Drug addiction: choice vs. disease model.

[EveryStar]

Background: All right, well this got me thinking, because I got popped June 21st with ice (felony possession in TX, under a g), got a lawyer who suggested I detox off methadone at a hospital for 10 days, and then go to a treatment facility. The judge approved the detox, it was the worst, most horrifying and painful week of my entire motherfucking life (@ 4 months 100mg daily going to the clinic), but I finally got those liquid handcuffs off my back.

Now the next step was to send me to a treatment center. At first it was going to be COPAC, a 12-step based rehab that offers long term treatment, located in Branson, Mississippi. The insurance wouldn't cover it but we found one called St. Gregory Retreat Center (Google it real quick you'll find it) and unlike all the 3 rehabs I've been to before, they are not an "addiction is a disease" model-based treatment facility. It's in Des Moines, Iowa, and so far it looks real nice just looking at the website (except I'm gonna have to detox off my benzos too, been on clonazepam and temazepam for about 10 months daily).

But so the question, like the topic, is this: do you think drug addiction is a behavioral problem made by poor choices & decisions, or do you think it is a disease that you'll live with for life, that will follow you around like cancer and diabetes, and that if you ever do a single drug again, you're gonna relapse and get addicted to your drug(s) of choice again all over again?

I've always believed in the choice-based model, but I'm curious what you guys think.

Any feedback appreciated.

 

[LSDMDMA&AMP]

you got busted with tweak and they put you on methadone?

 

[EveryStar]

I was using heroin on-and-off for 2 years and a half or so till early last year I became truly physically dependent. Kept it up, kept it under control, tried to maintain, and tried to get off in December last year, buying 'done and Sub off the streets. After a while I couldn't take it anymore so I just signed up at the 'done clinic. For about 4 months I was on 100mg daily, that's why the lawyer recommended detox then rehab. It was one hell of a horrifying week, I cried every day twenty times a day for no fucking reason, couldn't sleep for 3 days, didn't eat nearly a damn thing for 5 days, and it's all smoothing out now, day ten of my detox, I still get occasional cold sweats and goosebumps, but otherwise I'm not in pain. I'm lucky I hadn't been on it for years 'cause I'd be looking at an even longer withdrawal time.

Now to look forward to detoxing off benzos...how fun.

But now I have no choice. It's up to the judge. I'm just glad I'm not going to a fucking 12-step facility, I'd shoot up the second I walked out the door that's for sure.

 

[GSpot]

Sounds like you are really ready to quit and found the facility to help you make it.

 

[Sweet P]

But so the question, like the topic, is this: do you think drug addiction is a behavioral problem made by poor choices & decisions, or do you think it is a disease that you'll live with for life, that will follow you around like cancer and diabetes, and that if you ever do a single drug again, you're gonna relapse and get addicted to your drug(s) of choice again all over again?

I think it's somewhere between the two. Our choices can lead to addiction, but studies have shown that certain drugs do affect the brain's "reward system" which is primarily responsible for the actual addiction. With enough clean time, the brain can repair itself and return to normal levels of functioning. Addiction isn't necessarily something you'll have forever.

 

[justsayknow]

Yeah I am not a big fan of the once an addict always an addict school of thought.
It takes away a lot of the personal responsibility. I think in theory you can take drugs or even your drug of choice again after recovering and not necessarily relapse.

Theres a couple of interesting threads about NA/AA groups that discuss this going around at the moment that are worth a read too.

 

[Znegative]

my opinion on this, is that addiction is a sort of "disease", although I would feel more comfortable with the term "disorder". I also think that it's a symptom of a different problem, a theory which is often heard in the rooms, and is one that I agree with. There is an element of choice that goes into it too, for instance, you have the choice to seek treatment, to not pick up after periods of abstaining, etc, but I know for myself, that the draw I feel towards heroin and other drugs, is just to powerful, and sometimes, in the throws of my addiction, I feel like I really don't have a choice. I either use, or I suffer. And the fact that one would choose to go back to such a hellish predicament is surely a sign of some kind of problem. Why would you want to fuck up after making your life so much better? yet it happens ALL the time.

