Off Topic: Addiction: Ideas that do not help

_{Denyse O'Leary

May 11, 2009

Intelligent Design}

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Nora Volkow, director of the US National Institute on Drug Abuse, writes in Time:

David Sheff wrote a beautiful book called, appropriately enough, Beautiful Boy A Father’s Journey Through His Son’s Meth Addiction, one of the most compelling portrayals I’ve ever read of a parent’s loss of a child to drugs. …

Many people still call addiction a moral failing. But 20 years of research tells us that it’s a disease that results in part from the damage that abused drugs to the brain circuits required for self-control. Unfortunately that damage is long-lasting, meaning that the person remains vulnerable to relapse even after years of successful rehabilitation.

Sheff’s experiences highlight how poorly our society addresses addiction. … Yet punishment and stigmatization do nothing to ameliorate the problem. How could they, when about 50% of addiction is rooted in our genes and much of the rest is due to social and cultural factors such as stressful childhood experiences?

All true, but all irrelevant, and in my view, harmful.

Every recovering addict I have ever spoken to – and I used to have a social sciences beat – has simply decided to get better, and acted on the decision. Punishment and stigmatization often play a useful role because they help the addict remain aware that the problem is real, and costly. That’s important, because the addict is often in a conflicted state about whether to just drop out again into the unreal world of addiction, as opposed to pursuing recovery. If the rest of the world is vague and unreal too, what is the addict supposed to do?

Most, wisely, call themselves “recovering” addicts for that very reason.

Look, I don’t wish anyone hardship, but the mid- and late-life consequences of addiction can be horrific, so the last thing the typical addict needs to be told is, “You can’t help it.”

A better message would be, “Addiction is NOT a brain disease. It is a choice for coping with a world that is difficult for every human being. So what can we do to help you cope, while shedding your addiction?”

