Addiction, a disease? or self inflicted?

dartboardio wrote: »

Some of you may have heard the recent podcast on 98FM, where a woman came onto the radio sharing her story that she was a recovering drug addict, and that addiction IS infact a disease, apparently 'physical, spiritual and mentally'


Same as myself, the presenter Adrian was disgusted that she was trying to compare a self inflicted drug addiction (whether over years or months) was the same as let's say a stroke, or cancer, etc.

What does everybody think of this?

I'd certainly argue that addiction is an illness, but purely a mental one; where as cancer is a physical illness.

Like a lot if illnesses, though, what starts out as physical can effect your mental health as well, and vice versa.

sbsquarepants wrote: »

Other than the part that says "is a chronic disease" - what differentiates this from how the brain handles any other behaviour? Do it - like it - want to do it again? What I'm asking is, it says "is a chronic disease" but what actually makes it one?

How is this not just a stronger (maybe even much stronger) response than the average, but still just the same basic mechanism?

Some people just like certain things more than others - in the case of addiction up until the point of developing a chemical dependence - but a dependence is not a disease, it's your body adapting to what's going on around it - attempting to normalise whatever regular situations it finds itself in.




I have a couple of changes in mind - we'll talk!

"Mental Illness" is defined as: a condition which causes serious disorder in a person's behaviour or thinking.

Addiction could certainly fall into that category, even as defined above.

corner of hells wrote: »

I've a good few friends who are former addicts,work with ex addicts and work with addicts now and could probably think of just one ex addict who behaved with an air of superiority.

Outside of work most won't even discuss their past other than acknowledge it.

I was not referring to those who actually move on to do something in their lives. I meant the self indulgent ones who slump around with not taking drugs as their only achievement in life.

sbsquarepants wrote: »

Other than the part that says "is a chronic disease" - what differentiates this from how the brain handles any other behaviour? Do it - like it - want to do it again?

Well what they are indicating there is it does not just stimulate the reward systems to make you want to do it again, but actually causes changes at the level of the brain that not only strengthen that loop, but undermine other aspects of the brain that would be used to over ride or resist such urges.

When they say things like "supplant healthy, self-care related behaviors" that is a lot more going on than "do it, like it, want to do it again". And much more going on than simply people who "like certain things more than others".

sbsquarepants wrote: »

But how is that actually functionally different from liking anything else.

I think the answer to that is in the post you are replying to but I will focus on it a little more.

1) When you like something you want to do it again. I think we are together so far on that, as you have pointed it out too.

2) There are some things that are bad for you, so your desire to look after yourself and your own well being comes into play. So if you love mars bars and you want to eat more and more, you might say "Well I do not want to get really fat, or develop a diabetes sub-type, so I will eat less of them or none at all. That is to say, your self-care impulses over ride your desire for the "reward" you are resisting.

What the quote above is saying is that NOT ONLY is there a "Like it, want it, do it again" loop in play but the addiction will also "supplant healthy, self-care related behaviors" that come into play in 2) above.

And that makes it different from the other things you may like and not be addicted to.

Susceptibility to addiction has a large genetic element. So in some ways...I dont know if disease would be right word for it. But yeh it should probably be classed as something else as the same time.

I live a structured life and earning and providing for home,despite living with an addiction to alcohol and a certain class A drug and I'd definitely agree that addiction is self inflicted. I made my own luck.

harry Bailey esq wrote: »

I live a structured life and earning and providing for home,despite living with an addiction to alcohol and a certain class A drug and I'd definitely agree that addiction is self inflicted. I made my own luck.

Fair play to you. I admire your honesty, I strive to be that honest with myself. (I lie like a politician in a brothel to everyone else however:D)

I don't want to sound like an old fart, but I find that personal responsibility is becoming an alien concept to people - I'm always trying to drill in to my kids - whatever you do, is your own fault.

The whole world is gone all Taylor Swift - "look what you made me do"

I hope it all works out well for you.

sbsquarepants wrote: »

It is clearly different, Stevie Wonder can see that - but different doesn't necessarily equate to disease.

Indeed. I was focusing first on the differences between addiction and the "Have it, like it, want it again" dynamic you refereed to. I was moving away therefore from the use of the word disease. But as that tangent is ended I can go BACK to that conversation now.

All cards on the table I myself am not 100% in agreement with calling it a disease. So my posts are about WHY they all do it, rather than why they should be doing it. For me I think when a word comes to mean too much, it ends up meaning too little. And we have one umbrella term "disease" for too many things.

