The reason that addiction treatment programs find it so hard to treat 'addicts' is that they're dealing with the small subset of people who, for one reason or another, can't quit on their own. It's sort of the opposite of survivorship bias.
You can say addicts are irreversibly damaged, but there is little excuse for the authorities to sit idle while new people become addicted.
If the aim is to reduce harm to addicts, and the people around addicts, and the victims of crime perpetrated by addicts then authorities need to start treating addiction as a public health problem, with support from criminal justice around acquisitive crime.
Treating addiction as a criminal justice problem clearly, unambiguously, does not work.
In other places it has for example opiate use in China is 5x less than in the US.
Seems like there are many reasons why that might be true.
What I find irritating about these scientists crusading for "real science" and denouncing AA is that not a one of them would have the first clue how to get through to this type of alcoholic personality. All their ivory tower rhetoric just washes right off their back.
What I'm saying is AA is uniquely suited to this personality type in a way that no other program is.
However I've started to come to think of addiction notice a disease onto itself, but as a symptom of some other underlying "dis-ease", clinical or otherwise.
If anything, the debate over whether addiction is a disease underscores the fact that the people having the debate have a very narrow definition of "disease". If addiction isn't disease, then what is it?
Emotions are not super well understood, and I think they are at the root of addiction. If you are chronically unhappy, drugs let you feel good. You start feeling better because of the drugs, and lose the ability to respond to negative emotion in a healthy way. Healthy emotional balance lets people make good choices and fix bad problems. Being chronically unhappy - perhaps as a result of unresolved mental injury - will hamper a persons ability to make good choices, just like being keep in darkness for a log time will make your eyes way too sensitive to handle normal light.
Show me someone who is addicted to drugs, and I'll show you someone who is unhappy about something other than the drugs. The addiction just makes the underlying problem worse.
If you can learn to fix the underlying problem, then fixing the addiction itself is much easier.
Once you are knee deep in drugs, your life becomes awful which gives you more reason to keep using the drugs. It's like a local minimum, or an AI that learns to manipulate it's model of the world, because that's easier than manipulating the world itself.
I suspect that actually curing addiction, or many other mental diseases, will require not just changes within, but also changes externally.
The sooner society can rid it's self of the blame culture, and adopt the more pragmatic 'solve the problems' culture, the better.
One could argue, all that means is that "it" is addiction that one can't manage on one's own.
I'm not sure I will ever understand addiction. But I know that when I accepted personal responsibility for the things that I did to myself and others in order to get drunk/high, life became a least a little easier. It's not perfect, but to use AA terminology it's not "unmanageable" anymore, at least not as much as it once was. And I am grateful to be where I am today. I guess, for me, my compulsion to drink and drug was mainly caused by my surroundings and upbringing.
Although I don't go to AA or NA anymore, if it is working for some, I hope they see it through. Whatever is getting you through to the next day as an alcoholic/addict, my advice is to keep doing it. Whether it is spiritual cleansing or acceptance or doses of naltrexone/buprenorphine.
I also think it's mistaken to conflate "power" and "willpower." It may indeed not be a "problem of willpower", but that (at least to me) does not imply total powerlessness over a disease state in one's own body.
I honestly don't know if addiction is a disease. Certainly, anybody that has had the dts or benzo/opiate withdrawal will admit that there is a physical component to continued alcohol/drug abuse. I know many addicts (and myself was one) that continued using longer than wanted out of here of withdrawal.
But I didn't need to completely "give in" or submit to the disease, at least I think (others may be able to judge that better though). I wanted and still want so bad to never have to go through some of the things an active addict has to go through again that I am completely terrified to go out again. But at an AA meeting they would probably say that that time will come if I do not develop a spiritual connection to something greater than myself
Acknowledging that you don't have that kind of control is a huge psychological cliff to get over... it has been likened to mourning. In the end, it is quite freeing, because as you pointed out, it opens up a lot of options (power) to deal with your problem in a different way than you normally would (particularly: acknowledging that you need help).