Comments

for me it is the pretty much soul of relevance no less that we might actually (act ye as if u are my natural ally) have a discussion on a site such as UD about what might newly constitute in our estimation the difference between addiction and 'mere' 'onsession'- i mean obsession! Snesh! There is every beaston ( a small niggly heretofore undiscovered but definitely conceived-of particle) to bendlessly relive that first moment when another's body was percieved to be different than our own! That there should now be an industry dedicated to ensuring i never forget that no two bodies are the same and that this very reminder might forever jiggle the jar in which my brain is supposed to be resting is a consideration that i would expect ONLY the best intelligent designers to take on! (there, i've said it)little p_{May 14, 2009
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Marduk, "The silly idea that people aren’t physical beings is the utter bs that keeps free will / responsibility thing going. A persons mind is a circuit, if you short circuit that circuit it will not function properly." You might be short-circuited Marduk, if you don't see the self-referential incoherence of your position.Clive Hayden_{May 13, 2009
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little p: "i am sad also that my comment on the unique nature of addiction to the pornographic appears to have slipped beneath the radar - or however we are to conceive of the relevance-filters at work.. ..and play!" I think perhaps that pornography "addiction" falls more in the lines of obsession, than with addiction, so perhaps it's a little off topic. However, this entire thread is a little off topic. I think the difference between an obsession and an addiction lies in the fact that obsession tends to change over time - people's tastes in pornography can change from one particular feature to another, whereas, a drug addict is more or less addicted to the drug of choice, and is consistent in that choice, because it does something to him/her physically. Pornographic obsession does nothing physically, really, it's all psychological, it appears.CannuckianYankee_{May 13, 2009
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Marduk, Not picking on you're inteligence - it's just that you seem to be captivated by ideas that are not really logically sound, even though they might be popular at the moment.CannuckianYankee_{May 13, 2009
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"the thought that someone in 2009 could still manage to tell himself that religious belief is to be best understood as “some aspect of the nervous system” is dreadfully, dreadfully sad.." True, let's analyse it a bit. If the statement: "the human central nervous system (and also the brain) operate differently from person to person, and your experience of the world is DIRECTLY related to your nervous system, we could probably even explain religious belief some aspect of the nervous system itself, that if we changed it you would no longer believe in god....." is ture, then it should not just single out religious belief, but all belief. So,....let's change it around a bit: "The human central nervous system (and also the brain) operate differently from person to person, and your experience of the world is DIRECTLY related to your nervous system, we could probably even explain naturalistic belief as some aspect of the nervous system itself, that if we changed it you would no longer believe in Darwinism." Now, honestly, does that really work? How would you know what is then true, and what is false? If our brains control our beliefs - and it goes both ways with religious or non-religious, then truth is dead. This is one of the silliest ideas on the planet.CannuckianYankee_{May 13, 2009
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the thought that someone in 2009 could still manage to tell himself that religious belief is to be best understood as "some aspect of the nervous system" is dreadfully, dreadfully sad.. i am sad also that my comment on the unique nature of addiction to the pornographic appears to have slipped beneath the radar - or however we are to conceive of the relevance-filters at work.. ..and play!little p_{May 13, 2009
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Incidentally, Marduk, people with the ideas you have prescribed do not last long in mental health facilities, because this thinking contributes to the dangerousness of the behaviors associated with chronic mental illness. If you fail to hold them accountable on a certain basic level, you are in effect, encouraging dangerous behavior, and that's when people truly get hurt. I've seen this scenario over and over again over the years, until the leadership in our facility was changed about 7 years ago. Gone were the old excuses and ineffective programs, replaced with a Recovery Model approach, which offers positive incentives for appropriate behaior, and other motivators to discourage negative behavior. The change was dramatic. Our staff and residents feel more safe, and we are a preferred facility because of our approach. We treat our residents first as adults, not as mentally ill, and we expect them to behave accordingly.CannuckianYankee_{May 13, 2009
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Marduk: "The silly idea that people aren’t physical beings is the utter bs that keeps free will / responsibility thing going. A persons mind is a circuit, if you short circuit that circuit it will not function properly." The above thinking is a precise reason why in the mental health field, some do not recover. Some mental health professionals fail to encourage their patients to be accountable for their behaviors. Rather, their behavior is excused on the basis of their having a diesease, which renders them incapable of making appropriate decisions. I've worked in mental health for 20 years, and I can tell you that when the wrong approach is taken, people do not recover. Mental Health is more appropriately called "Behavioral Health," because behavior is the more recognizable manifestation of the illness. We don't just treat the mental impairment, rather, we treat the behavior that goes along with it, and this requires the patient to make the choice to be accountable for their behavior. This is the most effective approach that I have seen in the many years I have been working in the field. Believe me, I've seen the whole gamut of different approaches in that time.CannuckianYankee_{May 13, 2009
