Jessica Hamzelou in NewScientist (3 February 2018, paywall) has a bit of a rage at President Trump’s empty declaration of an opioid crisis, and then goes on to explore the problem of addiction a little further.
A similar approach used scare tactics in an attempt to warn teenagers off methamphetamine in the 2000s. The Montana Meth Project increased people’s awareness of the drug, but did nothing to reduce drug use, says Perry Kendall, a provincial health officer in British Columbia, Canada. In fact, the advertising was associated with increased risk of drug use, says Kendall. “The campaign was so over the top that people dismissed it,” he says. Some teenagers might have started using the drug in order not to feel left out, he says.
Wow. Taking drugs just so you don’t feel left out. Yet, a couple of years ago I was talking to an elderly friend of mine who’d lost his soul mate to lung cancer years earlier. The man’s lover had been a heavy smoker during an era in which we know that smoking is a bad habit to have, so I asked my friend why his lover had continued.
Peer pressure, he said. I’m still shocked. So should I really be astonished that some folks would take dangerous drugs just so they didn’t feel left out? Remind me to tell you the story about the supposed TV show test in which I was an audience member and evaluator someday …
Continuing …
Considering that Trump has said “it’s really, really easy not to take [opioids]”, it’s no wonder that public health officials are worried that the current administration might go down the same route.
Efforts in Canada show this is the wrong approach. There, advertising campaigns target people with addiction, offering advice on where and how to seek treatment. What’s more, they don’t paint drug dependence as a moral failing, and so avoid stigmatising people who need help. …
“Treating it as a crime is the worst thing you can do,” says Scott Weiner at the Brigham and Women’s Hospital in Boston. “If we start to recognise it as the disease that it is, we can treat it and get people back on track. If you criminalise it, you take away a person’s chance of a normal life.”
But it’s not a disease as we typically define disease, is it? Most diseases involve pathogens, bacteria and viruses which infect us and make us feel poorly until our immune systems kill the invaders – or we die. Of course, if we stare more closely, things get a bit fuzzier. Spanish flu, for example, didn’t kill humans directly, but rather by causing our immune systems to rev up and destroy our lungs – victims were literally asphyxiated. Or allergies, where often innocent, non-living debris – pollen, pet dander, even just dust – causes a similar, if less-pronounced reaction. Is that a disease? Well, it’s debilitating, but it’s not caused by bacteria or viruses. We theorize that it’s brought on by childhood environments being too clean.
So, like many specialists in the field of addiction, Weiner wants to call this an illness, but for many people, such as President Trump, they see it as a choice, and they’re not that far wrong, now are they? How can it be a disease if it starts with a free will choice to take the drug?
Skipping the argument about juveniles’ brains not being fully developed and how most addicts start young and thus free will is a problematic assertion, there’s an assumption here: that it’s always a choice. But this is a false assumption because these drugs often rewire the brain (perhaps it’s more accurate to say the brain adapts to the drug) so that there’s a craving for that drug, and there’s no known way (I hope someone tells me I’m wrong) to undo that rewiring. One or two shots and your brain is adapted to the drug. And when it’s a legal drug, prescribed by a physician for, say, pain? Is it still free will?
Yet that’s still not an invasion of the body by some pathogen. I think it’s clear that even if we restrict ourselves merely to an urge for precision, a new term is really needed to properly describe the properties of this condition and how it differs from traditional illness. Addiction is an old, worn-out term, so we may need something better. Mal-adapted Brain Disorder might be properly mystifying.
But I will not adhere to the restriction I mentioned, because I have two worries about this confusion of terminology.
First, it confuses the public, leaving them uncertain as to what to consider addiction. Disease? Possibly illicit choices? Moral simpleton? Uncertainty makes it a little harder to develop that public push to find ways to treat this family of conditions.
Second, and more importantly, I worry that this may place unconscious limits on our studies as to how to solve this problem. Many linguists have suggested that our limits on what we can think are directly traceable to our vocabulary, if I may simplify outrageously (I hope I have not misrepresented this position). Scientists, having taken up the position that addiction is a disease, may unconsciously limit themselves to researching therapies related to those already in use for other diseases. The applicability, to my untrained mind, may be uncertain.
