When it comes to thinking about addiction, opinions converge. Having bought into the addiction industry’s mantra, so-called social progressives and conservatives alike share the same ideological hangover from the Prohibition era, with a twist of AA sadism: all are religious about abstinence, and all accept as bible from Sinai the wisdom of coercing addicts into treatment regimens. But perhaps the greatest error made in the attempt at humane formulations about addiction is to cast as a disease what is essentially a problem of behavior.

The dangers of gathering more and more behaviors under the disease label is not something pharmacology moguls, politicians or health care professionals ruminate about, despite the ramifications for a society already committed to a morality lite and to diminished personal responsibility. In his book Diseasing of America, addiction researcher Stanton Peele breaks with this tradition. Disease conceptions of misbehavior are bad science and morally and intellectually sloppy, argues Peele. “Once we treat alcoholism and addiction as diseases, we cannot rule out that anything people do but shouldn’t is a disease, from crime to excessive sexuality to procrastination.”

While the application of the medical disease model to addictions was developed to “remove the stigma from these behaviors,” there is no genetic marker for alcoholism or drug addiction. Still, the misconception that these behaviors are linked to a genetic vulnerability is aired repeatedly by the media, in the absence of evidence. The rationale for using the disease model to describe addiction even though it is intellectually dishonest is that medical treatment is effective.

Yet another deception. An overview of controlled studies indicates that “treated patients do not fare better than untreated people with the same problems.” Of note is a 4500-subject-strong 1996 US epidemiological study conducted by the National Longitudinal Alcohol Epidemiological Survey. Treated alcoholics, it was found, were more heavily alcohol dependent on average than untreated alcoholics. Clearly a behavioral problem cannot be remedied by medical intervention. Addicts are cured when they decide to give up the habit.

The disease conception of addiction acts to isolate the noxious behavior from the person. Thus when we claim that drugs, much like the flu, “get a hold” of you, we conveniently deflect from that which mediates behavior: personality, values, character or lack thereof. Once someone becomes involved with drugs, we explain everything they do by saying it was due to the drugs, forgetting, in the process of this circular argument, that the source of the addiction is the person and not the drug. An honest look at drug-use means we cannot separate it from the person.

Heroin addicts are thus highly disposed to having social problems even before they become addicted, and truancy and smoking behavior serve as good predictors of future drug use.

With the disease label as a protective rampart, addicts have taken to comparing their “disease” with having, let’s say, diabetes or cancer. How opting to shoot up for the first time, then doing it again, then stealing to get some, even breaking and entering mimic the organic disease process in cancer or diabetes is unclear.

As Peele explains, addictive disorders are known only by the behaviors they describe. In the absence of the ongoing behavior there is no way of telling whether the person is, or will be addicted. “By claiming that alcoholics are alcoholics even if they haven’t drunk for fifteen years, alcoholism is made to seem less tied to drinking behavior and more like cancer.” But “a person does not get over cancer by stopping a … behavior”…while “the sole and essential indicator of successful remission of alcoholism is that a person ceases to drink.”

It is unfortunate that the various preventive programs school kids are exposed to are delivered by equivocating addicts-cum-activists who conveniently convey that “It” can happen to anyone, that kids have little control and that once diagnosed as an addict, always an addict. This sets in motion–where there is already some drug use–a self-defeating cycle of abstinence and relapse, not to mention an overall rise in drug related involvement.

Most youngsters outgrow their occasional binges and turn into responsible adults. For doing what they do as a rite of passage, teens and college students do not deserve to be labeled diseased. What they do need is to be held accountable for their behavior. Failure to hold the person who strays responsible for his actions means that you cannot credit the person who doesn’t stray. That’s the logic of diminished responsibilities all round.

For the rest, the lingering paranoia of the temperance and prohibition era, which has culminated in AA disease dogma, should be consigned to the historical dustbin.