 

[love2party]

I think it's both. First you make poor choices and then acquire the addiction disease.

 

[dokomo]

Yeah I am not a big fan of the once an addict always an addict school of thought.
It takes away a lot of the personal responsibility. I think in theory you can take drugs or even your drug of choice again after recovering and not necessarily relapse.

At the same time, you've got to take into account what mediates decisions about personal responsibility (the brain) and often the very systems that non-addicted persons take for granted. Addiction is tough, because there are huge psychological and organic components, and it is very difficult to draw the line between these areas when it comes to behavior.

I personally think that (at least with most addictive drugs) it is total fallacy when people think they can take their DOC again and not relapse. I think that an important part of recovery is learning not to trust yourself and your own judgement when it comes to drugs.

Heroin and other opioids for example hijack the human approach/avoidance system and strongly reinforce getting high (down to reinforcing even the basic rituals and activities that lead to it.) A junkie (or ex-junkie, whatever) is essentially running with faulty hardware for the rest of their life when it comes to making risk decisions about taking opioids again, which is why the only real solution is complete abstinence.

 

[evilthree]

while I think the disease model is complete horse shit, sometimes you have to fake it til you make it, as the cliche goes. Following the choice model, your average non-drug user assumes you to be responsible for all, and in their eyes consuming drugs is wrong. So, following this model, it lends itself for harsher punishments on the individual for being a user and choosing to use drugs. Not to mention the legal ramifications of most drugs

If addiction truly is a disease for some(it is WAAAY overblown should it be), alcoholics demonstrate it best. Their substance is legal and unrestricted, yet they seek help and treatment for a problem they cannot control. Again, I don't believe addiction a disease, but rather a symptom or a behavior indicative of other problems

Either way, I'd rather fake having an "addiction" then have to deal with the full punishment for some stupid drug charge. I hate faking, but I'd rather go through "treatment" then have to be caged up with murderers and rapists for possessing a bag of powder or a plant

 

[RedRum OG]

leaning towards the disease side. but its probably a little bit of both

 

[woamotive]

Kind of like what Sweet P said : We CHOOSE to use, bottom line. However, there are addiction genes, or genes that when present create a person to be more susceptible to addiction/addictive behavior/s. Say I have the gene/s in me: My environment plays a role in whether or not I'll become an addict as well as obviously my decision to use or not to use. I do? I flip that switch inside me and it becomes damn near impossible for me to turn it off.

 

[RedRum OG]

its a lot like nature vs nurture in developing kids- some cases one side has more pull, but usually both contribute

 

[justsayknow]

At the same time, you've got to take into account what mediates decisions about personal responsibility (the brain) and often the very systems that non-addicted persons take for granted. Addiction is tough, because there are huge psychological and organic components, and it is very difficult to draw the line between these areas when it comes to behavior.

I personally think that (at least with most addictive drugs) it is total fallacy when people think they can take their DOC again and not relapse. I think that an important part of recovery is learning not to trust yourself and your own judgement when it comes to drugs.

Heroin and other opioids for example hijack the human approach/avoidance system and strongly reinforce getting high (down to reinforcing even the basic rituals and activities that lead to it.) A junkie (or ex-junkie, whatever) is essentially running with faulty hardware for the rest of their life when it comes to making risk decisions about taking opioids again, which is why the only real solution is complete abstinence.

These are all good points. I think rather than "not trusting your own judgement" perhaps being aware of your tendencies and rationalisations might be how I would put it.

I have never been addicted to herion so I wouldnt be able to say if I could use again with out relapsing. I can really only speak about the drugs I have abused. I in no way want to discredit the physical/psychological conditioning that goes on for people that have opiate habits. I suppose I am just optimistic about people being able to "rewire" themselves.

