Addiction as a disease concept

[Bodymechanic]

I am interested in your views concerning addiction as a disease. It is my understanding that SMART recovery rejects the disease model of addiction. Is it that you reject the concept or do you simple believe that concept is useless when it comes to a practical solution to the problem?

I see the heart of the issue as being what is and what is not a choice.  I believe there are many things in life that we like to think are choices, which are in fact driven by biochemisty. The issue of choice is simply self deception.

I like to compare the choice of addiction to the choice of having children. Early on in my life I swore that I would never have children and I meant it.  Well at the age of 48 yr, guess what is sitting next to me.  A beautiful, bright eyed 13 mo old girl. I fought as long and hard as I could but in the end, the biochemisty was too strong for me. I had this child against my will in the same way that I find myself using drugs against my will.  Of course now that I have her, I would not trade her for the world.  

I believe that addicts don't choose to be addicts any more than homosexuals choose to be homosexuals or even a manic depressive  choose to be manic depressive.  There may be a choice in addictions but the degree is very unclear. I have read Jack Trimpey's book and he does make some good points.  Still I do not understand how anyone could believe an addict would "choose" to lead this type of life. I wish it were that simple. If I speak only for myself, than there is a strong biological component of this problem which cannot be ignored.

[groovygirl]

Interesting topic...I have gone back and forth with this.  I have a doctor who thinks that saying addiction is a disease is an excuse.  I find myself nodding and agreeing with him, because he makes a lot of good points...he thinks we have the choice to do anything, including taking drugs.  I don't want to get into it, because it's controversial and it makes people unfortable to think what they have may not be a disease but simply a choice that they made...a bad choice.

Addiction is addiction to me...I know myself, and I know I am weak when it comes to opiates.  From the time a couple years ago that I took my first Vicodin, I knew I was in trouble.  It made me feel great, and my problems seemed much more insignificant all of a sudden.  I remember standing in the ocean after taking my first pill, and a warmth spread through my body.  I was having fun with my child and husband, but I couldn't wait to get back to the car to take another pill.  I just wanted more of that good feeling.  I could go on and on, but I will spare you.  I'm depressed today, and a Vicodin (or a handful) would really feel good right about now.

[Bodymechanic]

I already know that I am asking a question that does not have an answer. All there will be is opinion. The problem is that if there is a biological component it needs to be addressed. Having said that, I would like to relate an experience I had concerning behavior and brain chemisty. About 10 years ago I went on prozac for about 4 months. Unfortuantely it did nothing for my depression. What facinated me was that during those 4 months I stopped biting my nails. I have been nail biter since early childhood. I am still a nail biter. When I was on the prozac I made no conscience decicion to stop biting my nails. I just stopped. I never liked the fact that I bite my nails but I do it "against my will".  The only change was a change in brain biochemistry.  I can stop biting my nails through "willpower" and have stopped for a few days at a time.  But it is an endless struggle. The second I take my focus off avoiding it, I find my fingers in my mouth.

At this point in my addiction, bupenorphine was suggested to me by a doctor of addiction.  In his opinion, I had a disease that needs treatment.  The same as any other chronic, re-occuring disease.  He did not seem to care if I called it addiction, fibromyalgia or depression. His only point was that I need to be on medication and someone else needed to control the pill bottle.  Sometime in early December I will start. Past that I am out of ideas. If I must I will go back to meetings 7 days a week, call my sponsor, work the steps, get involved in service work and basically spend a good portion of my life taking about my addiction.

[lisabet]

I agree with Bodymachanic's opinion of addiction being largely due to biochemistry.  Why would anyone want to "choose" to be an addict?  It's the same thing (as mentioned above) as anyone "choosing" to be gay.  Not to compare the two - but with all the stigma and prejudice why would anyone consiously "choose" to be gay?  I happen to come from a family with "alcoholic genes" - I'm always telling my son I hope he can distinguish being a social drinker, where you can have a drink or two and let it go at that - and a full blown "alcoholic" where you can't quit drinking once you start. (Like I'm such a good one to give advise...) ha.  Why is it one person can take pain meds responsibly and another abuses them?  I know in my heart that due to my chemistry, I'm "predisposed" to drug and alcohol problems, but that doesn't mean I, or anyone are doomed by this.  My father, who is an alcoholic, quit drinking when he had an almost fatal heart attack.  He felt miserable, but he knew he had to quit, so he did.  I have a friend, who smokes occasionally (as do I-only all the time), who amazes me with her ability to chain-smoke one day, and throw the cigs down the next with no thought to it; same thing with drinking.  I could "never" do that so easily.  I feel like I'm making progress, but it's a fight every day.  It will never be easy for me.  Lisabet

