Russell Brand: Addiction is an illness not a crime

[StoneHappyMonday]

Thought it might be interesting to add this - the ICD-10 criteria for addiction/depedence. You need 3 or more criteria.
(ICD-10 = International Classification of Diseases vol 10 - used by UK psychiatrists to classify psychiatric disorders; the Americans use the DSM-IV)

(a) a strong desire or sense of compulsion to take the substance;

(b) difficulties in controlling substance-taking behaviour in terms of its onset,
termination, or levels of use;

(c) a physiological withdrawal state (see F1x.3 and F1x.4) when substance use has
ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome
for the substance; or use of the same (or a closely related) substance with the
intention of relieving or avoiding withdrawal symptoms;

(d) evidence of tolerance, such that increased doses of the psychoactive substances
are required in order to achieve effects originally produced by lower doses (clear
examples of this are found in alcohol- and opiate-dependent individuals who may
take daily doses sufficient to incapacitate or kill nontolerant users);

(e) progressive neglect of alternative pleasures or interests because of psychoactive
substance use, increased amount of time necessary to obtain or take the substance
or to recover from its effects;

(f) persisting with substance use despite clear evidence of overtly harmful
consequences, such as harm to the liver through excessive drinking, depressive
mood states consequent to periods of heavy substance use, or drug-related
impairment of cognitive functioning; efforts should be made to determine that the
user was actually, or could be expected to be, aware of the nature and extent of
the harm.

Iinterestingly it lumps the "psychological" addiction in with the physical dependence, when actually the two are different things -

This'll be the same ICD-10 that only stopped categorizing homosexuality as a disease in 1992 I presume?

You need three of those points for addiction yes? Handy then that two of them are almost a given for anyone to start off with. Namely point a) a strong desire or compulsion to take the substance - well excuse me for liking something - and point e) progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance
or to recover from its effects; - which handily doesn't define 'alternative pleasures' (I doubt they'd accept a swap of smack for crack for example) and seems to not take into account prohibitions role in 'the increased amount of time necessary to obtain or take the substance'.

Not a fan of ICD-10 or DSM-IV.

The concept of addiction is more of a political issue than a biological one. Our prisons are full of drug addicts who have committed crimes only because of prohibition. They don't need prisons. They don't need hospitals. They need a change in the law.

I think everyone inside for a drug-related crime should be released as a political prisoner now.

It'd solve the prison crisis.

 

[auto448]

He's a complete fucking nutjob but he's no fool. HAd a few good things to say though. Won't make much of a difference though.

Personally I can't see even Cannabis even getting decriminalized in this country.

Fuck sake parts of the US have more or less given it a bye ball and it and its a backwards hole

 

[effie]

^^ Yes, sadly you are right about homosexuality SHM

I'm not a big fan of it either, for various reasons, and for addiction i really don't like how they lump the psychological syndrome of addiction (whether illness or a varient of normal behaviour) in with physidal dependence - they are two distinct entities ffs - but I thought I would post it as people might be interested. It does undermine my case somewhat I admit :D I prefer it to DSM-IV however.

For a) and e) I think they are both a continuum, from "normal" (whatever that is, but that is a slightly different debate) to "addict".

Take a): I like opioids, but I have spoken to a friend with opioid addiction and he wakes up every day thinking about them, and thinks about them all day. Pretty much everything is triggering to him, as his brain can make connections between anything and opioids. He has a huge compulsion to take them which overrules everything else.

And b): I like opioids and sometimes I'll rearrange me evening or day, or even weekend, so I can take them. My friend, at the height of his addiction, lost his job, girlfriend, sold all his possessions including his guitar and amp (he used to be in a band), stopped watching films and readong, stopped leaving his flat except to score, did absolutely nothing all day except shoot up.

I suppose that raises the question of whether functional addictrs have a disease. I wonder if they have the same changes to the reward pathway that I mentioned.

