SciTech

It's Not A Habit; It's A Brain Disease

MayorBob.

Posted to SciTech on Wed Aug 01, 2007 at 12:33:55 PM EST (promoted by port1080). RSS.

There is an attempt to promote the idea that addictions are diseases, specifically diseases of the brain. Recently, HBO aired a documentary and Time magazine ran an article spreading the "addiction as brain disease" gospel.  One of the primary advocates for this sea change in how we view addiction is Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA).  Dr. Volkow's essential position is that addictions are not matters of will power or something that can be overcome if only we try to kick them hard enough.  From her perspective they are a matter of brain chemistry with all addictions being basically alike and, in fact, everyone having the ability to be addicted to something.

It's no small matter if addictions are caused by weak willpower or are the result of disease.  For one thing, it would require health insurance providers to rethink limits they place on substance abuse treatment.  Secondly, calling a mental problem a 'brain disease' suggests that the addict isn't responsible for the effects of the disorder, and, consequently, their actions.  The brain disease model has caught traction politically.  US Senator Joe Biden (D - Delaware) has introduced legislation to change the name of NIDA to the National Institute on Diseases of Addiction and the name of the National Institute on Alcohol Abuse and Alcoholism to the National Institute on Alcohol Disorders and Health.  It's just semantics right?  Wrong, in the opinion of psychiatrist and psychologist Sally Satel and Scott Lilienfeld.

They argue that the movement to have addictions swept into a disease model "well-intentioned" though it might be glosses over a number of facts.  First, acceptance of the brain disease model means acceptance that addicts can never overcome their addictions.  Satel and Lilienfeld point out that addicts will often manage to find the wherewithal to fight their demons and overcome their addictions.  Dr. Anthony Daniels, writing as Theodore Dalrymple, also rejects the brain disease model as "poppycock."  Volkow and others contend that acceptance of the brain disease model would decrease stigma suffered by addicts.  However, there is evidence that pure biological explanations of mental problems have contributed to stigmatization, not necessarily reduced it.  Finally, there is also a case to be made for behavioral therapies proving their worth in helping people overcome addictions.

Tags: edited by Port1080, written by MayorBob, addiction, disease, mental health (all tags)

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Re: It's Not A Habit; It's A Brain Disease

thefadd.

Wed Aug 01, 2007 at 01:16:17 PM EST

none

Joe Biden has gone completely off the deep end. I don't know of one democrat who's sold his soul more completely to monied interests.

It is easy to buy small plaster models of what you think life is like.

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Re: It's Not A Habit; It's A Brain Disease

Steve Urkel.

Wed Aug 01, 2007 at 02:08:57 PM EST

none

Dalrymple/Daniels is a terrific writer (though he tends to bang on the same gloomy themes over and over). He used to work as prison doctor, and according to him the agnonies of heroin withdrawl are wildly exaggerated.

 

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Withdrawal

uncarved block.

Fri Aug 03, 2007 at 07:13:20 PM EST

none

    Yeah, I ran into some books in the mid 80s noting that heroin withdrawal was often overstated, and that alcohol withdrawal is fatal in the worst cases, while heroin almost never is. The pros in the recovery field seem quite aware of this, at least since the 70s. Makes you wonder who gained (and still gains) by keeping this stereotype alive in the popular culture . . .

Ex ignorantia ad sapientiam; e luce ad tenebras

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Re: Withdrawal

Lou.

Fri Aug 03, 2007 at 07:51:37 PM EST

5.00 (funny)

Only Bill W. knows for sure.

It's the end of the world as we know it, and I feel fine

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Re: Withdrawal

thefadd.

Fri Aug 03, 2007 at 08:19:33 PM EST

none

I've never heard of alcohol withdraw and the concept sounds pretty ridiculous to me. I've also known some people who went through some hardcore shit with heroin so I'm pretty skeptical of what you guys are saying.

It is easy to buy small plaster models of what you think life is like.

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^ 5

Oh, Yes

uncarved block.

Fri Aug 03, 2007 at 10:13:44 PM EST

5.00 (informative)

   If you've ever talked to any veterans from WWII, or watched a documentary or two on the right topic, you'll hear about men drinking rocket fuel, rubbing alcohol-- anything close to liquor to stave off the DTs, apparently. When I worked at the nursing home, one of the nurses had worked in VA hospitals* for years, and she'd seen this kind of thing often and close up, relating stories of little old men weighing 130 pound requiring three or four orderlies to keep them from hurting themselves or others with their fits once they were finally denied a drink for long enough.
    Heroin fatalities, from what I've read and heard, come more often from overdoses: too much, or too pure a dose. In theory, I guess, a heroin user could- with a clean supply and an eye toward restraint- take the drug for the rest of their lives. Alcohol deaths, on a guess, take place more often in hospitals than at home, and it's easier for the family to conceal (if they want) the actual cause of death; with heroin, death usually occurs in public (ie not at a hospital), and hence is less easy to obscure. The real heyday for DT deaths was during the world wars, too, when there were lots of soldiers dying for a lot of reasons, and a couple hundred alcohol deaths was easy to overlook.
    I want to be abundantly clear about one thing, though: I never want to imply that heroin withdrawal was anything less than nasty and terrible. The discrepancy is between the media accounts (sensationalist, usually) about how bad it is, and how bad heroin withdrawal is compared to another, very legal drug, are what is troubling, or at least curious.

    *As she noted, alcoholism was almost required for many years in the military, especially if you were an officer in peacetime. Many functions and events to attend, and liquor present (and urged, especially in the 40s and 50s) at every one. This nurse was hardly PC either: she was from Texas, and proud of that and her rough and tumble attitude. IIRC, she even missed wearing those nurses caps . . .

Ex ignorantia ad sapientiam; e luce ad tenebras

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Re: Withdrawal

Steve Urkel.

Fri Aug 03, 2007 at 08:42:38 PM EST

none

Alchohol withdrawl can be fatal:

"Despite appropriate treatment, the current mortality for patients with DTs ranges from 5-15%. Mortality was as high as 35% prior to the era of intensive care and advanced pharmacotherapy. The most common conditions leading to death in these patients are respiratory failure and cardiac arrhythmias. "

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Re: Withdrawal

pO157.

Mon Aug 06, 2007 at 10:37:04 AM EST

none

Makes you wonder who gained (and still gains) by keeping this stereotype alive in the popular culture . . .

The ONDCP? I have no idea why they have yet to produce an informational video on the joys of withdrawal and send that out to impressionable youth, much like the blackened cancer lung pictures on ciggies.

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Directly And Indirectly

uncarved block.

Mon Aug 06, 2007 at 08:16:54 PM EST

5.00 (brilliant)

    Well, the folks who profit directly would be anyone who writes (or "writes") a memoir about their addiction that anyone cares to read: rock stars, actors, comedians, say, but also less famous folks hungry enough to sell their past misfortune to sell some books. (Think James Frey, without the lying, though his drug was crack, apparently.) Publishers who profit from sensationalism also directly stand to gain, though that's a less direct explanation-- the "ex-drunk on a mission" type of book was around well before heroin ever became a source of public concern, and continues to this day. (Eg. Drinking: A Love Story, and at least two other memoirs that I can't recall the exact title at this moment.)
    Law enforcement agencies have had a stake in this perception, for many reasons. In the most charitable take, it's an attempt to prevent what addictions they can; Prohibition is never coming back, so pointing out that liquor is addictive is a waste of money that could be spent trying to combat meth, crack and heroin. In a less charitable take, it was a tool in the battle over federal funding, a way for city police departments to argue that they deserved more funding because they were dealing with worse problems. (This presumes that you think of heroin as primarily an urban phenomenon, an assumption that's dubious, to say the least.) At the policy making level, heroin (with other drugs) was the substance for which marijuana was a "gateway drug". If heroin withdrawal was perceived (rightly or wrongly) as no big deal compared to alcohol . . well, let's just say the 60s would have turned out a lot differently.
     Liquor companies have a huge stake in keeping their product looking benign, normal, even healthy. How much you can argue these companies profit directly from being able to fund massive advertising targeting a younger (and hence not yet addicted) market depends on whether you think they're marketing the glitz and glamor of youth, or whether they're seeking to addict new customers for the long haul. IMO, both trends are at work, and both are helped by heroin and other hard drugs as bogeymen in a "drug war" that doesn't include beer, wine or liquor . . .
    At least that's what I can think of off the top of my head.

Ex ignorantia ad sapientiam; e luce ad tenebras

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