Archives for February, 2011
In my last post I described why addiction is best considered a disease or medical illness, showing that the characteristics of addiction that are similar to those of other chronic diseases. The fact that addiction is a disease is no revelation to anyone who works in the field, yet there seems to be a collective blind spot among physicians when it comes to treating addiction like other diseases.
As we take on the issue of treating addiction as a disease, it is only fair that we first make certain that addiction does in fact meet that definition. Using the definition of disease from the World English Dictionary, disease is an impairment of normal physiological function affecting all or part of an organism, producing characteristic symptoms. From Miriam Webster's Medical Dictionary, disease is an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies performance of the vital functions. Disease is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors, to specific infective agents, to inherent defects of the organism, or to a combination of these factors. Addiction is clearly an impairment of the normal living state that interrupts or modifies the performance of the vital functions. I can't think of any ‘devil’s advocate’ position to the contrary. Likewise, there is no doubt that addiction is manifested by ‘distinguishing signs and symptoms.’ Signs of addiction include running around in a frenzy looking for the substance, even when such behavior causes negative consequences, or the physical signs that occur during withdrawal from opioids. Symptoms include constant cravings for opioids that are never satisfied and the utter demoralization of an addict who progresses deeper into his disease. Some of the attributes of addiction that I have always found fascinating are the similarities between the thoughts, feelings, and progression of illness among people addicted to opioids.
I would like to lay out a road map for the next few posts. I would like to write about several issues that relate in some way to the ‘disease theory of addiction.’ I want to explain why addiction is best considered a ‘disease;’ something that most people who work in the addiction field consider to be a fact, not a theory. From there I would like to point out the differences in how society views addiction, compared to other diseases. Finally, I want to present what I see as the fundamental flaw in how we treat addiction. To give a preview of that discussion, my concern about the treatment of addiction is that while many people CALL addiction a disease, few medical professionals or societies actually TREAT it that way. What I write will anger a few readers. I don’t WANT to make people angry at me; I just don’t see any way to present these ideas without causing anger. The obvious solution to that dilemma is to simply write about something else. But that hardly seems like the right thing to do. Opioid dependence is, after all, the most critical health epidemic in my lifetime— if being critical relates to the years of lives lost to the disease.
Below are comments from a reader of my buprenorphine blog, followed by comments of my own: I have been using various opiates for the past 2 years. I'm sure it has affected my life in numerous destructive ways, but at the same time I feel that it has given me hope. As a lifelong sufferer of anxiety and depression I have always looked for solace, and found it in books, art, music etc. But as I got older I got into drugs, in my case a path leading straight to opiates. As soon as I found them they were solution to all of my problems; I felt secure, safe, confident, sociable, and adventurous. I found myself taking the risks socially, academically, and spiritually that I always wanted to. The doubt, insecurity, contempt for myself and others were rendered inconsequential. I felt I had attained a balance in my mind that allowed me to be who I really was.
I haven’t felt like writing for the past few days. The wind was taken out of my sails a few days ago, when a patient’s mother called to tell me that her son died from a drug overdose. She told me to use the information in any way that I could, in order to keep someone else from dying. I have had several patients—all young men—who eventually died from their addictions. Each time that I have heard the news, I wanted to stay away from work, the phone, the computer—everything seems so heavy, so useless, and so sad. The grief of their parents is so great, and I have nothing to say to make them feel better. In each case I think through everything that occurred, trying to find something that I could have done differently. I know that in most of the cases, the parents have done the same, over and over again. In case any of the parents are reading this column, I want to say very clearly that you did all that you could. There have been times in my practice when I felt that parents were too harsh or too easy on their children. But in all of the cases I am thinking about now, the parents were about as perfect as they could have been—and yet in spite of their efforts, their children died. That the parents cared so much, and handled everything so well, makes the outcomes particularly frightening.