I guess to me, a disease is a disturbance of structure or function of part of the body which results in some degree of impairment. This isn't an official definition.. and actually, something like my psoriasis doesn't impair much, although I do try to hide it. An amputation is not really a disease, but that would fit the category. Hmmm this needs some refining I've deliberately not looked up the official medical definition as I don't want it to colour my thinking here.

I agree that to criminalise addicts is absurd. I don't think they all need hospital - if they are happy with their addiction and it does not disrupt their lives, then that's fine. Earlier in the thread I said that would be classified as a disease anyway, but I think I might be revising my definition now.However, the addicts to whom their addiction poses a disruption in function - yes, I would still say it is a disease. Not necessarily something that requires treating, that is up to the patient, but a disease nonetheless.

 

[charlie clean]

ICD 10 and American cousin DSM 4 both define illness from an establishment viewpoint. Before consulting, read Laing or Foucault and wise up to the politics of social control.

Perhaps coincidentally, both Laing and Foucault suffered sustained campaigns of character assassination and are largely forgotten nowadays. Their private, particularly sexual habits were seized upon to dismiss what they said as the product of 'sick' minds. The authorities will define what's sick and, if you disagree, it's an indication you're diseased as well. A revival for the 'anti-psychiatrists' is long overdue.

 

[effie]

I think there needs to be a shift in thinking, certainly. I feel that there is a place for psychiatry - I have benefited from seeing a psychiatrist, and I know people who are at times severely incapacitated by their mental illness (or syndrome, or collection of symptoms, if you wish to avoid the illness tag - which I can definitely understand even if I don't agree ) and who greatly benefit from psychiatric input (from their perspective, not just from the medical model of them being "better"). However, the focus is definitely too far towards illness vs normality and I would prefer to see a much more person-centred approach. The focus, I think, should be on how much distress there is (to the individual, but also to others around them to some degree, although you need to be very careful here). If there is distress, psychiatry should look at ways to alleviate it. If there is not, then there is no need to treat anything. This is probably hugely simplistic but it's my general feeling about this topic.

I had something else to say but I've forgotten it

I have read some Foucault, charlie, but it was a while ago. No Laing. I will rectify this, if you recommend it

 

[missing old pills]

If you make your life map one of substance abuse I can see how you could see psychiatrists as thought police and I've spent alot of my life feeling this way.
However imo I'm finding in the therapy I'm engaged in is giving me more freedom rather than taking it away.
I suppose it all depends what you want out of life.
I've often blamed the state for frustrations in my life but the sheer feeling of real freedom when I find the answer inside my self ranks up there with any of my best drug experiences.

 

[Myshkin]

Perhaps coincidentally, both Laing and Foucault suffered sustained campaigns of character assassination and are largely forgotten nowadays.

Foucault's actually pretty darn trendy nowadays, though you're right about Laing.

Aside from that, this thread is a prime example of ideology (whether that of the establishment or that of the anti-psychiatry contingent) making people lose sight of the fact that, as effie puts it:

The focus, I think, should be on how much distress there is (to the individual, but also to others around them to some degree, although you need to be very careful here). If there is distress, psychiatry should look at ways to alleviate it. If there is not, then there is no need to treat anything.

To claim that anybody who feels they genuinely suffer as a result of their addiction is merely succumbing to the establishment's expectations is equally as bad as the ICD / DSM attempting to define 'normal' behaviour, in my book.

Dogma locking horns with dogma.

 

[StoneHappyMonday]

To claim that anybody who feels they genuinely suffer as a result of their addiction is merely succumbing to the establishment's expectations

Dogma locking horns with dogma.

Er..wheres that claim? Plenty of people suffer because of their addiction. The vast majority of that suffering though can be attributed to prohibition. Prohibition establishes legal boundaries that criminalise the user and cultural 'norms' that ostracise the user from accepted behaviour, making the user feel their addiction is more problematic than it actually is.