[theGolden1]

Does the term "drug of choice" imply anything to you? How about "sexual preference"? Of coarse we have a choice. Maybe we are born with a certain predisposition to addiction and maybe we have the genetics to be an alcoholic from the first drink ... but we still have our "free agency". We can chose to try .... we can chose to fight. We can let the doctor hold the pill bottle or our mother or our husband .... we can alow ourselves to be brainwashed by one program or another. We can go to Tibet and hide in a cave for the next 5 years! The choice is ours. I'm sorry for getting so dramatic .... but I do think we have many options. We grows through overcoming adversity. I guess what I am trying to say is it's all true .... we should do whatever works. Getting clean is a process. I don't see why is has to be some kind of devistating experience. These are not the dark ages. I don't see how it would benifit anyone to suffer through W/D. We need to work with our medical professionals (someone we trust) and work on our spirituality to effect a real change in our souls so we can be free to love. It's funny how the love we feel for our children is more addictive than drugs.  Love will cure anything. Lets love ourselves ... guilt is not going to further us in anyway. I hope I haven't said anything wrong or offensive .... I appreciate you and everyone here. I'm even thinking of cutting another 25mil of ultram tommorrow .... (just thinking. I'm not ready yet) .... take care, Goldie

[theGolden1]

I re-read my letter and it sounds so "confrontational" .... I'm sorry. I am a lousy writer. I tried to make a point and got carried away (smile) ... please forgive me ... G

[bezz]

I believe opiate addiction is different than addiction to other drugs.  I am was never addicted to any drug until recently to opiates.  I am pretty sure that opiates changed my brain chemistry, receptor sites, etc.  I was not born with the altered brain chemistry and nor prior drugs changed my brain chemistry.  Opiates did, and now I need permanent help.  Like others, I have found that bupenorphine, or similar, is the solution.  Over a month of naltrexone did not provide enough time for my receptors and other chemicals which became out of whack, to restore to normal.  I either need a permanent supply of opiates, or a miracle medicine which does not yet exist.  I will settle for bupe, which has proven efficacious, twice daily.  I could not have made it through another month without something.  I cannot relate to those who say the first week is really all you need to be able to get through to detox, but we're all different I guess.

[bezz]

Sorry, my point was that for me, drug addiction was not a disease, but became one from opiate use, and not to all drugs, just a disease relating to opiates.

[FINISHED?]

I gotta say...I completely disagree with the notion that addicts are predetermined in the womb. I have tried just about every drug & none of which grabbed hold. I chose to become an addict to Vicodin. I chose to exceed my dose. I chose not to quit. These were all my choice & not some misfire in my brain. I've heard the term "addictive personality." This I'd support long before the idea that I was born with addictive brain chemistry. I do believe that it takes a certain kind of person to let themselves become addicted. Regardless of what you tell yourself, it was your choice therefore your fault. This does not make us bad people. It makes us people. People make mistakes. Some just worse than others.

[beenthere2]

I have a hard time with the term "disease" also.  Personally, I think its because I am a health care professional who has seen what diseases really are and what they aren't.  I consider my addiction a "habit".  If you really think about it and look at how and when you take your pills or snort your line, or shoot up, don't you usually correlate it with something you do?  For example, I would always take my first pill/pills in the morning with my 3rd cup of coffee.  So then I would have a pretty good buzz going when I was watching "Rosie"- lol.  I know this sounds simplistic but my point is that when you do this day in and day out, habits develop.  When I was working, I would take them when I hit a certain point on my drive; that way by the time I got to work I felt good.  So then it seems that it would be pretty easy to "break" this habit, right?  I mean, stop drinking coffee or watching Rosie, etc etc.  But its not that easy.  What about if you get used to being high while working?  Quit your job?  No, a lot of times, thats not a possibility.  It gets to a point then that you just get "used" to feeling high.  And thats the hardest damm habit to break.