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Unfortunately I think people get carried away here. The human central nervous system (and also the brain) operate differently from person to person, and your experience of the world is DIRECTLY related to your nervous system, we could probably even explain religious belief some aspect of the nervous system itself, that if we changed it you would no longer believe in god. The silly idea that people aren't physical beings is the utter bs that keeps free will / responsibility thing going. A persons mind is a circuit, if you short circuit that circuit it will not function properly.Marduk_{May 13, 2009
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Denyse: "The addict chooses his illness. So you are absolutely right to see personal choice as the key to resolving the problems of addiction. I don’t think the “brain disease” thesis is going to help much, but i can sure see how it would hurt." Well, Denyse, sorry to disagree with you, but drugs affect the brain, like smoking cigarettes affect the lungs. You wouldn't say that lung cancer is not a lung disease, even though the smoker "chose his/her dieseas." Therefore, since drugs adversely affect the functioning of the brain - more specifically the orbitalfrontal cortex, it is correct to say that drug addiction is a brain disease, and it cannot easily be reversed. I agree with you, however, that drug addiction is different than other diseases of the body in that it affects the thinking apparatus - rather than, say the breating apparatus. Because of this, there seems to be a tendency for materialists to assume that decision making is so adversely impaired as to be non-effective. But this overlooks the fact that most people unless they are in a coma of some sort, have the capacity to make basic decisions for themselves. Even chronically psychotic people can make decisions for themselves.CannuckianYankee_{May 13, 2009
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"So what can we do to help you cope, while shedding your addiction?" Punish and stigmatize?David Kellogg_{May 13, 2009
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"Addiction is NOT a brain disease. It is a choice for coping with a world that is difficult for every human being. So what can we do to help you cope, while shedding your addiction?” I have a question is UD addictive for the people here? For the atheists here is it a coping mechanism to deal with their delusions in an superficially logical way that seems non contradictory?jerry_{May 13, 2009
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@13. You are right. I am sorry I was unclear about that in my post. I did not mean to imply (though, re-reading my post, I did write as if I did) that iii) must occur exclusively from ii). My point was that stopping at ii) is inadequate. iii), at least in my experience and awareness, appears necessary in the majority of cases. Sorry for the confusion. As for 'inability to recover', I will reiterate what #19 says, as it reads to me as if iii) is still possible, just more difficult. From my experience assisting in a Juvenile Detention Centre (their families frequently have difficulties with drugs/alcohol) and listening to older, previous addicts of a range of substances, I have not heard of anyone 'lost' to their addiction to the point where compulsion had wiped out choice. But perhaps those actually involved in the profession have better 'anecdotal' evidence with regards to this.Avonwatches_{May 13, 2009
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Denyse: "Punishment and stigmatization often play a useful role because they help the addict remain aware that the problem is real, and costly." I don't think you are prescribing punishment and stigmatization as an intervention to addiction, but they are social consequences, which may leave a positive motivation for making the choice to recover. Punitive measures never work. However, when a person understands that there are negative social consequences to their drug abuse, they are more motivated to work towards recovery. I think the article that JTaylor cited has a valid point in that the ability to act on the negative consequences of addiction is impaired in the addict, which makes making the choice to recover more difficult, but not impossible. This is why I think that rehab is so important, because it takes the addict out of their addictive social environment; hence, they are more empowered to make the recovery choice. There are definitely social factors, which contribute to addiction. Rehabs tend to restrict those social factors, but not entirely nor permanently. Give dope to an addict, and he's gonna do the dope. I have freinds who are addicted to methamphetamine - a horribly destructive drug. They have been in and out of therapy, and they keep making the same mistakes. They say "this is it, I'm not going back," and they mean well, but invariably, they go back. Then I've met other former addicts, who are recovering. I think's it's simple to say that clinically, there's no exact science, and it's precisely due to the choice factor. But recovery from anything psychological is a long process. Because we don't see immediate results in an individual does not mean that in the long process of therapy and rehab, they cannot show some progress.CannuckianYankee_{May 13, 2009
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JTaylor, I read the article you linked, and discovered this interesting quote: "The OFC helps you learn from your mistakes so you can change your behavior when things don't go as you expect, Dr. Schoenbaum said. It's implicated in a host of neuropsychiatric disorders - depression, OCD, mania, maybe ADHD - and there's some sort of change in the brain of addicts that prevents them from modulating their drug-taking behavior." It seems that changes in OFC (orbitofrontal cortex) are implicated in other psychiatric disorders - including depression. So there seems to be a corelation. Also, the article does not seem to indicate that drug addicts cannot choose to recover, but that making the choice to recover becomes more difficult.CannuckianYankee_{May 13, 2009
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Re: #16 "I agree that recovery from depression is more complicated than simply giving somebody an antipsychotic." Sorry, I meant to say antidepressant, not antipsychotic. :)CannuckianYankee_{May 13, 2009
