I’m not a scientist. To be honest, I wasn’t even particularly strong in high school biology or chemistry. I did write a poem once that was well-received by my mother and it’s framed to this day. You may think that my background in education and fascination with hot tubs makes me uniquely unqualified to discuss matters of addiction. I don’t care what you think but please continue reading. It’s a topic that is extremely important and relevant from an economic, social, medical, and political perspective. As someone in recovery–and an overall curious person–I present you with a detailed overview of the issue as a whole. We, my fellow Jets (hot tub Jets), will explore the shitty world of alcohol and drug dependence by examining, what I believe to be, the key components:
- The Players Involved
- “Substance abuse” versus “Substance Dependence”
- “Addiction” as a disease. Or is it…?
- Current Research and Studies
- Treatment and the Future
Like I said before: I’m not an expert. I deal with behavioral data and have done so for several years now, but I don’t think that makes me any more qualified than any other curious person with analytic sensibilities. I do know some cool magic tricks and I’m good at ping pong but that’s just some information to make you more comfortable with me as a person. I did do research for this because I’m raising the bar on hot tub blogs as a whole. Most addiction-based research gained momentum in the 1970s, making the field really new. It’s not only new; it’s complex, and because we’re dealing with the brain and neuroscience, it’s easy to see why there has been a changing landscape of theories. Nevertheless, there is a new wave of solid data, replicated studies, and increased understanding when it comes to this stuff. I will try my best to objectively present what I know. But first, let us consider who is involved in this societal discussion and why there may be so many conflicting theories and feelings when it comes to addiction. This first part is on the boring side, but I think it’s a logical first step in the discussion. I’m calling these people and groups involved, The Players.
1.) People in Recovery/Active Users– These people are passionate, sometimes crazy, but always emotionally invested in the discussion. They are the ones actively using or those who are in the “recovery world” and have real-life experience with these matters. These two groups are easy to find but may be perhaps the easiest to misdiagnose in terms of understanding their agenda(s). Are their self-reports reliable? Do they have something to gain by labeling “addiction” one thing and not another? In my opinion, there seems to be an undercurrent from “non-alcoholics” that holds a position that sounds like this: addicts want alcoholism/chemical dependence to be a disease because it excuses their current behavior. It gives them a life-long get-out-of-jail-free card. Just like people who are overweight, they choose to behave in a way that is harmful for them.
I understand this logic, really. It epitomizes a value-system that I grew up with that emphasizes the importance of self-reliance, perseverance, and will-power. But… it still doesn’t make sense to me now. When I was drinking my face off, I didn’t care at all about whether or not it was a disease. You don’t really care about anything, never mind matters of intellectual and social debate. In my lived experience, this excludes some agenda from the active user. As for the people in recovery, this is whole lot little less clear. If you go on any comment thread relating to alcoholism or addiction, you will undoubtedly come across AA-ers emphatically telling you that alcoholism is a disease. This supports a disease-model they may have learned about on their path towards recovery. This lived experience may make them biased, for sure. To put this mentality in perspective, imagine you go on a diet and lose 50 pounds. Somebody comes up to you and says that your diet is unhealthy or a farce, anddddd that you didn’t lose 50 pounds because of it. Your head would explode because you’ve lived the results. You’re 50 pounds lighter and the only thing you did differently was this diet. They try to tell you that it wasn’t the cause for your weight loss, but a secondary result. You say ‘screw you’ because these skinny jeans think you’re a liar. Same analogy applies with many in recovery. Something has worked/is working, so they are 100% on board with the ‘teachings’ of what got them there.
The people in these two groups are very vocal in this discussion. Many may be biased but surely we must take into account their lived experience because it’s always important to take into consideration the people that are the most closely affected by an issue.
2.) Families/Persons Adversely Affected Second-Hand
This group is easy to understand. They have felt the pain, anger, and madness that accompanies the active user. They are either uniquely empathetic to those living with addiction or uniquely bullshit depending on how it all turned out. If you are going to call the person in recovery biased, you need to apply the same parameters to this group. Let’s be honest. It’s difficult to accept that your ex-boyfriend may have a “disease” when you’re still reeling about him stealing your credit card and fucking your roommate.
3.) Doctors/Drug Companies/Counselors/Health-Care Professionals
These are the groups that unfortunately, often have some hidden agenda. While some to many have altruistic goals, others have SOMETHING to gain. Maybe a doctor is “pro-disease” because his/her drug would be sold in higher volumes as a ‘cure.’ Maybe you are a counselor in the CBT field and have a bias that pushes this form of treatment. Maybe there’s a party involved that works in insurance and if alcoholism is, in fact, a disease, well, that’s something else you’ll have to pay for. These people/groups exist and when solid evidence and research–regardless of the results–isn’t the primary objective, you’re a real scumbag playing with the lives of millions.
4.) Tax-payers, Politicians, Judicial System, and Law Enforcement
Again, the agendas of these people will vary like with any hot topic. But just because they may not be personally affected by alcoholics, doesn’t mean they don’t have a stake in this discussion. Real money is involved in this issue when it comes to tax-payers. Maybe drugs are taking over your neighborhood. Maybe you’re bullshit that your tax dollars are going towards treatments you don’t believe work. Judges and lawmakers, while often questioned in terms of their genuine intentions, do need to make actual decisions. Where do you send repeat DUI violators? AA? Somewhere else? And lastly, law enforcement also has to deal with this issue in a very up-close-and-personal way. How do you punish offenders who commit crimes if they have a “disease?” Do we handle it in a punitive way or do we seek help for these people?
These are voices in this discussion. The voices are hardly in unison. And yet, the issue touches us all in some way or another. Good research and practical decisions based off this research need to happen and the sooner they do, the more lives can be helped. The types of research vary and serve as pieces of a larger, more complex puzzle. Such forms of research include:
- Biomedical- studies in animals or humans that examine physiological changes that come with a type of treatment.
- Clinical Research- more “applied” with investigations in humans for benefit.
- Psychosocial- carried out in human volunteers with measures of psychological and environmental change
- Epidemiologic research carried out using surveys, oral and written, under rigorous conditions—though, rarely address cause and effect
- Logitudinal (take place over a long period of time)
In part II, we need to address an issue that is at the heart of much of the confusion for the general public: “chemical abuse” versus “chemical dependence.”
Next time, on
Serial The Tub.