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Addiction is Not a Disease, as a Renowned Neuroscientist Sees It

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  1. Beenthere2Hippie
    Perhaps because so many of them are former drunks and junkies, ‘addiction experts’ are touchy people. Often they don’t like each other — hardly surprising, since they are fighting each other for such a lucrative business. You can make bigger bucks out of selling ‘recovery’ than by peddling drugs.

    That’s not to imply moral equivalence, but the two do have one thing in common: plenty of repeat customers. In any media report of a celebrity’s battle with substance abuse, the words that you’re most likely to read before ‘rehab’ are ‘in and out of.'

    Ah, say the addiction gurus, but that’s because they’re suffering from a disease. This is one area in which the rivals speak with one voice. The notion of addiction as an incurable, relapsing disease is the bedrock of the recovery industry. Especially the relapsing bit.

    It’s a brave man who challenges the disease theory — especially if he is himself a specialist in addiction and therefore runs the risk of being cold-shouldered at conferences and savaged in professional journals. Step forward Dr Marc Lewis, a neuroscientist who spent over 20 years as a professor of developmental psychology at the University of Toronto before taking up a teaching post in the Netherlands. His new book is subtitled ‘Why Addiction is Not a Disease’. He’s not the only academic to rubbish the disease model — but, so far as I’m aware, he is the first who has done so by setting out a comprehensive theory of addiction rooted in neuroscience.

    The Biology of Desire focuses relentlessly on the chemistry of the brain. That is what makes it the most important study of addiction to be published for many years. ‘Clear, insightful and necessary,’ proclaims the plagiarist Johann Hari on the cover — a worthless plug if ever there was one, but he’s not wrong.

    Neuroscience isn’t just a fashionable subject: it’s all-conquering. Since the 1990s it has colonised one area of research after another. The human brain is the most complex object in the universe, and recently we’ve begun to understand how it works. This makes neuroscience (which encompasses the entire nervous system regulated by the brain) a source of extraordinary promise and problems. Experts in one field after another have been forced to rewrite their textbooks; but their new findings are often out of date and sometimes discredited by the time they’re published.

    That’s because neuroscience relies heavily on functional magnetic resonance imaging (fMRI), a non-invasive but very expensive type of brain scan that allows us to see different regions of the brain light up as we perform everyday activities. One day, fMRI may help us to reverse Alzheimer’s and other horrors. It’s not a tool we can abandon just because researchers inevitably have to do a lot of guesswork based on small sample sizes. What we must stop doing, however, is turning that guesswork into grand theories that try to explain human nature on the basis of fMRI images of the brain lighting up when people (for example) say a prayer, vote Republican or chop up a line of coke.

    The study of addiction has been grotesquely distorted by ‘voodoo correlations’ between brain imaging and behaviour. In particular, as Lewis points out, fMRI scans have been a godsend to believers in the notion that addiction is a disease.

    Observable changes in the brain caused by drug use became part of a simple, scary, media-friendly narrative of drugs and other addictive experiences ‘hijacking the brain’. And the fact that these changes were still measurable after an addict cleaned up his act was taken as proof that the ‘disease’ of addiction is irreversible.

    Lewis is just the man to demolish this theory. First, he’s a seriously distinguished brain scientist. Second, as he revealed in his previous book, Memoirs of an Addicted Brain (2012), when he himself was a young man he was so ‘fucked up’ by his craving for a high that he stole opiates from the science lab. In the end he broke the habit. And that’s how The Biology of Desire portrays addiction: as a collection of habits deeply engraved in the brain. Lewis says there is no reliable formula for overcoming these patterns of behaviour, which — as his gruesomely entertaining case studies demonstrate — differ markedly from each other in respect of both biology and social context.

    The good news is that there are many different routes out of addiction, though the recovery movement does its best to block them by spreading the message that addicts are ‘powerless’ unless they surrender their willpower and their bank account details to its ‘experts’.

    Lewis is an amiable guy and tries not to be rude about his critics. He can’t, however, hide his contempt for most of the 15,000 drug and alcohol rehab centres for whom the ‘disease model’ is a licence to print money. The cold-blooded methods employed by the recovery industry have never been properly scrutinised. Perhaps they should be the subject of Lewis’s next book.


    By Damian Thompson Ph.D. - The Spectator/Aug. 20, 2016
    http://www.spectator.co.uk/2016/08/addiction-and-the-recovery-gurus-who-profit-from-it/
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    About Author

    Beenthere2Hippie
    BT2H is a retired news editor and writer from the NYC area who, for health reasons, retired to a southern US state early, and where BT2H continues to write and to post drug-related news to DF.

