This is a continuation on a series of blog posts about Addiction. You can read the other posts by clicking Addiction is a Disease and Myth: Addiction is a Choice.
Most Doctors Do Not Address Addiction
Half-way through non-sobriety, I scheduled a routine doctor’s appointment for my Addict which I attended. I wanted to get insight from a medical doctor about several health issues. One of the issues was my Addict’s glaring alcohol abuse. I wanted to have an intelligent, rational conversation about the most important health issue my Addict had. I was completely underwhelmed with the doctor’s response. Because she had to say something, she asked, “Why do you drink so much?” He responded, “Stress. Boredom.” And that was the end of the discussion. There was follow-up on other health issues involving medication, but none about alcohol. I found the realization that many doctors do not address addiction highly disturbing.
I can only surmise that the doctor didn’t think addiction was a health issue, or had no training to address it. Probably both. This realization made more sense when I read David Sheff’s Clean. Mr. Sheff opines, “Physicians aren’t interested in treating something they consider self-induced. [You have to] look for doctors with a fellowship in addiction medicine or addiction psychiatry, board certification in addiction medicine by the American Board of Addiction Medicine. ASAM-certified doctors.”
When my internal medicine doctor couldn’t treat my sinus infections with any success, he referred me to an ENT specialist. Breathing through my nose was important, but not life-threatening. I know from first-hand experience that addiction is a deadly disease. Yet when a patient bluntly said he drank too much, the doctor didn’t address the issue in any meaningful way at all. Why do doctors ask patients to fill out forms advising how much alcohol they consume if they aren’t going to discuss it with the patient? I’m not suggesting the continuing addiction was the doctor’s fault, but she didn’t treat it like a medical issue at all. She didn’t ask any questions about amount or frequency to know if the drinking was heavy or excessive. She didn’t inquire about alcohol consumption in any future appointments. Maybe she thought my Addict would outgrow it like he was going through a bad phase. How can untrained family members be expected to know how to treat their Addict or get the Addict help when the medical community doesn’t have a handle on it or consensus about treatment? “Medical detox is based on the fact that getting sober isn’t about character but about chemistry,” David Sheff points out.
Addiction Continues To Be a Medical Issue Long Past Detox
We would never discontinue medical oversight for a diabetic after stabilizing their blood sugar. The disease persists after the acute “saving life” phase. There are a lot of fine facilities out there that treat addiction. Still, many addiction rehabs treat addicts like fuck-ups to be fixed, to be shamed out of their rebellious, selfish immaturity. Their programs focus on powerlessness and weakness instead of playing to the individual and collective strengths. David Sheff astutely summarizes how I have come to understand addiction as disease when he said, “I’ve never heard of any disease that responds to censure, blame, or denial of treatment.” He goes on to say, “Addiction is the only disease whose patients are refused treatment for showing their symptoms. This disease has unusually complex physiological, psychological, social, environmental, and behavioral components and there are as many permutations of the disease as there are addicts.”
Got it. No shy here. Addiction is such a complicated thing. I think it’s important to debate and talk about it. I understand where you are coming from in terms of not being able to reconcile the fact that an addict is inflicting upon himself or herself the very thing that is killing them. I won’t debate the science with you. I can only comment about what I’ve read and what I’ve experienced living with my addicted first husband and my experiences with other addicts. I think there is a behavioral component that is very difficult to separate from the addict. There are other diseases in which there is a behavioral component as well as medical such as diabetes, obesity, heart disease. Not that this is new information to you.
This may be a bad analogy, and I’m just thinking of it as I type, but consider this scenario: Two people get kidnapped. One is left alone and the other is tortured for days. The kidnappers demand each of them to harm someone else. I would argue that the tortured person is far less capable of “choosing” to refuse. He’s been psychologically tortured and is therefore not in an equal position to make a conscious choice. There has been a fundamental change to his brain, his psyche.
Maybe we are approaching the concept of “choice” differently. And don’t misunderstand me. I am not sitting back feeling okay about addiction because it’s a disease. I still get pissed off at the recklessness and chaos the addicted inflict on themselves and others.
When I’m feeling down I’m totally going to check out how to get fatal malaria. Good tip!
Yes, there is a behavioral component to diabetes. But consider two things (to stick with diabetes as a good example).
