Thursday, February 2, 2017

Addiction and Recovery
It’s a disease, not a moral failing

By Bob Gaydos
Dr. Benjamin  Rush

There’s a week for everything in this country, some serious, some not so: National Handwashing Awareness Week; Celebrate Your Name Week; Fix a Leak Week; Mental Health Awareness Week; Freelance Writers Appreciation Week; Nurses Week; National Kraut Sandwich Week; National Indoor Plant Week.
One of the more serious ones -- National Drug and Alcohol Facts Week -- recently passed with little notice. However, there was a useful, informative blog about the week on the news site. It was written by Dr. Judith Branche, of Cornerstone Family Healthcare’s Center for Recovery in Newburgh. Dr. Branche is Board Certified in Addiction Medicine.
One paragraph in the blog especially struck home with me: “(A) significant problem is the lack of understanding of the problem for what it truly is. Therefore, I would like to take this opportunity to explain what a substance use disorder really is. Addiction is a chronic disorder of the brain which affects brain chemistry in a significant way. This may be a new concept for many who believe that drug addiction is no more than a moral failing or a character defect that a person should be able to overcome if he or she puts their mind to it. Nothing could be further from the truth.”
Amen, amen, amen. I’ve been writing on this topic for about a decade. In my opinion, this remains the biggest problem with regard to alcoholism and addiction -- that many, probably a majority, of people do not buy the disease concept. This includes  many government officials who are in a position to help lessen the harmful impact of the disease. They look upon it as a law and order issue, rather than a health issue.
So we declare a war on drugs and throw the addicts in prison along with the pushers. Diabetics don’t get locked up for being victims of sugar. More to the point, executives of food companies who load their products up with sugar under dozens of other names don’t get arrested for fraud or posing a public health risk. They get bonuses. Their customers who wind up addicted to sugar get insulin and a new diet plan. Follow it, or get sicker.
Addicts, alcoholics who want to fight their disease have to first fight insurance companies to get coverage for treatment, probably have to “fail” at outpatient treatment if they want in-patient rehab and then hope they are lucky enough to find an in-patient slot. Winding up in prison is a whole lot easier.
The tricky thing about the disease of addiction is that many of those who have it do commit crimes while under the influence or in search of money to get more drugs. Alcoholics do drive drunk and kill or injure others. This is where moral judgments take over, understandably. But while their disease may explain their actions; it does not excuse addicts from the consequences. Still, in paying the price, addicts should at a minimum also be offered a chance at treatment. It’s possible to get clean and sober behind bars.
Of course, much of the damage addicts do is not of the criminal variety. It is of the personal variety, often directed at those who care most about them. Living with an active alcoholic can be like living in a volcano -- unpredictably eruptive. Indiscriminately destructive. Loving the addict and hating the disease, as Al-Anon suggests, is excellent advice, but no one says it’s easy. It takes a lot of practice and patience and it does not mean accepting or enabling unacceptable behavior. But if more people tried it, I believe the disease concept would become more real and the stigma attached to the disease would lessen. That would help those seeking recovery and the people closest to the addict would be better able to deal with life, regardless of whether the alcoholic/addict was active or not.
Of course, the addict has to accept the disease concept as well if he or she hopes to having meaningful recovery. Simply abstaining from using through will power often makes for a more miserable person who is just not drinking. Rather than saying, "I'm an alcoholic and I can't drink for the rest of my life," the alcoholic can say, "I have a disease that makes it mentally and physically impossible for me to drink safely." Obviously, the alcoholic can drink anytime he or she wants, but the treatment for the disease is abstaining and finding some other source of solace, serenity, strength to deal with the rigors of life.
That's not an easy decision either. But the more society talks about addiction as a disease, not a moral failing, the sooner, I believe, we will see more positive results in fighting it.
(Author’s note: While the opinions expressed are solely mine, they are based on discussions with hundreds of alcoholics, addicts and professionals in the substance abuse field.)

Who says so?
  • American physician Benjamin Rush (1745–1813), who signed the Declaration of Independencence, is often cited as the first who understood drunkenness to be what is now called a "loss of control" and possibly the first to use the term "addiction" in connection with this meaning. He wrote: “My observations authorize me to say, that persons who have been addicted to them, should abstain from them suddenly and entirely. 'Taste not, handle not, touch not' should be inscribed upon every vessel that contains spirits in the house of a man, who wishes to be cured of habits of intemperance.’” He said, "Habitual drunkenness should be regarded not as a bad habit but as a disease," describing it as "a palsy of the will."
  • Between 1980 and 1991, medical organizations, including the AMA, established policies on the disease theory. These policies were developed in 1987 in part because third-party reimbursement for treatment was difficult or impossible unless alcoholism were categorized as a disease. The policies of the AMA, state, in part: "The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice." In 1991, the AMA endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.

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