 

[evilthree]

I forgot to add, given the monopoly and influence of the 12 steps in treatment in america, many views on addiction are shaped by this stronghold. The courts eat it up, and complete abstinence is supposedly the only option in the disease model. Catching people in the treatment web for making a choice could make them think they have a "disease", and broad generalizations help enforce this belief. The 12 step disease crowd really fosters strong collectivist attitudes

 

[OpiYum]

i think that addiction lies on the spectrum for different stages of addiction. When one is sooooo fucked up and keeps on doing the drugs regardless of the crappiest outcomes, it seems more like a disease. But as the addict recognizes the problem and actually wants to stop and is doing something proactive about it, the addiction slides more towards disorder (as zneg said above) and then after more support or coping mechanisms are in place, the addiction slides more towards choice.

I do not believe that addiction is an uncurable, lifelong disease and I believe there are many people who truly get over it. Meaning that they are 90 yrs old on a rocker and not craving a hit of heroin.

 

[Tchort]

Disease model, end of story. The 'moral model' (what you call 'choice') has been thoroughly discredited over the last century- as being Temperence/religious propaganda during a time period where fascistic social theories were being promoted (social darwinism, eugenics, racial hygeine, bionationalism, etc). In my opinion the 'Moral Model of Addiction' is simply another manifestation of this Western tendancy during the late 19th and early 20th centuries. Our criminal justice system is still based on it, as drug users and addicts are considered criminals rather than ill.

I think the 'genetic theories' of addiction fall in a similar category as the moral model. The idea that the children of drug users/addicts/alcoholics are genetically predisposed to be drug users/addicts/alcoholics borrows heavily from the turn of the century pseudo-scientific theories about criminality being a genetic mutation (which could be cured by sterilizing or exterminating habitual criminals, alcoholics, etc).

Proximity to addiction, environmental cues, socio-economics are the most likely causes of familial addiction- not some 'Degenerate genes'.

While the disease model explains the nature of addiction, the Marxist theory of Alienation gets at the root cause of the modern manifestation we know as addiction:

This fact simply implies that the object produced by labour, its product, now stands opposed to it as an alien being, as a power independent of the producer. The product of labour is labour which has been embodied in an object and turned into a physical thing; this product is an objectification of labour. ... So much does the performance of work appear as devaluation (dehumanization is the term used by the Josephsons in Man Alone, Giddens used vitiation) that the worker is devalued (or reduced) to the point of starvation. So much does objectification appear as loss of the object that the worker is deprived of the most essential things not only of life but also of work. Labour itself becomes an object which he can acquire only with the greatest effort and with unpredictable interruptions. ... the more objects the worker produces the fewer he can possess and the more he falls under the domination of his product, of capital.

-Karl Marx

Or to put it succinctly- from an old Praxis Poster from 1973:

Alienation: Work is viewed as an item to be bought and sold- a commodity. Our work becomes inhuman, a thing to be manipulated by our employer.

 

[Tommyboy]

Has anybody ever heard that part of the reason that they call addiction a disease is in order for insurances to pay for rehab? I recall hearing this in an outpatient rehab when discussing this very topic.

I believe that people have genetic predispositions that influence both if a person will use drugs, and also if they will become addicted after using. So since I believe it to be genetic, then I believe that it must be a disease, loosely defined at that. It would be way too much of a coincidence that multiple members of a family are addicts.

So although people choose to use in the first place, they do not choose to become addicted. And not everybody chooses to use. There are a lot of people that were prescribed a medication, whether it be opiates or benzos, and end up addicted.

 

[Khadijah]

At the same time, you've got to take into account what mediates decisions about personal responsibility (the brain) and often the very systems that non-addicted persons take for granted. Addiction is tough, because there are huge psychological and organic components, and it is very difficult to draw the line between these areas when it comes to behavior.

I personally think that (at least with most addictive drugs) it is total fallacy when people think they can take their DOC again and not relapse. I think that an important part of recovery is learning not to trust yourself and your own judgement when it comes to drugs.

Heroin and other opioids for example hijack the human approach/avoidance system and strongly reinforce getting high (down to reinforcing even the basic rituals and activities that lead to it.) A junkie (or ex-junkie, whatever) is essentially running with faulty hardware for the rest of their life when it comes to making risk decisions about taking opioids again, which is why the only real solution is complete abstinence.

This aint true. If you are educated about this subject you will also know that over time its totally possible to "re-re-wire" the brain, and correct the problem. Just like over time your reward system, etc gets fucked up and reinforces your bad decisions on a physical, organic brain-level it can also go the other way, and those same fucked up connections and path ways can get repaired.

