentence in the Wikipedia page on GAD (to which you linked) starts "This excessive worry often interferes with daily functioning".
Seeing "excessive" used in the context of the listed symptoms (DSM-5, your link), I'm hard pressed to view this as any sort of attempt to cull diversity.
As it is rather late in my timezone, I'm not going to go trawling for definitions, but if you're interested in reading more I can recommend NAMI, NIMH, the Mayo Clinic, etc. as good starting points.
As this isn't my area of expertise, I'm in no position to argue the specifics of ODD, but it has always been somewhat controversial [1], and particularly around the release of DSM-5, IIRC. But even if the whole world were to agree that ODD was poorly defined, or pehaps even concede that it was "designed to enforce normal behavior", it would not really say anything at all about neither the disease model, nor the field in its entirety.
Regarding ADD, the major controversy seems to be about possible overdiagnosis, and to some extent about relying too much on medications as opposed to therapy, AFAIK. I think there are several legitimate issues here, some of which are likely specific to culture, some to specific socio-economic contexts, others perhaps to the handling of ADD at large.
[0]: https://en.wikipedia.org/wiki/Generalized_anxiety_disorder
[1]: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder#...
The part about marked effect on the life of a would-be patient would not be explicitly stated amongst DSM diagnostic criteria, as it is not a symptom of the illness in question, but rather something most mental illnesses have in common (i.e. a large part of the reason for viewing mental disorders as illnesses). However, the second sentence in the Wikipedia page on GAD (to which you linked) starts "This excessive worry often interferes with daily functioning".
Seeing "excessive" used in the context of the listed symptoms (DSM-5, your link), I'm hard pressed to view this as any sort of attempt to cull diversity.
As it is rather late in my timezone, I'm not going to go trawling for definitions, but if you're interested in reading more I can recommend NAMI, NIMH, the Mayo Clinic, etc. as good starting points.
As this isn't my area of expertise, I'm in no position to argue the specifics of ODD, but it has always been somewhat controversial [1], and particularly around the release of DSM-5, IIRC. But even if the whole world were to agree that ODD was poorly defined, or pehaps even concede that it was "designed to enforce normal behavior", it would not really say anything at all about neither the disease model, nor the field in its entirety.
Regarding ADD, the major controversy seems to be about possible overdiagnosis, and to some extent about relying too much on medications as opposed to therapy, AFAIK. I think there are several legitimate issues here, some of which are likely specific to culture, some to specific socio-economic contexts, others perhaps to the handling of ADD at large.
[0]: https://en.wikipedia.org/wiki/Generalized_anxiety_disorder
[1]: https://en.wikipedia.org/wiki/Oppositional_defiant_disorder#...
I'm not saying it's an attempt to cull diversity. I'm saying that when the disease model is all you have, it's easy to say, "there is a difference we don't like, therefore it must be a disease".
I think we both agree it happens, though.
I think we both agree it happens, though.
Here's the DSM 4 criteria for GAD: http://behavenet.com/node/21591
> E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
I get what you're saying. We used to lock people up for many years just because they had an abortion at 17 and liked wearing yellow tights. But "Does this interfere with your day to day life? What do you want to change?" is an important part of diagnosis.
I think the problem I have with what you're saying is that I see, very often, people (mis)using psychiatric language to describe behaviour they don't like in other people.
Asshole boss? Sociopath.
Asshole employee? Asperger's.
Asshole with a gun? Psychopath. (Or, worse, psychotic.)
> A teacher friend once substituted in a classroom where every single child was on medication. Given that the disease prominence is circa 10% and not all kids are on medication, either she should have bought a lottery ticket or there was some other factor than strict medical necessity going on there.
Over-diagnosis is probably a problem, especially in the US. I don't know how diagnosis works over there. Over here it's probably too hard to get a diagnosis. But I'd be interested to know what a statistician would say about a class of pupils who were all on medication. We'd expect some clumpiness. And unless you know that 10% is evenly distributed (is there any reason to believe it is) you'd expect even more clumpiness.
> E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
I get what you're saying. We used to lock people up for many years just because they had an abortion at 17 and liked wearing yellow tights. But "Does this interfere with your day to day life? What do you want to change?" is an important part of diagnosis.
I think the problem I have with what you're saying is that I see, very often, people (mis)using psychiatric language to describe behaviour they don't like in other people.
Asshole boss? Sociopath.
Asshole employee? Asperger's.
Asshole with a gun? Psychopath. (Or, worse, psychotic.)
> A teacher friend once substituted in a classroom where every single child was on medication. Given that the disease prominence is circa 10% and not all kids are on medication, either she should have bought a lottery ticket or there was some other factor than strict medical necessity going on there.
Over-diagnosis is probably a problem, especially in the US. I don't know how diagnosis works over there. Over here it's probably too hard to get a diagnosis. But I'd be interested to know what a statistician would say about a class of pupils who were all on medication. We'd expect some clumpiness. And unless you know that 10% is evenly distributed (is there any reason to believe it is) you'd expect even more clumpiness.
I think we broadly agree.
What I'm pointing at is that the GAD criteria, as with the criteria for many diseases, is not, "Hey patient, is this a problem for you?" It's a judgment by the clinician over whether the impairment is significant. That's generally fine with wise clinical judgment and clear signals of illness. (E.g., there's little dispute over whether a broken leg is a problem.) But I think there are issues when things are only a problem for other people, or only a problem because other people are different. There I think applying the disease model can be mixed, both helpful (when it allows addicts to get the support they need) and harmful (when different people are treated as broken).
See, for example, the literature on medicalization of deviance: https://scholar.google.com/scholar?q=deviance+and+medicaliza...
This is especially problematic in the US because medicalization is not just socially convenient, but frequently profitable.
I also agree that people casually using diagnostic language is a problem. Indeed, I think it's closely related to the problem that concerns me, where people take traits that are helpful in some contexts and harmful in others and declare them to be diseases.
What I'm pointing at is that the GAD criteria, as with the criteria for many diseases, is not, "Hey patient, is this a problem for you?" It's a judgment by the clinician over whether the impairment is significant. That's generally fine with wise clinical judgment and clear signals of illness. (E.g., there's little dispute over whether a broken leg is a problem.) But I think there are issues when things are only a problem for other people, or only a problem because other people are different. There I think applying the disease model can be mixed, both helpful (when it allows addicts to get the support they need) and harmful (when different people are treated as broken).