Comments

  1. gonzochef
    I have to read this book. I've never believed that my addiction was a disease, rather that it is a behavior that is learned and reinforced so strongly by the reward system in my brain that I struggle endlessly to "break the habit." Any action which overrides the body's need and desire for food and water is powerful indeed, but does not a disease make. I know the result of giving in to temptation, but my addicted mind tells me to say "fuck it" for a good time. Many have compared this to diabetes patients who choose to eat sugary foods knowing that their disease cannot handle this action. I scoff at this comparison simply because there is nothing wrong with my body unless I put drugs into it, whereas someone with diabetes has a body that will continue to function abnormally with or without this action, witnessed in the need for insulin as well as proper choices. The brain is too complex to understand most disorders of a mental nature, addiction being one of them. However, a disorder is far from a disease. My bipolar disorder is just that: a disorder. As is my PTSD and General Anxiety Disorder. Unfortunately these disorders hinder my ability to overcome any one of them, including my addiction...
  2. aemetha
    I've touched on this before, but to claim addiction is not a disease is to redefine the word disease.

    From the Oxford Dictionary:

    1A disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury:
    'bacterial meningitis is quite a rare disease'

    1.1A particular quality or disposition regarded as adversely affecting a person or group of people:
    'we are suffering from the British disease of self-deprecation' Link

    I have no idea where this association between the terms disease and irreversible has originated, but it's certainly not in this definition of disease, and we treat all kinds of diseases every day. I certainly don't subscribe to the theory that addiction is irreversible or untreatable, the brain is incredibly plastic, we are capable of creating new neuronal links our entire lives, and we continue to trim unused ones our entire lives. We quite literally reprogram our brains for our entire lives.

    Addiction is an abnormality in the brain function that adversely affects people and fits the dictionary definition of a disease, and this article even acknowledges that when it talks about the fMRI scans. Have people used this fact to manipulate the unwary for their own agenda's? Of course they have. What they haven't done is lie about it being a disease. The author here, irrespective of how well qualified or highly regarded he may be needs to have his actions seen for what they are. He's not making a medical opinion in these statements, he is arguing semantics and trying to redefine the accepted definition of a word that extends far beyond the context of which he is discussing.

    Arguing against the entrenched view that addiction is irreversible and incurable to me seems valid, at the very least the jury is still out on that part. This article hasn't provided even a shred of evidence to suggest that addiction is not a disease though, and argues almost entirely for the point that addiction isn't incurable which is quite a different thing. Should the word disease have added to it's definition/s "except in the case of addiction."?

    Gonzo, I think I understand what you're getting at here, and I do agree with you about mental disorders being too complex to be fully understood. I don't agree with them not qualifying as diseases though, certainly not by the definitions I can find. The same dictionary lists disorder as a synonym of disease, and describes it as "An illness that disrupts normal physical or mental functions: 'skin disorders'". If we then look at the definition of illness we get "A disease or period of sickness affecting the body or mind: 'he died after a long illness'". As you can see it's a circular definition, but they amount to the same thing, hence my argument that the authors claims are nothing but semantics.
  3. gonzochef
    But Aemetha, look at your second definition: it is practically an accepted slang use of the word. I could just as easily claim racism is a disease among old white men. This is not medical in definition, but verbal. In THAT sense I agree that addiction could be called a disease, but not medically. I thought the article quite articulately stated that fMRI scans of the brain showing effects after the drugs are gone only shows what you stated about how the brain constantly evolves. A new neuropathway to pleasure after some other enjoyable activity doesn't make it a disease, does it? I think it is quite clear that the old saying that the more we know, the less we know, is absolutely true. I also site the horrific failure of many treatments for this "disease" as evidence that we don't know enough about the subject yet to define it. I DO believe I have a mental disorder, several actually, but not a disease. That is my belief. I agree with you that there is no point in arguing semantics on the issue, but I wanted to state my belief and the reasons for them. As with any belief, I could be wrong.
  4. aemetha
    Fair point, it still meets the first definition though. Addiction has changed the functioning order of the brain, but the definition has no requirement of cause of the disorder except that it not be physical injury.

