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Is addiction a moral defect or a mental illness?

By source, Jun 28, 2012 | Updated: Jun 29, 2012 | | |
  1. source
    Is addiction a moral defect, a mental illness or a party trick gone wrong?

    Two events, a policy and a book, pose the question again.
    The policy is from Iain Duncan Smith, ever fretting over a vampiric underclass and their disgusting habits. IDS is considering docking the benefits of addicts who decline "help"; it seems they must attend Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), or risk greater poverty and, inevitably, chaos.This is a tax on mental illness that will apply only to the poor; rich addicts, thankfully, will be left alone. Like many of Duncan Smith's dreams, the fantasy is grandiose and almost an acceptance of the disease model of addiction, if only from small state fetishism. Will we see more evidence of this acceptance in better NHS funding for psychotherapy and rehab, or an acknowledgement that drug and alcohol abuse flourish when there is no work? I doubt it, and in any case, the reality of his policy will be dust in his hands.

    As John Sutherland pointed out last week, willingness is essential to recovery, and willingness cannot be bought. Duncan Smith will pay people to go to AA, and AA will be filled with new members who are there because he made them go. This will make for some interesting sharing, but willing members will, in my case with boggling eyes, take responsibility for IDS's victims alongside their own illnesses, signing papers to provide evidence of attendance; imagine a mother and baby group at war. Anonymity, meanwhile, is smashed; it will go down like a Priory made of dominoes. In seeking to soothe addiction, IDS will imperil one of the only known means of arresting it. Wondrous.

    And so to the book – The Fix, by Damian Thompson of the Telegraph. It is a strange creature, in part a poison pen letter to AA from a former member. It attacks the disease model of addiction, which has been the accepted dogma for more than 50 years, endorsed by almost every medical authority in America, where most of the research is done – the American Hospital Association, the American Public Health Association, the National Association of Social Workers, the American College of Physicians, the National Institute on Alcohol Abuse and Alcoholism.

    For the vast majority of scientists, as Thompson acknowledges, you are no more responsible for being an addict than you are for having leprous limbs, even if this consensus has little impact on social policy where addicts are still treated with contempt. Even so, to dispute it is a popular game among libertarians. Last year the blogger Brendan O'Neill wrote a piece congratulating Amy Winehouse for not being suckered by the therapy industry, even as her ashes were interred in the mud. Thompson's status as an ex-AA member renders The Fix a dangerous polemic that exposes addicts to social censure – a daft fate for sufferers of an illness so intrinsically dependent on self-hatred – and financial and occupational insecurity: it is almost impossible for addicts to be insured, even in 2012.
    Thompson's opening passage on alcoholism is anecdotal, brutal, subjective. He describes an AA member – in unflattering terms – who will likely recognise herself. He says the group "seemed almost proud they had this 'disease'" – were they, or weren't they? He insists the members "describe disasters that befall those who stray from the true path [with relish]". Does he relate their testimony from memory, or did he take notes?

    Thompson bases his complaint on the stories of two of his friends. Both abused alcohol and drugs: one lived, one threw himself off a building. His conclusion is that, since some addicts recover it cannot be a disease. So what is it? "The behaviour of addicts," he concludes, "looks voluntary because it is … there will always be people who … change their mind and pull themselves out."

    What of the science? The most comprehensive study (by George Vaillant at Havard) suggests that almost no one who drinks alcoholically ever drinks normally again; twin studies suggest addiction is hereditary; A Thomas McLellan's enormous round-up of the data noted "higher rates of dependence among twins than among non-twin siblings and higher rates among monozygotic than dizygotic twins. Evidence," he says, "suggests significant genetic contribution to the risk of addiction comparable to that seen in other chronic illnesses … the choice to try a drug may be voluntary, [but] the effects of the drug can be influenced profoundly by genetic factors."

    McLellan admits: "It is not yet possible to explain the physiologic and psychological processes that transform controlled, voluntary use of alcohol and other drugs into uncontrolled, involuntary dependence", and this is the hole that Thompson crawls through.
    The Fix reads only like bitterness, an unconscious elegy to shame; add Iain Duncan Smith's coerced AA meetings, and fair treatment for addicts feels, as ever, far away.

    Tanya Gold, Guardian.co.uk.