So, while you are write that "powerlessness" probably is far too sweeping a word to use... it's helpful for getting people over that mental cliff and into a place where they can, ironically, exert some degree of power over their problems.
Personally, I think that this is enough to justify addiction as a true 'disease' that merits outside help. It takes a belief in some kind of strong definition of free will in order to maintain that people are suffering from character defects or should just pull themselves out of it at that point.
The genes that people are born with––in combination with environmental influences––account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction. -- drugabuse.gov
Maybe you got lucky that a combination of your genes and lack of certain mental disorders helped you get out of your addiction with sheer effort. Others may not be that lucky. If you had the same predisposition to getting addicted as other people you might not have made it no matter how hard you try. So, you can't generalize your individual experience with others.
> "How cool will it be if we can collect data on 9- and 10-year-olds that will help predict how all young people will function in later life?" asks Garavan. "This is the sort of information that will truly help people parent, and legislate, and educate, and live healthy lives."
I'm not as enthusiastic about that future as Garavan is, and especially not the idea that it could shape legislation in any kind of significant way. Doubly so if it's going to be done via statistical models and correlation, rather than a deeper understanding of the mechanisms involved.
Opposing scientific studies because they could be misused is no better than opposing scientific studies because they might not support your views. Both cases are fundamentally anti-science and there are no bonus points for trying. If you support science, then you support it. If you oppose science when it might not yield the results you want, then you are anti-science and have no place in a progressive society.
Thanks. I wasn't familiar with that piece. It'd save me a lot of talking/typing.
Underlying emotional pain is what causes people to literally self medicate.
This is not to say that substance abuse doesn't create actual physiological necessities to then continually consume the substance. It does- i.g. body stops producing it's own opioids when it starts to get them from the outside.
When someone begins using, then abusing, they are trying to relieve an underlying issue. The action is a symptom of a deeper problem expressing itself (the actual dis-ease). These issues are usually severely repressed and suppressed, so much so that one cannot articulate them-- only medicate them.
Digging out and resolving the root emotional issues goes a long way to curing someone. Afterwards, physiological damage still needs to be addressed.
Often enough that might simply be hunger and thirst, eg with coffee and cigarettes.
With other addictions a physical dependence is less apparent and I wondered before, why obsessive compulsion is never mention in this regard. Take gambling for example.
As the comment about rat-park points out, nicotine or opiate addiction do have an extrinsic physical aspect. In any case, the internal chemistry always plays a role.
I smoked for about a year straight, and then one day quit cold turkey and had no problems. I drink more than moderately - I'm a craft beer and whisky snob, and my SO loves wine as well. Most weeks, I'll average at least one drink a day, sometimes more. But sometimes I'll get busy and go a week, a month, with nothing or barely anything to drink across the period without really feeling the need to drink any more.
I've done a variety of drugs, and much the same - never felt an urge to do anything beyond mild recreational use.
Yet I'm completely and totally addicted to the internet. I am basically nonfunctional after prolonged lack of connectivity. if kept busy, I can go a weekend, but an unplugged camping trip for a week is a completely unpalatable idea for me.
ultimately I should be able to replicate your findings and you should be able to replicate my findings, otherwise it’s not science, it’s bullshit."
I absolutely, 100% support searching for alternative methods to help people who are drowning and suffering in addiction, but if a method doesn't work, there's no point in following it.
>seems like a debate about semantics.
a slim majority of the panelists, including Murphy, did not want to emphasize the word "disease," because it implies that chemical dependence is primarily a function of pathology, when in fact environmental factors (dysfunction at home, stress at work), learned behavioral patterns (binge drinking, for instance), and economic disparities have been shown to play a significant causal role. Clearly, the debate was not just semantic.
here we go
dis-ease: not being easy, uncomfortable, sickness
> (pathology) An abnormal condition of a human, animal or plant that causes discomfort or dysfunction; distinct from injury insofar as the latter is usually instantaneously acquired.
