30 ms·

A neuroscientist who believes addiction is not a disease

101 points by paublyrne 11y ago

spectrum1234 11y ago
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.
kephra 11y ago
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.
- paublyrne 11y ago
  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.
  - digi_owl 11y ago
    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.
    - girvo 11y ago
      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.
      - rokhayakebe 11y ago
        This is a great insight; the behavior is an addiction just as much as one can be addicted to the substance.
- tomhoward 11y ago
  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.
  - uptownJimmy 11y ago
    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.
  - im3w1l 11y ago
    If you feel comfortable sharing it, how did you get your life back on track?
- foobar2020 11y ago
  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.
  - digi_owl 11y ago
    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.
    - eivarv 11y ago
      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.
- Ollinson 11y ago
  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.
  - foobar2020 11y ago
    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.
- slfnflctd 11y ago
  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.
- andreasvc 11y ago
  > 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.
- facetube 11y ago
  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 11y ago
  [deleted]
jpwagner 11y ago
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.
- Sammi 11y ago
  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 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-addicti_b_6506936.html http://www.huffingtonpost.com/johann-hari/the-real-cause-of-...
  - tallerholler 11y ago
    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.
jokoon 11y ago
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.
tbolt 11y ago
Thomas Szasz - https://www.youtube.com/watch?v=Qj7GmeSAxXo https://www.youtube.com/watch?v=Qj7GmeSAxXo
stdbrouw 11y ago
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-grow-out-of-it-why-is-this-widely-denied/13017/ http://www.substance.com/most-people-with-addiction-simply-g... [2] http://www.substance.com/heres-what-ive-finally-concluded-about-12-step-programs/12344/ http://www.substance.com/heres-what-ive-finally-concluded-ab...
tomohawk 11y ago
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.
wpietri 11y ago
I think the disease model is in many ways flawed. It posits one notion of normal and then divides everything into "normal therefore fine" or "different, therefore broken". 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 https://en.wikipedia.org/wiki/Hunter_vs._farmer_hypothesis
- stdbrouw 11y ago
  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.
- girvo 11y ago
  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.
littlewing 11y ago
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.
- forgetsusername 11y ago
  >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.
swehner 11y ago
Addiction -- is simply its own category.
joesmo 11y ago
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/2012/01/02/144431794/what-vietnam-taught-us-about-breaking-bad-habits 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.
foopants 11y ago
Over consumption of food is one of the worst problems facing America. It's about time we held the obese responsive for their actions. Obesity, like other addictions, is a behavioral problem.
foopants 11y ago
Over consumption of food is one of the worst problems facing America. It's about time we held the obese responsive for their actions. Obesity, like other addictions, is a behavioral problem.
techbio 11y ago
> "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.
c3534l 11y ago
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.
- wahsd 11y ago
  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.
  - c3534l 11y ago
    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.
wahsd 11y ago
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.
equoid 11y ago
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.
unfamiliar 11y ago
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.

101 points by paublyrne 11y ago

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.

kephra 11y ago

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.

paublyrne 11y ago
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.
- digi_owl 11y ago
  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.
  - girvo 11y ago
    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.
    - rokhayakebe 11y ago
      This is a great insight; the behavior is an addiction just as much as one can be addicted to the substance.
tomhoward 11y ago
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.
- uptownJimmy 11y ago
  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.
- im3w1l 11y ago
  If you feel comfortable sharing it, how did you get your life back on track?
foobar2020 11y ago
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.
- digi_owl 11y ago
  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.
  - eivarv 11y ago
    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.
Ollinson 11y ago
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.
- foobar2020 11y ago
  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.
slfnflctd 11y ago
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.
andreasvc 11y ago
> 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.
facetube 11y ago
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 11y ago
[deleted]

jpwagner 11y ago

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.

Sammi 11y ago
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 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-addicti_b_6506936.html http://www.huffingtonpost.com/johann-hari/the-real-cause-of-...
- tallerholler 11y ago
  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.

jokoon 11y ago

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.

tbolt 11y ago

Thomas Szasz - https://www.youtube.com/watch?v=Qj7GmeSAxXo https://www.youtube.com/watch?v=Qj7GmeSAxXo

stdbrouw 11y ago

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-grow-out-of-it-why-is-this-widely-denied/13017/ http://www.substance.com/most-people-with-addiction-simply-g... [2] http://www.substance.com/heres-what-ive-finally-concluded-about-12-step-programs/12344/ http://www.substance.com/heres-what-ive-finally-concluded-ab...

tomohawk 11y ago

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.

wpietri 11y ago

I think the disease model is in many ways flawed. It posits one notion of normal and then divides everything into "normal therefore fine" or "different, therefore broken". 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 https://en.wikipedia.org/wiki/Hunter_vs._farmer_hypothesis

stdbrouw 11y ago
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.
girvo 11y ago
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.

littlewing 11y ago

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.

forgetsusername 11y ago
>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.

swehner 11y ago

Addiction -- is simply its own category.

joesmo 11y ago

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/2012/01/02/144431794/what-vietnam-taught-us-about-breaking-bad-habits 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.

foopants 11y ago

Over consumption of food is one of the worst problems facing America. It's about time we held the obese responsive for their actions. Obesity, like other addictions, is a behavioral problem.

foopants 11y ago

Over consumption of food is one of the worst problems facing America. It's about time we held the obese responsive for their actions. Obesity, like other addictions, is a behavioral problem.

techbio 11y ago

> "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.

c3534l 11y ago

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.

wahsd 11y ago
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.
- c3534l 11y ago
  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.

wahsd 11y ago

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.

equoid 11y ago

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.

unfamiliar 11y ago

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.