 Is addiction a disease?We live in a time where almost every form of deviating behaviour is considered to be a disorder. This applies to the somewhat overactive teenager that is conveniently diagnosed with ADHD. The silent, withdrawn child that has difficulty connecting with others, is quickly diagnosed with PDD-NOS. And if you are addicted, you are ill.
Source: Wim van den Brink, ‘Verslaving, een chronisch recidiverende hersenziekte', Verslaving, 1 (2005), pp. 3-14 Addiction as a disease In its 2002 report ‘Pharmacotherapeutic Interventions in Drug Addiction', the Health Council of the Netherlands states that addiction is a "condition with a biopsychosocial etiology [cause], which tends to run a chronic course." In short: addiction is a chronic brain disease. Connected to this is a destructive life style for the person in question as well as for his environment. Well, now it has become common knowledge for every addict. He knows his label and his place. In his oration of September 2006, entitled ‘Chronic addiction: the therapist, the patient and the disease', professor Cor de Jong - professor of addiction and addiction care at the Dutch Radboud University - that addiction care should evolve around helping the patient (!) deal with his disease. "Treatment of addicts must change. Therapists should learn to act according to the new insight that addiction is a chronic brain disease. They should say goodbye to their beliefs that addicts are actually hopeless cases,"* De Jong says in his inaugural lecture. "The therapist is part of the addict's problem. He should show involvement and concern, offer hope, try to eliminate physical and psychological complaints with medication or conversations, participate in re-integration and - here it is - speak about how to deal with your disease as a patient."* In response to the question whether or not an addict is chronically ill, De Jong states: "There is a rising scale from use, abuse and dependence towards addiction. It is determined that there is no gradual transition between the different stages but that at a certain point there is a permanent change. This mainly evolves around a loss of control. The sense of the importance of stimuli is distorted, the memory is mainly focused on use. There is a quick onset of craving and a diminished capacity to suppress behaviour, which leads to use. These are all complex processes in the brain. That's why we call addiction a chronic brain disease."* Criticism towards addiction as a disease Not everyone is eager to consider addiction to be a disease. In October 2006, the Dutch edition of the book ‘Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy' by the British author Theodore Dalrymple was published. Again, an entertaining book. With the sharpness and quick-wittedness he is known for, the author sharply challenges addiction care. "There has always been a great temptation to run away from the existential problems, discontent and horrors of life by means of a chemically induced rush. It will also be that way, at least until the meaning of life has been permanently found,"* Get real, addiction a disease?! Dalrymple blames the existing medical institutions should be there to help addicts of adopting a technocratic approach towards addicts and their problems. They avoid every referral to the moral and spiritual aspects of addiction. Addiction has medical consequences? Of course! "However, medical consequences, no matter how serious, do not make a disease."* According to Dalrymple, drugs and drug use are first and foremost moral and mental problems that will never cave for medical treatment. Considering addiction to be a disease and addicts to be patients has led to ever more expanding addiction care institutions. Because, Dalrymple cynically mentions, "it is easier to administer a dosage of medication than to give a reason to live. The latter medicine has to be offered by the patient himself."* We consider detoxification to be a larger problem than it actually is and we are too tense about the whole issue. It is not that difficult. Addiction literature has entered this idea into our heads but it is complete nonsense from a medical viewpoint. Dalrymple especially focuses on opiates, such as heroin. It is wrong to compare detox with a severe flue, he says. A severe flue is worse. Furthermore: addiction does not just happen to someone. This would reduce a person to the moral and intellectual level of fish. In his book, Dalrymple firmly fights against the image of the addict as a victim who cannot help being addicted and is hardly able to change his life for the better. Addicts always have a choice. Dalrymple: "The fact that there are people that use heroin at irregular intervals, as a ‘treat', and that most addicts begin their addiction by taking their drug over a longer period of time, at regular intervals, before using it three or four times a day, suggests that it is better to say that the addict hooks the heroin instead of saying that the heroin hooks the addict. The active principle in this interaction is the person, not the drug, and addiction is a freely chosen situation - a very clear fact that is being ignored by the addiction bureaucracy."* Addiction, a disease? Not according to Dalrymple. And that is obvious, he says, because you only have to look at the fact that this disease can be cured in such unorthodox ways as: coming after having served overseas as a soldier, internment or religious conversion. "Try doing this with cancer..."* He also states further on, "People are able to give up their opiate use when they want to. They want to when they have sufficient reasons to do so, either positive or negative ones."* Addicts continue to be responsible for the choices they have made and still make. Depriving addicts of their responsibility - something that is possible when addiction is considered to be a disease or when society tries to reduce the harm to addicts - is wrong. According to Dalrymple: "A harm reduction that consists of not fully taking responsibility for an increase in harm could probably better be called ‘employment."* Conclusion Considering addiction to be a (brain) disease causes certain risks. There is a real danger of not taking into account the other, important - maybe even more important - aspects of addiction. Last but not least, this also concerns the attention for the moral and existential aspects of addiction. By not taking these aspects into account, professional care misses its goal and fails in offering that which addicts really need to become healthy. * Translator's note - quotations: translation mine References
Published in De Hoop Magazine, no 5, 2006 |
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