So in my ever pokey quest to obtain the elusive PhD, I’ve been reading Addiction: A Disorder of Choice by Gene Heyman. Super interesting and provocative so far. I’m sure I’ll post more about the book later, but for now I want to mention his very helpful analysis of studies on the prevalence and natural history of addiction. As I’ve written before on this blog, the two dominant models of addiction are (and have been for decades) a disease model and a criminal justice model. Setting aside the criminal justice model, the disease model is generally characterized by two (not mutually exclusive) discourses: 1) addiction is a brain disease and 2) addiction is chronic, relapsing condition.
Heyman takes a close look at the scientific literature to better understand where the ‘chronic, relapsing condition’ notion comes from and how accurate it is. He notes that most of the studies upon which this paradigm relies are of based on samples of people in treatment. Turns out, not surprisingly, that those in treatment are quite different from others who use drugs but do not enter treatment. Heyman reviews several large studies based on samples of the general population, which reveal that, in sharp contrast to the rates of relapse among treatment-based samples, most folks who have been addicted to drugs quit on their own and do not relapse. In fact, three of largest national studies suggest that almost 80% of people who were addicted at one time are able to quit drugs and stay off them. Qualitative studies of former addicts support these data and indicate that many people quit as they mature and/or have increasing reasons to quit (e.g., job, family, health).
Research looking at what distinguishes treatment- and non-treatment-based samples shows that the biggest difference is that those in treatment-based samples have much higher rates of psychiatric comorbidity, which could plausibly affect the natural history of addiction quite differently. Heyman has taken a lot of heat for his primary thesis that addiction is a choice, but I think his analysis of these studies is really important. So much of what we know about addiction is based on research samples of those in treatment (my own included), which we know to be biased. A broader view suggests that, for a whole lot of people, addiction is not a chronic, relapsing disease. I am not suggesting that there are no folks who experiences addiction as a disease. I've known lot of people who do. But, I've also met a lot of people who reject the disease model of addiction and do not feel it resonates with their own experiences of addiction or recovery. What does seem to be true is that addiction is experienced very differently by different people. Maybe that's why I'm so interested in how the sociology of the body might be able to help lend some insights into how and why embodied experiences of addiction and recovery are so varied.
Another great post, Julie. I am looking forward to reading Heyman's book. Of course, just because people experience addiction as a disease tells us nothing about whether or not it is one. The question is: what is a disease? And, more importantly perhaps, why our obsession with categorizing habitual substance use and enforcing its cure (sobriety)? What's so great about being sober?
ReplyDeletePerhaps if we moved away from this extremely loaded word "addiction" we might begin to imagine a different paradigm of social response. Ask people what an addict is, and a lot of images are conjured up immediately, most negative. Ask them to talk about who habitual substance users are, and the image changes. Most of us engage in habitual activity, why are some habits considered good and others bad?
Your posts always get me thinking. I can't wait for the next one.
Addiction treatment is just one of the avenues that substance abusers need to undergo to live a sober life and be the persons that they should be regardless of what addictions they might have. Surely, these people need prompt help from knowledgeable and expert people.
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