[diso]

In my opinion, addiction BECOMES a disease.  Like many people here have mentioned we begin our addiction by making a series of choices.  In that way, addiction doesn't seem like your typical disease.  However, once addicted our choices become increasingly limited.  As the addiction takes over we become increasingly powerless to overcome it.  I guess to me the difference between addiction and a conventional disease is that there always seems to remain within the individual the power (no matter how weak) to choice to stop the addiction, in other words cure the disease.   Perhaps the use of the word "cure" is too strong.  Maybe once addicted we merely treat the disease of addiction for the rest of our lives.  It is forever there with in us but weakens if we don't relapse over time.  I know alcholics who have quit 20 years ago who still say they sometimes think about the alchohol.  Their thoughts have turned from full blown cravings to merely random unexpected thoughts.

Something seems to switch in our brain once we become addicted.  We cross a line that we can never return to.  For example, long before I became addicted to oxys I used them on occassion when I drank.  I didn't drink that often but when I did there was nothing better than what we called a "champ pill" like a loritab or oxy to increase the buzz.  I would take one pill and then not use another for 3 or 4 months.  When I became addicted I crossed that line of mere sporadic use forever.  I can never just take a pill here or there again.  My brain is reprogrammed and one pill will never satisfy it.  In that way, the addiction has become a disease.  The treatment of the disease of addiction is always in our control.  Of course, as mentioned above, the deeper we become addicted the more control we lose.  Some here have found the strength to overcome years, even decades, of addiction.  In some miraculous way, they were still able to exercise control, make the choice to become clean.  Hats off to all of you.  I was only addicted for about 8 months.  I got into a pretty heavy habit.  I do take responsibility for my choices.  I have made some pretty damn bad ones.  But I know I can never have a "champ pill" again.  I am an addict and I have a treatable disease.   Just my opinion.

[groovygirl]

I'm so freakin' sick of being an addict...of talking about addiction and thinking about addiction.  It's becoming a real bore to me.  I'd give anything...everything I have...to wake up tomorrow and not think about drugs ever again.

[FINISHED?]

Saying addiction becomes a disease? I don't believe that myself. A problem...YES. A disease...NO. I am an addict. It's as plain & simple as that. I'm not a person suffering from a disease. I am addicted to those little white pills. Sometimes it feels like a disease but I'd much rather call it a stronghold that Vicodin had on every aspect of my life. There is no clinical reasoning why we actually become addicted. Just ideas. That it all that I am sharing here. My ideas, feelings & experience. We all have a problem here & we've all been through the withdrawls, are going through them now or getting ready to. We should stop giving the problem a title & take it for what it is...a problem.

[diso]

Perhaps you are right.  Perhaps, an addiction is nothing more than a "problem."  I think people ook at the use of the term "disease" as to an addiction in one of two ways: (1) People use it as an excuse.  My addiction is a sickness and its not my fault; or (2) My problem is so serious and has rendered me so powerless that I need to treat it as if I had cancer.  I must exert the same energy in finding a treatment or a cure of this disease just as I would if I was diagnosed with cancer.

I think people are hesitant to label addiction as a disease because they are looking for an excuse.  This is a good thing.  I view it as a disease because I think it is, in your terms, a very serious "problem."  Perhaps, it is wrong to label it a disease but that label does impress the seriousness of what an addiction is.

[diso]

Just to correct one sentence I made above.  The first sentence of the second paragraph should read: I think people are hesitant to label addiction as a disease because they are NOT looking for an excuse.

[Sugarbeens]

My opinion.  You are all right! Addiction and habit run hand and hand. Love to all.  
Butterbean

[Rex1]

On addiction as a disease, I think an interesting factor to add to the occasion is the genetic link.

Take my family - alcoholic mom, alcoholic dad, and grandparents on both sides. When I quit booze the addiction doc said I was born with an alcohol bullseye on my head. "you can do a lot of things in your life", he said. "Drinking isn't one of them".

But then you go next door to my neighbors' house and they can have exactly two beers everynight. At a party I heard them say, "naw that's enough, two is enough". An addict rarely uses that phrase btw.

So you have two familes  - one genetically predisposed, and another not, just like cancer, or heart disease. The flip side of this argument is the issue of choice, which is where I think characater, morals, and your upbringing come in. If you have enough training upfront to know what's right and what isn't, you step around the quicksand end never get sucked in.

