I still hold the opinion that most of these arguments are less about whether it’s a disease and more about perceived social, cultural, personal and interpersonal implications of calling it a disease.
The alternative liberal media has been running more and more articles like this one about the “myth of the addict gene.” I suspect that there the following are at least a few reasons for these criticisms of the disease model, 12 step recovery, and any legal restrictions on drug possession or use:
- First, there is a strong anti-drugwar sentiment. Many of these writers and activists are rightly horrified by the appalling increases in incarceration for drug offenses. They want to shift policy toward harm reduction and decriminalization of drug use and possession.
- Second, there is anger at social mores and drug policy that characterizes all drug use as pathology and/or criminality. I’m of the opinion that they go too far in the other direction and seek to characterize all drug use as a lifestyle choice.
- Third, there is suspicion of 12 step group’s spirituality.
- Fourth, there are privacy concerns about all genetic testing.
There’s a way in which the article is a straw man argument. I don’t know of anyone who argues that there is a single gene that wholly determines whether one becomes an addict. We know from twin studies that genetics play an important role in the etiology of addiction. Evidence that addiction is a brain disease continues to grow, as well as evidence that multiple genes are involved. Even advocates of addiction as a purely biogenic problem would concede that environmental factors influence the onset, course, severity and treatment response of addiction.
A reader comments on my last post:
The anti-disease concept crusaders seem to ignore that environmental/psycho-social influences are proven to change the biochemistry of the brain. E.g. PTSD and sexual abuse have been shown to produce some of the same biochemical markers in the brain nake-up and chemistry that are present in addiction so small wonder there’s a correlation.
A lecturer I heard at a neonatal/pediatric pain management conference I attended a few years is a pioneer in neonatal pain research (Dr. Anand.) In one of his rat studies he demonstrated that rat pups exposed to minor but repetitive pain stimuli (i.e. neonatal stress) had many brain changes and associated behaviors as adult rats. One of the brain changes was a marked increase in the NMDA receptors (know to be associated with addiction as well as ADHD) and one of the behavior changes was a MARKED increase in alcohol preference – from 10% in the control to 90% (or as he put it in his melifluously accented voice, “The rats were really hitting the bottle.”) Sure sounds like a brain phenomena to me, whether it’s environmentally and/or genetically and/or otherwise induced.
There clearly is consensus building about the brain being central to addiction. However, the question that I rarely see address is this–assuming that addiction is a brain problem, are addicts born with a different brain, or is it created by drug use, life experience, etc?
My biggest problem with the trend I addressed in the previous post is the motives of the critics. If you’re offended by the war on drugs, attack that. If you want social mores and policy to create space for social drug use, make that case. It’s not necessary to attack the disease model to make their case. (I’ve got the same problem with people who characterize all excessive drug or alcohol use as a disease.) If they really question the disease model on scientific evidence, by all means, speak up. However, I suspect that too often there are other motives.