If we're all made to feel shit about our drug use, as we constantly are, it's hardly surprising many users and addicts have a negative 'set' to start with. The suffering may be genuine but it ain't necessarily the drugs themselves that are creating that suffering.

 

[charlie clean]

^^^^^^
So true.

Can only agree that conventional psychiatry can be a great help. Many a troubled soul keeps psychosis or other causes of mental distress at bay because of pharmaceutical advances. Whether 'therapy' should be the exclusive preserve of the psychiatric profession is a different matter altogether. You can tell, for example, missing old pills is in a standard therapy. He abused substances. Others use them.

Whatever gets you through. Different strokes for different folks and all that. Whether 'freedom' has a universal definition or is strictly an individual matter is a question for the philosophers. As long as you're happy, and are happy for others to be happy on their own terms, all is well. I was talking earlier with an ex-addict who's found his answer in a '12 step', abstinence based 'rehab' programme. I've no problems with his choice and he's no problems with mine. That's how it should be. The problems arise when you insist what's good for you is good for everyone else and, if it isn't your idea of what's good for you, it shouldn't be allowed for anyone. Which is how we were landed with the Drug Laws.

To broaden it out a bit, is anyone on here actually in favour of punishing drug use?

 

[badandwicked]

To broaden it out a bit, is anyone on here actually in favour of punishing drug use?

Can't really argue with this from Mr Brand though

He dismissed the role of celebrities and said he would back decriminalisation because he believes illegality is of no concern to users.
"I'm not a legal expert. I'm saying that, to a drug addict, the legal aspect is irrelevant," he said.
"If you need to get drugs, you will. The criminal and legal status, I think, sends the wrong message. Being arrested isn't a lesson, it's just an administrative blip."

 

[Myshkin]

If we're all made to feel shit about our drug use, as we constantly are, it's hardly surprising many users and addicts have a negative 'set' to start with. The suffering may be genuine but it ain't necessarily the drugs themselves that are creating that suffering.

True enough. Yet I don't see how it follows that all (or at least most) victims of the physically and psychologically detrimental aspects of addiction are suffering solely because of the establishment's negative attitude to drugs and drug users, which is what you seem to believe.

 

[Mr Smokes Blunts.]

Er..wheres that claim? Plenty of people suffer because of their addiction. The vast majority of that suffering though can be attributed to prohibition. Prohibition establishes legal boundaries that criminalise the user and cultural 'norms' that ostracise the user from accepted behaviour, making the user feel their addiction is more problematic than it actually is.

If we're all made to feel shit about our drug use, as we constantly are, it's hardly surprising many users and addicts have a negative 'set' to start with. The suffering may be genuine but it ain't necessarily the drugs themselves that are creating that suffering.

Your argument falls down pretty hard when you consider there are thousands and thousands of people suffering legal opiate/benzo/alcohol addiction. The fact is it just isn't enjoyable waking up day in day out, having to take a substance. Once the honeymoon period is over that's it, you are just taking to maintain. Undoubtedly running the gauntlet of the law to get your fix does make things more difficult, along with having society look down on you, but even so... They would just be more functional within society if they could obtain easily and safely, they wouldn't necessarily be any happier that they are reliant on something to feel normal.

 

[charlie clean]

As a ps, missing pills, anyone who blames the state - or, for that matter, anything else - for their problems isn't thinking clearly. You are the state and 'blame' is a redundant concept that's guaranteed to send you in the wrong direction. .

MSB, you're again attributing a universality to your personal experience. Probably a consequence of the appalling drug regimen you were prescribed.

 

[effie]

I still think that the situation I described, where an addict things about their DOC all day, has intense compulsions to take it, and excluded all else from their lives except the drug constitutes suffering which goes beyond the influence of prohibition and socially acceptable norms.

