Friday, August 8, 2008

Why Don't They Just Say No?

Are addicts at fault for refusing to get well?

It often seems as if alcoholics and other drug addicts are at fault for perversely refusing to get well. Rarely do the treatment methods, or lack of them, come under question. The traditional view of the addict as an immature and irresponsible person, short on will power, low on self-esteem, and forever at the mercy of his or her “addictive personality,” works at cross-purposes with the goal of helping addicts recognize the need for treatment. Addicts have traditionally been taught to think of themselves the way Franz Kafka thought of himself in relation to his tuberculosis: “Secretly I don’t believe this illness to be tuberculosis, at least not primarily tuberculosis, but rather a sign of my general bankruptcy.”

Who is really at fault here—the patients, or the healers? Most of our current medical, legal, and psychiatric approaches to the prevention and treatment of drug addiction have failed—and are continuing to fail. As Susan Sontag has written: “Psychological theories of illness are a powerful means of placing the blame on the ill. Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.”

In Samuel Butler’s classic utopian satire, Erewhon, sick people are thrown in prison, under a statute that makes it a crime to be ill. Is that our current approach to addiction? Does the drug problem belong in the Attorney General’s office, as it now stands, or in the Surgeon General’s office, where a growing number of researchers say it belongs? In light of new medical findings about addictive disorders, what is enlightened public policy, and what is not?

Recent research in neurophysiology, cell biology, and molecular genetics, coupled with breakthroughs in the science of brain imaging, have made it possible, for the first time, to venture a solid assault on the basic mysteries of addiction. The past fifteen years have been exhilarating times for biomedical researchers in general; a time when basic breakthroughs in the biomedical sciences have changed the way science approaches a variety of human afflictions. We have been used to thinking of such conditions as alcoholism, drug addiction, depression, and suicide in terms of causes rooted firmly in the environment. What events in a person’s life, what outside social factors, led to the problem? However, the new medicine is telling us that we have been looking in all the wrong places for causality.

When I first began following the scientific research on addiction and alcoholism, the field was small, the insights tentative, and the overall enterprise woefully underfunded. Today, more than a decade later, an interlocking maze of biomedical and psychiatric sub-specialties make up the world of addiction science. I can only hope to impart a sense of the important work being done in addiction science. What I had originally viewed as a series of potential breakthroughs in addiction research very rapidly became the tip of an enormous iceberg: brain science, and the revolutionary new directions represented by modern biological psychiatry. The brave new sciences strongly suggest that, when it comes to addiction, the place to look is inside the brain itself.

Photo Credit: Conversations on the Fringe


Peter O'Loughlin said...

This writer suggests that the reason anyone uses psycho active substances, regardless of their legal status, is to change the way they feel. Knowingly or otherwise, they are seeking an altered state of consciousness.

The resons why some people become addicted, defined here, as the inability to control use, are more obscure. Bearing in mind that Joseph Dubey noted that there were more theories about what caused addiction than there are drugs. I'm inclined to leave the answer to that mystery, to those more erudiite than myself, lest I end up with that incurable condition common among social learning theorists, politely described as rectal retention of the cranium.

On a more serious note of why some addicts are unable to say no, there is a highly interesting article by Mark Moran citing Nora Volkow in the July 6 2007, issue of Psychiatric News.

I found it free of unecessary jargon, together with a clear explanation, and completley logical.

Ashley M@Stonehill College said...

This article points to some of the most important issues surrounding addiction. First off, I definitely think blaiming the addicts themselves for not getting help causes more problems. When you are addicted, you already feel so useless, helpless, and insignificant that having more people, including professionals, tell you how at fault you are for not getting better will only lower your self-esteem, self-image, and motivation to seek help. At the very least, we could at least offer support and encouragement for addicts to get help, instead of playing the blame game.

Secondly, I think the question of who to blame is one that does not have a clear answer. I've already established that I do not think addicts are to blame for not getting help but we cannot place all the blame on drug counselors or drug programs as well. Addiction is a complex phenomenom - there are a variety of things that cause it, sustain it, and also make one get rid of it. Every addiction also manifests itself differently in each individual - one treatment plan may work for one person but not another. Can we really sit and blame treatment programs? Before we place blame on anyone, we need to invest more time, research, and effort into the complexities of addiction. That is the only way to truly know how and/or why healers are not getting through to addicts.

Lastly, it has clearly been shown that the brain plays a large role in addiction, though we are unsure of that exact role at the moment. It has been shown that addiction may also have a heritability component as well. My only concern would be to not forget the impact of environmental and social factors on addiction; I say this for two reasons. One reason is because placing too much emphasis on the brain may make drug users and addicts more likely to blame their habit on their "brain" and write it off as something they cannot control. As much as I believe addiction is a disease, we need to be careful that we do not give addicts an easy exit and/or excuse for their problem. My second reason is because, more likely than not, the brain probably interacts with environmental factors when it comes to addiction. This has already been shown to be the case in other psychological areas (nature vs. nurture debate, anyone?). If we can focus more on the brain AND environmental factors together rather than separate, I suspect that will yield better results.

Dirk Hanson said...

"My only concern would be to not forget the impact of environmental and social factors on addiction"

That's certainly a valid concern. I plead guilty to emphasizing the scientific and medical side, but in no way would I discount the many environmental and social factors that produce addictive behavior.

Anonymous said...

I`m sorry but drug addicts had a choice to take drugs or not.Nobody held them down and injected them with say herion...All the money spent on helping them is in my view misdirected.I personally smoke that is my choice i know it will damage my lungs and ultimalty kill me early but as i said its my choice same goes for drug users they had a choice to take drugs in the first place.Maybe now that they are addicted they havent but they did!I would say that all the money that is spent on mollycoddling addicts should be allocated to spent on enforcing detocox they should be made to come of drugs whether they want to or not,injecting drugs into either your groin or arm doesnt show a rational state of mind.
If went a person is arrested and is found to be an addict they shouldnt be given a bed for the night and a social worker!I work and have done so since i left school over 25 years ago and i resent the fact that drug addicts get treated with kid gloves"there there its not your fault"
I realise that my views are not pc but from people that i work with and family and friends i am not alone.

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