Bill White responds to a recent article that has gotten a lot of attention by Gene Heyman, a disease model critic. Heyman (and a couple of other recent articles) question whether it’s accurate to call addiction a chronic illness.
If there is anything that the full scope of modern research on the resolution of AOD problems is revealing, it is that the dichotomous profiles of community and clinical populations represent the ultimate apples and oranges comparison within the alcohol and other drug problems arena.
Conclusions drawn from studies of persons in addiction treatment cannot be indiscriminately applied to the wider pool of AOD problems in the community, nor can findings from community studies be indiscriminately applied to the population of treatment seekers.
Adults and adolescents entering specialized addiction treatment are distinguished by:
1) greater personal vulnerability (e.g., male gender, family history of substance use disorders, child maltreatment, early pubertal maturation, early age of onset of AOD use, personality disorder during early adolescence, less than high school education, substance-using peers, and greater cumulative lifetime adversities),
2) greater problem severity (e.g., longer duration of use, dependence, polysubstance use, abuse symptoms co-occurring with substance dependence; opiate dependence),
3) greater problem intensity (frequency, quantity, high-risk methods of ingestion, and high-risk contexts,
4) greater AOD-related consequences (e.g., greater AOD-related legal problems),
5) higher rates of developmental trauma and post-traumatic stress disorder,
6) higher co-occurrence of other medical/psychiatric illness,
7) more significant personal and environmental obstacles to recovery, and
8) lower levels of recovery capital–internal and external resources available to initiate and sustain long-term recovery.
Bill points out the real world consequences of these arguments.
This is not merely an academic question. Are families reading the headlined summaries of such reviews to conclude that the prolonged addiction of their family member results from moral and character defects of self-control that prevent “maturing out” of such problems that most people, according to these reports, achieve? Should such chronicity render one unworthy of family and community support?
Read the rest here.