It is like the word "religion" for me. An umbrella term that can mean Islam on one side and Jainism on the other, which are extremely different. Or "sport" which can be MMA bare knuckle fighting on one side and lawn bowling on the other. Two sports that, as a man funnier than I once pointed out, have little in common other than breathing.

So I think we need new words here to use in place of disease or at the very least to better sub-categorize the term. We have some such words already of course, but they are not really in the public psyche.

The reason they call it a disease, specifically a chronic disease, is mainly because attributes of it parallel diseases. And treatment modalities under the concept of disease work.

Like many diseases there is "Dysfunction" that leads to "biological and psychological manifestations" and even a "diminished" level of certain forms of cognition.

Further as ASAM point out " Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death."

At the risk of an "appeal to authority", the fact that the majority of these medical agencies are calling it a disease (and also for all my disagreements with them and their program it was I believe AA who was one of the forerunners of calling it a disease too, not just medical bodies) should tell you that there is more going on that merely "Different means disease". It is not just that it IS different that mediates the allocation of the word, but specifically what those differences are.

But a lot of it has to do with treatment modalities. As Maia Szalavitz writes in "Unbroken brain" "between the options of a moralistic view and a disease view, the disease view is the best way to address and treat that problem.". So a lot of the reason people use the word disease is not just that they think the word itself applies, but that way of thinking about it is beneficial too.

As "Recovery First" write about Szalavitz: "She also points to the well-established research that has identified complex biochemical processes under addiction. Addiction has its basis in neurophysiology, she says, which swings the pendulum in favor of the disease model."

Then there is a large % of people who have their addiction caused by, or at least massively exacerbated by, genetics. Link included.

I guess where much of the disagreement comes from on the issue is that no one (or at least very few) people arguing the use (or not) of the word actually list what they think the word means. It might be helpful for some to make a bullet point list of the MINIMUM things they believe something must have to be considered a "disease". Then identify which ones addiction is missing (if any).

For example if someone thinks it has to either be genetic or a pathogen then clearly straight away addiction is not a disease except perhaps in the cases of those people with the gene defect in the link above.

If someone defines disease however as "a disorder of structure or function in a human" then they would be harder pushed to NOT define it as "disease". While those who try (or like on this thread already tried) to make a distinction based on "choice" as the pre-cursor, then they have a chasm of semantics and tautologies and counter examples (Like HIV and some forms of diabetes) to over come to make that line of reasoning stick.

At the end of the day however the word "disease" and the treatment modalities and structures that come with that word have been useful and beneficial. Subjectively the only real reason I see resistance to the word tends to be because people think (wholly and entirely falsely in my opinion) that using the word negates any level of accountability or blame. And I do not think it does. HIV is a disease, but that does not remove accountability from the sexually active person who refuses protection. Some types of diabetes are a disease but that does not remove accountability from those who stuff 2 litres of coke into themselves every day (I am potentially that person, though so far so good, and I am fighting my own sugar addictions with mixed levels of failure).

sbsquarepants wrote: »

Where do things like will power fit in to this model?

Well I guess the difference "between the options of a moralistic view and a disease view" is that in the former view the addiction is seen as a will power failing on the part of the patient. With all the blame and accountability and sometimes judgement that entails.

Whereas under "disease" will power becomes a PART of the treatment modality, for which other aspects of the treatment provide a support structure.

So will power fits into the model, but more as a factor in treatment, than simply a factor in identifying causes and places to put our blame and judgement.

Also I am coming in recent times around to the idea of will power as a limited resource. You say, and I agree, that "Some just have more of it than others" but the demands we put on it are not always the same. Some studies recently are coming to the idea that will power is not some fixed value like a Dungeons and Dragons Character Stat, but is something with daily limits like endurance and energy levels. And while, like you, I am also sure it can be improved with certain practices and techniques, I think that can be hard won.

So a person with bugger all will power might be living an easy life and hence be able to resist addiction better. But someone with the MOST willpower you have ever observed in a human being might be placing periodic demands on that will power that exceed it's limits and so at the end of the day sitting at home across from the drinks cabinet or down the road from the off license..... they simply have no will power left. It is not a fixed value from one side of the day to the other.

So often people look at someone with addiction and think they just have no will power. Rather what they should possibly be looking at is what demands overall are being placed on the will power that person DOES have, and can we alleviate them to leave more for where they really need it.

