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Sunday, August 5th 2007

It's Your Own Darn Fault

I thought I was about as pro-personal responsibility as one could get but a non-mainstream psychiatrist and psychologist have shown me up good. They take Congress to task in a Slate piece for trying to,

change the name of the National Institute on Drug Abuse to the National Institute on Diseases of Addiction and change the name of the National Institute on Alcohol Abuse and Alcoholism to the National Institute on Alcohol Disorders and Health. Called the Recognizing Addiction As a Disease Act of 2007, it explains, “The pejorative term ‘abuse’ used in connection with diseases of addiction has the adverse effect of increasing social stigma and personal shame, both of which are so often barriers to an individual’s decision to seek treatment.” Addiction should be known as a brain disease, the bill proclaims, “because drugs change the brain’s structure and manner in which it functions. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.”

They contend that

Characterizing addiction as a brain disease misappropriates language more properly used to describe conditions such as multiple sclerosis or schizophrenia—afflictions that are neither brought on by sufferers themselves nor modifiable by their desire to be well. Also, the brain disease rhetoric is fatalistic, implying that users can never fully free themselves of their drug or alcohol problems. Finally, and most important, it threatens to obscure the vast role personal agency plays in perpetuating the cycle of use and relapse to drugs and alcohol.

I have a tendency to take pragmatic discussions into the ridiculous; the metaphysical. I’ll avoid a discussion of fatalism and free will here. Sticking on topic there is obviously a very large component of self determination in kicking any addiction and these health care providers writing in Slate obviously know the situation much better than myself. So, you can understand why the semantics of putting something like addiction up there with MS puts them off a bit.

At the same time it is clear that there are things structurally ‘abnormal’ in the brains of many addicts. Trying to balance this predisposition versus personal responsibility is the entire task. There are remarkable cases demonstrating the pathophysiology of some compulsions/addictions. The Slate article seems to contend we’ve gone too far in using whatever biological predisposition exists to relieve addicts of their personal responsibility. But have we really? This society still holds addicts largely responsible for their actions and view the addiction largely as merely a mitigating factor.

I agree, we need to be wary of the future development of fatalism when it comes to the view of addiction. It is a fine line, agreed. But is a huff necessary over renaming the NIDA? Probably not.