Is addiction a disease? (I don’t think so.)

My opinion is that it isn’t. I’ll present my argument, but first, here is the meme that brought the debate to my attention yesterday:

choiceordisease

My Facebook comment was this:

When I used meth, I made not one choice, but thousands. For example, I chose to buy my drug, I waited for 2 hours for the dealer to show up, then drove to buy a 12V bulb and plastic pen to make a meth pipe, then cut open the bulb, then used when I was alone and had the opportunity. I chose to use every time, despite thousands of opportunities to choose otherwise, and then four years ago, I chose to stop using.

12 steps are bullshit. I was never powerless over my addiction. That’s a copout, and when you believe shit like the 12 steps, you never take responsibility for your choices. It’s easier for it to be a disease, because then you aren’t responsible. The more difficult but more rational path for me was to admit that I chose to use despite considering the awful consequences. It also means that I could move on with my life easily – I don’t “work” on my recovery or repeat the same meaningless 12 steps over and over – I just live my life.

Every consequence, every bit of the behaviour when on drugs, falls into the normal neurological expected behaviour of your brain on drugs. There is no disease.

People don’t seem to like my anecdotal words… which makes sense I suppose, so let’s try another angle. Consider this analogy:

Let’s say you really don’t like being wet. Wetness is a problem to be avoided. But for whatever reason, you go for a walk in the rain. You really like walking in the rain, so you do it more often. Every time you do so, you end up getting wet, and you really don’t want to be wet, but you keep on walking in the damn rain.

What’s going on there? Well, I think we can all agree that such a person has some sort of a problem with a compulsive behaviour leading to an undesired consequence. We can also agree that whatever that problem is, being wet is a consequence, and not the problem itself. Yes, it’s a silly analogy, but its purpose is to separate the behaviour from the consequence, because when it comes to drugs and addiction, we don’t have a clear distinction and that, in my opinion, is where the confusion lies.

In addiction, we use drugs despite horrendous consequences, and we tell ourselves that we “can’t stop”. Some of those consequences happen to be effects of the drugs on our brains.

My argument is really simple: The effects of the drugs on our brains are within the parameters of expected, normal effects. Even the hijacking of the brain’s pleasure/reward system, which sets our “threshold” for the perception of pleasure so high that we can only feel normal if we continue using drugs. This leads to dependence on the drugs as our brains go into allostasis under the effects of the drugs, which leads to all of the behaviours related to addiction.

Take the drugs away for long enough, and all those effects on the brain are reversed. Without the dependence, when the pleasure/reward system of the brain returns to normal and homeostasis is achieved, the addiction-related behaviour stops.

So where’s the disease? In my analogy of getting wet in the rain, it was obvious that being wet was a result. I see the behaviours related to addiction as the same thing; the results of using drugs. Thus the behaviours related to addiction are the results of dependence on drugs, because of the normal neurological response of the brain under the adverse conditions drugs cause.

I believe that those who claim drug addiction is a disease are conflating the results of using drugs with the compulsive behaviour of addicts. They’re pointing to the results and calling it a disease. But those results are expected. Once you become dependent on drugs, behaving the way you do is perfectly normal. Simply put, they’re just consequences of a brain on drugs, a normal brain. There’s nothing wrong with the brain. Hence there is no disease.

Of course not everybody manages to stay clean. So it isn’t that easy to stop, and for some, it appears that just taking away the drug for long enough isn’t enough. Even so, what you have then is a compulsive behaviour. I’m not qualified to give advice on how to treat compulsive behaviours, but it seems to me that this is a problem for psychologists. And if you have a psychological disorder, you don’t necessarily have a disease. You might, but I have not seen clear evidence to support this. I have read arguments where the writers claim to have evidence, but it isn’t clear and there are other experts who disagree. Until there is real evidence and not the opinion of biased experts, it isn’t enough for me to decide one way or the other. And the default position for “I don’t know” for this atheist and skeptic is always going to be to presume the claim is not true.