See, for example, the literature on medicalization of deviance: https://scholar.google.com/scholar?q=deviance+and+medicaliza...
This is especially problematic in the US because medicalization is not just socially convenient, but frequently profitable.
I also agree that people casually using diagnostic language is a problem. Indeed, I think it's closely related to the problem that concerns me, where people take traits that are helpful in some contexts and harmful in others and declare them to be diseases.
Regarding addiction, it would seem to me pretty obvious that it can be diagnosed even when the person doesn't admit that it affects their day to day living. I've met homeless drunks who swear to me that they don't have a problem with alcohol, and denial is a large part of addiction. And then there's the category of high-functioning alcoholics [1], where even outside observers can say it doesn't affect their day to day living.
[1] https://en.wikipedia.org/wiki/High-functioning_alcoholic
[1] https://en.wikipedia.org/wiki/High-functioning_alcoholic
As I'm sure you realize, what is admitted, what is observed and what truly is are not necessarily the same.
Sure, which is my point. DanBC is claiming that the person with the nominal disease is the source of deciding whether it affects day-to-day life. I'm saying that's not the case. Other people get to decide whether it's a disease based on what's normal to them.
An example others brought up was that homosexuality was defined as a mental illness for many years. That's the same dynamic I'm pointing at.
An example others brought up was that homosexuality was defined as a mental illness for many years. That's the same dynamic I'm pointing at.
That's not the case, though.
Clients are typically asked to assess to what extent the perceived symptoms affects their day-to-day life, any changes, etc., in addition to conferring with friends/family for their point of view on this. These are considered in addition to an absolute deviance from the "average spectrum" and diagnostic criteria.
I don't really think the pathologization of homosexuality is comparable to modern issues, as the reasons for this were very much informed by its historical context (its history as an immoral concept in christian/western culture, the state of psychology and psychiatry as fields at the time vs. now, etc.) in a way modern diagnoses aren't.
Also, according to Wikipedia [0], APA members were critical to homosexuality as a disorder at least from its inclusion in the first DSM.
[0]: https://en.wikipedia.org/wiki/Homosexuality#Psychology
Clients are typically asked to assess to what extent the perceived symptoms affects their day-to-day life, any changes, etc., in addition to conferring with friends/family for their point of view on this. These are considered in addition to an absolute deviance from the "average spectrum" and diagnostic criteria.
I don't really think the pathologization of homosexuality is comparable to modern issues, as the reasons for this were very much informed by its historical context (its history as an immoral concept in christian/western culture, the state of psychology and psychiatry as fields at the time vs. now, etc.) in a way modern diagnoses aren't.
Also, according to Wikipedia [0], APA members were critical to homosexuality as a disorder at least from its inclusion in the first DSM.
[0]: https://en.wikipedia.org/wiki/Homosexuality#Psychology
What's your source for your claims? In the US, a lot of mental illnesses are medicated by general practitioners, and mental health insurance coverage is notoriously poor. That sounds like a great way to work, but it's not how I see the system actually working.
That you don't think pathologization of homosexuality is comparable is, I suppose, fine for you. I obviously do or I wouldn't have made the comparison. It's not like we don't have a historical context now as well; it's just a different context. In particular, the US has some very deeply culturally embedded notions about work ethic and willpower that are relevant to ADD and addiction treatment. That we corrected one mistake does not mean we corrected the general pattern of mistake.
Regarding the last bit, glad to know Wikipedia is now a reliable source when you're citing it in your favor.
That you don't think pathologization of homosexuality is comparable is, I suppose, fine for you. I obviously do or I wouldn't have made the comparison. It's not like we don't have a historical context now as well; it's just a different context. In particular, the US has some very deeply culturally embedded notions about work ethic and willpower that are relevant to ADD and addiction treatment. That we corrected one mistake does not mean we corrected the general pattern of mistake.
Regarding the last bit, glad to know Wikipedia is now a reliable source when you're citing it in your favor.
There are sources abound [0-3]. The four Ds of abnormality [0] might be of particular interest.
The point may be better explained (as I'll get back to) by textbooks and lecture notes, also available via Google.
That's the case in much of the world, which is indeed considered a problem, and may explain why medication may be overutilized. But the fact that the system's current practice is unfavorable, does not really say anything about the models used to understand mental illness.
ADD comes with certain dysfunction [0] (and perhaps distress) that homosexuality just doesn't, which is one of the reasons for my objection. While the field of psychopathology is certainly influenced by culture (as is readily acknowledged) I have yet to see any reasonable argument that addiction and ADD are pathologized on the sole basis of falling outside of "normal" experience. Additionally, the notions of work ethic and willpower that you mention might just as well be used to explain stigma towards the mentally ill – that they should just apply discipline and willpower.
Apropos of sources, I should very much like to see some that claim that ADD as diagnosis is inherently problematic, as opposed to it being abused as a consequence of certain cultures.
My gripe with your previous use of Wikipedia was not about Wikipedia itself, but the way it was used. By this I mean that while Wikipedia articles might contain misinformation, it is known to be surprisingly good, for the most part (though certainly no credible academic source). The problem, though, is that it will in quite a few cases not provide readers with minute details, standard practice or underlying assumptions – Wikipedia is an encyclopedia, not a practitioner's handbook.
[0]: https://en.wikipedia.org/wiki/Psychopathology#The_four_Ds
[1]: https://en.wikipedia.org/wiki/Mental_health#Perspectives
[2]: https://en.wikipedia.org/wiki/Mental_disorder#Classification...
[3]: https://en.wikipedia.org/wiki/Mental_status_examination
That's the case in much of the world, which is indeed considered a problem, and may explain why medication may be overutilized. But the fact that the system's current practice is unfavorable, does not really say anything about the models used to understand mental illness.
ADD comes with certain dysfunction [0] (and perhaps distress) that homosexuality just doesn't, which is one of the reasons for my objection. While the field of psychopathology is certainly influenced by culture (as is readily acknowledged) I have yet to see any reasonable argument that addiction and ADD are pathologized on the sole basis of falling outside of "normal" experience. Additionally, the notions of work ethic and willpower that you mention might just as well be used to explain stigma towards the mentally ill – that they should just apply discipline and willpower.
