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Addiction, a disease? or self inflicted?
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sbsquarepants wrote: »To be honest I suppose what I've done is I've equated the word disease with blameless - which is not correct.
I suspect you are not alone in this. The fact blame and accountability has come up so much in this still short thread suggests that that move is one a lot of people are making.
I feel not only is it the wrong move to make, but an irrelevant one. There is simply no one out there who matters, like the medical industry for example, who are defining "disease" in terms of accountability or blame. It is just not happening.
Rather they define it in terms of A) How it manifests at the level of the body and brain and
the treatment modalities that work on it.sbsquarepants wrote: »i'll withdraw my ill thought out comments entirely.
The fact you are considering and acknowledging my points and modifying your discourse in response rather negates your self depreciation of being "ill thought out". Looks to me, more than one or two I could name, that you are very much thinking it all out. That is, at least in my ideal fantasy, what a forum like this is for
To think out loud, and have those thoughts evaluated and molded by the responses of others. We could do with a lot more of you sbsquarepants wrote: »I think, largely from personal experience, that to become an addict you must ignore quite a few warning signs. You simply can not become an addict without being complicit.
Read my post #42 (wohoo 42!) above on this one. I myself dodged the bullet of addiction. How close a shave it was I will never know, nor do I really want to know as it kinda terrifies me looking back on it.
But at no point during it did I ignore the warning signs. I was wholly and entirely and blatantly ignorant of them and blind to them. Looking back now I see them as clearly as I see the monitor I am now typing this into.
So I can understand how a person like yourself might not understand how a person with an addiction could miss those signs. I AM (or at least nearly was) that person.... and even I do not understand how I was missing them at the time. So how could I expect you to?
Retrospect is a powerful thing!
But if *I* can not understand how *I* was blind to the signs.......... I genuinely feel for people who never had that experience who are looking from the outside in at addicts and their behaviors. So while I know you are misled in your thinking here...... I genuinely have no tools to adequately convince you of it.sbsquarepants wrote: »When you get to the stage where you are prioritising the buzz of anything over relationships, work, normal everyday life - you need to ask yourself some tough questions. If you don't ask those questions that's not a disease, that's a choice.
But as the ASAM say, by the time you get to the point where such questions need to be asked you have what they are calling the "disease". A disease that has modified your behaviors, your reward mechanisms, your motivational hierarchies and more.
Not by ANY means intending to use an insulting phrase to actually BE insulting but it kinda is one of those "Check your privilege" style things. We WITH the capability, and fully functioning motivational hierarchies and so forth, find it very easy to say "They need to ask the hard questions" because we have that capability and privilege. They, in many ways, have had that faculty eroded and it is not mere choice that has them avoiding the questions, or at least the "right" answers to those questions.0 -
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nozzferrahhtoo wrote: »But as the ASAM say, by the time you get to the point where such questions need to be asked you have what they are calling the "disease". A disease that has modified your behaviors, your reward mechanisms, your motivational hierarchies and more.
Not by ANY means intending to use an insulting phrase to actually BE insulting but it kinda is one of those "Check your privilege" style things. We WITH the capability, and fully functioning motivational hierarchies and so forth, find it very easy to say "They need to ask the hard questions" because we have that capability and privilege. They, in many ways, have had that faculty eroded and it is not mere choice that has them avoiding the questions, or at least the "right" answers to those questions.
I agree with most of what you say but I'm just not convinced of this part. How is this a disease that has modified their behaviour and not just the normal hardwired pleasure / pain reward circuit of the brain doing it's thing, same as it does for all of us.
Chocolate = feel good therefore eat more chocolate. We consciously have to learn too much chocolate = bad and force ourselves to override the compulsion to eat more of it. Leave a child alone and they'll likely eat it untill they puke!
Replace chocolate with cocaine / alcohol / gambling - how is it any different?nozzferrahhtoo wrote: »We could do with a lot more of you.
I'm always telling people this.......you're the first to agree:D0 -
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sbsquarepants wrote: »How is this a disease that has modified their behaviour and not just the normal hardwired pleasure / pain reward circuit of the brain doing it's thing, same as it does for all of us.
