It's a week old now, but I just caught up to a pretty fascinating piece in Maclean's - one of those stories that I like because it challenges accepted conventional wisdom. It's a Q&A with Harvard researcher Gene Heyman, who's come to the conclusion that addiction to drugs and alcohol isn't a disease, it's a matter of choice.
I expect it'll generate a ton of excited response, both from people who agree and disagree with Heyman's viewpoint. The comments section underneath the web version of the story frames the kind of reaction that will likely continue to reverberate. Some will see this as validation of the idea that addicts are simply irresponsible fuck-ups who deserve whatever misery their substance abuse brings upon them, while others will angrily defend the notion of dependency as a medical issue.
Much of the reaction on both sides will be based on the headline alone, I imagine, which is a shame because Heyman actually takes a very nuanced view on the subject. He doesn't condemn drug addicts, but concludes that addiction is the result of several small, individual choices that are in many cases influenced by underlying issues ranging from clinical depression to poverty. His data tells him that when people eliminate these underlying conditions, they are in most cases able to end their addictive cycle of their own free will. That undermines the disease model, he says, because if addiction was truly an illness, changes to these underlying factors wouldn't make any difference. He shows great empathy for addicts and an understanding of why people make self-destructive choices - he just thinks that they are choices.
What's most valuable about this article is that it introduces a new, more intellectually evolved way to think about addiction. As Heyman notes, the disease theory of addiction has taken root because people tend to have only two conceptual buckets in which to place self-destructive choices - they're either evidence of evil or weakness, or they're evidence of illness. He's right about this, I think, and I don't imagine either option in this binary system portrays addiction or addicts with much accuracy.
Nor does it serve addicts particularly well in terms of recovery. Being shunned and lectured by those who see substance abuse as purely an issue of free will isn't likely to steer an addict onto the recovery road, especially if mental health issues such as depression and low self-esteem are at the root of their dependency. And the medical model, while it has undeniably helped millions of addicts kick their habits, probably doesn't work the way folks think it does. Defining addiction as a disease frees a lot of people from the guilt they associate with their substance abuse, and when the guilt goes, self-esteem returns and the need to self-medicate goes away.
You can't argue with results, however they're achieved, but I'm guessing there's a whole population of drug addicts for whom disease theory makes their addiction seem inevitable or unbeatable, and thus hopeless. Furthermore, I imagine many addicts don't get to the underlying problems - the real illnesses - that led to their drug use once their addiction - more likely a symptom than a disease in itself - goes away.
Heyman's conclusions are sure to be controversial, but I hope they get some serious consideration. Treatment of addiction has been hampered by an either-or way of looking at a problem that more likely results from a mix of personal circumstance, general mental and physical health issues, genetics and, yes, personal choice. That the latter factor could be part of the equation shouldn't be dismissed out of hand by the medical community, nor should it be used as grounds for condemnation by self-appointed moral authorities.
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