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JTaylor: "There is still the issue of where a person’s brain (again through drug abuse, not depression) has become damaged to the extent that iii) is no longer possible. That was the point of Volkow’s article and it seems to be supported by clinical data. Or do people here simply not accept this to be the case?" I find myself agreeing with you here, JT. Several of the residents in my facility became mentally ill due to drug abuse. They are psychotic, and are preoccupied with their mental illness to such an extent that recovery is not an easy option. It's more complicated than simply having the will to recover. Read my post (#15) on "The Recovery Model," however, and I think you will see some value in what Denyse is saying. It's not one or the other (reductionist intervention or choice), it's a combination of the two that are the most effective. We don't simply give medications to our residents and expect them to recover. We engage them in group therapy, in which they learn to make appropriate choices. We teach them social and communication skills, frustration tolerance, coping skills, in fact, all of the skills that they require to live more independently. You are correct (as far as I can tell)from a clinical standpoint about the pervasiveness of drug addiction. However, the issue of recovery and therapy is more eclectic. Recovery Models tend to emphasize personal choice because in the mental helth field, one approach is often not enough. You need to offer as many approaches as possible to see what the individual responds to. The fact that people suffering from these illnesses or addictions often do recover, indicates that they have responded to something - i.e., they have made a choice. Part of my job as a Program Director in charge of the group therapy program in my facility is to do assessments on our residents when they first arrive in the facility. One assessment covers the individual's ability to make decisions. There has never been an instance where I have determined that an individual - no matter what their psychosis, was incapable of making decisions. They might have some impairments in that area, but ultimately, they can choose. My job is to help them to make appropriate choices. That is where the Recovery Model gets its strength - in the person's ability to make choices. If you look at the history of the treatment of mental illness, you will see a trend away from the kind of controlling "therapies" of the past, to more self-directed, choice-related therapies, because after all, we can all make choices. I mentioned in an above post about my experience with ECT. In the past "shock therapy" as it was once referred to was often forced on patients. Ever see "One Flew Over The Cuckoo's Nest?" But ECT in my case was my decision. I met with several doctors in order to make an informed decision, and I believe it was the right decision. I am so glad that my family did not simply resign to the fact that I had this illness, but they encouraged me to make the right decisions, and that is why today I am doing well. It's true that some people choose not to recover, and that is their decision. The important point is that we don't force them to recover, but leave that decision up to them as we show them both the benefits of recovery and the consequences of remaining where they are. Incidentally, the Recovery Model goes against much of the previous models of psychotherapy, and appears to be more successful. Perhaps simply having a "clinical" understanding of these very human issues, is not sufficient. You have to understand that humans make choices. For the addict, he/she made the decision to abuse drugs, and became addicted. Addiction does not have to be a prison. A person can make the decision to break free. For some it is more difficult than for others. But that's the point; as humans we have choices. We are not simply the makeup of brain matter.CannuckianYankee_{May 13, 2009
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"Speaking from my experience of suffering with clinical depression I would disagree that a person can just “choose not to be depressed” but at the same time, the depressed person is not just a victim of their brain chemistry." Jason, Interesting. I suffered from clinical depression for about 20 years. About a year ago I went through 9 treatments of ECT (Electro-convulsive Therapy). I've been off medication since, and doing extremely well. I feel like a "new person." Of course, there were some drawbacks to the therapy, such as short-term memory loss, but I recovered from that in about 2-3 months. Still have some minor memory issues, but the payoff was worth it. I had it done at Loma-Linda Medical Center here in California - which has many supporters of ID on it's medical staff. I agree that recovery from depression is more complicated than simply giving somebody an antipsychotic. None of them seemed to work for me. I was on Prozac, Paxil, Zoloft, Remeron, Trazadone and Effexor at one time or another. My Psychiatrist also prescibed some antipsychotics - even though I wasn't psychotic. Not having to take medications is a big step in the right direction for me.CannuckianYankee_{May 12, 2009
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"is it your opinion that thinking of mental illness in general as a “brain disease” is also a mistake? should insane people just make a choice to be sane and go from there? or do you think addiction is distinct from other mental illnesses? if so, why?" http://en.wikipedia.org/wiki/Recovery_model Interesting question. As a mental health professional in a facility in California, I would have to say that the trend is towards what is known as "The Recovery Model." It is a model based on personal choice, rather than the-over use of medication and institutionalization, which don't really help that much. Medications, of course are necessary for those suffering from psychosis. However, for many in the mental health system, medications don't work. People with "personality disorders" are not helped much by antipsychotic medications, and individual therapy does not seem to help much either. This is because their disorder thrives on individual attention, and they simply learn to become more engaged in the behavior - more manipulative, attention-seeking, as the people working with them simply feed into their behaviors. What they really require is people to set strong boundaries and limits on their behaviors, and for them to learn to set those boundaries themselves, so that they can learn to engage in a more healthy and responsible manner. This is what the recovery model is all about. Group therapy seems to work better, because the professional is not expending needless time with their issues, when what they need to learn is to engage more appropriately. As far as those with psychosis - it's more difficult, because they often have very disorganized thinking, which makes it difficult for them to make the choice to recover. Most county mental health departments in California strongly encourage the "Recovery Model" in the facilities where they place their clients. Schizophrenia, Bipolar Disorder and Schizoaffective Disorder and others are truly illnesses. Medication does help tremendously, and the newer medications, like Abilify, Seroquel, Risperidal and Zyprexa have fewer side effects than the older generation of antipsychotics - Haldol, Thorazine, Prolixin, etc. I'm not as well informed about drug addiction. However, if you follow the link to the Wikipedia article, you will see that a version of the "Recovery Model" is also being used in the treatment of drug addiction.CannuckianYankee_{May 12, 2009
