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Addiction is not a disease (unless you're a tory) - Tactical Ninja

Aug. 15th, 2014

09:25 am - Addiction is not a disease (unless you're a tory)

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So this happened yesterday. The Needle is a zephyrometer (pointy spike thing on swivels that responds to the wind) that has been in Evan's Bay out by the airport for as long as I've lived in Wellington. It's one of my favourite pieces among the public art sculptures that are built to take advantage of the wind out there. We had a sudden thunderstorm and it was sticking up into the air, and, well...



(15 second video) - Impressed that someone caught this on camera. Also, I hope they rebuild it.


I subscribe to a digest of academic stuff related to drugs, drug policy, and human rights. This morning a letter came through that'd been published in Nature magazine, and I thought it was worth repeating here.

"Addiction: not just brain malfunction
Irrespective of the animal-rights issues you discuss, we disagree with your one-dimensional view that addiction is a disease, and with your claim that this view is not particularly controversial among scientists (Nature 506, 5; 2014). Neuroscience has been widely documented as just one of many important influences in drug addiction.Substance abuse cannot be divorced from its social, psychological, cultural, political, legal and environmental contexts: it is not simply a consequence of brain malfunction.

Such a myopic perspective undermines the enormous impact people’s circumstances and choices have on addictive behaviour. It trivializes the thoughts, emotions and behaviours of current and former addicts. It also belittles the significant effect that public-health campaigns and legislation exert on curbing substance abuse.Addiction is too complex to be fought on a medical-research front alone. A variety of approaches based on diverse levels of analysis is required.

Derek Heim*
Edge Hill University, Ormskirk, UK.heimd@edgehill.ac.uk
*On behalf of 94 co-signatories; see go.nature.com/ehujzh for full list."

I've long been uncomfortable with the addiction-as-disease model. Partly because shifting the public perspective from 'drug users as degenerate criminals' to 'drug users as sick patients', while an improvement, still denies problematic drug users agency of their own and removes any context from the picture. It allows the medical profession to decide what's best for people and leads to the imposition of 'treatment' that can be as demanding and invasive on a person's life as criminal sanctions*. Never mind that as it says above, problematic drug use (I hate the word addiction) is more complex than that. And the medical model is not supported by evidence.

Don't believe me? Try this simple thought experiment. While rates of drug use are pretty even throughout society (in fact there's considerable evidence that white people use drugs more than black people), *problematic* drug use is most often centred among the poor and marginalised. While this much is clear, *why* this is is less so.

If we were to follow the medical model, we would be forced to assume that poor and marginalised people are more prone to problematic drug use because of something in their brains that makes them vulnerable. They are either physically or mentally different from everyone else, and that's why poverty and problematic drug use are correlated.

Does that seem like the sort of oversimplification that you might hear in a soundbyte from some conservative political candidate advocating for why all beneficiaries should be drug tested?

Yeah. And that's one of the reasons the medical model is problematic. Because it furthers the view that poor people are poor because there's something wrong with them personally.

If we subscribe to a more complex social model, we recognise that there are many factors that feed into poverty and marginalisation, and that there are many factors that feed into problematic drug use, and that some of these factors may be correlated and some may not. The very fact that cops are more likely to stop, search, and arrest brown people leads to more brown people being identified as problematic drug users and forced into treatment. And remember, our current system flags *any* drug use as problematic. These two very easily identified factors are both external to the person, but they have a huge impact on whether or not that person is labelled as a problem drug user. And of course once that label has been applied, it sets in motion other societal judgements that feed back into poverty and marginalisation. Reduced job opportunities, social stigma, yadda yadda.

Which makes it very difficult to support the notion that this person has something wrong in their head, and that's why they are an 'addict'.

I do believe there are internal factors at play in true problematic drug use. They are at play in any drug use. It's one of the first things you learn when you study drugs - that their effect is a combination of the drug itself, the user's personality, and external factors. Set and setting, yo. But those internal factors are not the only factors at play, and reducing problematic drug use to just a medical issue seems to me to be ignoring 2/3 of the factors involved.

