Addiction: Disease or Defect?

I think the govt. has put the fear of God into physicians by checking how much of certain pain meds they prescribe, so people who really need relief are made to suffer to such a degree that they may as well be dead, for the quality of life they have.

I agree that doctors must be careful in prescribing, but how often have we heard stories about people who are terminal and can't get proper pain relief until they are days from death because they might be addicted?

Very good article but the title is a tad misleading (imo), or maybe I missed the point. “What made me an addict,” she asks…
She says, “Addiction research has advanced dramatically since my high school years in the early 1980s, when I began using marijuana and psychedelics, then cocaine, in the hope they would relieve my social isolation…
By the time I got suspended from college for my involvement with cocaine, I was smoking it, often daily. And because I believed that my suspension meant I'd already ruined my life, I felt I had no reason not to try heroin. I just didn't care. Heroin became my drug of choice. It calmed me, gave me distance from my obsessions and anxieties. Over time, cocaine made me feel anxious, but heroin always soothed and smoothed…
Today's most widely accepted definition of addiction -- used in psychiatry's latest edition of its diagnostic manual, the DSM-IV-TR -- recognizes that compulsive use of a substance despite negative consequences is key. And that's exactly what I experienced: At least six times, I made it through the physical sickness of heroin withdrawal -- the shaking, diarrhea and vomiting -- only to use again because I wanted the drug.”

I am impressed by the author’s honesty. Even when we know that we do some “bad” things simply because we want to, we have a very hard time admitting it. Speaking for myself, my “dependence” was/is never due to a physical need, but rather an emotional need. I WANTED/WANT to not feel something. I replaced the sadness with false bravado/happiness. The addiction was the false feeling, and to get there I depended on alcohol (but it could have been anything, I grew up in Hollywood - California not Florida). Not every day or even on a regular basis, but the addiction was real. IMO, addiction stems from emotional need… I haven’t read Peele’s book but maybe I should.
I think that Szalavitz’s story of why she stopped using is right on key, and pretty much the same as why she started. “In my own experience, I stopped using when addiction threatened my core values. On my last day taking heroin, I found myself considering seducing a man to get drugs. Because I despised this guy and had a serious boyfriend, I was shocked that I would consider it: I knew that that was addictive behavior. At that point, my personal definition of an addict was someone who violates her own principles to get drugs. I sought treatment the next day and never used cocaine or heroin again.”
She stopped because she wanted to. Something clicks, something creepy reaches out and touches you, or maybe it just hits you that you really REALLY hate feeling so crappy after feeling so… numb/good. Whatever it is, it makes you say, “Enough, I don’t want this any-friking-more.”

“Another relevant factor seems to have been my youth: We now know that the frontal cortex, the seat of judgment, the region that should apply the brakes, is not fully developed until the early to mid-20s. I quit [taking drugs] at 23; when I look back on my behavior now, the sheer stupidity of some of the risks I took shocks me. Genetic research also suggests that certain people are more prone to addiction, particularly those with other mental illnesses such as depression, a condition I also have.
So does that make it a disease? Some would argue that my response to treatment proves it. I underwent seven days of detox, 30 days of rehab, then three months in a halfway house and ongoing self-help support. Later, antidepressant medication helped reduce the distress that I'd previously self-medicated with heroin.
As Thomas McLellan, chief executive of the Treatment Research Institute in Philadelphia and professor of psychiatry at the University of Pennsylvania, notes, treatment for addiction is as effective as treatment for other chronic diseases that involve lifestyle change, such as diabetes and asthma…
Says McLellan: "Yes, people with epilepsy were sent to priests and shamans, too -- but that was the 18th century. Addicted people are still told to get religion."
The program I attended, for example, told me that I would not recover if I didn't surrender to a higher power, make amends and pray.”

For me this brings up another question (which may not be well received but I believe it is worth asking): How many addicts and/or mentally “ill” people got to their illnesses because of the challenges of their religion(s)/reconciling the G-d they are taught about with the G-d they want in the world they live in/with?

“Further, labeling people with a brain disease characterized by lack of self-control can have negative consequences, particularly for adolescent users, most of whom are not addicts, suggest NIDA surveys and other research. In many teen rehabs, youths are told that they have "chronic, progressive" illness with a 90 percent chance of relapse. Forcing teens, whose identity is not fully formed, to accept an "addict" identity can be a self-fulfilling prophecy.
As Peele points out, "Self-efficacy and the image of the ability to control oneself are critical to recovery" -- as they are to maturation. For the same reason, it's a bad idea to tell people that without treatment, recovery is impossible.”

Amen to that!! How can you get “over it” when you are told you have no control? Why try not to sin when you are told that you were born “with a sinful nature” or even worse, with a sin already on your soul?

This part of the article is really sad: “As a result, experts -- including NIDA director Nora Volkow -- have called for the official name of the disorder to be changed from "substance dependence" to "addiction" in the next edition of the DSM. They say the confusion between physical dependence and addiction leads to under-treatment of pain: Surveys find many patients, even those who are dying, don't receive enough medication for effective relief.”
I have an uncle who died of cancer and to think of him not getting effective medication makes me cry. He was such a great guy – full of love and fun.

“So is addiction disease or learned behavior? Given its complexity, some experts say, what probably matters most is which view best yields compassionate and effective treatment.”

I say, addiction is the continuation of the disease that initially caused the person to self-medicate and become dependant on (fill in the blank) to alleviate an mental/emotional pain.
I could be wrong, but in my own case I’ve hit the nail right on the head.
hugz and Blessings,
Cully

Oh, as for the main question ...

I get less worked up about it than most people. Both depression and addiction are diseases where there is a biological component and an experiential component. I think the biological component is the majority in depression, and the experiential component is the majority in addiction. But both diseases have both components.

The problem, of course, is for people with "dual diagnosis," and how they balance their treatment(s). Because if they don't, the addiction can spiral them back into depression, the depression can spiral them back into addiction, ad infinitum.

I can't help but notice how the article used "substance dependence" and "physical dependence" for what is actually an addiction (period) to the stuff. When will the doctors stop sugar coating something that is a major issue in the world?

My father suffered from lung cancer and I had no problems with them medicating him to the point he became addicted to the stuff during the end of his life.

At the same time it is hard for a doctor to know how much is to much for someone suffering from chronic pain.

I believe the doctors that have the authority to write these prescriptions should be required to yearly attend a refresher course on prescriptions that cover the major medications that are regularly being prescribed.

Nancy a.k.a. sixlittlekitties

Margaret:

I don't want to take Vicodin away from you.

I want doctors to dispense it a lot more responsibly -- as, I hasten to add, I want Pdocs to dispense benzos and sleeping pills a lot more responsibly.