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The disease model of viewing addiction was a step forward from the prevailing moral failure viewpoint. As the saying goes, the man takes a drink, the drink takes a drink, and the drink takes the man. In the case of active alcoholism the mind is impaired and the drink is continually taking a drink because the drunk never sobers up long enough to get out of the vicious cycle. If you know anyone trying to discontinue drinking be sure that they get medical attention because you can die from alcohol withdrawal. A recovering alcoholic myself, I thank God for Alcoholics Anonymous.Davem_{May 12, 2009
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@12 Again I don't think it is that black-and-white - I don't think that thinking and thought are always sufficient in themselves to cure/manage the problem, but sometimes a combination of "reductionist" methods may be needed too (i.e., ii) and iii) ) There is still the issue of where a person's brain (again through drug abuse, not depression) has become damaged to the extent that iii) is no longer possible. That was the point of Volkow's article and it seems to be supported by clinical data. Or do people here simply not accept this to be the case?JTaylor_{May 12, 2009
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@11. The point of the depression 'anecdotes' (or shall we say testimony?) is that: i) Dz thought/has a medical, physical (biochemical) basis. ii) Physical, reductionist methods are unable to counter problem. iii) Thinking and thought have cured/managed these, rather than the attitude "I can't help it". Which is one of the points Denyse speaks of. Also, I would casually point out that even these 'anecdotes' should not exist. The "power of thought" should not be able to alter the physical and biochemical brain. Nor should the placebo effect exist. It isn't a "well, there are more people who don't get better by thinking alone, therefore it doesn't really exist". Rather, it is: "these examples should not exist at all, from a reductionist framework." But they do.Avonwatches_{May 12, 2009
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The comments about depression above are touching - I certainly do not doubt that self-will is an important element in recovery. But the piece quoted isn't talking about depression, but about drug abuse, and in particular that long-term drug abuse can damage the brain: "But 20 years of research tells us that it’s a disease that results in part from the damage that abused drugs to the brain circuits required for self-control. " There does seem to be a large body of evidence that clearly demosntrates that the brain can be damaged through extended drug abuse. And it isn't that hard to find reputable studies that clearly indicate self-control can be compromised by some kinds of brain damage: http://www.aan.com/elibrary/neurologytoday/?event=home.showArticle&id=ovid.com:/bib/ovftdb/00132985-200902190-00015 Although Ms O'Leary's anecodotes about how people overcome their drug abuse with wanting to get better are illuminating, in the end that are just that - anecodotes (and I can just as easily counter with anecdotes of people I have known who have who also willed to be better and have not in fact been able to do so). It may be true that addiction is not caused by a brain "disease" but there does seem compelling evidence that addiction can cause the brain to be diseased - and that at this point recovery is more involved than just willing the addiction to go away. I've no doubt though that the will to want to recover is an importnat component to recovery, but as Jason Rennie has so aptly pointed out above, this is a more complex and subtler issue than O'Leary makes it out to be.JTaylor_{May 12, 2009
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Avonwatches- I also can relate to your story about depression. My wife struggled with it for a while after we first met (I'd like to think it wasn't because she met me :) ). She saw several doctors, took countless medications over a couple years. It was the first time I truly witnessed the incompetency of a reductionist medical system. It is great at dealing with a majority of medical problems, but the closer you get to the "self", the less effective it is. After watching her depression worsen after months and months of medication, I finally stepped in and said, "You're done with medication. You don't have to be like this." It was her decision to change her outlook on her life that ended her depression for good. I have a hard time believing that was a calculable phenomenon in brain activity instead of an actual decision by a conscious human being. The reductionist worldview is ANYTHING but following the evidence where it leads. Re: Original post
Every recovering addict I have ever spoken to - and I used to have a social sciences beat - has simply decided to get better, and acted on the decision. Punishment and stigmatization often play a useful role because they help the addict remain aware that the problem is real, and costly.
I've never been close to a person struggling with something like a drug addiction, so my experience with it is mainly relegated to episodes of "Intervention". But it seems to be a very telling show. There were two common themes that were the key to every single intervention I saw, as organized and directed by an expert interventionist. #1) The addict's closest family and friends basically telling him "this is not okay" (obviously that comes out much more emotionally and heartfelt than that). #2) The addict choosing to completely change their life. The interventionist would almost always say that if the addict doesn't choose to change voluntarily, they will not. Obviously what follows is extended stays in rehab centers, tons of support from family and friends, getting a job, etc. But the two points I mentioned are glossed over by the reductionist statement quoted in the original post.uoflcard_{May 12, 2009