    My main concern in the redefining it as not being a disease, is that we have for a long time worked to establish drug addiction as an issue best treated medically and therapeutically rather than criminally and punitively, and the statistics generally seem to bear out that it is more effectively treated that way. If we go back and redefine it as not being a disease, that can be used as a justification to put it back in the criminal category rather than the medical one as far as treatment goes. At the very least when making such distinctions, we need to clarify what it is as well as what it isn't.

    I'm sure this isn't what the author intends, and I think his rejection of the industry philosophy of powerlessness is admirable in all honesty. I think the subtitle however is a poor choice of words and tangential to what he seems to be trying to achieve, which is from what I can tell, is a rethinking of how we approach drug treatment, and disposal of those concepts with dubious evidentiary foundation such as incurability and powerlessness. The subtitle only clouds the subject and creates controversy where it isn't required if this is his argument here.

    On a slightly lighter note. I am a little curious. If the title of the article was "Addiction is a disease" would the article instead belong in the health news section? Sorry, my mind drifts to such questions occasionally.
  5. gonzochef
    You make some very valid points in regard to how addiction is seen and treated. I still believe it should be considered a medical condition in need of treatment, and not a criminal issue. That point I concede with every fiber of my being. Declassifying it as a disease could easily and disastrously change the already minefield-like quality of the politics surrounding this issue.
  6. Emilita
    I don't think addiction is a disease, l know this conflicts with how many people see it on DF and rightly so because it does fall under the subject of being subjective.

    No ones experience with addiction is like anyone else's, it is purely a personal response to outside stimuli and our internal manner of coping with that outside pressure. I, self medicate like many on this forum use substances in an effort to cope with my own issues. The value and depth of these issues l and anyone else has is not measurable by any outside source such as a medical professional or addiction specialist.

    Althought my point is brief l think this subject is intresting and sure to have many people holding different opinions on the subject because of its subjective nature.
  7. pdoc
    Yeah, I feel like this is almost exclusively an argument about nomenclature/symantics. I think if you accept a modern conception of the brain/mind as coming from the same stuff and consciousness being solely a manifestation of physical, biological processes in the brain, it's hard to distinguish addiction with diabetes.

    It's quite genetic, but also dependent on environmental influences, and the individual's interaction with those influences, as well as the individual's own behavior. It affects people at a variety of ages, is worse when it's younger, and can arise spontaneously in a family without any history. Most people have some susceptibility if given the right conditions (e.g. being in a sugar-centered country, being in a place where people smoke a lot of cigarettes)..

    Everybody's diabetes is different, too, but in a way that's not quite so easy to observe as behavior.

    I personally distinguishing between 'disease' and 'mental disorder' just implies that the brain isn't a regular old organ that can have a disease. The difference between disorder and disease is not really that clear or well defined as far as I can tell. It looks like some definitions say that disorders are less understood than diseases, but this isn't really consistently used this way: see metabolic disorder.

    Overall, I appreciate this guy's focus on habits rather than the ridiculous obsession w/ tolerance and withdrawal among people talking about addiction. Otherwise, I don't think he's really adding anything.
  8. perro-salchicha614
    I really appreciate the fact that this guy is calling BS on people trying to make money peddling the "cure" to addicts who have been enticed by the idea of being absolved of responsibility for their situation. I think the definition of disease really hinges on the concept of injury.

    Is drug use a form of self-injury? I would argue that it is. I, like many others here, do my fair share of self-medicating. I am aware that what I am doing is altering the way my brain works, and I do it anyway. I know that what I'm doing is injurious to my health, and I've decided to say "fuck it" because I have emotional issues that make it very unpleasant for me to be sober.

    Addiction can be a disorder without being a disease. It is not the result of some spontaneous mutation of cells or some pathogen that has infected the brain; it is the result of a conscious decision a person has made to do something harmful to their health. That is why addiction is not a disease, in my opinion.
  9. jgillz123
    THE AMA (THE AMERICAN MEDICAL ASSOCIATION) IS A GROUP OF THE BRIGHTEST PEOPLE IN THE MEDICAL FIELD WITHIN THE UNITED STATES. Although I am far from dumb, I have a feeling that all the knowledge I possess does not outweigh the intelligence of those in the AMA. THEREFORE IF THE SMARTEST MEDICAL PROFESSIONALS SAY ADDICTION IS A DISEASE THEN GUESS WHAT, IT IS A DISEASE. If my computer isn't working and a computer whiz says I need a BLANK chances are that's what I need.
  10. aemetha
    The argument is more about definitions than anything, and one needn't be a doctor to have a valid opinion on a definition in this regard. Questioning the scientific consensus is a key step in progressing our knowledge sometimes, otherwise we'd still be living on a flat world which is at the centre of the universe.

