Current Addiction Theories Don’t Explain the Facts

Ask 10 Americans what addiction is and what causes it and you might get at least 10 answers. Some will insist addiction is a failure of morality or a spiritual weakness, a sin and a crime by people who won’t take responsibility for their behavior. If addicts want to self-destruct, let them. It’s their fault; they choose to abuse.

For the teetotaler and politicians, it’s a self-control problem; for sociologists, poverty; for educators, ignorance. Ask some psychiatrists or psychologists and you’re told that personality traits, temperament, and “character” are at the root of addictive “personalities.” Social-learning and cognitive-behavior theorists will tell you it’s a case of conditioned response and intended or unintended reinforcement of inappropriate behaviors. The biologically oriented will say it’s all in the genes and heredity; anthropologists that it’s culturally determined. And Dan Quayle will blame it on the breakdown of family values.

The most popular “theory,” however, is that addictive behaviors are diseases. In this view, an addict, like a cancer patient or a diabetic, either has it or does not have it. Popularized by Alcoholics Anonymous, the disease theory holds that addictions are irreversible, constitutional, and altogether abnormal and that the only appropriate treatment is total avoidance of the alcohol or other substance, lifelong abstinence, and constant vigilance.

Absolving The Diseased

The problem with all of these theories and models is that they lead to control measures doomed to failure by mixing up the process of addiction with its impact. Worse, from the scientific standpoint, they don’t hold up to the tests of observation, time, and consistent utility. They don’t explain much and they don’t account for a lot. For example:

  • Not all drugs of abuse create dependence. LSD and other hallucinogens, caffeine, and tranquilizers are examples. Rats, for example, which can be easily addicted to heroin and cocaine just like humans, “just can’t appreciate a psychedelic experience,” notes Childers. “The same is true of marijuana and caffeine; it’s hard to get animals to take them. People take these drugs for different reasons, not to feel pleasure.”At the same time, rats and other animals can become physically dependent on alcohol, but won’t seek out alcohol even when they are in convulsions of withdrawal. Says Jack Henningfield, Ph.D., an addiction researcher at the National Institute of Drug Abuse in Baltimore, “we can get rats physically dependent on alcohol and even get them to go through DTs by withdrawing them. But we can’t get them to crave alcohol naturally.” Apparently, they have to learn, to be taught to want it. “Only when we give them the rat equivalent of smoke-filled rooms, soft jazz, and other rewards will they seek out alcohol.”
  • Some substances with dearly addictive properties are almost universally used and socially acceptable. Giving up coffee and colas containing caffeine can yield rapid heart beats, sweating, irritability, and headaches—markers of withdrawal.
  • People can experience withdrawal syndromes with drugs that don’t addict them or make them physically or psychologically dependent. Postsurgical morphine is always withdrawn gradually in the hospital, but most people who get morphine still undergo so-called white flu—flu-like symptoms after they leave the hospital. They are actually undergoing withdrawal symptoms, but they have not become dependent on or addicted to the morphine. There is also no evidence that terminal cancer patients in severe pain get “high” on heavy doses of morphine, although they do become dependent.
  • Some drugs of abuse produce tolerance and some don’t. Heroin addicts need more and more of it to avoid withdrawal symptoms. Cocaine produces no tolerance, yet most would say cocaine is far more addictive because craving accelerates to sometimes lethal doses. If permitted, lab rats will continue to take cocaine until they die.
  • Some people, notably celebrities, check in regularly at the Betty Ford Center to overcome addiction to painkillers, alcohol, and barbiturates. Yet one of the most famous studies on Vietnam veterans shows that very few of those who returned addicted to heroin stayed addicted. Lots of planning went on for intensive treatment for them. But on follow-up back home, their rate of continuing addiction dropped to levels no different than those of the general population, despite their exposure to lots of drugs, stress, high-risk environments, youth, and other risk factors that predicted a serious addiction epidemic. They had no trouble for the most part leaving their addictions behind in the jungles, while in the U.S., relapses are legendary and widespread.For decades, we’ve sent heroin addicts to Lexington, Kentucky, for treatment in an isolated treatment facility; the idea was to remove them for long periods from their conducive environments. Almost all got “clean” and stayed that way, but when released, still sought out their old haunts and relapsed. Yet the majority of people living in drug-infested cultures never get addicted.
  • The children of alcoholics have a much higher risk of alcohol abuse than children of nonalcoholics. Some studies show that alcoholics have an enzyme abnormality related to alcohol activity that doesn’t seem to exist in people who’ve never had a drink. Yet some people who are classic alcoholics can and do learn to drink moderately and safely. Others quit even when they know they can drink moderately.

Read full article by Joann Ellison Rodgers, Psychology Today

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