Because it is more than just the pleasure responses of the brain in play. Other areas are affected too. Perhaps a more copious amount of quotation from ASAM, rather than my select quoting, is warranted here. I will include it at the end of this post due to it's length.
But suffice to say / TLDR........ the modifications they are suggesting are occurring are slow, cyclical, iterative, and encompass a lot more than merely the reward centers. Rather they impact entire behavior modules, including those of decision making, self care, and more.
So it gets massively more complex than "X feels good = I want more of X".
Further these people generally do not LEAP from moderate use to crazy over use. Rather in a slow iterative process they simply need a tiny bit more.... then a tiny bit more...... to merely get to the SAME level of satisfaction.
If it were a case they were jumping from a glass of wine to a bottle of whisky a day..... I doubt there would be many addicts. They would recognize that "enough / too much" divide of which you speak. But it rarely happens that way. It is much slower, with each increase being so moderate that the person themselves fails to rate the relevance of it.
In my own case, when I avoided falling into the pit of addiction I was so close to falling into, I progressed over a period of 7 and a half years from a beer once a week on a friday......... to 4 and sometimes even 5 1 liter bottles of wine once a week on a friday. To you, and even to me NOW, that is insane. How I did not notice "Hang on, this is an issue" makes no sense to me now. In fact I now believe the only thing that stopped me being addicted, was that I did only ever drink on a friday. Had it been multiple nights a week....... well I dont wanna think about it
But in the moment(s) each increase was so small it is like those times where you look at your finger nails and go "Crap when did THEY get so long, I did not notice AT ALL". Each increase genuinely seems meaningless and irrelevant in the moment.sbsquarepants wrote: »I'm always telling people this.......you're the first to agree:D
Well I am not suggesting a direct cloning program here or anything
At least not one without the potential for some beneficial modifications to the template 
Long Definition of Addiction:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Addiction affects neurotransmission and interactions within reward structures of the brain, including the nucleus accumbens, anterior cingulate cortex, basal forebrain and amygdala, such that motivational hierarchies are altered and addictive behaviors, which may or may not include alcohol and other drug use, supplant healthy, self-care related behaviors. Addiction also affects neurotransmission and interactions between cortical and hippocampal circuits and brain reward structures, such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.
The neurobiology of addiction encompasses more than the neurochemistry of reward.1 The frontal cortex of the brain and underlying white matter connections between the frontal cortex and circuits of reward, motivation and memory are fundamental in the manifestations of altered impulse control, altered judgment, and the dysfunctional pursuit of rewards (which is often experienced by the affected person as a desire to “be normal”) seen in addiction--despite cumulative adverse consequences experienced from engagement in substance use and other addictive behaviors. The frontal lobes are important in inhibiting impulsivity and in assisting individuals to appropriately delay gratification. When persons with addiction manifest problems in deferring gratification, there is a neurological locus of these problems in the frontal cortex. Frontal lobe morphology, connectivity and functioning are still in the process of maturation during adolescence and young adulthood, and early exposure to substance use is another significant factor in the development of addiction. Many neuroscientists believe that developmental morphology is the basis that makes early-life exposure to substances such an important factor.
Genetic factors account for about half of the likelihood that an individual will develop addiction. Environmental factors interact with the person’s biology and affect the extent to which genetic factors exert their influence. Resiliencies the individual acquires (through parenting or later life experiences) can affect the extent to which genetic predispositions lead to the behavioral and other manifestations of addiction. Culture also plays a role in how addiction becomes actualized in persons with biological vulnerabilities to the development of addiction.0 -
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Long Definition of Addiction:
Addiction is a primary, chronic disease of
brain reward, motivation, memory and related circuitry. Addiction affects
neurotransmission and interactions within reward structures of the brain,
including the nucleus accumbens, anterior cingulate cortex, basal forebrain and
amygdala, such that motivational hierarchies are altered and addictive
behaviors, which may or may not include alcohol and other drug use, supplant
healthy, self-care related behaviors. Addiction also affects neurotransmission
and interactions between cortical and hippocampal circuits and brain reward
structures, such that the memory of previous exposures to rewards (such as food,
sex, alcohol and other drugs) leads to a biological and behavioral response to
external cues, in turn triggering craving and/or engagement in addictive
behaviors.