Over-medicalising addiction and looking to treat it as a purely biological phenomenon is obviously incorrect, but then so is taking the opposite view and treating it as an entirely social construct. Reality lies somewhere in the middle, I think. I still standby my statement that addiction is a disease (although I concede that labels are not necessarily the best approach in psychiatry) - calling it a disease gives it the same status as other psychiatric illnesses such as depression. The cause of depression is thought to be an interplay between psychological factors (eg stress, bereavement), social factors (eg societal pressures, financial concerns) and biological factors (serotonin depletion, although this is being challenged, and a genetic predisposition). Each case is unique and some can appear to be primarily biological, or psychological, or social.

The same is true for addiction - social factors can include society's views on drug use, prohibition, housing (or lack of), unemployment etc; psychological - stress, abuse, traumatic life events, boredom/dissatisfaction etc; and biological - changes to the reward pathway, genetics. Again, each of these can be of varying prominence in individuals. There is also often a coexisting disorder such as depression, anxiety or schizophrenia

To me they are diseases, but you could call them whatever you like. The important thing is that for many people, it will have a negative impact on their life. Psychiatry can help treat this. Current treatments may leave a lot to be desired, but in my experience treatment for drug addiction does at least attempt to address the psychological and social aspects, as well as the biological (through maintenance therapy). I agree that it does need a shift in perspective further away from the medical model, and that not all addicts need treating; the profession's views on "normal" and "abnormal" also need to be dramatically altered.

To me as I said before, the bottom line is whether it is causing distress and/or impaired functioning, and if so, whether the addict would like to pursue treatment or not. If they would, then psychiatry does have a role in my opinion.

Charlie, I am not in favour of punishing drug use, no :D

As long as you're happy, and are happy for others to be happy on their own terms, all is well.

I really like this, and I absolutely agree. I am not saying that psychiatry is the only way to treat addiction, far from it. As you say, different strokes for different folks. I was just arguing that there can be a place for psychiatry in the treatment of addictions, because in my eyes it is no different to other psychiatric conditions, and also that a good psychiatrist should look at the bio-psycho-social factors and address them all rather than just throw meds at someone Of course some people are happy without the imterference of a psychiatrist, and others find different approaches more successful. Each to their own..

 

[Mr Smokes Blunts.]

As a ps, missing pills, anyone who blames the state - or, for that matter, anything else - for their problems isn't thinking clearly. You are the state and 'blame' is a redundant concept that's guaranteed to send you in the wrong direction. .

MSB, you're again attributing a universality to your personal experience. Probably a consequence of the appalling drug regimen you were prescribed.

I am not saying it is universal, I am merely using it to refute SHM's universality statements... I don't doubt there are some people out there who do enjoy their addictions, and who want to maintain them. I'm just saying the fact there are plenty of legal things people are addicted to, that make them feel just as bad as those with illegal addictions, refutes any notion that almost all or all the negatives of addiction stem from a substances legality. I don't really know anyone who enjoys their addiction, legal or illegal. Whether it's to food, alcohol, benzos, heroin, tobacco etc.

 

[knock]

As a ps, missing pills, anyone who blames the state - or, for that matter, anything else - for their problems isn't thinking clearly. You are the state and 'blame' is a redundant concept that's guaranteed to send you in the wrong direction. .

Much as I enjoy a lot of what you write Charlie I have noticed you come out with the occasional huge generalisation that I can only call nonsense.

The idea that people are fully responsible for their own situation is trendy and simple. It's also simplistic and wrong.

Just as an extreme example to demonstrate that the generalisation is wrong, take slaves. Are they not entitled to blame those who buy and sell them? Or is their condition entirely their fault? Are they not thinking clearly?

So in the general case you're obviously wrong.

OK, so I know you were not talking about slaves, just us normal people. But our condition in life is determined by two things, our selves and our environment. Our environment is entirely out of our control. It's also vastly more powerful than us. It not only determines what choices are available to us from one moment to the next, our experience of our environment determines what specific choice we make from those available! I'm not even sure where we come into it most of the time.