©2000 by Ilana Mercer
The Calgary Herald
June 22

Disease labels are now being slapped on an ever-wider range of behavior. Members of the psychiatric and medical professions and their patients have all taken to the idiom of disease like ducks to water. The twin evils of reductionism and the pathologizing of everyday behavior are at work here. Complex behavior, once considered the function of morals, choices and yes, character, is now routinely reduced to the basic components of genetics and biochemistry and outsourced to the ‘expert’. Thus the thief is a kleptomaniac; the arsonist a pyromaniac; and the promiscuous a sex addict. This is both poor scientific practice as well as morally and intellectually impoverished.

It has not stopped Dr. John Ratey, a Harvard associate professor and a well-respected, prominent psychiatrist from claiming in his 1997 book Shadow Syndromes that quirky behaviors are actually mild mental illnesses resulting from brain dysfunction.

The lout who is appropriately obsequious with the boss because he knows where his bread is buttered, but who is less dainty with the wife, even thumping her occasionally, would be a candidate for compassion. He is after all doing battle with what Dr. Ratey terms “Intermittent Rage Disorder”. And the dad who dotes on his children while they are with him, but fails to mail them child support money as soon as they are out of sight, is simply afflicted with “Environmental Dependency Disorder”: He remembers his kids only when they are around. Is there proof for these sub-rosa disease categories? None whatsoever, although this has not prevented Ratey and many like him from coating their pronouncements with a patina of scientific respectability—and then cashing in.

If Ratey is up the creek without a paddle, then he is up there with the best of company. The Psychiatric Diagnostic and Statistical Manual (DSM-IV), the Rosetta Stone of the profession, has grown since its inception in the 1950s from 60 categories of abnormal behavior to about 410 diagnostic labels today and counting. Many of the disorders described in it are a matter of trend and niche. One of the diagnoses Dr. Ratey is particularly fond of is Attention Deficit Hyperactivity Disorder (ADHD). So fond is he of this chimera that he diagnosed himself with it. The reason this seemingly competent person decided he had a learning disorder is because he was unable to free associate during psychoanalysis!

Indeed, ADHD is the focus of a growing industry. The Canadian ADD Foundation says this learning disorder is likely genetically transmitted, affecting six to seven per-cent of the population. There are pervasive efforts underway to pronounce ADHD a disorder of the brain, although the evidence for this is scant. Driven by advocates and special interests, among them former U.S. Vice President Al Gore’s wife Tipper and a slew of medical professionals and peddlers of pharmaceuticals, U.S. legislation has pronounced ADHD a brain-based disorder. This is most curious because the flagship American National Institutes of Health (NIH), led by a panel of independent scientists, concluded that there is as yet “no independent valid test” for ADHD, and that “further research is necessary to establish ADHD as a brain disorder”.

The treatment protocol for ADHD is another aspect of this controversial diagnosis that gives the NIH pause. Children with ADHD are often given powerful psychostimulants. Yet there are no long-term studies of either stimulants or psychosocial treatments, and certainly “no information on the long-term outcomes of medication-treated ADHD individuals in terms of educational and occupational achievements, involvement with the police, or other areas of social functioning”. But what must surely put the advocates to shame is the NIH’s consistent findings that treatment for ADHD yields little improvement in academic achievement and social skills. Treatment, it seems, doesn’t do what it is supposed to do.

If nothing else, it is an interesting exercise to scrutinize the DSM-IV-based ADHD diagnostic criteria. Who doesn’t know a child who “has difficulty sustaining attention, doesn’t seem to listen when spoken to directly, loses things necessary for tasks, fidgets, or is on the go constantly”? Come to think of it, most adults at some point or another answer to such a description. Couple such subjective diagnostic criteria with the fact boys outnumber girls with the condition by nine to one, and ask yourself whether the ADHD-diagnosis is not inadvertently targeting typical male exuberance.

The ADHD-experts claim that children who take these drugs are better liked by other children and experience less punishment for their actions, which in turn improves their self-image. Considering that the adverse effects from the prolonged use of medications for ADHD can range from cardiac arrhythmia through to seizures and liver damage, this is some price to pay for popularity.

©1999 Ilana Mercer
  The Calgary Herald
  December 28