Apropos of sources, I should very much like to see some that claim that ADD as diagnosis is inherently problematic, as opposed to it being abused as a consequence of certain cultures.
My gripe with your previous use of Wikipedia was not about Wikipedia itself, but the way it was used. By this I mean that while Wikipedia articles might contain misinformation, it is known to be surprisingly good, for the most part (though certainly no credible academic source). The problem, though, is that it will in quite a few cases not provide readers with minute details, standard practice or underlying assumptions – Wikipedia is an encyclopedia, not a practitioner's handbook.
[0]: https://en.wikipedia.org/wiki/Psychopathology#The_four_Ds
[1]: https://en.wikipedia.org/wiki/Mental_health#Perspectives
[2]: https://en.wikipedia.org/wiki/Mental_disorder#Classification...
[3]: https://en.wikipedia.org/wiki/Mental_status_examination
You seem to be arguing from the theory of mental health; I am talking about what people do in practice, and the cultural norms and views that shape the application of theory.
As to, "I have yet to see any reasonable argument" bit, I can certainly believe it. But I think that's mainly because you haven't looked. Plenty of people have talked about rampant overdiagnosis of ADHD in the US because putting everybody on stimulants makes classrooms easier to control. Overdiagnosis here means taking healthy but inconvenient behavior and pathologizing it. If people only have "dysfunction" in particular classroom environments with particular teachers, I think it's reasonable to suggest that what's dysfunctional is the environment and the expectation of universal conformity, not the people who are different.
It seems like we are mainly talking in circles here, and given that this is a topic on which I have paid attention to for a couple of decades and also have direct experience, your arguments from Wikipedia theory links aren't going to do much for me. Maybe we should stop now?
As to, "I have yet to see any reasonable argument" bit, I can certainly believe it. But I think that's mainly because you haven't looked. Plenty of people have talked about rampant overdiagnosis of ADHD in the US because putting everybody on stimulants makes classrooms easier to control. Overdiagnosis here means taking healthy but inconvenient behavior and pathologizing it. If people only have "dysfunction" in particular classroom environments with particular teachers, I think it's reasonable to suggest that what's dysfunctional is the environment and the expectation of universal conformity, not the people who are different.
It seems like we are mainly talking in circles here, and given that this is a topic on which I have paid attention to for a couple of decades and also have direct experience, your arguments from Wikipedia theory links aren't going to do much for me. Maybe we should stop now?
I realize what you're talking about.
The problem is that you talk about what you perceive as flaws in the disease model (theory) in your original post, and unsubstantiatedly claim that 'It posits one notion of normal and then divides everything into "normal therefore fine" or "different, therefore broken".', which is incorrect (as pointed out by DanBC).
If someone applies the model incorrectly, that doesn't undermine the model.
I have looked, and I have heard the arguments you are talking about, some of which I agree with (as you can see from earlier posts), but a common sentiment amongst some of these seem to be the almost conspiratorial belief that it is all based upon suppressing anything other than normal behavior.
I think it is more reasonable to suggest that the bar might be set too low when it comes to this diagnosis in the U.S., than it is to discredit the illness entirely because of what amounts to misdiagnosis. The subject is fraught with nuance.
As for the use of sources, there is clearly a discrepancy between our posts, though mine are admittedly often from Wikipedia.
The problem is that you talk about what you perceive as flaws in the disease model (theory) in your original post, and unsubstantiatedly claim that 'It posits one notion of normal and then divides everything into "normal therefore fine" or "different, therefore broken".', which is incorrect (as pointed out by DanBC).
If someone applies the model incorrectly, that doesn't undermine the model.
I have looked, and I have heard the arguments you are talking about, some of which I agree with (as you can see from earlier posts), but a common sentiment amongst some of these seem to be the almost conspiratorial belief that it is all based upon suppressing anything other than normal behavior.
I think it is more reasonable to suggest that the bar might be set too low when it comes to this diagnosis in the U.S., than it is to discredit the illness entirely because of what amounts to misdiagnosis. The subject is fraught with nuance.
As for the use of sources, there is clearly a discrepancy between our posts, though mine are admittedly often from Wikipedia.
> There are a ton of people previously diagnosed with Asperger's who lead happy, productive lives.
Who said being diagnosed with Aspergers meant you didn't have a happy, productive life? A disease doesn't mean you're debilitated.
Who said being diagnosed with Aspergers meant you didn't have a happy, productive life? A disease doesn't mean you're debilitated.
I'm obviously not saying that, but it gets said a lot. Anything defined as a disease is seen as a problem, even when the person with it just sees it as a difference. An example people gave elsewhere in the thread was homosexuality, which was defined as a disease for years and years.
A better understanding of addiction is the key to effective treatment – and treatment really isn't very effective right now – so the question is whether the harm from any increased stigma is offset by the benefit of better treatments.
It's always possible to willfully misinterpret Marc Lewis' message as saying that addicts just need to grow a spine, and it's definitely possible that a certain group of people will try to appropriate him to that end, but the interview itself is very nuanced.
It's always possible to willfully misinterpret Marc Lewis' message as saying that addicts just need to grow a spine, and it's definitely possible that a certain group of people will try to appropriate him to that end, but the interview itself is very nuanced.
The rosy, noble rebellious picture you paint of ADD isn't really what the disease looks like in people who are suffering: https://www.youtube.com/watch?v=LyDliT0GZpE
Having been diagnosed with it in college, and knowing many similar people, I agree that it isn't all puppies and flowers. However, if that's how all humans were, it wouldn't be defined as a disease, it would just be human nature.
It's also about human performance in very specific environments, that being certain industrial and early-post-industrial environments. And I'll add that most humans have inadequate attentional mechanisms for those environments, which is why 80% of adult Americans consume attention-enhancing stimulants every day, and why it is extremely rare to find an office environment without ready caffeine.
One caveat: there are a variety of things that get lumped under the term ADD, like organophosphate pesticide poisoning [1]. There are people with severe attentional issues who do indeed suffer, and would even in historical human environments. Here I'm speaking only of the 5-10% of the population with the standard sort of ADD that appears to be genetic, and wouldn't have been recognized as a disease until recently.