So no I can't agree with this, it's conservative nonsense.

 

[Mr Smokes Blunts.]

Much as I enjoy a lot of what you write Charlie I have noticed you come out with the occasional huge generalisation that I can only call nonsense.

The idea that people are fully responsible for their own situation is trendy and simple. It's also simplistic and wrong.

Just as an extreme example to demonstrate that the generalisation is wrong, take slaves. Are they not entitled to blame those who buy and sell them? Or is their condition entirely their fault? Are they not thinking clearly?

So in the general case you're obviously wrong.

OK, so I know you were not talking about slaves, just us normal people. But our condition in life is determined by two things, our selves and our environment. Our environment is entirely out of our control. It's also vastly more powerful than us. It not only determines what choices are available to us from one moment to the next, our experience of our environment determines what specific choice we make from those available! I'm not even sure where we come into it most of the time.

So no I can't agree with this, it's conservative nonsense.

It isn't about people being fully responsible, it's about them being partly responsible. Yes growing up in a horrible household does increase your chances of becoming an addict 'x' amount, but there are plenty of people who grow up in those homes who don't grow up to become addicts. What about wife beaters? Almost all of them come from wife beating families, so they don't know any better. Let's just say 'fuck it, it's not their fault' shall we? You also have to bare in mind that the actions of the wife beater has an affect on their children too, substantially increasing their chances of becoming a wife beater too. Eventually the buck has to stop with the individual or nothing would work or function. Charlies point is that if you justify your actions and behaviour by blaming others, you need to sort your own life out and change it.

 

[knock]

It isn't about people being fully responsible, it's about them being partly responsible. Yes growing up in a horrible household does increase your chances of becoming an addict 'x' amount, but there are plenty of people who grow up in those homes who don't grow up to become addicts. What about wife beaters? Almost all of them come from wife beating families, so they don't know any better. Let's just say 'fuck it, it's not their fault' shall we? You also have to bare in mind that the actions of the wife beater has an affect on their children too, substantially increasing their chances of becoming a wife beater too. Eventually the buck has to stop with the individual or nothing would work or function. Charlies point is that if you justify your actions and behaviour by blaming others, you need to sort your own life out and change it.

Sure, the individual seems to have some responsibility (I'm not confident enough to say that they definitely do or do not, none of it makes sense to me. How can we have responsibility in a deterministic world? If the world is not deterministic then what is it? I'm not clever enough to make sense of this and I distrust anyone who claims they are) but that wasn't Charlie's claim. He said it makes no sense to blame anything outside ourselves. My claim is that's wrong, it often makes a lot of sense.

EDIT and if that wasn't charlie's point, that's how it read to me.

EDIT you've (significantly!) edited your post and not left a trail, why?

EDIT you seem to have edited it back!

 

[Mr Smokes Blunts.]

I added a sentence to my post I think? Determinism is definitely something to take into account when deciding what to do about a situation. However, it doesn't make sense to blame anyone beyond yourself. They suffer the same deterministic logic you are using to defend their actions. So at the end of the day the only actions you can even possibly hope to control are your own.

 

[knock]

I added a sentence to my post I think?

you removed one then you added it back, anyway it doesn't matter.

Determinism is definitely something to take into account when deciding what to do about a situation.

What do you mean, take into account? Determinism is (supposedly) how the world operates. We don't take it into account. It happens within us and around us. Deterministically.

however, it doesn't make sense to blame anyone beyond yourself.

Why not? If a slave trader trades me I will blame them for making me a slave. What is your alternative? I blame myself for being in the wrong place at the wrong time? In your world, everything is MY fault! fuck you!

They suffer the same deterministic logic you are using to defend their actions. So at the end of the day the only actions you can even possibly hope to control are your own.

It seems to me we can have conversations (and engage in other social behaviours) which affect each other's opinions and behaviours. So we seem to have some kind of influence over other people's actions at the social level.

Therefore, no I disagree with you.