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well, there is one area addiction-wise methinks that i have yet to see anything like wisdom distilled from, and that is the addiction that is like no other - the addiction to the pornographic! It is more than embarrassing that the sum total of wisdom webchristianwise on this problem amounts to 'find your wife (should you indeed have such!) newly stimulating' and let intimacy triumph all over again over the phenomenon of inexhaustible re-presented esthetic form! I would give anything (!) to seriously dialogue on this but i fear that xians are notoriously coy and circumspecticized when it comes to the big erotic crunch!little p_{May 11, 2009
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What I want to say might be perceived as good news or bad news or maybe totally discounted. I think it is well known that once a person is addicted, they face a lifetime of erupting cravings to go back after they have kicked the addiction. This gives rise to the AA doctrine that a former alcoholic is always "recovering" and cannot take a drink. However, there are pathways which a person can take which undoubtedly will help conquer these cravings, and one of them is ibogaine (a psychedelic) treatment, which is available in Mexico and is a 24 hour session. A good friend came to Houston in the early '90's to found the pain management center at MD Anderson clinic. During his tenure at the clinic he became addicted to pain killers and alcohol. He lost his job, not over this, but soon after losing his job he lost his license to practice after becoming a helpless full-blown alcoholic. Then after a couple of years of this he took action, and fortunately was familiar with the success stories surrounding the use of ibogaine, so he went to Mexico for the treatment and now is craven-free. And it seems that one of the hallmarks of a successful ibogaine treatment is a powerful spiritual experience, which my buddy did have during the session. So my theory is that an addiction puts a person in line for a dramatic spiritual experience, and can never go back to the pre-addiction state - the die is cast so to speak, and the only way through is to connect with one's deepest self. A currently emerging success story involves another psychedelic, psilocybe cubensis, which recently has demonstrated remarkable success with people suffering from serious mental illness. The successful progression is again accompanied by dramatic spiritual breakthroughs for the patient. Medical research on this substance has in the last few years been sanctioned by the government, and has also shown it to have powerful healing properties for addicts.groovamos_{May 11, 2009
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I will attest to what Denyse writes. Dealing with my own depression (diagnosed whilst in year 10 @ school, and put on 'the drugs'), that attitude "it's my genes, my body" DOESN'T help. Even GP's don't deal with the disease/malfunction on a purely 'have some drugs to fix your problem' basis. Believe it or not, positive thought has played the largest part in management of my depression. Now, I don't mean wishy-washy "just think happy thoughts". I mean taking up the realization that "I am in control; I can exert an effect on what I experience". Contrast this with earlier years when I 'accepted' that it was 'just me', 'just my genes', etc. The drugs give a nice buzz (similar to coffee, I suppose), but really just mask the effects. I would feel a compulsion to socialize, or 'be happy', but still feel the underlying unease/social lethargy. Like a guy on pain-relief that can still see the plank of wood sticking through his torso. In the last year and a bit I don't even take the drugs. Has my Dz gone away? No. But my thinking has changed. And for some strange reason I prefer to get up at 7am rather than stay-in until 12 everyday...Avonwatches_{May 11, 2009
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Nice post Denyse (as always). Speaking from experience with mental illness and addiction, you are right that addiction is largely a choice, but there is also the addictive nature of it that makes it harder to get off the merry go round as you proceed. The behavior reinforces itself. I agree with you completely that any attempt to make addicts out to be "victims of their genes" is only going to harm people in the long run. Speaking from my experience of suffering with clinical depression I would disagree that a person can just "choose not to be depressed" but at the same time, the depressed person is not just a victim of their brain chemistry. It seems much subtler and more interesting than that. I really must get around to writing that article I wanted to write on Substance Dualism, Depression and Medication, one of these days.Jason Rennie_{May 11, 2009
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Denyse, is it your opinion that thinking of mental illness in general as a "brain disease" is also a mistake? should insane people just make a choice to be sane and go from there? or do you think addiction is distinct from other mental illnesses? if so, why?Khan_{May 11, 2009
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Thanks, Bill One thought that occurs to me is this: A drug addict, a drunk, or a smoker whose lungs are deteriorating can actually stop further damage just by deciding to stop damaging his body. Consider, however, the following cases: 1. The person with a disease that requires multiple drugs with conflicting and deteriorating effects (but better than short term death). 2. The diabetic who faces blindness due to retinopathy or amputation due to circulation problems. 3. The miner who never smoked but spent 30 years underground - and has the rotten lungs to prove it ... Does anyone in their right mind think that these people would not just walk away from their illnesses, if they could? That is the key difference between illness and addiction. The addict chooses his illness. So you are absolutely right to see personal choice as the key to resolving the problems of addiction. I don't think the "brain disease" thesis is going to help much, but i can sure see how it would hurt.O'Leary_{May 11, 2009
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