[1] http://thelastpsychiatrist.com/2010/06/there_is_no_link_betw...
It's also about human performance in very specific environments, that being certain industrial and early-post-industrial environments. And I'll add that most humans have inadequate attentional mechanisms for those environments, which is why 80% of adult Americans consume attention-enhancing stimulants every day, and why it is extremely rare to find an office environment without ready caffeine.
One caveat: there are a variety of things that get lumped under the term ADD, like organophosphate pesticide poisoning [1]. There are people with severe attentional issues who do indeed suffer, and would even in historical human environments. Here I'm speaking only of the 5-10% of the population with the standard sort of ADD that appears to be genetic, and wouldn't have been recognized as a disease until recently.
[1] http://thelastpsychiatrist.com/2010/06/there_is_no_link_betw...
Both do same error, that they start with premise of curing addicted people. The same error that nearly all psychologist or psychiatrists share. They declare people who are not normal as insane, and want to change them. A better way, imho, is to make people conscious that they are different, and thats important for them to find a place in life, where their difference is a bonus.
One of my favorite parable, is the imagination: You are very talented. You can lay eggs. Society defines being healthy as not picking on other chicken or own feathers. But its not you who is insane, the cages are a system of insanity.
The extreme cases of junkies on the street, and alcoholics in their flat come into mind, when thinking about addiction. Those are extreme cases of people who have no place in real life also. The drugs, are their way to find a place in life to be happy. Even if only for a short time. Teach them ways to become autonomic, to find their own path through life, and addiction will calm down by itself.
One of my favorite parable, is the imagination: You are very talented. You can lay eggs. Society defines being healthy as not picking on other chicken or own feathers. But its not you who is insane, the cages are a system of insanity.
The extreme cases of junkies on the street, and alcoholics in their flat come into mind, when thinking about addiction. Those are extreme cases of people who have no place in real life also. The drugs, are their way to find a place in life to be happy. Even if only for a short time. Teach them ways to become autonomic, to find their own path through life, and addiction will calm down by itself.
I can attest to this. In the past few years I've watched two close friends destroy their lives through addictions to alcohol and drugs. One of them died recently after years of severe alcoholism. The other is now in prison for drug-related offences.
I recall with fondness and sadness, both of them at their best... kind, generous, witty, intelligent; highly capable in their careers and loving and supportive to their families and close friends.
But each of them had ways in which they didn't quite fit in, and didn't always get the returns for the efforts they put in to try to achieve what they wanted in life, and as their frustrations grew, their self-destructive behaviours escalated, and the key support structures in life - most crucially their jobs and relationships - began to fall away.
But it was absolutely not the substance abuse issues that came first; in both cases that happened after the heavy knocks of life took their toll.
From observing these stories, I've become painfully aware that society just isn't very good at equipping people to understand why and how they're going wrong in life and how they can correct and achieve happiness and fulfilment. The support services that do exist, like therapy, AA, rehab etc, only become available when the problem is already entrenched and that much harder to turn around. I learned this when I recognised that I was starting to head down the wrong path in life and sought help before it got out of control, but the response was generally something like "you're pretty fine, don't waste our time".
I did end up finding an effective way of getting my life on track, and things are now going very well for me. I hope to live to see a time when it's much easier for far more people in the world to recognise their own failings and risk factors before they get out of control and find a better path before it's too late, and I'll be doing what I can to contribute to that cause.
I recall with fondness and sadness, both of them at their best... kind, generous, witty, intelligent; highly capable in their careers and loving and supportive to their families and close friends.
But each of them had ways in which they didn't quite fit in, and didn't always get the returns for the efforts they put in to try to achieve what they wanted in life, and as their frustrations grew, their self-destructive behaviours escalated, and the key support structures in life - most crucially their jobs and relationships - began to fall away.
But it was absolutely not the substance abuse issues that came first; in both cases that happened after the heavy knocks of life took their toll.
From observing these stories, I've become painfully aware that society just isn't very good at equipping people to understand why and how they're going wrong in life and how they can correct and achieve happiness and fulfilment. The support services that do exist, like therapy, AA, rehab etc, only become available when the problem is already entrenched and that much harder to turn around. I learned this when I recognised that I was starting to head down the wrong path in life and sought help before it got out of control, but the response was generally something like "you're pretty fine, don't waste our time".
I did end up finding an effective way of getting my life on track, and things are now going very well for me. I hope to live to see a time when it's much easier for far more people in the world to recognise their own failings and risk factors before they get out of control and find a better path before it's too late, and I'll be doing what I can to contribute to that cause.
Thanks for writing this. It roughly describes my own experiences. I managed to pull out of my own spiral primarily because the love of my life didn't leave my side, and because I continued to feel hope and the possibility for change. And I worked my butt off to get out of the hole.
The hopelessness and loneliness and anxiety came first, though. Heavy knocks of life, indeed.
The hopelessness and loneliness and anxiety came first, though. Heavy knocks of life, indeed.
If you feel comfortable sharing it, how did you get your life back on track?
There are sure to be several ways we could categorize different types of addictions and the people they affect. It does seem, however, that much of the underlying machinery is consistent.
For me, there were signs of compulsive behavior very early on - from food to reading novels nonstop - and I knew after the first time I experienced a 'buzz' as a child (probably an antihistamine) that this could cause me even more trouble.
Would I have sought escapes out less if my family and social lives had been better, or would I have been drawn in no matter what? I have no idea. Regardless, I did manage to learn with time that 'finding a path', as you say, led me to deeper experiences that not only reduced my desire to escape, but made even the escapes richer and more enjoyable. Of course, the pendulum swings, but it is good to know there are other ways one can live-- which is not always clear to younger people, simply because they haven't proven it to themselves yet.
One of the worst ways we fail young people seeking meaning is by giving them incomplete, conflicting and downright false ideas about what to value. I suspect this in large part because we haven't quite properly reached consensus on this as a species. In any case, I certainly believe we can do better.
For me, there were signs of compulsive behavior very early on - from food to reading novels nonstop - and I knew after the first time I experienced a 'buzz' as a child (probably an antihistamine) that this could cause me even more trouble.
