DISCOUNTING ADDICTION AS A DISEASE

THE June 4 column I wrote disputing the disease theory of addiction, in
which I relied on Dr. Stanton Peele's work in the field, prompted readers to
request that I revisit the topic, and how better to do so than with an
interview with Dr. Peele?

Dr. Peele is a psychologist, an attorney and an addiction expert with an
international reputation.

A recipient of the Mark Keller Award from the Rutgers Centre for Alcohol
Studies and the Lindesmith Award for Career Achievement in Scholarship from
the American Drug Policy Foundation, Dr. Peele is the author of 120 articles
and seven books about chemical and relational addiction.

Q: Dr. Peele, do you believe addiction is a disease?

A: "No. Most emphatically not. It has become the style to call negative
behaviours, which people often experience as compelling motivation,
"diseases." As though nail-biting, overeating and wife-beating were like the
malignant growth of cancer cells.

"Much self-defeating and anti-social behaviour has a common thread. People
engage in it because they feel degraded and disapproved of, which feeds into
their motivation to continue the negative behaviour.

"But how ultimately do people stop drinking too much, overeating, and biting
their nails?

"They feel, internally, that the balance of their desires and rewards is not
to act this way; people make positive choices when they feel they have the
opportunity to engage -- and are supported -- in more positive choices. The
toughest addiction to quit is smoking. Right now about 50 million Americans
have quit smoking, over 90% without a patch or formal therapy."

Q: How have we progressed to thinking about addiction as a disease?

A: "We have developed a faith in medical advances that is steeped in the
legend of the 'microbe hunters,' the generation of researchers and
physicians who identified the bugs that cause many of the major killers of
humans.

"This worship of medicine has become a fetish in North America. If we can
describe a malady in medical terms, we feel we have somehow conquered it.

"Yet with psychological disorders and problems of behaviour -- namely,
addictions -- such labelling and accompanying medical mumbo-jumbo have not
led to improvement in treatment outcomes.

"In many ways, in fact, turning our sense of ourselves over to medicine
seems to be making things worse. Surveys repeatedly confirm that a
generation of education about addiction has led to people's spiralling out
of control now more than ever."

Q: What is the science upon which the disease proponents of addiction base
their demand for considering addiction a disease?

A: "There is no inherited mechanism that leads a person to be unable to
control their substance use, to go on tremendous binges, or to leave off
their connection to people and environments in order to consume a substance.

"Genetic theories, being the modest things they are, can never explain the
experience of loss of control. An overview of the research on alcohol and
drugs never supports the wild claims made by some proponents of the disease
model.

"These claims reflect fundamentally anti-scientific attitudes and a lack of
understanding of the confluence of human motivation in response to
experience, biology and external stimuli.

"Consider this example: A 1996 headline in The New York Times declared that
brain images of addiction in action show its neural basis.

"The article reviewed research showing that many different drugs -- namely
heroin, alcohol, amphetamines or nicotine -- activate common neural
pathways. Its author surmised that these drugs bathe the neurons at these
sites so as to reduce natural supplies of dopamine, and thus stimulate a
craving for more of the drugs to compensate for this depleted supply of the
neurotransmitter.

"And this was taken to mean that addiction is purely brain-driven. In my
critique of this folly I explain that the wide range of activities that
stimulate the pleasure centres of the brain -- including sex, eating,
working, chocolate -- should alert us that these brain theories tell us
nothing about differences in behaviour, let alone addiction.

"Apparently, stimulation of a pleasure centre is only one small component in
the entire addiction syndrome.

"Moreover, if any activity can be pleasurable -- from work, to sex, to
parenting and so on -- identifying activities as stimulating the pleasure
centre simply begs the questions: why do people find different things
pleasurable and why do different people react in destructive, addictive ways
to some of these things, while others incorporate them into a balanced
overall lifestyle?"

Dr. Peele's position is at odds with that of the drug reform movement.

While being a proponent of harm reduction policies such as needle exchange,
he views treatment as part of the coercive state since most of those
attending treatment are forced to do so.

Here's something to mull over: Vancouver Sun columnist Patrick Nagel offered
the alleged resumption of Stephen Reid's career as a bank robber as proof
that addiction is a disease completely separate from "the man's morality."

Believe this leap of abstraction if you like but consider this: if addiction
is a disease of the mind, then its behavioural manifestations are still an
extension of the person's character.

Progressives espouse a holistic view of human motivation. This means that
behaviour needs to be seen as a consequence of every facet of our
biopsychosocial beings. But at the same time progressives are so unclear as
to what holism means that they are willing to explain an individual's
behaviour by reducing it to biology alone.

This demonstrates a flaw in thinking. Hence, you cannot separate Reid's
penchant for drugs from his choice of robbery as an outlet.

In a deluge of liquor, some people will do their best writing; some will go
bungee jumping; and others will choose to break the law.