I am clean and not using at all period now, but for a long time after I got clean, i was able to use here and there occasionally for a day once in a while, and have absolutely zero bad effects from it. It wasnt like i was able to control myself from just goin balls to the wall, all-out junkie mode again---its that i actually didnt even want to. I didnt have to control myself to prevent myself from havin a "relapse" and bingeing out and goin crazy--the desire to do that wasnt even there. I did my shit, had my fun, and was perfectly satisfied with it, and then that was it.

I did that for almost a year, usin once every few months was the usual schedule, sometimes I would use again 2 or 3 weeks later, but it was never more often than that, and I didnt have no problems bein able to do that.

before I got clean (and for the first time actually really succeeded) I was shootin half a brick or more a day (of dope) , i had got arrested 3 times in 7 months, had 2 felony convictions one that I had been facin state prison time for, had already managed to get 2 dirty piss tests within the first 4 months of my probation and was a millimeter away from catching a VOP and goin right back to court and prison. I was fucked up , I had been bootin dope for over 2 years at that time, (i had first tried shooting D when i was 16, and used for a little over a year and stopped for about a year n a half, but used oxys, etc, so i dont really count that as quittin)...My point is that I had been usin heroin since I was 16 and opiates since i was about 13 or 14, and Im 23 now. It was not like this was a short term habit that was easy to break. It was hard as hell, and i been thru my share of overdosing and all that other misery.

But I am living proof that the idea that an addicts judgment will be permanently fucked is wrong. For some people its like that and they doomed just to fail over and over, thinkin "this time I can do it" and they cant. but some people CAN, and I aint the only one ive known. Once i was out of the addiction, free from the obsession and all that, it was very different. Even when i was usin and out of control, it was never like the stereotype idea "One minute I was in the bar just havin a drink and my friend asked if i wanted to sniff a bump of dope with him, the next minute its 2 weeks later, im in a cockroach hooker motel with dirty needles laying all over the room and I just blew thru 5000 dollars in the past week from shooting heroin and coke nonstop. I just lost it, one thing led to another! Im just hopeless, i really just CANT have just one or I will end up addicted all over again!"

It aint never been like that for me, and i think its mad ignorant to generalize that all or none addicts can use again or cant use again, etc. Everybody is differnet, and for some people their addiction really does take the form of a completely controlling monster that they just lose it, but some people got much more personal control involved. And i aint talkin about the amount you use or nothing like that, its just the WAY you live and the WAY you use. You can have 2 junkies who do the same exact amount of dope everyday, and is both as equally addicted, but they might not be the same type of addict. One of em can be the type who will just make the same mistake over and over and over and over and over and over again, and just shoot up til he dies, get clean for 8 months and then just sniff one Oxy and then go right back into full fledge addiction from that. The other one might be the type who uses just the same amount, is totaly, hopelessly addicted, but got a better ability to control their use once they get clean, and CAN have "just one" without automatically just going on auto-pilot into another rock bottom.

Ill come back to say more later.

 

[Tommyboy]

Lacey, I am not saying that it's not possible to re-rewire the brain, but I don't see how you can say that you are an example since you are on methadone. Thats not the only reason, the other reason being that in your other post in the thread about "the idea of being clean" you said that the methdone is just pretty much balancing out the chemicals in your brain to make you feel normal. I know it's for pain too, but how can you say that you beat addiction yet you need the methadone to keep your brain level so that you don't want to do dope to feel better. Also, can it be a blockade effect that is making you not want to use? I am not that familiar with methadone, or the dose that you are at. I know that when I was on suboxone I said and truly felt that even if I had a pile of 80mg OC's (my DOC) in my hand that I would throw them out. That blockade effect really worked on me and re-wired my thinking, but I can't say that it lasted forever after I weaned off of them. So IMO the methadone is pretty much the medication that you are prescribed to treat your addiction.

I gotta call it like I see it, and the two posts seem to contradict somewhat. I know your interested in this topic, otherwise I woulda let it slide.