Monday, May 11, 2009

Addiction: Ideas that do not help

Nora Volkow, director of the US National Institute on Drug Abuse, writes in Time:
David Sheff wrote a beautiful book called, appropriately enough, Beautiful Boy A Father's Journey Through His Son's Meth Addiction, one of the most compelling portrayals I've ever read of a parent's loss of a child to drugs. ...

Many people still call addiction a moral failing. But 20 years of research tells us that it's a disease that results in part from the damage that abused drugs to the brain circuits required for self-control. Unfortunately that damage is long-lasting, meaning that the person remains vulnerable to relapse even after years of successful rehabilitation.

Sheff's experiences highlight how poorly our society addresses addiction. ... Yet punishment and stigmatization do nothing to ameliorate the problem. How could they, when about 50% of addiction is rooted in our genes and much of the rest is due to social and cultural factors such as stressful childhood experiences?
All true, but all irrelevant, and in my view, harmful.

Every recovering addict I have ever spoken to - and I used to have a social sciences beat - has simply decided to get better, and acted on the decision. Punishment and stigmatization often play a useful role because they help the addict remain aware that the problem is real, and costly. That's important, because the addict is often in a conflicted state about whether to just drop out again into the unreal world of addiction, as opposed to pursuing recovery. If the rest of the world is vague and unreal too, what is the addict supposed to do?

Most, wisely, call themselves "recovering" addicts for that very reason.

Look, I don't wish anyone hardship, but the mid- and late-life consequences of addiction can be horrific, so the last thing the typical addict needs to be told is, "You can't help it."

A better message would be, "Addiction is NOT a brain disease. It is a choice for coping with a world that is difficult for every human being. So what can we do to help you cope, while shedding your addiction?"

I also wrote this to a friend:

One thought that occurs to me is this:

A drug addict, a drunk, or a smoker whose lungs are deteriorating can actually stop further damage just by deciding to stop damaging his body.

Consider, however, the following cases:

1. The person with a disease that requires multiple drugs with conflicting and deteriorating effects (but better than short term death).

2. The diabetic who faces blindness due to retinopathy or amputation due to circulation problems.

3. The miner who never smoked but spent 30 years underground - and has the rotten lungs to prove it ...

Does anyone in their right mind think that these people would not just walk away from their illnesses, if they could?

That is the key difference between illness and addiction.

The addict chooses his illness. So you are absolutely right to see personal choice as the key to resolving the problems of addiction.

I don't think the "brain disease" thesis is going to help much, but I can sure see how it would hurt.