There is no debate to be had at all. I get where this comes from, the scientific definition is more involved, but then addiction is just a symptom, while the damage, eg. to the nervous system, is material. Would ignorance count as disease?
In fact its very common in this kind of discussion to see an argument like "If you believe <positive statement> then you must support <morally abhorrent policy>". But mostly the morally abhorrent policy doesn't actually follow from the positive statement, and if the person making this argument were forced to accept the positive statement, they would not in fact support the policy. In this debate
<positive statement> = addiction is not a disease
<morally abhorrent policy> = people with addiction don't deserve any sympathy or help
A truth with modifications. It both individualized alcoholism, and made it more acceptable in a sense. Before, alcoholism wasn't a thing, "drunkenness" was, and it was societies that had a drunkenness problem, not individuals.
Note: below is a link from reddit about their opinions from the video (maybe or maybe not they are actually a neuroscientist ¯\_(ツ)_/¯ )
Not found!? Well, I'm just the motile conglomeration of vermin for the job! "Rat Park", a utopia for rats, is (IMO) a critical component of the pushback against the disease model of addiction. An illustrated summary can be found in this lovely comic , while more interested parties can peruse the works of Dr Bruce Alexander, in the form of a blog-retrospective , or a slightly more technical presentation to the Canadian Senate , or his excellent book, The Globalization of Addiction: A Study of Poverty of the Spirit .
A layman-readable synthesis goes something like this: folk wisdom holds that some drugs are insanely addictive, as an inherent property of the drug. But this has generally  been borne out by introspective interviews of inveterate drug abusers and highly technical experimentation on lab animals (mostly social animals, like primates and rats). Introspection, for most domains of psychological study, is never used and treated as hearsay (it's not a contentious claim in psychology that people aren't good at examining their own mental states in a scientifically useful way). The methods of the experiments on social animals like rats and primates often dictate cramped, isolated and impoverished conditions. The "Rat Park" study took normal lab rats and placed them in an enormous array filled with nesting-boxes, large open areas, wheels and toys. The control rats, by contrast, were treated in every way identically to a standard addiction study -- tiny cage, no comforts, no stimulation but for a human changing their litter tray. Various experiments ensued, but even with different experimental treatments, the researchers couldn't induce addiction in the rats of Rat Park, while even fiercely bitter, heavily-diluted morphine-water was the choice of the isolated, imprisoned rat.
The orthodoxy of invincible permanent addiction was vanquished in these animals (and the minds of the researchers), by providing a more stimulating, spatious environment filled with fellow rats with whom to interact. This might say something important about the nature of addiction in other social animals, like humans.
 It IS true that you can see pretty drastic rewiring in the ventral tegmental area (which covers, generally, reward systems, drug addiction, strong emotions) with things like nicotine and cocaine, so the picture is probably more complicated than 'it's purely a social problem', but the ascendancy of the dogma of the disease model of addiction functionally prevents further study. Note that the Rat Park paper was very difficult to publish and received no attention for years.
Suffering is a human universal.
Much of social science is unreplicatable, psych especially. Is this because it's wrong, or because of other factors? Take the easiest, most commonly replicated, least contentious conclusion one can come to in a drug study, namely : "rats will intravenously self-administer (IVSA) cocaine". As you can see if you read the link, there's all kinds of caveats to this statement! If you're not very scrupulous about everything from catheter diameter to the cleanliness of your lab coat (yes, seriously), even this piece of orthodox obviousness can suddenly become "unreplicatable".
>It's a sham
It's very difficult to get funding for a large-scale drug study that goes against the underpinnings of the grant, hypothesis and conclusion of almost all the other drug abuse rat-studies of the last forty years. Publish-or-perish culture is no less pervasive in psych, and generally speaking, heterodox opinions don't get a lot of airtime in grant application review, let alone academic journals. How many other institutions have even tried to replicate Rat Park, let alone actually achieved some shadow of its methodology? I think the answer might surprise you. edit: or not, you've looked it up! Great! See?!