First, type 2 diabetes (not speaking of people born with insulin issues) can be brought on by bad behavior: eating to excess (typically). But while choice is always present in life to do the right thing (in this case, to eat better and to exercise), choice doesn’t enter into the picture once people HAVE diabetes — except, of course, to do what one can to reverse it or to keep the worst of it at bay. Second, we hear a lot about the phrase “drug dependency” where illegal drugs (and alcohol) are concerned. This is pure fiction. There is no person in the history of the world who is “dependent” on alcohol or cocaine or heroin for the plain reason that no person ever needs to ingest these drugs to maintain biological survival. By contrast, consider those diabetics who need to inject insulin to survive. Now there’s a perfect example of real drug dependency. Same goes for epileptics. These are people who are truly drug dependent (on anticonvulsants), whereas it would be wrong to make a comparison to those who ingest a recreational drug to excess.
I’m troubled by this “disease” talk when it comes to drug misuse (notice I didn’t use the word “abuse”) because the word serves to deflect the element of choice and responsibility, whereas for real disease choice doesn’t enter into the picture (except, again, to do what one can to rid one’s self of the disease or to lessen the symptoms or progress of it). Anyway, you might want to look further into the work of Herbert Fingarette and Gene Heyman. Both men argue that drug-taking behavior cannot ever be a disease. That’s exactly right.
Lastly, a little snippet from my book:
Mary Tyler Moore once said that she inherited her mother’s alcoholism. Julie Andrews once said that arthritis runs in her family. But people with arthritis are unwilling victims of an inflammatory disorder, whereas people with life-destroying drinking habits are willing participants in their self- destruction. One common rejoinder is that some people’s constitution is such that just a little amount of alcohol will set them off on a binge. Well, let’s break that down. If a person discovers she is predisposed to being more sensitive to alcohol when compared to other people, it means two things: a) that you possibly may have an “allergy” to alcohol, and b) armed with such knowledge—that you get tipsy more quickly than other people—you are now MORE responsible for controlling your drinking. But there is no disease involved here. As Steven Wisotsky puts it: “Even if the theory that promotes a genetic etiology of alcoholism is ultimately validated, the ‘prescription’ for the ‘victim’ of that genetic deficiency would be the same for a genetically ‘normal’ individual: moderation or abstention.” My nephew once told me that he finds it difficult to understand how people can go through life sober. I’m sorry he thinks this way, but if he has a difficult time being sober (the default state of being alive), his problem has nothing to do with his brain “commanding” him to be inebriated or high. His problems are existential. Or as Shirley Chisholm once noted, “It is not heroin or cocaine that makes one an addict. It is the need to escape from a harsh reality.”
Exactly: disease has nothing to do with chronic drug misuse because existential problems in living are not medical quandaries. Dr. Carl Hart also talks about drugs in this vein. You should look him up. You’ll find many interviews with him online.
Take care. And if you’re curious enough to read my book, do leave a review at Amazon!
Barry- I have no desire to tear you and your comments a new one about your opinion that drug habits are a choice. In fact, reading what you wrote actually informed me that though we don’t agree about the primary question of addiction as a choice or disease, I agree with you that chronic drug habits are rooted in problems dealing with life. I also agree that it’s counterproductive to force addicts into counseling. The War on Drugs has done a huge disservice to the disenfranchised. Criminalizing drug use makes no sense to me. It’s like polishing a vehicle that just suffered a car accident. I’d rather look for similarities rather than differences. I appreciate your comments!
My asking to be torn apart was only my way of saying “don’t be shy!”: if you disagree with me, tell me!
I don’t see how choice doesn’t enter into the matter. Where real disease is concerned, protein corruptions and cellular pathologies occur without my self-interest involved. I and no one else would ever deliberately choose to do something to come down with measles or malaria (except of course as a novel form of suicide).
But drugs, no matter the allure or the psychological situation (problem in living), remain exogenous substances: we must act upon on them to do with them what we will (drink, inject, smoke, and so on). Therefore, the element of choice is always present—and the consequences of choosing to use a drug, that is, when the drug is acted upon with regularity and severity and for a long time, can certainly lead to disease like cirrhosis or cancer.
Nice comment about polishing a vehicle!
Drug habits are not diseases. I welcome you to tear me and my comments apart on this matter: