ADDICTION IS NOT A DISEASE!!!!

Well, now that I have your attention with a title that is almost guaranteed to be controversial, let me explain what I mean. I have seen and heard a number of debates, television programs, etc. all talking about the disease aspects of addiction. I have a number of different problems with this particular definition.



I am not going to say that there is not a physical or genetic component to compulsive behavior, because there clearly is. My problem with the disease definition is that it expiates the need for personal responsibility on the part of the individual. I am not responsible for stealing, my drug addiction pushed me to it. I am not responsible for losing my house, my gambling addiction caused that. I am not responsible for destroying my family, my alcohol addiction caused that.



Now I am not saying that people who have these disorders (characterised by compulsive behavior) are not sad cases, nor am I saying that all addicts make excuses like this - on the contrary, it is the non-addict population who generally makes these kinds of arguments. But notice that I did use the moniker "disorder" rather than disease. For many, this might be pure semantics, but for me it is not. A disease implies no choice - you cannot "will away" the symptoms. Even the physical components of addiction still have a choice involved. Diseases have no choice - once you have them you cannot get rid of them.



Of course, most treatment programs have this as part of their mantra - once I have this disease, I have it forever, I can never have another drink, another pill, or whatever, but to me I still think this is a distinction without a difference. You can still choose to not have the disease. The disease proponents define the cravings as the disease, while I define the cravings as more akin to a mood disorder.



Let me be more specific. If you get cancer, AIDS, Lyme disease, swine flu, or any other physical ailments, you cannot use a cognitive coping skill to stop the symptoms. You cannot just choose not to have cancer. There may have been choice involved in getting the disease - by exposing yourself to risks, but I am talking about the actual disease. You cannot just say, "I don't have AIDS", and then the AIDS is gone. However, you can say that I will not take that next drink, pill, or whatever.



The world of psychological disorders is varied and, in some ways, controversial. (Interestingly enough, Madhouse by Anthrax just started playing on my play list - fun little coincidence). Many psychological problems have psychiatric components, an most illnesses can be treated by a combination of drugs and counseling. But even people in the medical world draw a distinction between mental illness and mood disorder. For example, if I have schizophrenia and hear voices, no amount of choice on my part makes me not here the voices. Even medications are only mediocre at suppressing this, and cognitive coping skills only help alleviate the person's reaction to the auditory hallucinations. Someone with clinical depression (like me, for example) can actually change their symptoms with sufficient cognitive coping skills. I can, essentially, will myself to feel better. While I always have some symptoms of the disorder, I can take positive actions to make it so that I experience less or no symptoms. Since these are within my power, I am responsible for my own state of mind. I am responsible for seeking out help when I need it, or for maintaining my good mental state by good personal habits that reinforce my good state.



"Addiction" is very similar to this. Most addictions should be more properly called compulsions, especially the ones that involve a social behavior - like gambling, for example. Gambling can be compulsive, but it is not an addictive disease. If I have to get in my car, fill it with gas, drive 3 and a half hours to Atlantic City, access my bank account, take out a loan on my home, then lose all my money gambling, why would this be anyone but my fault. I cannot blame my "gambling addiction" or the casino - I am an idiot. Believe it or not, a few years back, some idiot did exactly that and tried suing the casino for not appropriately monitoring his behavior because he had a gambling addiction.

Addiction is much more akin to a mood disorder. By elevating it to the status of disease, we abrogate any responsibility on the part of the abuser. It does not help them to get clean, any more than the "12-step" program of acknowledging you are powerless over your addiction and you need God's help to get through it. (Incidentally, 12 step success rate is about the same as quitting cold-turkey with no assistance, the God thing is just the brainchild of the devotee who created the program. I am not saying faith plays no part in combating addiction, I just don't buy the 12 step idea. If you do, and it works for you, that is great). My problem with that should be obvious - if you do not believe in God, then you cannot recover from your addiction according to this model, and I have severe reservations about sentencing drug/alcohol offenders to these programs - it is a bit too close to state-sponsored religion.