Other than the part that says "is a chronic disease" - what differentiates this from how the brain handles any other behaviour? Do it - like it - want to do it again? What I'm asking is, it says "is a chronic disease" but what actually makes it one?
How is this not just a stronger (maybe even much stronger) response than the average, but still just the same basic mechanism?
Some people just like certain things more than others - in the case of addiction up until the point of developing a chemical dependence - but a dependence is not a disease, it's your body adapting to what's going on around it - attempting to normalise whatever regular situations it finds itself in.nozzferrahhtoo wrote: »Well I am not suggesting a direct cloning program here or anything At least not one without the potential for some beneficial modifications to the template
I have a couple of changes in mind - we'll talk!0 -
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begbysback wrote: »Alcoholism / addiction are illnesses which form over time - hard enough for those to understand who actually suffer from the illness, almost impossible for those to understand who have never suffered from it.
Like most mental illnesses, for example someone who has never suffered from depression would not fully understand depression if it was explained to them by one who suffered chronic depression.
I think that's arguing from an individual perspective, as in someone else may not understand that person's individual experience with their experience of ill mental health, but that then suggests that medical professionals and researchers would only understand a condition if they experienced it for themselves, in spite of their experience in dealing with many people whom they have observed the condition in.
It's the classic conflict between social and medical models of any condition. There's also a third model that is used by the WHO of how to view disability for example and that is the biopsychosocial model. There's an interesting (IMO at least!) TED Talk on that model here -
Really the point is that it depends upon the language and the model used as to what way a person is given or giving an understanding of their experiences. Not all addictions necessarily cause or lead to ill mental health and destructive behaviours either. It completely depends upon the way the condition manifests and expresses itself, and that in itself is dependent upon a number of other factors as to the degree in which the underlying condition manifests and expresses itself depending upon how the individual processes their own experiences.0 -
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sbsquarepants wrote: »It is clearly different, Stevie Wonder can see that - but different doesn't necessarily equate to disease.
Indeed. I was focusing first on the differences between addiction and the "Have it, like it, want it again" dynamic you refereed to. I was moving away therefore from the use of the word disease. But as that tangent is ended I can go BACK to that conversation now.
All cards on the table I myself am not 100% in agreement with calling it a disease. So my posts are about WHY they all do it, rather than why they should be doing it. For me I think when a word comes to mean too much, it ends up meaning too little. And we have one umbrella term "disease" for too many things.
It is like the word "religion" for me. An umbrella term that can mean Islam on one side and Jainism on the other, which are extremely different. Or "sport" which can be MMA bare knuckle fighting on one side and lawn bowling on the other. Two sports that, as a man funnier than I once pointed out, have little in common other than breathing.
So I think we need new words here to use in place of disease or at the very least to better sub-categorize the term. We have some such words already of course, but they are not really in the public psyche.
The reason they call it a disease, specifically a chronic disease, is mainly because attributes of it parallel diseases. And treatment modalities under the concept of disease work.
Like many diseases there is "Dysfunction" that leads to "biological and psychological manifestations" and even a "diminished" level of certain forms of cognition.
Further as ASAM point out " Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death."
At the risk of an "appeal to authority", the fact that the majority of these medical agencies are calling it a disease (and also for all my disagreements with them and their program it was I believe AA who was one of the forerunners of calling it a disease too, not just medical bodies) should tell you that there is more going on that merely "Different means disease". It is not just that it IS different that mediates the allocation of the word, but specifically what those differences are.
But a lot of it has to do with treatment modalities. As Maia Szalavitz writes in "Unbroken brain" "between the options of a moralistic view and a disease view, the disease view is the best way to address and treat that problem.". So a lot of the reason people use the word disease is not just that they think the word itself applies, but that way of thinking about it is beneficial too.
As "Recovery First" write about Szalavitz: "She also points to the well-established research that has identified complex biochemical processes under addiction. Addiction has its basis in neurophysiology, she says, which swings the pendulum in favor of the disease model."
Then there is a large % of people who have their addiction caused by, or at least massively exacerbated by, genetics. Link included.
