Thursday, January 7, 2010

no one is addicted AT you.

the reason i was reluctant to set up a blog for so long is that i wasn't sure i had anything new to say to the world -- what choir wants another preacher, after all.  but the "heroin for dummies" episode has shown me that maybe i'm wrong, and that maybe the ideas i take for granted aren't obvious to everyone.  so with that in mind (and awareness that you may totally already know that), here is the first in a list of things i have to say: 

1. drug addiction is a disease.

most people who got their panties all in a bunch over the injection booklet opposed its distribution on grounds like "they deserve the consequences of their habit" or "they won't read the booklets anyway."  as if by virtue of their drug addiction, people automatically got stripped of their humanity.  they are not animals, and they are not morons.  they are people, who are suffering from a disorder, and presumably would prefer to continue living.  so rather than arguing about how they got themselves into it (which ideally should be, but realistically can't always be, prevented), and holding them in contempt for their actions (which can be self-destructive and costly to others, but are perpetrated because that is the nature of the disease), a more humane approach would be to understand the disorder, admit that it's there (and recognize that wishing otherwise doesn't change that), and figure out realistic approaches for dealing with it. 

the first step in understanding addiction is recognizing it as the chronic, relapsing disorder that it is -- and not blaming those suffering from it for showing the main manifestation of the disease: compulsive disadvantageous decision-making.  click below to see what i'm talking about.

drug addiction is a disease.  it is not a choice.  as far as harmful consequences go, people didn't "ask for it," and it's not "what they had coming" for their inferior morals or irresponsible attitude or malicious intent or other such despicable character flaws.  we're long past the decade of the brain -- let's stop getting caught up in dated, hand-wavy notions of weak minds, depravity, and misbehavior that warrants punishment.  we're dealing with a disease, and a tricky one at that, because it happens to affect the organ we consider the seat of free will.  the very nature of the disease is to corrode adaptive decision-making and behavior-control, and to replace it with habitual and disadvantageous action.  the national institute on drug abuse recognizes this (two great walk-throughs here), and tons of studies point to biopsychosocial bases.  if you're into academic reading, and have access to them, here are some  articles  i  like (i'm especially fond of this one).  if you aren't, just trust me that we're starting to get a rough idea of what addiction is in a scientific sense -- and that the number of factors that contribute to it is staggering.  i tried to go into them, but just wound up being long-winded.  let's just say that aside from the neurobiological adaptations that come with repeated drug exposure (hijacking your brain's reward system, interfering with the systems underlying self-control, changing the brain's response to stress, etc.), there are vulnerability factors for getting hooked in the first place (genetics, brain chemistry, personality, environment) -- none of which a person asked for.  so say someone has a particular neurochemistry, disposition, and set of circumstances... they'll experiment, and like it -- and we are wired to pursue things we like.  after enough times taking it though, the person may not necessarily like it anymore, but find themselves unable to get away from it, because their brain has changed and is only after one thing anymore: more.  ...and has turned off the brakes ...and overreacts to anything reminiscent of the drug.  this brain gets to guide how the person behaves (that's what it does, after all), so of course they'll do things that fulfill the brain's orders -- despite knowing better, despite negative consequences, despite society's disapproval.  drug-seeking isn't a take-it-or-leave-it proposition to them anymore - their brain has been conditioned to take, and rendered incapable of leaving.  so what may sound like a set of shameful personal flaws, or the spiteful actions of an incorrigible jerk, is actually just the manifestation of a particularly unfortunate combination of predisposing factors and brain alterations following drug exposure.  my point is that the very nature of the disease is to create, amplify, and perpetuate "bad decisions," so whatever the behavior is that you find so offensive -- ask yourself if it might have a biological basis, whether it's necessarily the person's fault that this basis is the way it is, and whether there's any chance the person might prefer not to be in this predicament, either.

and yes, sure, it's a preventable disease.  he who never tries drugs, can't get addicted to drugs.  i get it.  but this logic is as unrealistic (how's that abstinence-only sex education working out?) as it is irrelevant (to the person that's addicted today, how is "you shouldn't have" useful?).  we are dealing with humans, not machines.  as much as we all want to be perfect angels, we like to seek pleasure, escape, feed our curiosities, expand our minds.  (some of us have stronger desires for these and will consider riskier options than others -- and yes, there are neurobiological bases for that.)  depending, again, on individual circumstance, prevention efforts will be more or less effective (rant on the importance of improving prevention strategies coming soon).  so even if a disease is preventABLE, it can't always be preventED -- as we know from other preventable diseases, like heart disease, or type 2 diabetes.  just as with addiction, precautions can be taken for their prevention -- and yet, people get them.  but when they do, they receive care.  not many people would willfully stand in the way of their management, dismiss the predispositions and interactions that resulted in their onset, or contest efforts to alleviate their victims'  suffering.  there certainly is no uproar when pamphlets go out illustrating how to properly monitor blood sugar, or cautioning to exercise or lay off the donuts.  there is no good reason i can think of to treat drug addiction differently than other preventable chronic diseases (i can only think of bad reasons like ignorance and stigma), and it makes no sense that the response to one preventable disease should be medical care, while the response to another is finger-pointing and contempt.

oof that's only 1/3 of the point i was going to make, but the rest needs to wait till later.

(also, as an aside/future rant: i'm not saying neurobiological explanations excuse addicted people from seeking treatment --  i think they should.  but as many of them don't, or can't, it isn't fair to hang them out to dry and treat them inhumanely in the meantime.)

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