
A neuroscientist who believes addiction is not a disease - paublyrne
http://www.theguardian.com/culture/2015/aug/30/marc-lewis-the-neuroscientist-who-believes-addiction-is-not-a-disease
======
wpietri
I think the disease model is in many ways flawed. It posits one notion of
normal and then divides everything into "normal therefore fine" or "different,
therefore broken".

Some good, HN-relevant examples are ADD and autism-spectrum "disorders". One
of the hallmarks of ADD is hyperfocus, so ADD is a misnomer; it could easily
be called, "doesn't pay attention when the teacher wants syndrome," or "is not
interested in your boring trivia syndrome". There are a ton of people
previously diagnosed with Asperger's who lead happy, productive lives. Both of
these characteristics can be positive in the world of tech entrepreneurship,
and could well have been positive in previous environments. [1]

That said, I think this guy making his central message, "Addiction is not a
disease," is dangerous to the point of idiocy. In our current society, we
really only have one mechanism for aiding those who will need a lot of help,
and that's saying that they're sick. If he would like to make a full-scale
assault on the disease model, godspeed. But a lot of people already want to
believe that addicts could quit any time if they just applied a little
willpower. Reinforcing that means that people who could be saved will die
unnecessarily.

[1] See, e.g., the hunter vs farmer hypothesis for ADD:
[https://en.wikipedia.org/wiki/Hunter_vs._farmer_hypothesis](https://en.wikipedia.org/wiki/Hunter_vs._farmer_hypothesis)

~~~
mistercow
>it could easily be called, "doesn't pay attention when the teacher wants
syndrome,"

This is a common misunderstanding. My experience with ADD is that it's not
just "doesn't pay attention to what someone else wants"; it's "I _can 't_ pay
attention to what _I_ want to pay attention to".

And yeah, I do think that ADD has some beneficial effects as well. Syphilis
can sometimes attack the nervous system in ways that create permanent elevated
mood. I don't think that makes syphilis "not a disease".

~~~
bumbledraven
> My experience with ADD is that it's not just "doesn't pay attention to what
> someone else wants"; it's "I can't pay attention to what I want to pay
> attention to".

So kids with ADD can't concentrate for hours on, say video games or other
interests?

~~~
oofabz
A kid might focus for hours on video games, while telling himself he really
needs to write that paper for class tomorrow. Maybe you could say his id is in
control of focus, not his ego.

~~~
tomp
Doesn't that describe pretty much everyone? Or maybe I have ADD as well...

~~~
wpietri
If you're curious, I found the books by Hallowell and Ratey helpful. One of
them contained a self-assessment quiz. It's meant to be descriptive, not
diagnostic, but it was very useful to me in seeing the pattern. Here's a web
version:

[http://www.drhallowell.com/blog/adhd-self-assessment-
quiz-2/](http://www.drhallowell.com/blog/adhd-self-assessment-quiz-2/)

------
kephra
Both do same error, that they start with premise of curing addicted people.
The same error that nearly all psychologist or psychiatrists share. They
declare people who are not normal as insane, and want to change them. A better
way, imho, is to make people conscious that they are different, and thats
important for them to find a place in life, where their difference is a bonus.

One of my favorite parable, is the imagination: You are very talented. You can
lay eggs. Society defines being healthy as not picking on other chicken or own
feathers. But its not you who is insane, the cages are a system of insanity.

The extreme cases of junkies on the street, and alcoholics in their flat come
into mind, when thinking about addiction. Those are extreme cases of people
who have no place in real life also. The drugs, are their way to find a place
in life to be happy. Even if only for a short time. Teach them ways to become
autonomic, to find their own path through life, and addiction will calm down
by itself.

~~~
tomhoward
I can attest to this. In the past few years I've watched two close friends
destroy their lives through addictions to alcohol and drugs. One of them died
recently after years of severe alcoholism. The other is now in prison for
drug-related offences.

I recall with fondness and sadness, both of them at their best... kind,
generous, witty, intelligent; highly capable in their careers and loving and
supportive to their families and close friends.

But each of them had ways in which they didn't quite fit in, and didn't always
get the returns for the efforts they put in to try to achieve what they wanted
in life, and as their frustrations grew, their self-destructive behaviours
escalated, and the key support structures in life - most crucially their jobs
and relationships - began to fall away.

But it was absolutely not the substance abuse issues that came first; in both
cases that happened after the heavy knocks of life took their toll.

