collaterlysisters:

fetteredreams:

collaterlysisters:

fetteredreams:

pseudo-euphoria:

hobbitsaarebas:

cs-inactive1:

yeah so basically drug addiction, across the board, actually has the best prognosis of any mental illness without any treatment whatsoever. The vast majority of people who meet criteria for addiction to any drug (75-95%) do not seek treatment and no longer meet criteria within 5-10 years. Depending on the drug in question, about half of this population becomes abstinent and half continues to use their drug of choice and/or other drugs without meeting criteria for addiction. These are federal statistics published by NIDA. 

Here is the stereotype: drug addiction is a progressive, incurable brain disease that will cause worsening dysfunction without a 12-step inspired treatment plan and lifelong abstinence. Once you are an addict, you are always an addict, because it is a brain disease. The addiction brain disease is caused by exposure to drugs. This may certainly be true for some people, but it is obviously false for the vast majority of people who meet criteria for addiction, for any drug. It is not based on evidence, it is based on dogma. It is also a self-fulfilling prophecy that teaches patients they are powerless and must practice lifelong vigilance – if they don’t feel like that’s true for them, it’s because they’re dangerously reckless and their judgement is distorted by their brain disease! Studies have shown that addicts who believe in the medical model of addiction are more likely to relapse than those who do not.

This dogma arose from the origin and intensification of the racist drug war, and to a lesser degree from the temperance movement. For a variety of material reasons, social violence and dysfunction arising from race, class and economic disparity was attributed to the intrinsic properties of drugs rather than these factors. (To be fair, abundant cheap alcohol did not exactly improve matters much.) During the victorian era, addiction was commonplace and viewed as a harmless eccentricity of the wealthy. Indeed, the surgeon my hospital is named for was a lifelong morphine addict himself. Everyone just thought he had really steady hands. It is only once drugs became associated with poor people, black people, asian and hispanic people, and communists that they became evil. The stereotype is reinforced by the fact that addiction professionals see only the people who see addiction professionals. Our society stigmatizes the hell out of addiction, and addiction treatment is notoriously punitive and inadequate. If you’re an addict and you do not absolutely need to seek this form of treatment, you don’t. Because for the vast majority of people, addiction simply is not like that.

In fact, drug addiction is best described as a developmental disorder caused by trauma and untreated physical or emotional pain. In the classic “rat park” experiment used to uphold the classical addiction model, a rat in a cage self-injects cocaine until it dies, forsaking food, water, and sex. When you place that rat in a larger cage, with other rats and shit to do besides inject cocaine, the rats ignore the cocaine or use it sparingly. I could talk your ear off about all that and its implications but yeah. We have all been really fantastically lied to about addiction and drugs, and our approach to the problems these things do cause makes them worse. Read up on Carl Hart and Bruce K Alexander to learn more.

For those who are interested, there is a great book on this subject called Chasing the Scream: The First and Last Days of the War On Drugs by Johann Hari. 

Dr Carl Hart has written extensively about this also and has lots of resources on his website (I don’t have it handy but Google his name).

I’ve met people who’ve had lifelong addictions while never ‘hitting rock bottom’ – they have jobs, relationships, stable housing etc. Harm reduction has been shown to work far better than the abstinence model. We should be talking about supplying drug users (addicted or not) with clean injecting equipment, safe disposal and naloxone, not to mention mental health services (since there’s a huge overlap between problematic drug use and mental illness).

So I have some issues with the way that this is framed. Certainly in the US, we stigmatize the use of drugs and moralize about it in ways influenced by the War on Drugs. However, I’m looking through these NIDA links and continue to have a hard time believing that if we focus simply on harm reduction (which is a good and safe thing) that most people who struggle with addiction will get recovery on their own? Which seems to be how this is framed.

I don’t think that’s what either of us are saying. For my part, I strongly believe in harm reduction and a wide range of treatment modalities, including but not limited to abstinence-oriented programs. The main thrust of my post was not endorsing some dismissive and highly restricted approach to substance-related harm. What I was pointing out is that the field of addiction medicine currently adopts a highly restricted approach to therapy, based on a range of misapprehensions about what “all,” “most,” or “typical” addiction. These interventions may well be perfect for a minority of addicts, but there is a broader majority that are harmed by these interventions or simply have very different needs. It seems like @pseudo-euphoria is on more or less the same page, to me. I don’t think that either of us can be reasonably read as dismissive of the health needs (or the negative health outcomes) of the drug using population.

And yes, the simple and straightforward fact is that the majority of all human beings who at one point meet clinical criteria for addiction, and never seek care, will not meet those criteria within 5-10 years. I made no comment as to whether this was ideal, or whether we should stop worrying about the issue at all. I am simply responding to the incorrect and broadly held view that addiction is a specific incurable organic brain disease that must be treated with lifelong abstinence. There are frankly a wide range of reasonable places you can go with this information, which is part of why I focused on the misconception and did not get into ideal forms of treatment for every possible pattern of harmful substance use. 

I am not surprised if you find it difficult to internalize this information, because we have been thoroughly propagandized on the subject. So while I can understand it seeming that way, I am not asking you to conclude that actually drug addiction is fine and good for health or whatever. I am asking you to recognize that this clinical definition describes a vast population, makes very specific, rigid medical claims about them, and that while these claims are accurate for some people (and indeed a minority of addicts fit the model perfectly and seem to absolutely need our current mainstays) they are not accurate for most.

This explanation is a very good one and I appreciate you having written more.

Thank you! It has been kind of a wild ride today so I apologize if any of that comes off as terse, but I am thrilled to talk about this stuff whenever I can