Is "it" a "disease" or ain't it???

Thu 14 Feb 08, 10:24 a.m.

Hi all,

Rex here.

Chatting with Jim this morning, some musings on the "disease model" of addictions.

I should have responded just a bit more directly. I am reluctant to because, as I said, the debate is not meaningful to me in a personal or practical way. Whatever "it" is, I got "it", and I therefore need to respond appropriately.

However, in the spirit of intellectual honesty, it is worth noting that the only way to diagnose alcoholism is indirectly; by observing behavior, by reports from those close to the alcoholic; family, police, judges, employers, etc., by knowing a patient's drinking amounts and patterns, by observing secondary morbid conditions and disease states which are the direct and indirect result of excessive drinking and using, e.g., liver damage. However, the actual symptoms of alcoholism are primarily morbid, anti-social, destructive and self-destructive behavior. So we know that, as I said, something is driving this collection of secondary symptoms and indications. However, we still do not know what the "it" actually is. At one time, genetics was strongly favored a a cause. Some still favor this, but it remains theory, we as yet have not positively identified a genetic link. We know that addictions, as well as other "issues", run in families, but that is only suggestive of what is going on. Then there is the problem that virtually any lab animal will become addicted given the proper conditions, and that many "normies" become addicted to pain meds following a hospitalization. This, of course, does not disprove a genetic, familial, hormonal, biochemical "push" in the direction of addiction for some individuals, but it certainly suggests the the problem is very complex.

We know there is an "it", but we still do not know what "it" is. I suspect we will learn more over time, and as we do, the possibility increases that there may be better treatments for reducing or eliminating cravings and even for changing thought and behavior. Gawd knows, an alcoholic who continues to drink and use in spite of the obvious often devastating consequences to himself and those around him surely has "something" seriously wrong with his thinking and behavior or he would not drink. In a Republican sort of way, it really is that simple. It is like the cocaine addicts who seek medical treatment for a perforated septum, and when informed that part of the treatment includes the necessity of not using cocaine respond, "Are you out of your fucking mind!!!"

To wrap it up for now, while many things abut addictions "suggest" many things about addictions, we have yet to identify a specific and direct cause; psychological, familial, genetic, hormonal, biochemical. That does not mean that a cause does not exist, just that we have not identified it yet. Meanwhile, as long as it quacks like a duck, I have no problems with the disease metaphor, or if you prefer, disease model. If you are an alcoholic/addict, becoming too entralled with or inflamed by the disease debate misses the pont, really, and distracts you from the important business of recovery.

Aloha,

Rex