The New York Times published an interesting article on July 10th that is worth a look. It talks about a growing trend to treat addiction as a medical problem rather than a spiritual, or psychological, disorder. The article speaks of addiction as a “disease” which will bother some. I’d prefer the word “condition.” It compares addiction to diabetes, which is interesting because diabetes is often the result of unhealthful behavior, just as is addiction, although both may have genetic factors. Diabetes is also often completely controlled, though not cured, by following certain dietary strictures, which is of course similar to what happens with addiction.

As a practical matter, moving addiction more firmly into a medical category could lead to both opportunities and dangers.  On the positive side, it would help in de-stigmatizing addiction and might lead to research on better treatments. But it also could conceivably make the downside of drinking/using seem even less threatening to people than is currently the case. Diabetes suffers from this phenomenon — even as treatments for type 2 diabetes improve, people ignore the evidence linking it to obesity and continue to overeat. Or look at obesity itself — virtually everyone views it as a serious medical problem, but vast numbers of people ignore the evidence and/or resist the obvious solution.

–Craig W.

 

3 Comments

  1. JeffK on July 23, 2011 at 11:10 pm

    Interesting read! I know Kaiser has addiction medicine specialists already, but I don’t know if this is common in other health care systems. From what I’ve seen, this approach can be very helpful especially for opiate addicts, and addicts in general when it comes to perscribing pain and psychiatric medications that don’t tempt the reptilian brain that wants to get high, but it doesn’t have to lead into an “is addiction a disease?” discussion as the article implies. I personally chafe a bit at using the word, because it tends to imply that the chemically dependent person cannot control his own destiny and has to rely on medications forever, as a diabetic might – this puts your future in the hands of medications, and presumes that you will take the medications or be forced to take the medications indefinitely (for example, it’s really not difficult to “forget” to take your antabuse for a while…). But chemical dependency is clearly associated with sometimes-dramatic changes in the brain, causing what non-addicted people think is bizarre behavior indicative of some sort of moral failing, and a perhaps-permanent predisposition to relapse followed by more chemical dependency if abstinence isn’t maintained scrupulously. I think it’s important for people in general to appreciate this if the stigma that’s still associated with chemical dependency and addiction is to be removed.



  2. Mimsey on July 15, 2011 at 3:04 pm

    Craig, thanks for sharing this article. I love the resources you come up with. However, I question your statement that diabetes type 2 is caused by the “bad behavior” of over-eating which causes obesity. This may be the common media myth, but science doesn’t really bear that out in general (of course, there are exceptions). For example, the vast majority of obese persons are not diabetic. And a significant number of diabetics are normal weight. From what I’ve read, current thinking is trending toward regarding obesity in diabetics as a “symptom” of a metabolic disorder. This Metabolic Syndrome is characterized by a number of other issues, such as thyroid problems, high blood pressure, elevated LDL cholesterol and triglycerides, etc. The metabolism can’t process carbohydrates properly, which raises insulin in response. But the carbs can’t get into the cells which send out “I’m starving” messages to the brain, hence the destructive overeating feedback loop which is really just a side effect of the basic metabolic issue.

    If the diabetes-as-symptom theory is true, it is interesting that this disease (or metabolic disorder) is being stigmatized as a character flaw, much as alcoholism (a brain pathway disorder, IMHO) has been….

    Just to clarify, this in no way implies that we aren’t responsible personally for dealing with our own conditions once we’ve got them, whether diabetes or alcohol….I’m just sayin’



  3. Cat Henley on July 14, 2011 at 11:18 am

    Thanks Craig. The sooner we rethink addiction as a medical disease rather than a strictly psychological one, the better! There are so many issues in our society, due to this misconception, including our jails being overloaded because they are filled with people suffering from addiction. Not to mention how poorly those of us that suffer from addiction are treated by society, like it’s a weakness. I love how we are moving towards understanding brain chemistry and addiction. Thanks for posting/Cat