Would I have sought escapes out less if my family and social lives had been better, or would I have been drawn in no matter what? I have no idea. Regardless, I did manage to learn with time that 'finding a path', as you say, led me to deeper experiences that not only reduced my desire to escape, but made even the escapes richer and more enjoyable. Of course, the pendulum swings, but it is good to know there are other ways one can live-- which is not always clear to younger people, simply because they haven't proven it to themselves yet.
One of the worst ways we fail young people seeking meaning is by giving them incomplete, conflicting and downright false ideas about what to value. I suspect this in large part because we haven't quite properly reached consensus on this as a species. In any case, I certainly believe we can do better.
I was under the impression that this is what psychology/psychiatry is supposed to do by charter.
Most professionals I know in the field take the attitude that a patient's psychological state should only be corrected if that patient feels they are an impediment to their own goals. This also goes along with the popular alcoholics anonymous mantra "we can't help you till you want to help yourself" (I'm not advocating AA just that it's a popular approach).
Of course this doesn't apply to people who have behavior disorders or are violent and end up committed.
Most professionals I know in the field take the attitude that a patient's psychological state should only be corrected if that patient feels they are an impediment to their own goals. This also goes along with the popular alcoholics anonymous mantra "we can't help you till you want to help yourself" (I'm not advocating AA just that it's a popular approach).
Of course this doesn't apply to people who have behavior disorders or are violent and end up committed.
It is true that a mental patient can be forced to treatment only if (s)he is considered a serious danger to the society, or herself/himself (includes suicidal tendencies). In many jurisdictions a court's decision is necessary, usually obtained on a rather short notice (24-48 hours).
But this does not mean that patient's consent is required for a valid diagnosis of a mental disorder. Denial is a serious problem and somehow an internal part of certain diseases such as mania, or, as you mentioned, early stage addictions.
But this does not mean that patient's consent is required for a valid diagnosis of a mental disorder. Denial is a serious problem and somehow an internal part of certain diseases such as mania, or, as you mentioned, early stage addictions.
The real problem, I believe, is the shame associated with mental disorders, and addiction in particular. Addiction is in many cases a (sign of a) legitimate disease, rooted deeper than just a nasty habit of popping Hydrocodone pills. We have reasons to believe that while addiction can be influenced by individual's choices, it is often not exclusively the patient's fault.
We allow patients to follow a slightly different path than the rest of the society till full recovery in the case of disorders such as cancer or depression, which can take years. Addiction should be treated the same way.
We allow patients to follow a slightly different path than the rest of the society till full recovery in the case of disorders such as cancer or depression, which can take years. Addiction should be treated the same way.
I would not call it shame, more that society does not take it seriously. I have often mused that if my mental issues had turned my skin bright blue or similar i would get a whole lot more sympathy.
Just try it, wrap a bandaid around your otherwise functioning arm (so its visible) and watch people become more helpful.
Just try it, wrap a bandaid around your otherwise functioning arm (so its visible) and watch people become more helpful.
I think it's more about society more easily understanding and thus being able to sympathize with physical pain and disability rather than the visibility of it itself.
Stigma is, after all, more about stereotypes and misinformation (or lacking information) than anything else.
If mental illness also affected skin hue, mental illness might just become more readily identifiable, and (some) people might just be bigoted against blue people instead.
Stigma is, after all, more about stereotypes and misinformation (or lacking information) than anything else.
If mental illness also affected skin hue, mental illness might just become more readily identifiable, and (some) people might just be bigoted against blue people instead.
Teach them ways to become autonomic, to find their own path through life, and addiction will calm down by itself.
Yes, but as addiction goes deeper it becomes more difficult to escape. It's not a nice thing to say, but there is probably a point of no return for many, after long periods of drug and alcohol abuse. Early interventions are crucial.
Yes, but as addiction goes deeper it becomes more difficult to escape. It's not a nice thing to say, but there is probably a point of no return for many, after long periods of drug and alcohol abuse. Early interventions are crucial.
In essence, addiction is many things rolled up in a single term.
Yes, it is a chemical reaction inside the brain. But over time that chemical reaction gets padded by conditioned reflexes. This to the point that one may find some relief by mimicking the actions related to the chemical reaction.
The real crazy stuff comes when it becomes harder to kick those conditions reflexes than the chemical addiction itself. Meaning that the body no longer craves the chemical, but still react to external stimuli by attempting to go through the actions related to taking the chemical.
Yes, it is a chemical reaction inside the brain. But over time that chemical reaction gets padded by conditioned reflexes. This to the point that one may find some relief by mimicking the actions related to the chemical reaction.
The real crazy stuff comes when it becomes harder to kick those conditions reflexes than the chemical addiction itself. Meaning that the body no longer craves the chemical, but still react to external stimuli by attempting to go through the actions related to taking the chemical.
As an example: when I was an addict, and was in severe withdrawals, I would go through the motions and inject saline solution. This would, despite me knowing it's not actually a drug, get rid of my withdrawals for a while; the placebo effect coupled with the "ritual" is very powerful. After I got clean, and the cravings went away, I would still have dreams of injecting drugs; not heroin, but anything. The behaviour was an addiction in and of itself.
This is a great insight; the behavior is an addiction just as much as one can be addicted to the substance.
Here's an example of a real difference in the brain that predicts an interesting relationship with psychoactive substances, both endogenous and exogenous: the OPRM1 A118G SNP. There's evidence that it predicts (i) a much greater risk of alcohol dependence; (ii) a much greater chance that naltrexone can be used to successfully treat said alcoholism once it happens; and (iii) a requirement for dramatically more opioid pain medication to achieve equal pain relief after surgery. This is a functional polymorphism that changes the way beta-endorphin binds in the brain; i.e. it's a real physical thing that you're born with. FAAH 385A is another interesting one.
[deleted]
> Teach them ways to become autonomic, to find their own path through life, and addiction will calm down by itself.
How is this any different from the "premise of curing addicted people"? It seems naive to expect problems to go away by themselves.
Your comment seems to present some sort of anti-psychiatry narrative, which is a dangerous and irresponsible set of ideas, IMHO.
How is this any different from the "premise of curing addicted people"? It seems naive to expect problems to go away by themselves.
Your comment seems to present some sort of anti-psychiatry narrative, which is a dangerous and irresponsible set of ideas, IMHO.
A while back on HN someone linked to "Most People With Addiction Simply Grow Out of It" [1] and "Here’s What I’ve Finally Concluded About 12-Step Programs" [2], which argues that many of the ways in which we try to treat addiction just make things worse, e.g. by recommending that a former alcoholic never again has a drink, you're actually making it more likely that when they do snap, they will not have learned to keep things under control and they'll probably feel so guilty about drinking that they will hide it from others rather than seek help.
I'm really not qualified to argue one way or another, but I find the idea intriguing.
[1] http://www.substance.com/most-people-with-addiction-simply-g...
[2] http://www.substance.com/heres-what-ive-finally-concluded-ab...
I'm really not qualified to argue one way or another, but I find the idea intriguing.
[1] http://www.substance.com/most-people-with-addiction-simply-g...
[2] http://www.substance.com/heres-what-ive-finally-concluded-ab...
This is not a new way of looking at addiction. In fact, it's the OLD way.
Animal models clearly show compulsive behavior, and through various techniques scientists can modulate that behavior. As far as I care, that's how we roughly define a disease.
No, he's right, it's not a disease in the sense of "[patients listen to your doctor and take your medicine]" but that's always the case with mental disorder.
Animal models clearly show compulsive behavior, and through various techniques scientists can modulate that behavior. As far as I care, that's how we roughly define a disease.
No, he's right, it's not a disease in the sense of "[patients listen to your doctor and take your medicine]" but that's always the case with mental disorder.
Animal models only show compulsive behavior in bad circumstances. Put a rat in an empty cage, it will misuse drugs. Put it in a cage full of other rats and things to dig in and climb on, and it will not misuse drugs.
https://en.wikipedia.org/wiki/Rat_Park
So if this model is valid for humans, then it means that addicts are unhappy about their circumstances. Modern society is making some people so unhappy that they turn to drug misuse. Modern society is sick. It is making people feel lonely and isolated. We need to heal our society collectively. Spread the love.
http://www.huffingtonpost.com/johann-hari/the-real-cause-of-...
https://en.wikipedia.org/wiki/Rat_Park
So if this model is valid for humans, then it means that addicts are unhappy about their circumstances. Modern society is making some people so unhappy that they turn to drug misuse. Modern society is sick. It is making people feel lonely and isolated. We need to heal our society collectively. Spread the love.
http://www.huffingtonpost.com/johann-hari/the-real-cause-of-...
this resonates with me... I found myself in a series of bad incidents that pushed me towards escaping with alcohol. then due to my compulsive nature, it spun out of control and I ended up in rehab etc and took 2 years to pull back out. when it all started I had run out of money, was extremely lonely (needed therapy but didn't even know how to get it then), and had lost my job etc. it caused me to self-destruct at age 29 because my vision for life suddenly seemed lost to me. now I'm 32 with s great job, sober, stable, and life is great.
Thomas Szasz - https://www.youtube.com/watch?v=Qj7GmeSAxXo
I've know a few addicts. They were brother and sister.
The brother was addicted to meth and recreationally used other things (pot, various uppers and downers, etc.). He went to jail for selling, then cleaned up, was eating healthy, got another college degree, held a respectable job, then went back to hanging out with an old boyfriend who was bad news, and ended up back in jail for carrying a large amount.
The sister just used pot, which many argue isn't an addictive, but I think when you get up every morning and have to have it and then divorce primarily because of substance abuse, that's a problem. She finally beat it after 30+ years of use.
Here are some common characteristics:
* Their mother had a pro-medication attitude. I don't think this causes addiction, but I think it may have been a contributing factor.
* They are both very intelligent and confident.
* They have both historically been very opinionated and were not easily swayed to other opinions.
* Both associated with people and lived in communities that were more liberal.
It's possible they have a predisposition to addiction, but I don't think it's possible to prove that one way or the other.
People can be chemically addicted. Heroin and meth for example are both very tough to beat after you've started. I've know people that died early because of past heroin addiction. It is a terrible thing, and it scares me to think that some day all drugs may be legalized.
Environment influences attitude toward drug use, and then personality traits can reinforce behavior. If you can avoid people that use drugs or have a liberal attitude towards drugs, you can avoid addiction. If you are a parent, talk with your kids about drug use. Let them know that you care about them and that you want them to avoid those that use drugs.
Addiction is a product of environment, personality traits, possibly innate tendencies, and exposure to chemically or psychologically additive substances. Whether addiction is a disease or not isn't important to me. Just stay away from people that do drugs, and if you get addicted, get off of drugs, and get out of that environment.
The brother was addicted to meth and recreationally used other things (pot, various uppers and downers, etc.). He went to jail for selling, then cleaned up, was eating healthy, got another college degree, held a respectable job, then went back to hanging out with an old boyfriend who was bad news, and ended up back in jail for carrying a large amount.
The sister just used pot, which many argue isn't an addictive, but I think when you get up every morning and have to have it and then divorce primarily because of substance abuse, that's a problem. She finally beat it after 30+ years of use.
Here are some common characteristics:
* Their mother had a pro-medication attitude. I don't think this causes addiction, but I think it may have been a contributing factor.
* They are both very intelligent and confident.
* They have both historically been very opinionated and were not easily swayed to other opinions.
* Both associated with people and lived in communities that were more liberal.
It's possible they have a predisposition to addiction, but I don't think it's possible to prove that one way or the other.
People can be chemically addicted. Heroin and meth for example are both very tough to beat after you've started. I've know people that died early because of past heroin addiction. It is a terrible thing, and it scares me to think that some day all drugs may be legalized.
Environment influences attitude toward drug use, and then personality traits can reinforce behavior. If you can avoid people that use drugs or have a liberal attitude towards drugs, you can avoid addiction. If you are a parent, talk with your kids about drug use. Let them know that you care about them and that you want them to avoid those that use drugs.
Addiction is a product of environment, personality traits, possibly innate tendencies, and exposure to chemically or psychologically additive substances. Whether addiction is a disease or not isn't important to me. Just stay away from people that do drugs, and if you get addicted, get off of drugs, and get out of that environment.
>If you can avoid people that use drugs or have a liberal attitude towards drugs, you can avoid addiction.
Almost everyone I know has a "liberal" attitude towards drugs. And they're all great, functional, non-addicted people.
>Just stay away from people that do drugs
You're going to live a pretty solemn existence in modern society, where the majority of Westerners require morning caffeine.
