The danger of treating addiction as a disease

When you treat addiction with a 12 step program, it’s about as useful as treating a driver who drove into a tree by talking to him about the tree. Why did you drive into this tree? Is it because the tree is green? Trees are good for the environment, you know? Let’s sit together and pray. Maybe write a letter to the tree and say sorry. Let’s go to a meeting and sit with lots of other people who drove into trees and talk about the trees.

My analogy is absurd, but accurate. As in my analogy where the problem dealt with is never even the driving, let alone finding out whatever caused such reckless driving, when you work a 12 step program, it’s never about your choices, let alone why you made those choices. They say, “look at the similarities rather than the differences”, and sure, we are all similar. We all fucked up in the same way. We all got dependent on drugs, felt isolated because we isolated ourselves, and once dependent, all developed the same sort of problems as a consequence of our behaviour. By looking at our similarities, we do nothing about our actual problems or their root cause, but sure, let’s sit together and ask a higher power to fix us. Or just talk to the fucking trees.

It only makes matters worse to then say, “But addiction is a disease”. If you have a disease that can’t be cured, you have a wonderful excuse not to stop using drugs, or to relapse and deny any accountability. “I can’t help it. I have a disease.” Well, boo-fucking-hoo.

Likewise, when you return to meetings, it is with the usual excuses… “I wasn’t working the steps properly” or “I wasn’t truly in recover” (Yeah, and you ain’t a true Scotsman either), but that doesn’t mean shit when the steps don’t address your real problem anyway. Relapse isn’t exactly encouraged, but it is taken as par for the course, so they condone it.

Make no mistake, addiction is a disease, but not for the reasons you think. Recently I found this out after asking the question on Skeptics Stack Exchange. Is addiction a disease? The answer surprised me but I accepted it because it is technically correct…

Addiction is a disease not because of evidence, not because of it being any kind of sickness, not because of it being a medical condition (It isn’t), but because it is defined as a disease. That’s all. It’s a disease because enough people have a problem with it, because the definition of addiction and disease itself are vague and open to interpretation, and addiction had to be catalogued as something.

Unfortunately that means two things:

1. As long as addiction is assumed to be a disease, it will be used as an excuse either not to stop using drugs or to justify relapse, because you externalize the problem and never take personal responsibility, as well as fail to even try addressing the root cause of your behaviour.
2. There are people who will use it against you. No matter how long you are clean, even if it is several or many years with no symptoms of addiction and no interest in using drugs, there are people who will claim that you always have a risk of relapse because you have a disease and can never have control, and these people will dismiss everything you say, and use it against you in any way they can.

I can’t do anything about the second point. As for the first point, my advice is not to assume it is a disease. It can’t be treated as one anyway, because there is no medical treatment for addiction. In the end, it doesn’t matter if addiction is a disease, a chronic condition, or something else, but treating it as a disease only leads to problems.

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:

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.