From observing these stories, I've become painfully aware that society just
isn't very good at equipping people to understand why and how they're going
wrong in life and how they can correct and achieve happiness and fulfilment.
The support services that do exist, like therapy, AA, rehab etc, only become
available when the problem is already entrenched and that much harder to turn
around. I learned this when I recognised that I was starting to head down the
wrong path in life and sought help before it got out of control, but the
response was generally something like "you're pretty fine, don't waste our
time".

I did end up finding an effective way of getting my life on track, and things
are now going very well for me. I hope to live to see a time when it's much
easier for far more people in the world to recognise their own failings and
risk factors before they get out of control and find a better path before it's
too late, and I'll be doing what I can to contribute to that cause.

~~~
uptownJimmy
Thanks for writing this. It roughly describes my own experiences. I managed to
pull out of my own spiral primarily because the love of my life didn't leave
my side, and because I continued to feel hope and the possibility for change.
And I worked my butt off to get out of the hole.

The hopelessness and loneliness and anxiety came first, though. Heavy knocks
of life, indeed.

------
stdbrouw
A while back on HN someone linked to "Most People With Addiction Simply Grow
Out of It" [1] and "Here’s What I’ve Finally Concluded About 12-Step Programs"
[2], which argues that many of the ways in which we try to treat addiction
just make things worse, e.g. by recommending that a former alcoholic never
again has a drink, you're actually making it more likely that when they do
snap, they will not have learned to keep things under control and they'll
probably feel so guilty about drinking that they will hide it from others
rather than seek help.

I'm really not qualified to argue one way or another, but I find the idea
intriguing.

[1] [http://www.substance.com/most-people-with-addiction-
simply-g...](http://www.substance.com/most-people-with-addiction-simply-grow-
out-of-it-why-is-this-widely-denied/13017/)

[2] [http://www.substance.com/heres-what-ive-finally-concluded-
ab...](http://www.substance.com/heres-what-ive-finally-concluded-
about-12-step-programs/12344/)

------
jpwagner
This is not a new way of looking at addiction. In fact, it's the OLD way.

Animal models clearly show compulsive behavior, and through various techniques
scientists can modulate that behavior. As far as I care, that's how we roughly
define a disease.

No, he's right, it's not a disease in the sense of "[patients listen to your
doctor and take your medicine]" but that's always the case with mental
disorder.

~~~
Sammi
Animal models only show compulsive behavior in bad circumstances. Put a rat in
an empty cage, it will misuse drugs. Put it in a cage full of other rats and
things to dig in and climb on, and it will not misuse drugs.

[https://en.wikipedia.org/wiki/Rat_Park](https://en.wikipedia.org/wiki/Rat_Park)

So if this model is valid for humans, then it means that addicts are unhappy
about their circumstances. Modern society is making some people so unhappy
that they turn to drug misuse. Modern society is sick. It is making people
feel lonely and isolated. We need to heal our society collectively. Spread the
love.

[http://www.huffingtonpost.com/johann-hari/the-real-cause-
of-...](http://www.huffingtonpost.com/johann-hari/the-real-cause-of-
addicti_b_6506936.html)

~~~
tallerholler
this resonates with me... I found myself in a series of bad incidents that
pushed me towards escaping with alcohol. then due to my compulsive nature, it
spun out of control and I ended up in rehab etc and took 2 years to pull back
out. when it all started I had run out of money, was extremely lonely (needed
therapy but didn't even know how to get it then), and had lost my job etc. it
caused me to self-destruct at age 29 because my vision for life suddenly
seemed lost to me. now I'm 32 with s great job, sober, stable, and life is
great.

------
tbolt
Thomas Szasz -
[https://www.youtube.com/watch?v=Qj7GmeSAxXo](https://www.youtube.com/watch?v=Qj7GmeSAxXo)

------
littlewing
I've know a few addicts. They were brother and sister.

The brother was addicted to meth and recreationally used other things (pot,
various uppers and downers, etc.). He went to jail for selling, then cleaned
up, was eating healthy, got another college degree, held a respectable job,
then went back to hanging out with an old boyfriend who was bad news, and
ended up back in jail for carrying a large amount.

The sister just used pot, which many argue isn't an addictive, but I think
when you get up every morning and have to have it and then divorce primarily
because of substance abuse, that's a problem. She finally beat it after 30+
years of use.

Here are some common characteristics:

* Their mother had a pro-medication attitude. I don't think this causes addiction, but I think it may have been a contributing factor.

* They are both very intelligent and confident.

* They have both historically been very opinionated and were not easily swayed to other opinions.

* Both associated with people and lived in communities that were more liberal.

It's possible they have a predisposition to addiction, but I don't think it's
possible to prove that one way or the other.

People can be chemically addicted. Heroin and meth for example are both very
tough to beat after you've started. I've know people that died early because
of past heroin addiction. It is a terrible thing, and it scares me to think
that some day all drugs may be legalized.

Environment influences attitude toward drug use, and then personality traits
can reinforce behavior. If you can avoid people that use drugs or have a
liberal attitude towards drugs, you can avoid addiction. If you are a parent,
talk with your kids about drug use. Let them know that you care about them and
that you want them to avoid those that use drugs.

Addiction is a product of environment, personality traits, possibly innate
tendencies, and exposure to chemically or psychologically additive substances.
Whether addiction is a disease or not isn't important to me. Just stay away
from people that do drugs, and if you get addicted, get off of drugs, and get
out of that environment.