Almost everyone I know has a "liberal" attitude towards drugs. And they're all great, functional, non-addicted people.
>Just stay away from people that do drugs
You're going to live a pretty solemn existence in modern society, where the majority of Westerners require morning caffeine.
"where the majority of Westerners require morning caffeine"
Also alcohol.
My observation of popular HN culture shows its believed to be easier to live and socialize as a vegetarian than a non-alcohol drinker. This comes up often in semi-unrelated topics about new urbanism and the perceived level of importance of living within walking distance of bars, not to mention the supposed death of car culture. And it also comes up in "how do I meet people" socialization topic discussions. And health oriented discussions. Occasionally hobby related discussions, also.
Given the enormous PITA it is, according to some, to not drink alcohol, it would seem an obvious startup opportunity for social media inspired socialization or whatever. I'm not currently aware of any non-alcohol related startups. There is at least some love for vegetarianism, so there should be space for not getting drunk as a lifestyle, given that it is supposedly an even stronger social death sentence.
Also alcohol.
My observation of popular HN culture shows its believed to be easier to live and socialize as a vegetarian than a non-alcohol drinker. This comes up often in semi-unrelated topics about new urbanism and the perceived level of importance of living within walking distance of bars, not to mention the supposed death of car culture. And it also comes up in "how do I meet people" socialization topic discussions. And health oriented discussions. Occasionally hobby related discussions, also.
Given the enormous PITA it is, according to some, to not drink alcohol, it would seem an obvious startup opportunity for social media inspired socialization or whatever. I'm not currently aware of any non-alcohol related startups. There is at least some love for vegetarianism, so there should be space for not getting drunk as a lifestyle, given that it is supposedly an even stronger social death sentence.
> Almost everyone I know has a "liberal" attitude towards drugs. And they're all great, functional, non-addicted people.
And that sister I was talking about was thoroughly convinced for years that pot had a beneficial affect on her well-being, there were studies to prove it, but she was addicted.
It can happen.
And that sister I was talking about was thoroughly convinced for years that pot had a beneficial affect on her well-being, there were studies to prove it, but she was addicted.
It can happen.
I feel like this is arguing semantics. Drug addiction is a problem that you can seek help for and should. There are physical components to it and psychological components. The author doesn't seem to be describing anything fundamentally different from how the addiction community already treats addiction. It's certainly not true that you can just snap out of an addictive cycle by choosing to not be a drug addict. But it's also not true that behavior isn't the primary think you need to treat in most cases.
I don't think you can so easily dismiss the differentiation based on semantics. You should be clear on the differences and the difference in approach to a solution each demand.
Most practitioners already tailor their treatment to what has been found to be beneficial to drug use and even the drug specifically. Heroin users can die if they go from heavy usage to no usage and prescriptions are needed. A user who drinks to forget, maybe infrequently, but intensely and who has no symptoms of physical dependence needs a different kind of therapy than someone with no history of dependence who has become hooked to percocets following a surgery. That is, people already recommend treatment based on what the problem is and whether or not it is technically a disease or if it's something different; it's a point that's contentious for many people, but I'm not sure how relevant it really is.
Surely the "addiction is a disease" mindset is a defensive response to the (especially in America) mindset that addiction is a moral failing. I.e. one crackpot opinion begets another.
The truth about 'addiction' is complex and different for each individual but, given that no one is born an addict, at heart the concept describes how many people have learnt to cope with their individual circumstances. Disease and morality are both inadequate to discuss this.
The truth about 'addiction' is complex and different for each individual but, given that no one is born an addict, at heart the concept describes how many people have learnt to cope with their individual circumstances. Disease and morality are both inadequate to discuss this.
Golden Hammer.
Doctors have medical background, so they tend to see things through that lens and solve problems with the medical tools they have on hand.
Cops tend to apply law & order solutions to the problems they see, because that is what they know.
Scientists tend to ...
Engineers tend to ...
It's hard for us to remove ourselves from what we know and have spent so many years studying, and look at problems with fresh eyes.
Doctors have medical background, so they tend to see things through that lens and solve problems with the medical tools they have on hand.
Cops tend to apply law & order solutions to the problems they see, because that is what they know.
Scientists tend to ...
Engineers tend to ...
It's hard for us to remove ourselves from what we know and have spent so many years studying, and look at problems with fresh eyes.
Seems like a semantic technicality. A disease is a disease. An addiction is an addiction. The benefit in calling it a disease is in getting people to change their perspectives and precognitions about it - to see it as something at least partly out of the victim's control to be treated with compassion.
Yeah in that angle addiction is mostly a political or social term.
I wonder if psychology really accounts how society can be oppressive for certain people who can't integrate properly because of their education.
I wonder if psychology really accounts how society can be oppressive for certain people who can't integrate properly because of their education.
Addiction -- is simply its own category.
I've been thinking this for awhile and kinda forgot this wasn't standard thinking.
Obviously there are physical components and psychological components. But when you look to animals (rats eating junk food obsessively, etc) its obviously an addition.
The conscience mind humans have cannot supersede the this fact that its first an addition for all of our ancestors (and thus, us). Therefore while it is clearly both physical and psychological, it always starts psychologically and so the only way to fully cure it is also psychologically.
Obviously there are physical components and psychological components. But when you look to animals (rats eating junk food obsessively, etc) its obviously an addition.
The conscience mind humans have cannot supersede the this fact that its first an addition for all of our ancestors (and thus, us). Therefore while it is clearly both physical and psychological, it always starts psychologically and so the only way to fully cure it is also psychologically.
> "So there’s something going on that makes it hard to stop for very good neurological reasons. So then, do you want to call addiction a disease? Well, maybe, then you’re getting close I think, because you could call it a pathology I guess."
Science left the room, this is semantics. HN's comments here are orders of magnitude more valuable than TFA. This reflects the thinking of a book salesman, not a doctor of neuroscience.
Science left the room, this is semantics. HN's comments here are orders of magnitude more valuable than TFA. This reflects the thinking of a book salesman, not a doctor of neuroscience.
Totally agree. I would just go a bit further and days that beyond just a basic behavioral problem it is a neurological mental disorder that is either hereditarily deposed and/or triggered through behavioral issues.
