A paper presented recently to the Psychological Society of Ireland described an alternative treatment to rehabilitate alcoholics. This programme offers the goal of controlled drinking to people seeking help with drink-related problems. The philosophy behind it challenges the conventional "addiction as disease" model of alcoholism and other addictive behaviours. This whole area is comprehensively discussed in Diseasing of America: Addiction Treatment out of Control by Stanton Peele (Lexington Books, 1995).
It has been conventionally accepted that people addicted to alcohol or other substances suffer from a medical condition with a clear-cut physiological basis. This "addiction as disease" model makes the following assumptions: the addictive substance exerts a chemical effect on the body which produces an overpowering physical addiction and a user who will stop at nothing to get a "fix". The only solution to using the addictive substance. The slightest backslide during abstinence-recovery produces full-blown addiction again: "one drop makes a drunk". Recovery from addiction is a hard road because of severe withdrawal symptoms.
The model of addiction as disease has been promoted with great gusto even though there is much evidence that it is, at best, only partially correct. It now covers not only chemical dependency, but many other compulsive behaviours, including over and under-eating, gambling, fornication and shopping. I just heard of a couple who became "addicted" to the Internet, neglecting their children, who were found roaming the streets barefoot.
The commonest image conjured up by the word addiction is abuse of narcotics, particularly heroin, cocaine, morphine and opium. Opiates have been widely used for most of recorded history. A 1610 account described withdrawal symptoms associated with abrupt cessation of regular opium ingestion: sweating, loose bowels, frequent urination, itching and depression.
Opiate use increased gradually in Europe and the US during the 18th and 19th centuries. Physicians prescribed opiates widely and didn't consider they were especially harmful, although their consumption was often described as addictive.
Towards the end of the 19th century the idea crept in that drug addiction had an underlying physiological basis, i.e. was distinctly different from a behavioural phenomenon describable as a passion or a vice. Scientific medicine was making great strides in conquering infectious diseases and there was optimism that medical cures would be found for every ill.
Little research was carried out to discover the physiological basis of drug addiction until 1925. Researchers in Philadelphia administered large doses of morphine to a group of drug addicts and checked for evidence of physiological addiction during withdrawal from the drug. The results indicate that addiction resides largely in the imagination of the subjects. Many later studies agree.
No distinct changes in the subjects' metabolism, blood composition, circulation or respiration were noted during withdrawal. Withdrawal symptoms such as vomiting, sweating and diarrhoea were noted, but not with sufficient consistency to warrant being labelled a medical syndrome. The researchers found similar symptoms among football players before a big game.
One subject refused to continue with the experiment after 36 hours and demanded more drugs. He was given a placebo injection (sterile water) and promptly fell asleep, thinking he had received morphine. The other addicts begged for drugs during withdrawal, but their requests were refused. They overcame the withdrawal symptoms and lost their cravings in due course.
But if there is no purely pharmacological or biological explanation for addiction, why do people become addicted? Taking a drug has an effect on the body and the mind. Some people who find this experience pleasurable conclude that it is unbearable to live without it. This is a matter of individual perception and choice.
If you have a drug problem and you accept the addiction-as-disease model, you will behave and feel as that model predicts. Thus, heroin addicts today display severe and unremitting withdrawal symptoms when taken off the drug at treatment centres, in contrast to the addicts in the 1925 study.
If the conventional model is wrong, treatment prescriptions based on this model are unlikely to be right. But, you may ask, is complete abstinence from ingestion of the drug not the best choice anyway for susceptible people? Yes, that can be a good policy for many people, and it can also be the easiest. With this policy you only have to remember one thing: avoid the drug. Taking the drug in moderation needs more careful monitoring and vigilance.
But what about the person who has a slip during the complete abstinence prescription? The addiction-as-disease model now gives him full permission to descend again into full-blown addictive behaviour.
The alternative model says: "No, stop it here, this is a behaviour for which I have responsibility". In the alternative model, complete abstinence is one of several treatment options which can be chosen, but all in the light that one retains responsibility for one's behaviour.
The addiction-as-disease model has also absolved people of individual responsibility for atrocious conduct: the addict is "suffering from a disease" and is not responsible for his actions. There have been many examples of serious crimes committed by addicts where the only penalty imposed by the court was that the addict should enrol on a course of treatment.
One of the most human things we have is self-responsibility. We are each fundamentally obliged to take responsibility for our own lives. Nobody has the right to take away this obligation. Unfortunately, there is no shortage of philosophies and organisations which would remove self-responsibility from various groups. But, even in the case of drug addicts, it appears that this is not justifiable.
William Reville is a senior lecturer in biochemistry at UCC