  1. source
    This topic has obviously been posted about before, I just found this article quite interesting.
    The Fix, a book by Damian Thompson of the Telegraph looks like a very interesting read; I have been to NA and I find his comments pretty similiar to my own experience..

    Quote: "He says the group "seemed almost proud they had this 'disease'" – were they, or weren't they? He insists the members "describe disasters that befall those who stray from the true path [with relish]"."

    "Thompson bases his complaint on the stories of two of his friends. Both abused alcohol and drugs: one lived, one threw himself off a building. His conclusion is that, since some addicts recover it cannot be a disease. So what is it? "The behaviour of addicts," he concludes, "looks voluntary because it is … there will always be people who … change their mind and pull themselves out."

    Just made me think..
  2. Mindless
    If AA or NA are willing to accept coercion as a means of getting people to meetings, I feel this would reflect unfavourably on on them. It seems pretty basic that you can't force a drug user to enter 'treatment' of any kind; there would be no point and it is a violation of human rights. I have strong reservations regarding the ethics of enforced treatment and view any participating agencies with suspicion. AA and NA would do well to turn Ian Dunce Smith away and refuse to participate in enforced treatment.

    If the proposed changes make treatment effectively compulsory for benefit claimants with addictions, nothing will be achieved apart from an increase in the misery of poverty. Jobseekers with addictions will probably end up playing along in terms of attendance in order to qualify for benefits, so government targets will be met, but no-one's life will change for the better. It's probably more cost effective to offer support and treatment to those who want it than to try to force everyone into treatment. A ridiculous and sinister idea, and just one step away from compulsory urine tests for all claimants.

    This does not invalidate the illness or disease model of addiction, but naturally addicts do best when taking personal responsibility for actions (just like everybody else). Addiction may be a disease, or a learned behaviour with a genetic and biological basis, but it is certainly not a sign of moral deficiency. Is the proposed abandonment of those who need help with addiction a sign of a diseased society, or one that is morally defective?
  3. kailey_elise
    Here in the States, many AA meetings already accept forced treatment/coercion as a method of getting people in the door. Here, judges sentence people to 30/60/90 meetings in 30/60/90 days, and to prove you were at the meeting, the chairperson or whatever signs "court slips" at the end of the meeting.

    Granted, I do believe this is something the "group conscious" decides is appropriate or not for their group, and not all groups do it (I've heard the "see so-and-so to have court slips signed after the meeting" spiel far less in my more recent visits to the halls - then again, I tend to go to closed groups and discussion meetings more than open speaker meetings, since speaker meetings tend to trigger me). This isn't an edict handed down from AA Central Service or whatever it's called. And I have only seen this court slip signing at open meetings, which welcome anyone who's interested in learning more about it (opposed to closed meetings, which are for people who already identify as being addicts/alcoholics); open meetings can be attended by family members, friends, etc of an alcoholic.

    I'm not sure how I feel about the court slip signing. I mean, even in meetings, people say you have to be willing. But there's also something to be said for going before you're ready, because you might hear/learn things you didn't know before, which could help you at some point - maybe not ready to stop using now, but you can keep it in the back of your mind that there were people who stopped who seem fairly happy. I dunno.


  4. esoteric_explorer
    What the hell is "disease" even supposed to mean in context to describing addiction? It's not like you take heroin once and "catch" opiate addiction, then you go to the doctor and get medication for it

    It seems to me, based on my brushes with it, that addiction is not a defect or disease but simply caused by lack of exposure to people with drug problems, real drug problems, from a young age

    If I grew up in an bad inner-city neighborhood and saw junkies every single day, I would understand from a very early age that becoming addicted to a drug is a serious issue, and it would be much less likely that I would allow myself to begin spiraling into addiction because I had spent my whole young life face-to-face with the consequences of out of control drug use

    however, if I was raised in a nice suburb in Massachussets somewhere and had been constantly sheltered from people who have serious drug issues, even if I understood what addiction was, I wouldn't really get it, and therefore would probably be much less likely to know when I was beginning to spiral into it than the inner-city kid would be, just because I wouldn't be as familiar with the consequences and would only be familiar with the fun aspects