I think the disease model is the primary model of addiction in the US because it helps relieve the stigma and hate of the rest of society against addicts, not because it's an accurate model. It's popularized by 12-step programs a lot more than it is by doctors, thus most people that support this model have no scientific basis, rationale, or reasoning for doing so other than it's better than the alternative, which is to see addiction as a moral failing, a failure of willpower, or a character defect. As another post here points out, those are indeed the old ways of seeing addiction, of society to blame and ostracize addicts. That model is also incorrect, mostly postulated by people who are not addicts, have no experience with addiction, and are generally just looking to place blame and hate rather than for a realistic model of addiction.
Personally, I think both camps are wrong and the most evidence is towards addiction being a societal problem, rather than an individual disease. It's easy to underestimate the influence of one's environment on one's actions, but phenomena like the massive drop-off in addiction rates of Vietnam veterans are rather hard to explain otherwise (http://www.npr.org/sections/health-shots/2012/01/02/14443179...). This is a hard pill to swallow in a place like America where it's ingrained in the culture that people be blamed for whatever wrongdoings they have committed, regardless of the utility of such blame, and regardless of the reality of the blame. A lot of people want to maintain a moralistic high ground and many of those do it simply because they enjoy putting others down and causing conflict (usually because they are suffering themselves). How can people with such attitudes ever look honestly at themselves, their own actions, their communities, and ask themselves if some of these things might somehow be responsible for the suffering of others' in society? They can't and they won't.
I do not think any one particular societal problem can be blamed for addiction, but things like poverty, disease, lack of opportunities, exposure to hate, exposure to trauma, etc. are likely culprits. In a country where anything related to the common good or community is eschewed and often considered un-American, it's no wonder that many people find themselves disconnected, alone, and unwanted. Our society not only shuns the poor and different, but even many of those actively involved in building it, people with jobs who are actively striving to make things better for themselves. Teenagers and young adults who don't live in a city are left to their own boredom by parents who may care, but who cannot do anything about the boredom of suburbia. These people often turn to drugs because they're essentially being neglected by their parents, peers, and likely the educational system or simply do not have the means to socialize because of the distances involved. They develop addiction patterns they will rely on as adults. These are just a couple of examples I can think of off the top of my head of neglect, abuse, hate, poverty, and trauma than a huge portion of the population in the US experiences. Certainly, not everyone will become an addict, but such extreme societal disfunction is a much more likely culprit for addiction than either the disease model or the morality/willpower model.
Specifically, the disease model fails to explain people who are 'cured' and stop using, people who use for only a few years, people who can stop and use at societally accepted levels, etc. The morality/willpower model assumes that we are in control of all actions, that outside events and the environment have no influence on human behavior, and most ridiculous of all, that humans act in a rational matter 100% of the time (silly Kantian ideas). The failings of both of these models are so egregious, I do think it's time to retire both and start to seriously study addiction scientifically rather than provide explanations that we have been pre-conceived ahead of time and fly in the face of evidence.
Personally, I think both camps are wrong and the most evidence is towards addiction being a societal problem, rather than an individual disease. It's easy to underestimate the influence of one's environment on one's actions, but phenomena like the massive drop-off in addiction rates of Vietnam veterans are rather hard to explain otherwise (http://www.npr.org/sections/health-shots/2012/01/02/14443179...). This is a hard pill to swallow in a place like America where it's ingrained in the culture that people be blamed for whatever wrongdoings they have committed, regardless of the utility of such blame, and regardless of the reality of the blame. A lot of people want to maintain a moralistic high ground and many of those do it simply because they enjoy putting others down and causing conflict (usually because they are suffering themselves). How can people with such attitudes ever look honestly at themselves, their own actions, their communities, and ask themselves if some of these things might somehow be responsible for the suffering of others' in society? They can't and they won't.
I do not think any one particular societal problem can be blamed for addiction, but things like poverty, disease, lack of opportunities, exposure to hate, exposure to trauma, etc. are likely culprits. In a country where anything related to the common good or community is eschewed and often considered un-American, it's no wonder that many people find themselves disconnected, alone, and unwanted. Our society not only shuns the poor and different, but even many of those actively involved in building it, people with jobs who are actively striving to make things better for themselves. Teenagers and young adults who don't live in a city are left to their own boredom by parents who may care, but who cannot do anything about the boredom of suburbia. These people often turn to drugs because they're essentially being neglected by their parents, peers, and likely the educational system or simply do not have the means to socialize because of the distances involved. They develop addiction patterns they will rely on as adults. These are just a couple of examples I can think of off the top of my head of neglect, abuse, hate, poverty, and trauma than a huge portion of the population in the US experiences. Certainly, not everyone will become an addict, but such extreme societal disfunction is a much more likely culprit for addiction than either the disease model or the morality/willpower model.
Specifically, the disease model fails to explain people who are 'cured' and stop using, people who use for only a few years, people who can stop and use at societally accepted levels, etc. The morality/willpower model assumes that we are in control of all actions, that outside events and the environment have no influence on human behavior, and most ridiculous of all, that humans act in a rational matter 100% of the time (silly Kantian ideas). The failings of both of these models are so egregious, I do think it's time to retire both and start to seriously study addiction scientifically rather than provide explanations that we have been pre-conceived ahead of time and fly in the face of evidence.
Some good, HN-relevant examples are ADD and autism-spectrum "disorders". One of the hallmarks of ADD is hyperfocus, so ADD is a misnomer; it could easily be called, "doesn't pay attention when the teacher wants syndrome," or "is not interested in your boring trivia syndrome". There are a ton of people previously diagnosed with Asperger's who lead happy, productive lives. Both of these characteristics can be positive in the world of tech entrepreneurship, and could well have been positive in previous environments. [1]
That said, I think this guy making his central message, "Addiction is not a disease," is dangerous to the point of idiocy. In our current society, we really only have one mechanism for aiding those who will need a lot of help, and that's saying that they're sick. If he would like to make a full-scale assault on the disease model, godspeed. But a lot of people already want to believe that addicts could quit any time if they just applied a little willpower. Reinforcing that means that people who could be saved will die unnecessarily.
[1] See, e.g., the hunter vs farmer hypothesis for ADD: https://en.wikipedia.org/wiki/Hunter_vs._farmer_hypothesis