    I think there are some valid points made about differentiating between a self inflicted injury and a disease. I'm not sure we have an appropriate alternative term for the type of condition addiction fits. As I said above, my main concern is it being viewed as a non-medical issue, and I firmly believe if we define it as something other than a disease it must remain a medical issue and term. I'm not opposed to redefining it in this way however, a more accurate and specific definition can only be beneficial for communicating the nature of it.
  11. Diverboone
    Whether it is or isn't the article is correct concerning the money spent and made with the rehabilitation industry. It's amazing that any business could be so profitable with a less than 50% success rate. To be honest I'm unaware of the statistical success rate, but I'm quite confident that it's less than 50%.
  12. DiabolicScheme
    I think that addiction can be best described as a condition/disorder rather than a disease. To me disease seems like an excuse to not get better and implies that it can't be defeated by behavioral changes.

    The last thing addicts need is a reason or excuse to feel like they are powerless over their addiction and the word disease gives just that in my opinion.
  13. monkeyspanker
    Whether it's called one thing or another, I say we need more great people like Dr. Lewis out there in the field, doing research, writing articles :thumbsup: :thumbsup:

    Great posts from all of the above as well :applause:
  14. mess clean
    Everything everyone posted so far is valid. You've all done a good job of arguing your positions quite well.

    I won't get into whether I think addiction is a disease or not. I will say, however, that this article doesn't strike me as objective. It seems rather biased, and the author came in with a clear agenda. This, however, is beside the point.

    One thing that struck me as ridiculous is the claim that "the human brain is the most complex object in the universe." Really? Maybe it's better stated as, "the human brain is the most complex object on this planet that we know of."

    To make such a sweeping generalization about how "complex" our brain is makes me question everything that follows. If such a point can be so exaggerated and biased, then why not the author's original thesis and conclusions?

    We don't know enough about ourselves to say that we know whether addiction is a disease or not. It's a game of semantics. And to say that we know about everything in the universe...and that our brain is the most complex object in it...well, it seems both egocentric as well as pushing its own agenda. We know barely a sliver of what the universe contains, or if it really even ends where we think it does. Or, even if it's the only universe or one of many.

    If we say that addiction is not a disease, I guarantee you a new crop of therapists will come up with their own schemes on how to make money off the new "science".

    fMRIs can show us many things that occur in the body, as it happens. But it doesn't tell us the hows and whys. That is always open to interpretation. Whether by neuroscientists, or whomever. It isn't evidence of anything. It's information which must be processed. It can be used to support or refute, but not prove.

    The other problem is that we are studying an organ in the body which we all have...and it's also the organ involved in thought. So, studying the organ that makes us think and behave, and then using that very organ to try and process what is happening, seems a bit logically tautological. It's like saying something cannot be opposed by logic, while offering no evidence to truly support the ultimate conclusion.

    So that's my brain on the topic of the brain and addiction. Everyone can do the same and end up in a different place.
  15. Joe-(5-HTP)
    Addiction being a disease may indeed provide an excuse to some people to use.

    While that is a potentially disastrous consequence of believing addiction to be a disease, it logically must be recognised to have ZERO bearing on whether addiction is in FACT a disease or not.

    Just cause believing something to be true leads to outcomes we don't like, doesn't mean it's not true.

    I say this in every debate thread about this topic because it seems always to be overlooked.

    It's entirely possible for addiction to be both a disease and for it to be believed a disease as an excuse to use by some addiction. Both these things can be true!! And I believe they are.
  16. Emilita
    So you are technically sitting on the fence on this subject Joe?

    I feel althought debilitating and has dramatic consequences on ones life it is intact not a disease. Whether or not l like the fact that l use it is simply and most definitely my decision to put a substance into my body.

    I can see your point of view but curious if what your stance is on the subject.
  17. Joe-(5-HTP)
    A disease affects a certain function of our body.

    Our ability to make choices is a certain function of our body which the disease of addiction affects.

    So I don't agree that it's somehow illogical to say that if addiction is a disease then we have no choice. Addiction doesn't remove our ability to choose altogether, it just makes it a lot harder than normal. Our normal ability to choose has disrupted function.

    Addiction is merely unique as a disease in that the part of the body it affects is the part which makes choices. Some diseases affect our body's function to produce red blood cells, others disrupt out ability to make choices.

    Other diseases affect parts of our body we don't have choice or control over, but people shouldn't therefore conclude that the definition of disease regards whether we have choice or control over it.

    A disease is something which causes a dysfunction. It's got nothing to do with choice. This is just a giant confusion, and addicts wouldn't be able to turn the addiction-as-disease model into an excuse if people weren't so confused by this.
  18. Phungushead
    Personally, I do not believe that addiction is actually a disease. Just because some organization or group of people have given a specific name to a behavioral problem that goes contrary to the societal norm, it does not necessarily mean that it is a disease.

    I do understand how it can be hard to differentiate between addiction and disease at times. Obviously, diabetes or high blood pressure are diseases, but many people have these conditions because of their own unhealthy life choices.

    Instead, addiction is simply a human condition of no longer being in control of your own life. A state of mind, as opposed to actually being 'sick' or having something wrong with your genetic makeup. It is something that could easily happen to any one of us, if we do things in excess.

    Some people are addicted to drugs. Many more are addicted to food, sex, video games, the internet, etc. - Are these addictions diseases as well? It's possible to be addicted to just about anything... It's just that while some addictions are relatively harmless, some can be devastating.

    One problem with classifying addiction as a disease is that it creates a dichotomy of victim vs. adversary. For example, an addict may make a statement something like "The addiction made me to it" as opposed to "I am taking part in addictive behavior". However, ultimately there is no external force to blame... Instead, we do it to ourselves.

    Perhaps the biggest problem lies in that accountability and responsibility are certainly not the same thing, but they often get treated as such. By ignoring fault, by labeling addiction as a disease, still does not remove the responsibility that the individual has for their own life. The obligation for recovery falls upon the sufferer, regardless of the cause. If I break my arm, the responsibility for recovery is up to me, regardless of whether I was physically attacked or jumped off a bridge...

    Just my honest opinion.
  19. aemetha
    In case anyone is interested in other discussion of this subject here is a couple of links.

    The National Institute on Drug Abuse is a governmental agency who define addiction as a disease. Their approach to it is that addiction is a chronic disease and that "treatment for drug addiction generally isn’t a cure. However, addiction is treatable and can be successfully managed.". https://www.drugabuse.gov/publications/drugfacts/understanding-drug-use-addiction

    This article on psychology today argues that it should not be called a disease because it doesn't fit many peoples perception of what constitutes a disease, but that however it is defined it needs to retain the beneficial aspects of its association with the term disease, specifically being treated as a health issue and a less judgemental approach to dealing with it. https://www.psychologytoday.com/blog/the-heart-addiction/201112/is-addiction-really-disease

    It definitely appears there is a great deal of scope for differing opinions on the subject. Ironically given my objection to the author's assertions in the original post, I'm more inclined to lean toward the opinions expressed in the second link I've posted here. I don't believe that (as stated in the first link) addiction is incurable or necessarily a lifelong affliction, because contrary to what was thought in the past we now know the brain is plastic enough to develop new neurons throughout our entire life in addition to pruning them (Sanei, S. (2013). Adaptive processing of brain signals.). If we are naturally capable of sculpting our brain structure and function, it stands to reason to me that we are capable of redefining our compulsions in regard to addiction.

    I don't claim we fully understand the brain or its complexities, and I am inclined to agree with Mess Clean in that it is perhaps the most complex organ we know of. Having said that, we do know some of how it functions and I base my personal opinion of the subject on the knowledge we do have of it and its plasticity. If addiction is considered a harmful behaviour, as it is by most definitions I would posit that a compulsion toward harmful behaviours constitutes a disorder of structure or function (the first part of the definition of disease) because it is counter to our basic instinct for survival. This is of course just my opinion, and given the absence of complete information because of the aforementioned complexity it really can't be anything more than an opinion.

    Perhaps disorder is a more apt word to describe addiction without the attached prerequisite for an absence of direct injury (the second part of the definition of disease), however this opens a can of worms in terms of other conditions referred to as diseases such as type 2 diabetes and lung cancer which can also be arrived at through a process that may be interpreted as gradual injury as highlighted earlier by pdoc. It therefore seems to me that if we are incorrectly classifying addiction as a disease, it's not the only condition we are doing that for. This puts me in two minds as to whether addiction should be defined as something other than a disease, or if disease should be redefined to include those conditions that are arrived at through this gradual injury process.

    I'm going to try posting a poll in the surveys section to see how other people view the subject.
  20. monkeyspanker
    Awesome idea aemetha, I'm very much looking forward to the poll!!
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