~~~
forgetsusername
> _If you can avoid people that use drugs or have a liberal attitude towards
> drugs, you can avoid addiction._

Almost everyone I know has a "liberal" attitude towards drugs. And they're all
great, functional, non-addicted people.

> _Just stay away from people that do drugs_

You're going to live a pretty solemn existence in modern society, where the
majority of Westerners require morning caffeine.

~~~
VLM
"where the majority of Westerners require morning caffeine"

Also alcohol.

My observation of popular HN culture shows its believed to be easier to live
and socialize as a vegetarian than a non-alcohol drinker. This comes up often
in semi-unrelated topics about new urbanism and the perceived level of
importance of living within walking distance of bars, not to mention the
supposed death of car culture. And it also comes up in "how do I meet people"
socialization topic discussions. And health oriented discussions. Occasionally
hobby related discussions, also.

Given the enormous PITA it is, according to some, to not drink alcohol, it
would seem an obvious startup opportunity for social media inspired
socialization or whatever. I'm not currently aware of any non-alcohol related
startups. There is at least some love for vegetarianism, so there should be
space for not getting drunk as a lifestyle, given that it is supposedly an
even stronger social death sentence.

------
c3534l
I feel like this is arguing semantics. Drug addiction is a problem that you
can seek help for and should. There are physical components to it and
psychological components. The author doesn't seem to be describing anything
fundamentally different from how the addiction community already treats
addiction. It's certainly not true that you can just snap out of an addictive
cycle by choosing to not be a drug addict. But it's also not true that
behavior isn't the primary think you need to treat in most cases.