I'm sorry, too.
I should say, the results have not been replicated. There's only been a few attempts. Maybe the replicators screwed up!
To quote the root article: "But ultimately I should be able to replicate your findings and you should be able to replicate my findings, otherwise it’s not science, it’s bullshit."
So far Rat Park has not be replicated.
Addictions are not simple like Pellagra or Scurvy, but when you figure out what a specific person actually needs, they can rapidly recover. I've done it twice - my alcoholic friend is doing quite well; my poly-addict (opiates/cocaine/alcohol) would be doing quite well if she hadn't been captured and court-ordered to endure palliative Psychiatric treatment.
The Alcoholic became an alcoholic when she discovered that Vodka helped her anxiety more than Xanax. Benzodiazepienes lose effectiveness after about 4 weeks - when a person who is addicted to this class of drugs tries to quit, their anxiety is worse than it was before. She was peri-menopausal at the time, which was probably a huge factor...
As for the poly-addict.... When I met her, I said to myself, "this woman is 'high as a kite'..." As the months went by, she gradually invited me into her world, and I learned that she really was self-medicating with the street pharmacy.
She latched on to me like a life preserver. After almost six months of my influence, and a little non-quantifiable hocus-pocus, she called to share three insights, spread over 3 days:
- "I wish I wasn't a drug addict..."
- "I should only use substances which are legal!!! *Alcohol is legal...* "
- "I hate methadone, I hate everything about it."
So after six months, she was doing rather well. But alcohol is hard to kick on your own, and she was taken to the hospital as "psychotic"... The psychiatrists got hold of her - it's been a disaster. . They pretend that the symptom of withdrawal from substances ("psychosis") justifies the use of so-called anti-psychotics in perpetuity. Robert Whitaker has looked at the evidence, and has concluded that there is no benefit to the routine use of these drugs ...
The mental health field needs a clean-sheet redesign. Nothing else will help.
(edits: formatting, clarity )
If addiction is a disease why wait for an addict to hit rock bottom?
Would you wait for a diabetic/heart disease patient to hit rock bottom before treatment?
Dependence is when your body depends on a substance (generated internally or externally), and suffers withdrawal when it's missing.
Addiction is any repetitive self-reinforcing behavior.
Whether an addiction is "good or bad" is a value judgment which is very dependent on sociocultural and legal context.
Going to work every day to a job you love, can be considered a "good addiction". Same for a "runner's high".
Addiction occurs when the behavior is self-reinforcing and other behaviors of the same or less cost cannot produce the same relative reward that the addictive behavior does. The reward can be decreased pain, distraction from stress, euphoria, or other conditions which subjectively feel better than the status quo. Usually this means there's a stressful situation or lack of pleasure in the status quo. Addiction can be viewed as a rational economic decision based on limited information or time preference, with benefits and costs which are totally subjective to the addict. The benefits and costs do not need to appear to be rational to an outside observer, who has different subjective values and time preferences. 
The AA model of complete abstinence and submitting to a higher power is bad for several reasons: It can trigger painful or life-threatening withdrawal symptoms; it denies the person the power to control their addiction, causing learned helplessness; and it does not allow the person to learn to moderate their own addiction.
People behave rationally towards satisfying their addiction, such as by taking complex steps to buy drugs, and they rationally avoid law enforcement and/or medical intervention which prevents them from satisfying their addiction. Their behavior may not be legal, wise, moral or safe, but it is rational towards their immediately perceived needs. They are not hostage to a "disease" which makes them behave uncontrollably, like a seizure does. A disease does not involuntarily make one correctly drive a car down a complicated route to satisfy an addiction. Addiction is a choice.   
To say "addiction is a choice" does not imply any moral failing of the addict. In societies where addiction is not tolerated and is viewed as a moral failing, this can either help or hurt the addict, depending on their temperament and situation.