I guess where much of the disagreement comes from on the issue is that no one (or at least very few) people arguing the use (or not) of the word actually list what they think the word means. It might be helpful for some to make a bullet point list of the MINIMUM things they believe something must have to be considered a "disease". Then identify which ones addiction is missing (if any).
For example if someone thinks it has to either be genetic or a pathogen then clearly straight away addiction is not a disease except perhaps in the cases of those people with the gene defect in the link above.
If someone defines disease however as "a disorder of structure or function in a human" then they would be harder pushed to NOT define it as "disease". While those who try (or like on this thread already tried) to make a distinction based on "choice" as the pre-cursor, then they have a chasm of semantics and tautologies and counter examples (Like HIV and some forms of diabetes) to over come to make that line of reasoning stick.
At the end of the day however the word "disease" and the treatment modalities and structures that come with that word have been useful and beneficial. Subjectively the only real reason I see resistance to the word tends to be because people think (wholly and entirely falsely in my opinion) that using the word negates any level of accountability or blame. And I do not think it does. HIV is a disease, but that does not remove accountability from the sexually active person who refuses protection. Some types of diabetes are a disease but that does not remove accountability from those who stuff 2 litres of coke into themselves every day (I am potentially that person, though so far so good, and I am fighting my own sugar addictions with mixed levels of failure).sbsquarepants wrote: »Where do things like will power fit in to this model?
Well I guess the difference "between the options of a moralistic view and a disease view" is that in the former view the addiction is seen as a will power failing on the part of the patient. With all the blame and accountability and sometimes judgement that entails.
Whereas under "disease" will power becomes a PART of the treatment modality, for which other aspects of the treatment provide a support structure.
So will power fits into the model, but more as a factor in treatment, than simply a factor in identifying causes and places to put our blame and judgement.
Also I am coming in recent times around to the idea of will power as a limited resource. You say, and I agree, that "Some just have more of it than others" but the demands we put on it are not always the same. Some studies recently are coming to the idea that will power is not some fixed value like a Dungeons and Dragons Character Stat, but is something with daily limits like endurance and energy levels. And while, like you, I am also sure it can be improved with certain practices and techniques, I think that can be hard won.
So a person with bugger all will power might be living an easy life and hence be able to resist addiction better. But someone with the MOST willpower you have ever observed in a human being might be placing periodic demands on that will power that exceed it's limits and so at the end of the day sitting at home across from the drinks cabinet or down the road from the off license..... they simply have no will power left. It is not a fixed value from one side of the day to the other.
So often people look at someone with addiction and think they just have no will power. Rather what they should possibly be looking at is what demands overall are being placed on the will power that person DOES have, and can we alleviate them to leave more for where they really need it.
But further as I pointed out, part of the "disease" is to undermine these "self care" hierarchies at the level of the brain too. So will power is not alone enough of a factor. They could have all the will power in the world but if their "self care" behaviors are not on line or correctly aligned what will make them correctly use it?
So yes, will power is a huge factor here, but how it fits into the over all picture is a sensitive and important issue.sbsquarepants wrote: »If there was an actual physiological disease of addiction - surely those suffering from it could and would become addicted to basically everything and anything.
How many people have you met that had, say, measels and the flu at the same time? Ok I am a bit tongue in cheek there, but at the same time people quite often do not have multiple issues at the same time.
That said though, many people DO have the issue you describe. Alcohol and drugs....... and alcohol and gambling......... are two common combinations of addiction. With the recent rise of incredibly accessible porn I think porn addiction is more and more an issue and that also combines with alcohol quite well.
But often when one becomes really mired in an addiction, while the potentially could get addictions to "anything and everything" else............ their investment of time and energy into the thing they ARE addicted to precludes the time, energy, money and sometimes physical capability to get addicted to anything else.sbsquarepants wrote: »Is the fact that people very much tend to become addicted to the things they like most (at least at the start) not a strong indicator that it is largely brought about by good old fashioned poor life choices?
Perhaps it is in many cases, but as we have gone back to discussing specifically the term "disease" I have to repeat the position that a disease is often still a disease even if "poor choices" got you there. So if we are discussing the term "disease" itself still (though I admit we have both gone on multiple tangents along the way) then it's origin (or not) in choices is not relevant to the definition or its applicability.0 -
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