Addiction, a disease? or self inflicted?

djPSB wrote: »

People need to take personal accountability. We all have an addictive trait in us somewhere and need the self control to know when to stop.

For gambling, a lot of it comes down to greed. Not surprisingly, alot of the high profile GAA players who have come out with these problems are not very nice people. One was stealing from parents, families and charities and had over ten incidents of assault. Another is up in court for assaulting his girlfriend.

These lads chased the high life and went bust and didn't care who they hurt on the way. 100% self centered.

They then come public to 'help others'. Who are they trying to cod. They tell their story to try make a few pound for themselves by selling books telling their story. Or by making a career in counseling out of it. Everything evolves around themselves.

May sound crude but that's the reality.

sounds like you need to do a bit more research into all this, id highly recommend chatting to mental health professionals for more info

nkav86 wrote: »

I think to call it a disease though, negates the choice that someone made to take drug and can absolve them of the blame that is there. Rightly or wrongly, that's the best way I can describe my thoughts on it.

Choice is not a part of the definition of disease though. So while it is clear what you want to say here, and you say it clearly, it is not actually a relevant point.

Lung cancer is a disease for example despite the "Choice" involved in starting to smoke cigarettes. Obesity and certain types of diabetes can also be formed based on the "choice" to feed yourself swaths of cola, sweets, crisps and biscuits every day.

What is or is not a disease is not defined by whether it's root causes were formed in or by choice or not. Though, like yourself, I think a lot of the reluctance to use the word "disease" in conjunction with "addiction" very much is couched here....... in the fear that it will remove our ability to allocate initial blame for the condition at the feet of the patient.

dartboardio wrote: »

I completely agree with you there, it certainly doesn't start out as a disease, and if anything, the person using CREATES that 'disease'.. from their own choices. (maybe not choice, maybe they felt they had to) but still doesnt change the fact that it is a conscious decision.

While pedantically accurate in some senses though, I am not sure this is a useful way to look at it. It may have been a conscious decision to START drinking SOME alcohol. But I doubt very much that many people with addictions made any kind of conscious decision to first abuse.... and subsequently become addicted to....... it.

A huge % of people in our country drink alcohol. I would suggest that the "conscious decisions" of those not addicted to it are not all that different to the "conscious decisions" of the people who are if you were able to hold them up side by side and compare them usefully.

djPSB wrote: »

People need to take personal accountability. We all have an addictive trait in us somewhere and need the self control to know when to stop.

You are over simplifying the issue here by speaking of it from the perspective of a "healthy" person that has that self control and the borders on where to stop. But as the ASAM says when they define addiction as a disease..... the processes and development of addiction basically alter the reward structures and decision making areas of the brain and actively impinge upon the very processes you are calling on when discussing their "accountability".

The very motivational hierarchies of the brain you are appealing to here when discussing accountability are exactly the ones that are altered and impaired by the processes of addiction.

So yes, by all means we should not lose sight of accountability by any means. But when a person with addiction issues presents before us for treatment and assistance......... it is only a small part of a much bigger and more important picture........ and the treatment of the disease becomes distinct from the initial causal pathways of it.

djPSB wrote: »

For gambling, a lot of it comes down to greed.

Actually for gambling a lot of it comes down to poor judgement and desperation, not greed. The person is not being greedy when they get into dire straits and debt, rather they get locked into a cycle of simply believing they can recoup their loses eventually. They are not being motivated by greed for more and more money........ they are motivated by a desperation to get back to square 1 and simply recoup the money they lost.

I am not sure there is much benefit to be gleaned from cherry picking 2 or 3 anecdotes of people with such addictions as if to paint the entire world of gambling addiction by the crimes of one girlfriend beating horror. 2 Anecdotes is not, as you claimed, "a lot".

I am not even convinced, as you appear to be, that people who get into a cycle of gambling addiction were ever "chasing the high life" while doing so. Rather it is often a cyclical series of minute abuses of their brains reward mechanisms that probably started out with them putting a little money on a horse "Just because".

djPSB wrote: »

They then come public to 'help others'. Who are they trying to cod.