But I have gone rather far afield (this is why I try to write everything in one sitting, rather than starting and coming back later). The fact that we can make rational decisions is one key thing that separates us from animals. We are not slaves to instinctual behavior, we can actually make real choices about behavior. We do not act on every sexual impulse, every hunger, or every desire. We do not mindlessly engage in physical tests to attract mates, nor do we attack anything that encroaches on our territory. While we have an animal nature, there is something different about us. We are not just bundles of incoherent instinct and desire, forced into gratifying our every whim. We are social, rational, emotional, and spiritual - all of these play into what and who each of us are (and while you may not buy the spiritual bit, you would be hard pressed to counter any other of the three). We are capable of self-denial, even to the point of self-destruction. To claim that we have to fall victim to our desires is to deny the noblest part of our nature. If a person can starve himself to death (or near to death) or immolate himself in protest of human rights abuses, if we can subject ourselves to beatings and torture because we believe in a cause that is greater than ourselves (even if the cause may not end up being right) - if we can overcome our very survival instinct, surely it is not to much to ask to overcome addictive tendencies.

Believe me, I have them myself. I could virtually guarantee that I have a huge potential problem with any substance were I to engage in that activity. I even approach prescriptions somewhat warily because I know myself. If I start to feel like I need to do something, that is when I refuse to do it. I have taken heavy-duty narcotic painkillers to deal with pain from injury or oral surgery, and I have had times when I felt like taking a pill or two, even if I didn't really need it, and even though it had no apparent effect on me. This is a trigger for me to stop. I can recognize impulses and stop myself. It is a skill every person has, impulse control (those who have none are not long for civilized life) - we do not say everything or do everything that comes into our head, we self-censor for our own and others well-being. To forgo these qualities is to become ultimately self-centered and narcissistic to the point where only your own appetites matter, and all else becomes secondary - in effect you sacrifice your own humanity and become more of an animal than a person. I believe that we are better than that, and we ought to be careful how we classify a psycho-social problem like addiction/compulsion.

Let me give you another example. All my friends know that I am a gambler. I have a "system" like every gambler, and like every gambler, I believe mine works (I know it works, because I have actually kept track of every dollar I have spent over the last 3 years, and I am well ahead of even), but that notwithstanding, I can still recognize compulsive behavior. I know when to stop because I feel like I have to continue. If I ever get that feeling, I force myself to stop. If I ever think about doing something that I would regret telling my wife or my friends, I stop. I do not lie about my wins or my losses, any temptation to do so is a clear indicator that I am making a poor choice and I should not continue in that course of action.

This is not some unique ability - all it takes is a modicum of self awareness; something that we as a society seem to want to completely stamp out in favor of an all-encompassing nanny state that takes care of us... and I think I'll leave it there, because this goes into my response to SuperGoober's response to my health care blog... I understand that he is detailing some opposition arguments and some of his own, but he has missed some of the point of what I wrote and also used some specious reasoning (a rarity for him, but it is a mistake we all make from time to time). I will try to address everything tomorrow, but I am going to be playing some 40k in the evening, so I don't know if I will be able to blog.

BTW, I am not heading to Reno this weekend. I feel kind of lonely and depressed, and that is never a good combination in a casino, so I am going to be gaming instead. Hopefully, this will bring me out of my funk. The wife came home for two days, but now she is gone away again. It is a weird feeling coming home to an empty home. We've been apart before (my camping trips, etc.), but it is different coming to an empty house that we have been sharing for 11 years. We've been living together for about 15 years, so this is just a weird, depressing couple of months. I don't have any idea how you can do it, ntt's brain. I mean, I am an antisocial loner, and all, and I could adjust to this pretty easily, but I really don't want to go back to being that way...

Wow, that is just too damn depressing, sorry all... I am going to watch the top 10 UFC fights of all time on Spike, that should cheer me up ;)