IS ADDICTION REALLY A DISEASE?

I've known a lot of addicts in my life - some of them all too well.
Some were hooked on booze, some on cigarettes, a few on pot and one or
two on harder stuff. Sometimes, their destructive behaviour wrecked
marriages and careers, and occasionally it killed them. Some have died
of lung cancer and cirrhosis of the liver, one of an overdose, and one
from falling down the stairs dead drunk.

But most of these people eventually recovered - usually when they
became totally disgusted with themselves, or when they realized that
the alternative (losing their spouse, going broke, social ostracism or
winding up dead) was even worse. Tough love often helped.

And so I've always doubted that addiction is best described as a
"disease." A disease is a condition that's beyond your power to
control. There's a fundamental difference between kicking your
nicotine habit (which millions of us have managed to do, at the urging
of the state ) and kicking your lung cancer.

The disease metaphor has been crucial - and very welcome - in the
struggle to destigmatize mental illness. Now it also dominates
enlightened public discussion of addiction. Redefining addiction as a
disease and not a vice has powerful effects. It encourages compassion
toward the sufferers (and that's a good thing). It also suggests that
punishing, or even criticizing, them for their dependency is cruel and
unjust.

The medicalization of addiction is fundamental to the case for Insite,
the supervised-injection site in Vancouver that may become a precedent
for other sites elsewhere. Insite's advocates argue that by reducing
overdoses, it saves lives and minimizes the impacts of the disease -
just as cancer drugs do - and should therefore be provided as a
medically necessary service under the Canada Health Act.

Advocates for the disease model of addiction say their arguments are
evidence-based, and that their opponents are driven by ideology. But the
closer you look, the shakier is the evidence for the disease model of
addiction. The most cogent critique comes from Gene Heyman, a research
psychologist and lecturer at Harvard Medical School. His book Addiction: A
Disorder of Choice makes a convincing case that choice plays a much more
important role in addiction than in other psychiatric disorders. And it
demolishes the current "enlightened" picture of addiction as a chronic,
relapsing illness with a bleak prognosis for recovery.

In fact, a mountain of research shows just the opposite. Most people -
even hard-core addicts - successfully quit by themselves. In one study
of U.S. soldiers who became addicted to heroin in Vietnam, no more
than 12 per cent stayed hooked after they got home. Doctors and
airline pilots who get addicted to drugs (and there are lots) have
recovery rates of 85 per cent or more. Even in the roughest
neighbourhoods, most people with a drug habit manage to kick it by the
time they're 30. "Whether addicts keep using drugs or quit depends to
a great extent on their alternatives," Mr. Heyman writes.

The trouble is that experts have based their views on an
unrepresentative sample of addicts - that is, the kind of people you
tend to find at Insite. These are the hardest of the hard cases. Most
have additional psychiatric disorders, and few have meaningful
alternatives. They are poor candidates for treatment (which doesn't
mean we shouldn't try). But does that make their addiction a disease?
No. Drug addiction is a set of self-destructive impulses that are out
of control - just like all the other impulses that lead us to choose
short-term pleasure at the price of long-term pain. Drug addiction
isn't measles, and Insite is not a hospital, and we should stop
pretending that it is.