Yea because it is impossible that people who recovered from addiction might sometimes ACTUALLY genuinely intend to help others. Absolutely unimaginable that that can sometimes be the case, is it?

RobertKK wrote: »

Some of it is due to genetics.

Could we tease apart the following two things?

• weakness to resist a habit (yes genetics may play a part here - possible brain chem issues)
• the stupidity to start a habit (not genetics - total personal responsibility issue and absolutely nothing to do with a disease)

topper75 wrote: »

Could we tease apart the following two things?

• weakness to resist a habit (yes genetics may play a part here - possible brain chem issues)
• the stupidity to start a habit (not genetics - total personal responsibility issue and absolutely nothing to do with a disease)

Again a massive over simplification going on there. For many people there is no distinction between the two things on your list.

If, for example, you are genetically disposed to it then that is not something you are likely to know. You are going to start drinking at the same time, and in the same way, as most of your peers most likely.

So one is stupidly "starting a habit". Abuse, dependence, and addiction are often something that happens so incrementally that it sneaks up on one before they even see it. Sometimes they do not even see it even when people around them start to see it. A real "not seeing the woods because all the trees around you are getting in the way" kind of situation.

It would indeed be stupid of anyone to sit down and decide to form a dependence or addiction to something. To sit down and say "this is going to become a problematic habit". But I am not convinced many, if any, people are actually doing that.

I myself have a few addictions, mostly benign and mostly sugar based. I was never "addicted" to alcohol but I think I narrowly missed that bullet myself. My drinking patterns were once a week only, but in slightly ever increasing amounts. I did not see it as a problem until SUDDENLY I realised it potentially was. And I stopped drinking.

Now it has been 14 months since I have had any alcohol and looking back I can NOW see blatantly obvious warning signs of my developing issue that I was, to say the least, absolutely and entirely blind to at the time.

So blatantly obvious that I genuinely can not get myself BACK into the head space of being blind to them. But at the time, that is what I was. Totally. Entirely. Blind.

And I do not, though I suppose self evaluation is a dangerous game, think any of this was due to "stupidity". Rather the changes in my behaviors and alcohol use were so incremental and tiny over the space of a 7 year period that they were simply invisible to me at the time.

Which was not helped by the fact that during that 7 year period I had a 7 month period with zero alcohol and I did not miss it once. So I convinced myself, as many with developing issues do, that I was a "I can stop any time no problem" case and therefore I did not have any alcohol problems. Now I realize that alcohol problems take many forms, some of which do indeed mean you CAN stop any time.

It is so easy to merely hand wave it away with things like "your choice" or "stupid" and so on. But to do so is an over simplification that I think misses the masses of nuance and incremental changes that actually go on in the life of many people who end up with dependency, abuse and addiction problems.

sbsquarepants wrote: »

My personal 2 cents is that if you can't catch it without being at least partially to blame, it's not a disease.

I am not sure I am parsing your post right? Perhaps the double negative is throwing me and I am parsing it as meaning exactly the opposite of what it does mean? If so my bad!

But if I am reading the above correctly..... HIV and AIDS is not a disease then?

What about people who drink loads of cola and eat loads of sweets and develop diabetes? Are those forms of diabetes not a disease then?

What about lung cancer caused by cigarettes?

I do not think anyone in the medical industry defines what is and is not a disease in terms of the initial hand the patient has (or has not had) in the causes of it.

RobertKK wrote: »

Some of it is due to genetics.

I don't see it so much as genetics than just plain old "monkey see monkey do"

Nurture, not nature.

sbsquarepants wrote: »

Addiction however, any and every addiction, REQUIRES the addict to take steps to get themselves addicted.

I am not really getting the distinction you are trying to make.

You recognize that the vast majority of people who get HIV did something themselves that led to it (took drugs, unprotected sex, whatever) but there are SOME exceptions to this like transfusions.

You then go on to say that the vast majority of people with addictions, did something themselves that led to it (actively taking alcohol or whatever for example) but there are SOME exceptions to this (babies of addicted people being the example here).

So..... both the same thing then? In both cases they are VASTLY more often caused by the patient initiating it in some way..... and in both cases there are a set of minority exceptions.

Further, just to be a little extra pedantic since it is what I am apparently known for when you say "possible to catch them accidentally without ever endangering yourself. Say via a blood transfusion for example. " I do not see that distinction either. Giving or taking a transfusion IS endangering yourself. Undertaking any medical procedure is to endanger yourself. Every medical procedure comes with risks. Risks of complications. Side effects. Infection.

Not meaning to hammer on you too much here as I know you are just giving YOUR PERSONAL definition of "disease" here and not claiming in any way that it is the correct one, the medical one, a useful one, or anything but your own personal one..... so no one can be called "wrong" for making up their own word or their own definition for an existing word.... as long as they are acknowledging that is, in fact, what they are doing.

But it does, I hope you forgive me for saying so, come across strongly like having come to a conclusion first and are attempting to fit the definition to it second. Which is..... not an approach I generally recommend if asked.

But what I would say is that the "choices" (which seem to be the focus of your definition) that an addict made are generally little different to the choices non-addicts made. They start drinking a little, like most of us did. They over time increase how much they drink like most of us did. And some point along the process this went awry. I think you would be hard pushed to analyse, say, 100 random addicts and coherently identify any point in their process where they made a "choice" we can point at and say "There, that was it".

The path to addiction for most, I warrant, is a slow and incremental one that.... for much of the initial stages.... likely map near 1:1 with the same things that go on in the rest of us "normal" people.

I take your point.

To be honest I suppose what I've done is I've equated the word disease with blameless - which is not correct.

I still don't believe that addiction is an actual disease per se - but the points you make about blood transfusions etc are correct, so i'll withdraw my ill thought out comments entirely.

I think, largely from personal experience, that to become an addict you must ignore quite a few warning signs. You simply can not become an addict without being complicit. When you get to the stage where you are prioritising the buzz of anything over relationships, work, normal everyday life - you need to ask yourself some tough questions. If you don't ask those questions that's not a disease, that's a choice. Sometimes people don't make the hard choices, the allure of the easy route is very strong.

I've taken lots of drugs in my time, I know all to well that it is much more enjoyable to stay partying than sober up and go to work (I've done just that many times) But overall you just have to do what you have to do. Being irresponsible is not a disease, it's a character flaw.

Its the world we live in these days for people to say its a disease so its not " there fault "
Look life is tuff life is hard people have up and downs are born into worse situation than others , but its up to you as a person to take control of your life to steer your own ship and not get into the situation where addiction can become a problem ,
Addictions come from the choices you make in your life, Even when bad situation happen people always have a choice on what way to tackle it, yes some are shocking situation and you can understand why people end up becoming addicts to alcohol or drugs but even those people had a moment where they decided what path to take , some times they change there mind but addiction already has a hold of them but i'm a firm believer Addiction comes from your own choices you make,
Now I do understand there are rare cases where it's not the person fault , where there born into family where they know nothing else and addiction seems like normal life and other cases they don't have control off, but you get my drift,

Some people are more prone to addictive behaviour than others. However, the whole 'disease' label for alcoholics and drug addicts is used as an exemption from any self awareness or responsibility.
Also, there is always the big deal over how long they have been 'clean' for delivered with an attempted air of superiority. Most of us do not allow ourselves to fall that low in the first place but do not go around expecting rounds of applause for it.

sbsquarepants wrote: »

How is this a disease that has modified their behaviour and not just the normal hardwired pleasure / pain reward circuit of the brain doing it's thing, same as it does for all of us.

Because it is more than just the pleasure responses of the brain in play. Other areas are affected too. Perhaps a more copious amount of quotation from ASAM, rather than my select quoting, is warranted here. I will include it at the end of this post due to it's length.

But suffice to say / TLDR........ the modifications they are suggesting are occurring are slow, cyclical, iterative, and encompass a lot more than merely the reward centers. Rather they impact entire behavior modules, including those of decision making, self care, and more.

So it gets massively more complex than "X feels good = I want more of X".

Further these people generally do not LEAP from moderate use to crazy over use. Rather in a slow iterative process they simply need a tiny bit more.... then a tiny bit more...... to merely get to the SAME level of satisfaction.

If it were a case they were jumping from a glass of wine to a bottle of whisky a day..... I doubt there would be many addicts. They would recognize that "enough / too much" divide of which you speak. But it rarely happens that way. It is much slower, with each increase being so moderate that the person themselves fails to rate the relevance of it.

In my own case, when I avoided falling into the pit of addiction I was so close to falling into, I progressed over a period of 7 and a half years from a beer once a week on a friday......... to 4 and sometimes even 5 1 liter bottles of wine once a week on a friday. To you, and even to me NOW, that is insane. How I did not notice "Hang on, this is an issue" makes no sense to me now. In fact I now believe the only thing that stopped me being addicted, was that I did only ever drink on a friday. Had it been multiple nights a week....... well I dont wanna think about it

But in the moment(s) each increase was so small it is like those times where you look at your finger nails and go "Crap when did THEY get so long, I did not notice AT ALL". Each increase genuinely seems meaningless and irrelevant in the moment.

sbsquarepants wrote: »

I'm always telling people this.......you're the first to agree:D

Well I am not suggesting a direct cloning program here or anything At least not one without the potential for some beneficial modifications to the template

Long Definition of Addiction:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Addiction affects neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and addictive behaviors, which may or may not include alcohol and other drug use, supplant healthy, self-care related behaviors. Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.


The neurobiology of addiction encompasses more than the neurochemistry of reward.1 The frontal cortex of the brain and underlying white matter connections between the frontal cortex and circuits of reward, motivation and memory are fundamental in the manifestations of altered impulse control, altered judgment, and the dysfunctional pursuit of rewards (which is often experienced by the affected person as a desire to “be normal”) seen in addiction--despite cumulative adverse consequences experienced from engagement in substance use and other addictive behaviors. The frontal lobes are important in inhibiting impulsivity and in assisting individuals to appropriately delay gratification. When persons with addiction manifest problems in deferring gratification, there is a neurological locus of these problems in the frontal cortex. Frontal lobe morphology, connectivity and functioning are still in the process of maturation during adolescence and young adulthood, and early exposure to substance use is another significant factor in the development of addiction. Many neuroscientists believe that developmental morphology is the basis that makes early-life exposure to substances such an important factor.


Genetic factors account for about half of the likelihood that an individual will develop addiction. Environmental factors interact with the person’s biology and affect the extent to which genetic factors exert their influence. Resiliencies the individual acquires (through parenting or later life experiences) can affect the extent to which genetic predispositions lead to the behavioral and other manifestations of addiction. Culture also plays a role in how addiction becomes actualized in persons with biological vulnerabilities to the development of addiction.

I have seen what addiction can do to people and its far from pretty. I'm no scientist so my ideas are based purely on observation.

When someone destroys their life to the point they lose their family and their job and they still can't improve then something out of the ordinary is at play. Logic/common sense/wjatever you want to call it would suggest you sort yourself out. If, however, you continue doing something that is destroying your life then you need help as you obviously can't do it on your own, its just not in your nature for whatever reason.

While addicts can be incredibly selfish and ignorant of other people's feelings, I believe this is a symptom rather than the cause.

From the addicts I know, a lot seemes to stem from a deeper unhappiness and not knowing how to deal with it. People aren't perfect, there are plenty of people out there with mental health issues abd who just can't deal as easily with life. Some of this shows itself in the form of addictions.

These people need help, not judgement. Sure, it's not nice to see addicts deterioriate as people and turn to crime in extreme cases but it is a symptom of addiction, not them using addiction as a cloak. At the end of the day, they need help because they can't cope with what life has given them.

If a lack of some abstract quality that is something you can't grab on to while a lot of other people seem to have can be considered a disease, then I'd say it's a disease. However, most importantly is that these people need help and sympathy because addiction turns them in to ugly people, they weren't ugly to begin with, life just ****ed them over.