Kind of like saying a dog bit a person because it is savage, and ignoring that the dog had been trained by some idiot to bite people and also that it hadn't been fed for days and oh also that the person it bit was teasing it with a bit of meat. You know?

It's the kind of judgement that's made by people who don't think very deeply, and I expect better from our medical profession and policy makers.

* The kind of 'treatment' imposed often involves abstinence-only models with strict testing regimes and punitive measures for anyone who backslides even a little bit, with very little follow up support.


Anyway, I was glad to see this perspective getting some airtime in Nature magazine, because every time I hear people talk about addiction as a disease, I cringe a little. I know I'm on the extreme end of this view, in that I advocate for the recognition of psychoactive substance use as part of the normal spectrum of behaviour and incorporation of safe use guidance into our education system. I feel very strongly that the othering of drug users exacerbates any harm related to drug use, and I'm tired of hearing about how drug use is deviant behaviour. Put simply, it's not. And while moving problematic drug use from the criminal policy field to the health policy field is a step in the right direction, the medicalisation of problem drug use is problematic in itself.

Baby steps, I guess.

Comments:

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From:fbhjr
Date:August 15th, 2014 01:12 am (UTC)
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Sorry about the storm.

Having lost a grandfather to substance issues, I agree about the complex issues.
I have no answers to any of it. But, agree it is complex...
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From:tatjna
Date:August 15th, 2014 08:40 am (UTC)
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Yeah, it's a difficult issue. I've been studying it for some years and the evidence suggests that relaxing the laws and instead spending that money on support services seems like a good plan.

Create regulations that allow screening of those whose drug use comes to the attention of the authorities, so that those who could use help actually get it without threat to their livelihood/lifestyle, and those who don't need help don't get bothered. It's more or less what they've done in Portugal, and it seems to be working there.

The full report is worth reading if you're interested, but the one-page summary gives the basic rundown.
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From:fbhjr
Date:August 15th, 2014 11:34 am (UTC)
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Interesting article. Thank you for it.

I've always thought that it is not the supply side that should be addressed, but the demand. But, I think that about a lot of things the government wants to regulate.
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From:tatjna
Date:August 16th, 2014 05:39 am (UTC)
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Unfortunately, most western governments think demand-side solutions have to involve sanctions against users - again, in the face of overwhelming evidence that it achieves nothing.
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From:meathiel
Date:August 15th, 2014 07:17 am (UTC)
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Oops ... a bit unfortunate with the lightning ...
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From:tatjna
Date:August 15th, 2014 08:42 am (UTC)
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Yeah - especially since it wasn't even made of metal and it's right next to a big hill with a cellphone tower on top of it, and a marina with a whole bunch of masted yachts. ;-)

I still really hope they rebuild it though.
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From:t_c_da
Date:August 16th, 2014 02:44 am (UTC)
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Reading the story on Stuff (not the most reliable news source, I will admit) it seems that Meridian energy apparently partly funded the original installation back in 2003, and have made noises indicating that they're not averse to funding it's repair and re-installation. So here's hoping!

Also apparently it was a steel and fibreglass composite structure, which would have added to it's tastiness for the lightning.

A friend on Friday night said that he heard the zephyrometer explosion immediately after the thunderclap from where he was in Thorndon at the time. He didn't realise the noise came from that far away at the time, and only connected the dots when hearing about it on the news.
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From:pundigrion
Date:August 16th, 2014 09:55 pm (UTC)
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I had such a lightbulb moment when you posted about rat park before. I think rather than a disease model it is more likely a combination of profiling (cops are more likely to search people they already suspect) and that being poor and/or the "wrong" race makes your life pretty sucky and you likely have more need of an escape.
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From:ms_hecubus
Date:August 16th, 2014 11:06 pm (UTC)
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That's crazy they just happened to catch it on video. Although I'm not sure much happens these days that isn't caught.
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From:julianbuchanan
Date:August 18th, 2014 10:36 am (UTC)

the dangers of criminalisation, medicalisation and a disease model

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Well said - and it's good to see widening debates ripple out!
:)
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