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