“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.’"
I agree with this assertion, but not the reason provided in the Act. It’s true that drug addiction affects the brain chemicals (just as the foods you eat do), but there is also substantive evidence that those who are labeled “addictive personalities”, regardless of what they’re addicted to, have abnormal brain chemical balances. However, and the exorbitant prices of a long-term addiction can cause the addict who continues using to choose between financial well-being and a life of crime. In addition, the neurochemical changes influence the decision-making process, which can make impulsive behaviors more likely. It is a combination of neurochemical susceptibility causing addiction, further imbalances in brain chemistry caused by drugs, and psychosocial issues arising around addiction that cause “harmful behaviors”.
“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.”
Depression, too, is often an issue of brain chemistry—but is affected by desire to be well and legitimate, effective treatments like Cognitive Behavioral Therapy. The authors’ assertion denies research that shows that many brain chemistry/mental health issues are lessened by a combination of increased skill sets (skill sets meaning how one perceives, considers and responds to life events and sensations) and medication. In many cases, the confidence gained by increased skill sets can lessen the need for costly medications—a definite threat to one of our authors, a psychiatrist (An MD that primarily treats mental illness by medicating it).
Furthermore, medicines for mental illness are not always the best path. In many cases we don’t know why a psychoactive medication works—only that it seems to, so we use it. Compare this to antibiotics or insulin. Scary, no? In addition, many times the side effects of these mystery pills undermine the quality of life of the patient. A man unable to achieve erection is likely to become more depressed, not less.
“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.”
Personal agency is sometimes what causes an addict or mentally ill person to seek and comply with treatment. Treatment, when accompanied with training for skill sets (recommended by the authors on page 2 of this article), sets the stage for success. How is de-stigmatizing addiction by declaring it an issue of brain chemistry going to obscure personal agency?
“Telling the public that addiction is a "chronic and relapsing brain disease" suggests that an addict's disembodied brain holds the secrets to understanding and helping him. It implies that medication is necessary and that interventions must be applied directly at the level of the brain.”
This is simply a restatement of the claim that this bill denies personal agency on the part of the addict.I believe I have adequately explained above why this is false.
“But that's not how people recover. For actress Jamie Lee Curtis, for example, quitting painkillers was a spiritual matter.”
Each addict’s path is a bit different. Not all people have the spiritual or personal strength of someone like Jamie Lee Curtis. I would be interested in hearing the authors’ suggestion for those without said strength who have a legitimate desire to heal. Or do they fall prey to the Calvinist theory that we are rewarded in accordance to our goodness?
“Finally, dare we ask: Why is stigma bad? It is surely unfortunate if it keeps people from getting help (although we believe the real issue is not embarrassment but fear of a breach of confidentiality). The push to destigmatize overlooks the healthy role that shame can play, by motivating many otherwise reluctant people to seek treatment in the first place and jolting others into quitting before they spiral down too far.”
Shame does not cause us to reach out, but to hide beneath or within. The example of a certain restroom-visiting senator notorious for his anti-gay stance comes to mind. Does it matter why stigma is bad, or does it matter more that the less shame and fear we experience, the more free we are to forgive ourselves and move toward healthy lives?
“You would think Congress has better things to do than legislate name changes.”
Congress made a positive choice in this change. The recognition of addiction as an illness paves the way for better coverage of treatment, which will mean less addiction.
“And in the long run, the well-meaning effort to overmedicalize addiction could have baleful consequences. Addiction is not as hopeless or uncontrollable as the brain disease metaphor suggests. Yes, like other bad habits, it is in our brains—but like other bad habits, it can be broken.”
If you cannot hear how incredible this statement is, indulge me: replace the word addiction with depression or diabetes. They’re all issues formerly handled in silent shame. They’re also best treated by trained professionals (preferably ones NOT named Sally Satel and Scott Lilienfeld).
