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.
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