I personally believe that alcoholism and drug addiction is a disease, and is part of the complex triangle of genetics, environment, and willpower that forms the brain at an early age. Any one of these factors is too dominant or weak, and the disease gets worse.

Finally, I always wondered why, since I was a teenager, I thought to myself "If I am not on something, I am not having fun, and a party is not going on. And life sucks if you're not living a party 24x7." Where did this come from? I can tell you this is my dad to a tee when he doesn't have his vodka to a Tee - he's miserable. Some of what I have I got from him. And ALL of my brothers and sisters are the same exact way.

JImmy Carter lost 2 brothers and sister to pancreatic cancer I believe it was. A disease genetically passed to his family sonehow. I see the similiarities with drugs/alcohol in my life with one exception, as 1day mentioned. If and when I choose to, with some outside help and a higher power, I can get out.

Out is a relative term, though. Many don't know that the song Hotel California by the Eagles is about Alcoholism. "You can check out anytime you like, but you can never leave".

sounds like a disease to me.....

Rex

[groovygirl]

Why did you address this to me?

[groovygirl]

P.S.  I AM familiar with the song, and I know what it is about.  I never said addiction isn't a disease.  I said one of my doctors thinks it is not.  I have not made up my mind what I think, and it wouldn't really help me to know one way or the other.  I am an addict whether it is a disease or not...no sense in arguing about it.

[Rex1]

No offense meant.

Rex

[Bodymechanic]

All things considered I agree with my friend Mariposa. The disease concept of addiction is a good topic of  conversation.  Unfortuantely at the present time a definative answer one way or another is not very useful.

In the end I suspect it will turn out to be both a disease and a choice.  A very complicated web of biochemisty, genetics and social factors will surely be involved.  If one assumes it to be a biochemical disease, then it might be best treated biochemically. Too bad the only biochemcial treatment for addiction is methadone and buprenorhine. Neither which is a real cure.  Both could best be described as harm reduction since when you use these things you are still an addict. On the other hand if it is strictly a problem of personal maladaption to one's own life then maybe 12 step meetings, jails, and rehab programs would be the way to go.

What pisses me off immensely is that is far as I know, no one is doing any research to find out how to solve this problem. We spend billons of dollars punishing people for selling and useing drugs. Not to mention the crimes committed by people trying to keep up their habits. Is it only me that thinks that this is a tremendous waste of money, time and lives.

[Rex1]

I agree with you on the issue of disease vs choice - it's a complex issue.

But one day, (not be confused with 1day ;-)), they will understand what fuels and addicts mind, and solve it likely genetically.

Where I disagree is on the issue of your last statement. We spend billions of dollars punishing people who BREAK LAWS. There has to be a law and right now the law says that is illegal, so if you break the law you go to jail.

To me there is no more vile person on the earth than the people pushing street drugs which eventually lands kids in a life they never expected to lead. It's all for their personal wealth.

There is a big difference though, between the big drug companies and the street guys.For one, currently prescription drugs are legal. For another, there is (usually) a doctor as a middle man, and you can even count the pharmacsists too. And the most compelling case is that many, probably most addicts of pharm. drugs have a legitimate need, or at least started out that way. I have yet to see a medicinal need for Cocaine or crack, or ecstacy.

Are people abusing the pres drugs? Yes. Do they know this? Yes. Until soomeone makes it unlawful, they will keep doing it. My point is I see a huge gulf between drug dealers and drug companies. I believe the vast majorty of peopel using Vicodin are using it responsibly.

Can you say that about people using street drugs? Would you kill someone to get your next Vike. I may have been bad, but never ever ever close to waging the war the street dealers have for a long time.

A key point which I have not seen here is this. At every major drug company, there are bean counters monitoring the shipment numbers of Vicodin, Oxy, Percs, and everything else under the sun. And there is absolutely no doubt whatsoever that the numbers and profits for these companies are exploding in very recent history. IS there not an Alarm going off somewhere?

These profits should be harnessed and invested into the issue you spoke of - researchj into the addicts mind. In the meantime, the war on (street drugs) goes on.

My humble opinion only, and thanks for the topic,

Rex

[RobynBanks]

I dont think addiction is a disease but i do think 1. LOW IMPULSE CONTROL is something you are born with 2. I agree that once addicted to your drug of choice, it alters your body chemistry 3. Environment (access to drugs) during 'vulbnerable ages/stages of life' plays a key factor I WISH I HAD A SOLUTION