I’ve tried to steer clear of 12 step programs and all that nonsense today, but for the record, if you have a disease, you certainly don’t treat it by going to meetings and talking to people who have the same disease. I know there is more than one camp claiming that addiction is a disease… those who follow 12 step nonsense tend to accept it,  just as they so credulously accept other things – and then claim that it can be “treated” but can’t be cured. The other camp realize that 12 step programs are not based on evidence, but still repeat the claim that addiction is a disease. But diseases are not vague or undefined things. If it is a disease, those who maintain that it is should be able to define specifically how the brain is diseased (and not normal but operating under stressful conditions as I believe), and while they may not be able to supply a cure, they should at the very least be able to define what exactly the disease is.

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About Jerome

I am a senior C# developer in Johannesburg, South Africa. I am also a recovering addict, who spent nearly eight years using methamphetamine. I write on my recovery blog about my lessons learned and sometimes give advice to others who have made similar mistakes, often from my viewpoint as an atheist, and I also write some C# programming articles on my programming blog.
This entry was posted in Addiction, Methamphetamine, Recovery and tagged . Bookmark the permalink.

8 Responses to Is addiction a disease? (I don’t think so.)

  1. bbnewsab says:

    Disease isn’t the right word here. I prefer to use the term disorder (in the brain). Some of us want to have a reward here and now. Others can wait for a while for the reward, especially if the reward then increases in value. Cf. the Stanford Marshmallow Experiment, https://en.wikipedia.org/wiki/Stanford_marshmallow_experiment .

    The ventromedial Prefrontal Cortex (vmPFC) interacts with the ventral striatum. vmPFC says “Wait, there’s another day tomorrow!”, while the ventral striatum yells “I wanna have it all now, I can’t wait”.

    If the connections between vmPFC and the striatum are good, then vmPFC is able to tell the striatum to shut up and listen.

    If the connections are bad, then you can call that a mental disorder. You are like a child, want everything here and now and won’t listen to the logical reasoning power/capacity centered in your left brain hemisphere.

    Liked by 3 people

    • Jerome says:

      Interesting experiment.

      It would be good to know if using drugs changes those connections, maybe during drug dependence, and whether those connections improve after not using the drug for a while. And it would also be interesting to know if some people just start out with such a disorder, or whether drugs can induce it temporarily.

      But yes, it looks more like a disorder to me too, though I know nothing about the science or psychology behind it.

      Like

      • In short: yes. This article alludes to changes in the striatum resulting in drug seeking (and other compulsive) behaviour.

        This opinion piece is written by neuroscientist Marc Lewis, one of the scientists in the camp of ‘addiction is not a disease’.

        https://www.theguardian.com/commentisfree/2016/jun/07/addiction-not-disease-science-stigma

        You might be interested in his blog too: http://www.memoirsofanaddictedbrain.com

        I’m not convinced it is a disease either. Regardless of whether it is or not, the disease model is often so discouraging. It removes the power to stay sober from the individual.

        I’m so happy that many addictions programs are moving away from the 12 steps, towards more evidence based approaches. It is slow but the fact that there are now secular cognitive behavior therapy support groups to support sobriety that you don’t have to attend indefinitely is s step in the right direction.

        Liked by 1 person

        • Jerome says:

          Cool. Thanks very much. I am, of course, interested in the neuroscience behind addiction. My arguments are based on my experiences plus logic, but knowing some of the actual science behind it would be better. I can also then use it to write better arguments.

          This would also be good to use, to then refute those in the “once an addict, always an addict” camp. That is, if those changes are reversible, then the argument that you remain an addict is moot. (Then again, those in that camp are mostly 12 steppers and they have bigger problems than just this one.)

