Choosing To Use?

Theodore Dalrymple argues that addiction isn’t a disease:

To take only one point among many: most addicts who give up do so without any medical assistance—and most addicts do give up. Moreover, they do so at an early age. The proximate cause of their abstinence is their decision to be abstinent. No one can decide not to have rheumatoid arthritis, say, or colon cancer. Sufferers from those diseases can decide to cooperate or not with treatment, but that is another matter entirely. Therefore, there is a category difference between addiction and real disease.

The pretense that a non-disease is a disease may actually hinder people from deciding to behave better: they will instead wait for their medical savior, as Estragon waits for Godot. Whether this hope is justified or not, the pretense will certainly involve much public expense, just as would fitting out an expedition to discover unicorns somewhere in the world.

To treat addicts as people to whom something has happened rather than as people who have decided to do something is to infantilize them. It is another small step in the transformation of the population into wards of government.

A doctor in the comments section pushes back:

I understand the frustration with categorizing a choice-based malady with other conditions that seem to occur for now reason. But as a doctor, I see lots of people with diabetes, hypertension, or cancer that was caused by their choices.

Drug abuse and addiction are simply on the continuum of diseases, whether self-induced or otherwise. True, rheumatoid arthritis is good old-fashioned all-American disease, but drug abuse, while less pure, still encompasses all the standard attributes of disease. The issue is that due to neurochemical changes caused by the initial exposure to, say, methamphetamine, the victim may lose the ability for further decision making. Thus they induced an essentially incurable disease state in themselves. Calling it a disease helps when it comes to the science of studying it and trying to provide the afflicted with better tools to fight it.

Another commenter:

Dr. Dalrymple. I”ve read most of your books and many of you articles, and I agree with all of them except this one. When you see the destructive power of addiction among both rich and poor, educated and uneducated, and the powerlessness of otherwise intelligent people, it’s hard for me to understand how you view this as essentially a “will power” issue. You’re wildly off base. I’m very disappointed. This is a wholly unsupported thesis. No facts or numbers to justify your rash claim. Highly unusual for you.

But an addiction counselor agrees with Dalrymple:

I retired after spending 25 years counseling alcoholics and drug addicts. IMHO, advances in neuroscience show that there is definitely a physiological component to substance abuse. There are some people who just like doing drugs and alcohol and have no desire to quit, but they are a definite minority. There is a another definite minority who do quit and make it stick, they do not relapse. Then there is the large majority who want to quit but keep relapsing. Some of that may be that they are too lazy to follow a treatment regimen, but for most of these people the problem is that they come from family and social backgrounds that are not supportive of their efforts to stay clean and sober. And no medical intervention can cure laziness or a dysfunctional family/social environment. So government efforts to treat addiction like a physical disease are doomed to failure. But this will only be apparent much useless expenditure of the taxpayers’ hard earned money.

Previous Dish on addiction here and here.