February
26, 2001
Addictions Are
About Behavior, Not Disease
(part 1)
by Ilana
Mercer
When it comes to thinking about
addiction, opinions converge. Having
bought into the addiction industry's
mantra, so-called social progressives and
conservatives alike share the same
ideological hangover from the Prohibition
era, with a twist of AA sadism: all are
religious about abstinence, and all
accept as bible from Sinai the wisdom of
coercing addicts into treatment regimens.
But perhaps the greatest error made in
the attempt at humane formulations about
addiction is to cast as a disease what is
essentially a problem of behaviour.
The dangers of gathering more and more
behaviors under the disease label is not
something pharmacology moguls,
politicians or health care professionals
ruminate about, despite the ramifications
for a society already committed to a
morality lite and to diminished personal
responsibility. In his book Diseasing of
America, addiction researcher Stanton
Peele breaks with this tradition. Disease
conceptions of misbehavior are bad
science and morally and intellectually
sloppy, argues Peele. "Once we treat
alcoholism and addiction as diseases, we
cannot rule out that anything people do
but shouldn't is a disease, from crime to
excessive sexuality to
procrastination."
While the application of the medical
disease model to addictions was developed
to "remove the stigma from these
behaviours", there is NO genetic
marker for alcoholism or drug addiction.
Still, the misconception that these
behaviors are linked to a genetic
vulnerability is aired repeatedly by the
media, in the absence of evidence. The
rationale for using the disease model to
describe addiction even though it is
intellectually dishonest is that medical
treatment is effective.
Yet another deception. An overview of
controlled studies indicates that
"treated patients do not fare better
than untreated people with the same
problems." Of note is a
4500-subject-strong 1996 US
epidemiological study conducted by the
National Longitudinal Alcohol
Epidemiological Survey. Treated
alcoholics, it was found, were more
heavily alcohol dependent on average than
untreated alcoholics. Clearly a
behavioral problem cannot be remedied by
medical intervention. Addicts are cured
when they decide to give up the habit.
The disease conception of addiction
acts to isolate the noxious behavior from
the person. Thus when we claim that
drugs, much like the flu, "get a
hold" of you, we conveniently
deflect from that which mediates
behavior: personality, values, character
or lack thereof. Once someone becomes
involved with drugs, we explain
everything they do by saying it was due
to the drugs, forgetting, in the process
of this circular argument, that the
source of the addiction is the person and
not the drug. An honest look at drug-use
means we cannot separate it from the
person.
Heroin addicts are thus highly
disposed to having social problems even
before they become addicted; and truancy
and smoking behavior serve as good
predictors of future drug use.
With the disease label as a protective
rampart, addicts have taken to comparing
their "disease" with having,
let's say, diabetes or
cancer. How opting to shoot
up for the first time, then doing it
again, then stealing cash to get some,
even breaking and entering - mimic the
organic disease process in cancer or
diabetes is unclear.
As Peele explains, addictive disorders
are known only by the behaviors they
describe. In the absence of the ongoing
behavior there is no way of telling
whether the person is, or will be
addicted. "By claiming that
alcoholics are alcoholics even if they
haven't drunk for fifteen years,
alcoholism is made to seem less tied to
drinking behaviour and more like
cancer," but "a person does not
get over cancer by stopping a ...
behavior"... while "the sole
and essential indicator of successful
remission of alcoholism is that a person
ceases to drink".
It is unfortunate that the various
preventive programs school kids are
exposed to are delivered by equivocating
addicts-cum-activists who conveniently
convey that "It" can happen to
anyone, that kids have little control and
that once diagnosed as an addict, always
an addict. This sets in motion--where
there is already some drug use--a
self-defeating cycle of abstinence and
relapse, not to mention an overall rise
in drug related involvement.
Most youngsters outgrow their
occasional binges and turn into
responsible adults. For doing what they
do as a rite of passage, teens and
college students do not deserve to be
labeled diseased. What they do need is to
be held accountable for their behavior.
Failure to hold the person who strays
responsible for his actions means that
you cannot credit the person who doesn't.
That's the logic of diminished
responsibilities all round.
For the rest, the lingering paranoia
of the temperance and prohibition era,
which has culminated in AA disease dogma,
should be consigned to the historical
dustbin.
© 2000 - 2001 Ilana Mercer
Previously Published in the Calgary
Herald
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