    It seems to me that a lot of the process for developing susceptibility to a drug problem happens during childhood, and addiction is less about the drug actually causing a disease, and more about the person lacking the life experience necessary to really understand the whole picture of drug use

    I've spent some time with people like the sheltered suburb kid I mentioned, and I've seen this happen myself
    It starts with vicodin and fun, and it spirals out of control faster than you'd believe

    "It can't happen to me" syndrome is the #1 reason I've seen naive, sheltered people fuck their lives up

    I'm sure it's much more complicated than just what I talked about, but then again it can't just be explained away as a "disease" either, and I like that this article acknowledges the fact that heroin doesn't just follow you home and shoot you up while you sleep, and addiction isn't entirely an involuntary process, but one that the addict must actively let happen
  5. kailey_elise
    That's a lovely idea, however it just isn't true. I grew up with addict parents (though when I was young I was only aware that my father was an alcoholic; they saved the drugs for the weekends when we were at our grandparents' house. well, until they couldn't wait anymore, due to going deeper into addiction...), alcoholic aunts & uncles, my grandmother drank Coors Light like they were water & they were always kept in the left crisper drawer of the fridge & Nana always asked you to go get her a beer...

    I grew up poor, and thus not in the nicest of neighborhoods at times. My uncles all had varying degrees of drug problems. My mother got sober when I was 11 & dragged me to AA meetings with her & told me about her addiction & its progression. My uncle got AIDS from sharing needles & ended up giving it to my aunt (& no, not his wife...it was his brother's wife, while brother was in jail); she died a little over 4 years later.

    I was well aware of the consequences of drug addiction. But hell, I'm really smart (genius level IQ, I'm told), so I can just use them now & then & then watch out for the signs, if any happen to show up, that my drug using is getting problematic & I need to stop or at least cut down. And everyone drinks, so that's never going to be a problem. Nope...didn't happen. Though I did get clean at 18, but relapsed about 6 years later.
    As above, this isn't true. And I dunno why people seem to think Massachusetts is this safe, white-bread place. Massachusetts has the highest rate of Heroin overdose in the entire USA. And kids in the suburbs, rural & urban areas are all getting high, and on hard drugs as well. Kids come from Peabody & Danvers into Lynn to get their crack & Oxys, then crack & Heroin, and whatever else they might "need." Massachusetts has some of the highest rate of opioid addiction in the country; we don't have a methamphetamine problem, we still have a serious, SERIOUS Heroin problem here. There are plenty of instances of out-of-control drug use in the Massachusetts suburbs to learn from as well; you don't have to be in the ghetto to see it 1st hand.

    Although we are pretty fucking white. hahaha.

  6. esoteric_explorer
    haha, shows you what I know

    I have a habit of talking out of my ass when I'm speeding
    I suppose to really get it you have to have lived it, otherwise you're just speculating
  7. source
    Well I was brought up by a coast, a village where you could leave your doors open without fear. I was a VERY naive lonely child without much social interaction and was dead against drugs of any kind throughout my childhood.
    It wasn't until after school when we moved into a city that I started to hang around with other users and started to use drugs. I found life so unexciting and wanted something different.
    When I was 21 my sister went into hosptial with drug-induced psychosis and that was the real turning point... I had to experience everything then and push myself to the limit.

    On the subject of courts etc pushing people to go to meetings - I don't think its a bad idea to be honest, but open meetings only, half the people at open meetings are off their faces anyway (might only be my own experiences) Our local drug drop in service has people attending groups there that need to go for a set amount of hours a week - this is good because they get help and support from workers and also recovering addicts themselves in a social kind of atmos.

    There are addicts on benefits that have no interest in getting clean and that is pretty sad, I do believe a gentle push to these support meetings would be a good idea, and might be just what some people need. However taking benefits away is wrong; its like saying "Do this or you don't deserve to live" Hitler died didn't he?
  8. Mindless
    If you believe what he says here, Iain Dunce Smith is the addicts champion, only seeking to help us by 'soothing' our addictions. My hero!


    Iain Duncan Smith at No 10 ... ‘In seeking to soothe addiction, IDS will imperil one of the only known means of arresting it.' Photograph: Ben Stansall/AFP/Getty.

    Where is the evidence that enforced treatment will have any positive outcome? Anyway, I look forward to the soothing.
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