"There is always a philosophy for lack of courage."—Albert Camus

Thursday, July 20, 2006

Addicts Are Wrong, Not Sick: Psychiatrist

Dr. Anthony Daniels, an English psychiatrist who usually writes under the name Theodore Dalrymple, has produced another excellent article, this time on drug addiction. Writing for the Times of London, Daniels' point in "Don't Blame Me, I'm Just the Junkie," is twofold: one, that heroin addiction is not mainly a producer of crime but just another wrong thing criminals do, and two, that the assertion that addiction is a sickness is incorrect and harmful both to users and society. Daniels writes:

The addict sees himself as a person who is ill, like someone with pneumonia, whom it is the duty of the “system” — the paraphernalia of doctors, nurses, social workers, drug counsellors and so forth — to cure. Until such time as the system fulfils its duty, the addict can continue in his habit, secure in the knowledge that he is not to blame, but the system that has failed to cure him. . . .

[I]n so far as there is a causative connection between addiction and criminality, it is that criminality — or whatever predisposes people to it — causes addiction and not addiction that causes criminality. . . .

It is not true that heroin addicts take a couple of doses and then find themselves enslaved. On the contrary, addicts usually spend a year or so taking heroin intermittently before they decide to take it regularly. It would be truer to say that they hook heroin, than that (as they usually put it, in order to deny their own responsibility) they are hooked by heroin. It is simply implausible to suggest that addicts become addicted by inadvertence or ignorance: the vast majority of the addicted come from backgrounds in which ignorance of history and arithmetic is perfectly possible, but not ignorance of the heroin way of life.

Is any great harm done by pretending that opiate addiction is a disease like any other? After all, a portion of mankind will always resort to mind- altering drugs to obscure the existential problems that confront us all. Certainly methadone when prescribed carelessly — as it is in Britain — is a dangerous drug, and can cause nearly as many deaths as heroin itself.

There is a more intangible harm, however, to the pretence: the existence of drug clinics sends a message to addicts that they are ill and in need of treatment rather than they have chosen a disastrous path in life. It conceals from people their responsibility for their own lives, a responsibility we all find irksome at times, but acceptance of which is the only basis of a meaningful life.

Daniels is not arguing that we should feel no sympathy for addicts. On the contrary, he is pointing out that the way to reduce addiction and its horrible consequences for users, their friends and familes, and society in general, is to recognize that drug use is ever and always a choice. That is a change in attitudes we should certainly strive to create. Daniels' article includes additional counterarguments against the current thinking regarding drug addiction, and you should read it in its entirety in order to understand his argument fully.

6 comments:

Tlaloc said...

Would that he were a doctor instead of a psychiatrist. If so he might have studies the effects of physical addiction which are in fact directly comparable to a disease.

James Elliott said...

Psychiatrists are doctors. Otherwise, they wouldn't be allowed to prescribe medication. It's what distinguishes them from psychologists.

That's an interesting take from the good doctor. I find it compelling. I recently read an article that talked about reevaluating how we look at suicide not as a final act of despair but as an act of narcissism. There's some pretty good reevaluations of old paradigms going on in psychology.

Kathy Hutchins said...

I've long been of the opinion that the prevailing disease paradigm of alcoholism is deeply flawed and harmful. I hope to God that psychology is going to re-evaluate that received wisdom as well.

Tlaloc said...

"Psychiatrists are doctors."

Doh, you are right of course, I was thingking psychologist.

Pity, now the author has no excuse for his ignorance.

patience said...

Rather than an actual disease, addiction is a condition to which there is no cure, but is controllable. The addict must first address the fact that he is an addict, then he must accept help for this condition. Otherwise he will always be controlled by addiction.

Many addicts consider that they suffer from the "disease" of addiction, and as you said, believe that it is the "duty of the system" to fix his problem. Otherwise he can justify continuing his drug abuse, with all that goes with it. He can't help it, he has a "chemical imbalance", a "disease". Until the addict takes responsibility for his condition, for his actions, and for the consequences, nothing will change.

M. Simon said...

The US Army can suggest opiates for preventing PTSD.

http://www.nejm.org/doi/full/10.1056/NEJMc1001716#t=article

Now what about undiagnosed PTSD from child abuse? When Ted wrote his article there was quite a bit known on the subject. We now know 10 years more. And he was wrong then. He is even more wrong now.

Dr. Lonny Shavelson found that 70% of female heroin addicts had been sexually molested in childhood. It surprised him.