          And lastly, it would interest me to know if people exist with striatum connections such that they always have the problem of being compulsive without any degree of control. This could potentially lead to them being “born” addicts, could it not? I had an argument back in a school debate when I was very much younger about just this. I proposed that there exist people who are born to be addicts or alcoholics, and the whole class laughed me down. But it looks like I might be right after all…

          Like

  2. Yeah.. I don’t really believe in “Addiction”…..
    I drank Alcohol for years.. TONS of it… 1/2 fifth/day for years…
    Just decided I was bored with it.. wanted to lose weight.. quit…
    Girl at work is a 12 stepper AA Sponsor.. always tried to tell me I was an addict…
    then I quit.. no prob.. started losing weight.. THEN she said I was suffering SERIOUS withdrawals cuz I was losing weight.. and COULD DIE !!!! nope.. fine…
    THEN I’d lost 45 lbs in 9 months… that’s like 5lbs/month… no alcohol.. cut out crap..
    GUESS WHAT… THEN she accused me of being on Methamphetamine.. need to see a doctor.. my face is all withdrawn.. I COULD DIE… OMFG..
    I said OF COURSE my face looks drawn out.. I’m 55 and just lost 45 lbs.. it’s not PUFFED up with alcohol and fat anymore.. AND.. I’m planning on losing 30 more lbs.. Can you say FLIPPED? lolol
    I smoke.. 2packs/day at the time. …. .. had some teeth pulled couple years ago .. couldn’t smoke for a week.. I just.. “DIDN’T”.. no problems.. no withdrawls.. no mood swings… was fine..

    I’ve snorted coke.. smoked crack, smoked pot.. done acid.. smoked Meth.. Crank, etc.. months at a time at times in my life. off and on for YEARS.. .. you name it.. bout every “Addictive” drug they say is… No problems EVER stopping.. I’ll do one for awhile…. then.. hmm better give my body a break.. POOF.. STOP… NO PROBLEMO

    SO.. I DON’T get when people say they’re addicts???
    My motto is… I LIKE DRUGS… I LOVE DRUGS.. DRUGS ARE FUN !! SAY YES TO DRUGS !!
    I could go buy meth, coke, etc.. TODAY… smoke it for 6 months … then meh.. not smoke it again for years,
    And I think drugs being illegal is total horseshit….. I mean Alcohol is the worst thing EVER !!

    Liked by 1 person

    • Jerome says:

      Not everybody who uses is an addict though… According to the last program I attended (outpatient required by court before I got my son back), there are more or less three groups:

      1.  Users, who use drugs with no consequences.
      2.  Abusers, who use drugs with consequences, but get it together and stop by themselves.
      3.  Addicts, who use despite horrendous consequences and “can’t stop” by themselves.

      That would make you an abuser, according to them.

      I’m not sure I buy that definition though. I mean, being arrested would be a consequence, but one that is imposed on you because of the criminalization of drugs. And sure enough, there were people in the program I attended whose only consequence was having been caught, people who nevertheless were treated just like the other addicts.

      Strictly speaking, when I refer to addicts, I mean those who think they can’t stop, those who use impulsively and compulsively despite losing it all. I just don’t believe that they really can’t stop – it’s an excuse; one that’s reinforced by 12 step bullshit.

      Like

  3. bbnewsab says:

    Talking of nature vs. nurture, I hope you’ll find this press release interesting, Jerome: https://www.sciencedaily.com/releases/2017/07/170711121438.htm .

    Maybe also this article: https://www.scientificamerican.com/article/pinpointing-the-brain-rsquo-s-motivation-switch/ . Please notice that the brain’s grit center (at least one of the most important centers) seems to be in the dorsomedial PFC, It’s very close to the vmPFC area I mentioned in an earlier comment (see above). So a strong and active vmPFC can easily spill over to the dmPFC.

    Liked by 1 person

  4. I absolutely agree and love this post. You nailed it.
    As a recovering addict (seven months clean and counting every day) this really strikes a chord with me.
    Through my five year long battle with opioid addiction, I learned so so so much about addiction, withdrawal, relapse, rehab, drugs themselves, strategies for staying sober… the list goes on. Anyways I decided to put my knowledge to use and so I started a weekly podcast called Addictions on iTunes and googleplay.
    I feature valuable insight for anyone effected by addiction check it out if you get a chance. My WordPress site will lead the way to your listening pleasure.

    Liked by 1 person

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