Conversely, saying "addiction is a disease, and not a choice" does not help a person gain control of their addiction, and it delivers an underhanded moral judgment against them, similar to calling someone a sinner but praying for them.
In some societies, ingesting psychotropic substances like coca tea is common, even among children, and does not generate social stigma. There's also not an expectation of intoxication, which decreases the somatic effect it has on the person, and lowers its addictive potential. Zinberg called this "Set and Setting" .
In societies where certain behaviors are severely punished, there can be a higher rate of addiction, because of the "forbidden fruit" syndrome, and because the addictive behavior is one of only a few ways out of an seemingly oppressive situation, giving the person a temporary feeling of self-control.
The disease model of AA is unscientific. It presupposes a biological disease, without any demonstrable etiology or mechanism.
When addiction researchers describe changes in body chemistry, MRI scans, etc., they are rarely controlled experiments, so it is uncertain whether the observed changes are due to: 1) random variation among the population, 2) a preexisting condition which increased the chances of the addictive behavior, 3) a symptom of the addictive behavior itself, 4) the effects of (sometimes involuntary) medical treatment post-addiction, or 5) the stress of simply being tested. 
Addiction is a learned behavior which provides a temporary subjective reward over not doing the behavior. There is no disease or involuntary lack of control over the behavior. The reward is extremely subjective, and depends on the biology of the person, their social/psychological state, the effects of the behavior on the person's biochemistry, and the social/legal consequences of others learning about their addiction. Everyone will value the multitudes of factors differently. But they always make the final decision of whether to continue the addictive behavior or not.
However, that doesn't mean AA doesn't work for some people.
I have read somewhere it has a 10% success rate, so we can't ignore that for some people, as flawed as it might seem to some, it does work.
Powerlessness is just about "I dont have power over X" where x=other people, other circumstances, etc etc.
All you have power over is your OWN actions. And thru that you gain immense power.
The steps are just about clearing out the shitty character your developed lying and cheating your way to get high/drunk... So you can start making decisions without trying to cover up 100 other shitty decisions.
The higher power thing is just about not being so self centered and framing the world from a point of view where the addict isnt in the center of it, but a participant equal to all others.
Theres lots of crazy everywhere, and AA attracts alot of them. But people who have found true freedom outside of addictions thru the process. And many people just build new frameworks to be assholes with.
How many of those are people that would have successfully quit on their own, but instead of trying to fix it themselves when they realized they had a problem, almost immediately went to AA?
I don't think a 5-8% success rate is really indication on its own that AA provides any positive benefit
An addiction researcher put it like this:
> If the consumer's sole motive for changing his level of patience is to escape an allocation that is dictated by his first order preference (including time preferences), but that contradicts his second order preferences, he will not be able to achieve this by rational means.
The researcher proposed that it might be possible to escape this conundrum by seeing patience as valuable in itself. If you only value patience because you'd like to escape your addiction in the long term, you won't succeed, because you do in fact value the thing you're addicted to more in the short term.
Yet, can you just choose to value patience in itself? What things you value can force you to change the things you value? Isn't it all dictated by our biology anyway, even if it isn't a disease?
There are a lot of paradoxes about willpower. It may not be something you can think yourself out of, no matter how smart you are. It's not really surprising Robert Smith threw his hands up and decided he needed a miracle/supernatural help to break out of it.
But maybe this is all the more reason to try to solve addiction as a social problem, not on an individual level as a problem of willpower (or disease).
If you mean reasons that make sense, sure, of course there's a reasonable explanation for why religion is so prevalent throughout history.
If you mean reasons that involve benefit to humans, I'm rather skeptical. There may be, but the mere fact that it's common doesn't mean that there must be. Cancer and broken bones are pretty common too.
So I agree with you. I too am skeptical being human is beneficial to being human, it's just that I'm not really sure what we'd do without it, either.