~~~
wahsd
I don't think you can so easily dismiss the differentiation based on
semantics. You should be clear on the differences and the difference in
approach to a solution each demand.

~~~
c3534l
Most practitioners already tailor their treatment to what has been found to be
beneficial to drug use and even the drug specifically. Heroin users can die if
they go from heavy usage to no usage and prescriptions are needed. A user who
drinks to forget, maybe infrequently, but intensely and who has no symptoms of
physical dependence needs a different kind of therapy than someone with no
history of dependence who has become hooked to percocets following a surgery.
That is, people already recommend treatment based on what the problem is and
whether or not it is technically a disease or if it's something different;
it's a point that's contentious for many people, but I'm not sure how relevant
it really is.

------
equoid
Surely the "addiction is a disease" mindset is a defensive response to the
(especially in America) mindset that addiction is a moral failing. I.e. one
crackpot opinion begets another.

The truth about 'addiction' is complex and different for each individual but,
given that no one is born an addict, at heart the concept describes how many
people have learnt to cope with their individual circumstances. Disease and
morality are both inadequate to discuss this.

------
tomohawk
Golden Hammer.

Doctors have medical background, so they tend to see things through that lens
and solve problems with the medical tools they have on hand.

Cops tend to apply law & order solutions to the problems they see, because
that is what they know.

Scientists tend to ...

Engineers tend to ...

It's hard for us to remove ourselves from what we know and have spent so many
years studying, and look at problems with fresh eyes.

------
unfamiliar
Seems like a semantic technicality. A disease is a disease. An addiction is an
addiction. The benefit in calling it a disease is in getting people to change
their perspectives and precognitions about it - to see it as something at
least partly out of the victim's control to be treated with compassion.

------
jokoon
Yeah in that angle addiction is mostly a political or social term.

I wonder if psychology really accounts how society can be oppressive for
certain people who can't integrate properly because of their education.

------
swehner
Addiction -- is simply its own category.

------
spectrum1234
I've been thinking this for awhile and kinda forgot this wasn't standard
thinking.

Obviously there are physical components and psychological components. But when
you look to animals (rats eating junk food obsessively, etc) its obviously an
addition.

The conscience mind humans have cannot supersede the this fact that its first
an addition for all of our ancestors (and thus, us). Therefore while it is
clearly both physical and psychological, it always starts psychologically and
so the only way to fully cure it is also psychologically.

------
techbio
> "So there’s something going on that makes it hard to stop for very good
> neurological reasons. So then, do you want to call addiction a disease?
> Well, maybe, then you’re getting close I think, because you could call it a
> pathology I guess."

Science left the room, this is semantics. HN's comments here are orders of
magnitude more valuable than TFA. This reflects the thinking of a book
salesman, not a doctor of neuroscience.

------
wahsd
Totally agree. I would just go a bit further and days that beyond just a basic
behavioral problem it is a neurological mental disorder that is either
hereditarily deposed and/or triggered through behavioral issues.

------
joesmo
I think the disease model is the primary model of addiction in the US because
it helps relieve the stigma and hate of the rest of society against addicts,
not because it's an accurate model. It's popularized by 12-step programs a lot
more than it is by doctors, thus most people that support this model have no
scientific basis, rationale, or reasoning for doing so other than it's better
than the alternative, which is to see addiction as a moral failing, a failure
of willpower, or a character defect. As another post here points out, those
are indeed the old ways of seeing addiction, of society to blame and ostracize
addicts. That model is also incorrect, mostly postulated by people who are not
addicts, have no experience with addiction, and are generally just looking to
place blame and hate rather than for a realistic model of addiction.

Personally, I think both camps are wrong and the most evidence is towards
addiction being a societal problem, rather than an individual disease. It's
easy to underestimate the influence of one's environment on one's actions, but
phenomena like the massive drop-off in addiction rates of Vietnam veterans are
rather hard to explain otherwise ([http://www.npr.org/sections/health-
shots/2012/01/02/14443179...](http://www.npr.org/sections/health-
shots/2012/01/02/144431794/what-vietnam-taught-us-about-breaking-bad-habits)).
This is a hard pill to swallow in a place like America where it's ingrained in
the culture that people be blamed for whatever wrongdoings they have
committed, regardless of the utility of such blame, and regardless of the
reality of the blame. A lot of people want to maintain a moralistic high
ground and many of those do it simply because they enjoy putting others down
and causing conflict (usually because they are suffering themselves). How can
people with such attitudes ever look honestly at themselves, their own
actions, their communities, and ask themselves if some of these things might
somehow be responsible for the suffering of others' in society? They can't and
they won't.

I do not think any one particular societal problem can be blamed for
addiction, but things like poverty, disease, lack of opportunities, exposure
to hate, exposure to trauma, etc. are likely culprits. In a country where
anything related to the common good or community is eschewed and often
considered un-American, it's no wonder that many people find themselves
disconnected, alone, and unwanted. Our society not only shuns the poor and
different, but even many of those actively involved in building it, people
with jobs who are actively striving to make things better for themselves.
Teenagers and young adults who don't live in a city are left to their own
boredom by parents who may care, but who cannot do anything about the boredom
of suburbia. These people often turn to drugs because they're essentially
being neglected by their parents, peers, and likely the educational system or
simply do not have the means to socialize because of the distances involved.
They develop addiction patterns they will rely on as adults. These are just a
couple of examples I can think of off the top of my head of neglect, abuse,
hate, poverty, and trauma than a huge portion of the population in the US
experiences. Certainly, not everyone will become an addict, but such extreme
societal disfunction is a much more likely culprit for addiction than either
the disease model or the morality/willpower model.

Specifically, the disease model fails to explain people who are 'cured' and
stop using, people who use for only a few years, people who can stop and use
at societally accepted levels, etc. The morality/willpower model assumes that
we are in control of all actions, that outside events and the environment have
no influence on human behavior, and most ridiculous of all, that humans act in
a rational matter 100% of the time (silly Kantian ideas). The failings of both
of these models are so egregious, I do think it's time to retire both and
start to seriously study addiction scientifically rather than provide
explanations that we have been pre-conceived ahead of time and fly in the face
of evidence.