But further as I pointed out, part of the "disease" is to undermine these "self care" hierarchies at the level of the brain too. So will power is not alone enough of a factor. They could have all the will power in the world but if their "self care" behaviors are not on line or correctly aligned what will make them correctly use it?

So yes, will power is a huge factor here, but how it fits into the over all picture is a sensitive and important issue.

sbsquarepants wrote: »

If there was an actual physiological disease of addiction - surely those suffering from it could and would become addicted to basically everything and anything.

How many people have you met that had, say, measels and the flu at the same time? Ok I am a bit tongue in cheek there, but at the same time people quite often do not have multiple issues at the same time.

That said though, many people DO have the issue you describe. Alcohol and drugs....... and alcohol and gambling......... are two common combinations of addiction. With the recent rise of incredibly accessible porn I think porn addiction is more and more an issue and that also combines with alcohol quite well.

But often when one becomes really mired in an addiction, while the potentially could get addictions to "anything and everything" else............ their investment of time and energy into the thing they ARE addicted to precludes the time, energy, money and sometimes physical capability to get addicted to anything else.

sbsquarepants wrote: »

Is the fact that people very much tend to become addicted to the things they like most (at least at the start) not a strong indicator that it is largely brought about by good old fashioned poor life choices?

Perhaps it is in many cases, but as we have gone back to discussing specifically the term "disease" I have to repeat the position that a disease is often still a disease even if "poor choices" got you there. So if we are discussing the term "disease" itself still (though I admit we have both gone on multiple tangents along the way) then it's origin (or not) in choices is not relevant to the definition or its applicability.

RobertKK wrote: »

Some of it is due to genetics.

I didn't pay much attention to this thread after my first post, but I see some think addiction is something self inflicted and has nothing to do with genetic susceptibility to addiction.
This is wrong.


http://www.apa.org/monitor/2008/06/genes-addict.aspx

At least half of a person's susceptibility to drug addiction can be linked to genetic factors. Presenters at an April 8 congressional hearing outlined new research on the genetic basis for addiction and recommended ways to incorporate those findings into treatment.

When it comes to tobacco, genetics account for about 75 percent of a person's inclination to begin smoking, said University of Pennsylvania psychologist Caryn Lerman, PhD. Genes also account for 60 percent of the tendency to become addicted and 54 percent of one's ability to quit.

the number of a certain type of dopamine receptor, known as D2, might someday be used to predict whether someone will become addicted to alcohol, cocaine and heroin. Brain imaging suggests that people with fewer D2 receptors are more likely to become addicted than those with many of the receptors--and how many of these receptors people have is, in part, genetically determined. Of course, environmental factors also play a role, so propensity isn't destiny,

Addiction, it is like how people's genetics give them a higher or lower risk of getting a disease. One's own genetics determines to a certain degree the risk level in getting an addition.

nozzferrahhtoo wrote: »

All cards on the table I myself am not 100% in agreement with calling it a disease. So my posts are about WHY they all do it, rather than why they should be doing it. For me I think when a word comes to mean too much, it ends up meaning too little. And we have one umbrella term "disease" for too many things.

.

To be honest, I think we're singing from the same hymn sheet. I agree with pretty much everything you've said - my issue is with calling it a disease is largely semantics and therefore most probably also largely pointless.

It doesn't really matter if you insist on calling an elephant an ant, it's still going to hurt if it steps on your toe!

....... wrote: »

Pretty much all addicts start out this way - most do not go from no addiction to full blown uncontrolled addiction overnight. For a long time most normalise the addiction and are functioning.

But for some, that stops and the addiction takes over. Wheres the tipping point? Who knows?

It is just part of life for me, I'm 36 and I've been though the mill. I got into ecstasy in my early teens, and take drugs almost every day. As I said I function well, I'm a good provider to children. I'm a functional adult. If I was going down the needle in the arm job route it woulda happened years ago. The drink is my problem these days. I'd never get a load of sniff if I was sober.

....... wrote: »

Pretty much all addicts start out this way - most do not go from no addiction to full blown uncontrolled addiction overnight. For a long time most normalise the addiction and are functioning.

But for some, that stops and the addiction takes over. Wheres the tipping point? Who knows?

Good point, apart that it didn't start out that way. I'm 36 now, when I was 20 I was drinking, screwing and snorting all around me and in the pub every night of the week, long before I had young Harry and later little Harriet. I realised my demons years ago, had my occasional stint of abstinence and each time just felt miserable. I just go with the flow now.