A chronic illness?

~ Jason Schwartz
addiction
addiction (Photo credit: Alan Cleaver)

Bill White responds to a recent article that has gotten a lot of attention by Gene Heyman, a disease model critic. Heyman (and a couple of other recent articles) question whether it’s accurate to call addiction a chronic illness.

If there is anything that the full scope of modern research on the resolution of AOD problems is revealing, it is that the dichotomous profiles of community and clinical populations represent the ultimate apples and oranges comparison within the alcohol and other drug problems arena.

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Conclusions drawn from studies of persons in addiction treatment cannot be indiscriminately applied to the wider pool of AOD problems in the community, nor can findings from community studies be indiscriminately applied to the population of treatment seekers.

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Adults and adolescents entering specialized addiction treatment are distinguished by:

1) greater personal vulnerability (e.g., male gender, family history of substance use disorders, child maltreatment, early pubertal maturation, early age of onset of AOD use, personality disorder during early adolescence, less than high school education,  substance-using peers, and greater cumulative lifetime adversities),

2) greater problem severity (e.g., longer duration of use, dependence, polysubstance use, abuse symptoms co-occurring with substance dependence;  opiate dependence),

3) greater problem intensity (frequency, quantity, high-risk methods of ingestion, and high-risk contexts,

4) greater AOD-related consequences (e.g., greater AOD-related legal problems),

5) higher rates of developmental trauma and post-traumatic stress disorder,

6) higher co-occurrence of other medical/psychiatric illness,

7) more significant personal and environmental obstacles to recovery, and

8) lower levels of recovery capital–internal and external resources available to initiate and sustain long-term recovery.

Bill points out the real world consequences of these arguments.

This is not merely an academic question.  Are families reading the headlined summaries of such reviews to conclude that the prolonged addiction of their family member results from moral and character defects of self-control that prevent “maturing out” of such problems that most people, according to these reports, achieve?  Should such chronicity render one unworthy of family and community support?

Read the rest here.

Published by Jason Schwartz

I have been an addiction professional and social worker since 1994. I started blogging in 2005 as the Clinical Director at Dawn Farm. I no longer work at Dawn Farm and am now the Director of Behavioral Medicine at a community hospital, and a lecturer at Eastern Michigan University’s School of Social Work. Views expressed here are my own. Keep in mind that the field, the contexts in which the field operates, and my views have changed over time.

7 thoughts on “A chronic illness?”

  1. Well, to me this also basically states that not everyone (most) people calling themselves “alcoholics” ARE truly drunks. I think there is a very wide spectrum of alcohol use disorders, just like there is autism spectrum disorders. The sooner this spectrum–and the appropriate individualized treatment–is recognized by everyone, including but not limited to AA, the better.

    1. Agreed. At the same time, I think the people Bill’s addressing probably never even make it to AA. They’re the people that party hard in their early 20s and quit or moderate when they have kids, graduate, get a “real” job or get a drunk driving.

      The problem with these surveys is that they typically ask people a question like, “Did you have a problem with alcohol at one time and no longer do?”

      Obviously, this is going to capture a lot of people who don’t even think of themselves as alcoholics.

  2. Problem drinking is NOT addiction. By definition. The disease model, to the extent it is effective in recovery, is fine with me. I would leave the nomenclature to MDs, (many of whom I have sponsored in my twenty eight years of sobriety). The experience of the founders describes obsession, and compulsion. These terms are useful in anyone’s recovery. Beyond that, if one continues the debate, one has too much free time on one’s hands, imo. Get BUSY, it’s in the Book. (Not the ‘literature’)……

    1. Thanks for the comment! I agree that these are not concerns for people who find themselves in the grip of a mental obsession and physical allergy. The issue here is who research classifies as alcoholics and whether that ends up misrepresenting alcoholism to researchers, doctors and other helpers.

  3. That was certainly an interesting read. Bill White certainly knows how to write! And I find the notion that people with AOD problems will simply outgrow it rather ridiculous. If that were indeed true, then why precisely would it be termed as an ‘addiction.’?

    1. Careful. Some ‘diagnosed’ patients will ‘outgrow’ the ‘disease’. And some are ‘incurable’. “Faeries/Pin”. As a recovered alcoholic of twenty eight years sobriety, I personally don’t buy the “disease” protocol. Spontaneous recovery is not unknown; the ‘medical model’ works, as does the “social” model. As a paying passenger on the Titanic, I thought very little of the deck chair rearranging I was subjected to in my beginnings in AA….Tradition Ten would suggest to us that AA stays out of such arguments. I speak for myself.

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