Many people sneer at the idea that addiction is a disease. "Surely so-and-so can just stop drinking" they say about alcoholics, unaware that an alcoholic can't control his craving for more drink -- just as a cancer or diabetes patient can't control the progression of his disease. Anyone who knows an alcoholic, or a hard core drug addict, will know that many of them desperately want to give up but are unable to.
"I don't believe that addiction is a 'disease' in the true sense of the word", writes Damian Thompson, editor of the Telegraph blog and author of The Fix, a new book on addiction. Thompson has some really interesting views on the "modern" addictions and his new book suggests that we are all addicted to the wonderful new toys, foods and behaviours of the 21st century; he talks about the addictive apps on iPhones, the tactics the online gaming industry uses to hook their users and he says a lot about cupcakes.
Thompson also dismisses the 12 step methodology of Alcoholics Anonymous. AA is a network of small meetings all over the world, where people get together every evening to share their experiences and help each other with the ongoing struggle of staying sober. AA is based on the idea that alcoholism is an incurable disease and it has helped millions of people over the last 50 years cope with it. But Damian Thompson says "the 12 step dogma can leave people trapped in a situation in which they define themselves by their addictions."
I work for a drug and alcohol rehab clinic and in order to find out more about addiction I went to three "open" AA meetings (an "open" meeting is one that non-AA members can attend). In each meeting I was surrounded by people whose lives had completely fallen apart (they had hit "rock bottom" in their jargon) and were now re-discovering life through the perspective of sobriety. What kept each one of these people going was the knowledge that they will always be in the grip of a chronic disease but if they face up to this and learn the tactics of avoiding drink, they can thrive. I was impressed by their humility, discipline and sense of liberation (none of them seemed "trapped").
Damian Thompson is entitled to his opinions, and we should be grateful that he is stimulating a debate on addiction issues, but I think he is very wrong to dismiss the "addiction-disease model" so glibly. After all, 80 experts of the American Society of Addiction Medicine recently confirmed that addiction is indeed a chronic disease.. And Psychology Today recently published an article under the heading "Obsession or Addiction? They're not the same thing."
I would like to explain to Mr Thompson that the "addiction-disease-model" is incredibly useful for all those who come into treatment because it gives them a platform to understand the illness and deal with it. When an addict learns that he has a disease and not a failure of morality, he can start to deal with the guilt and shame that he (and others) have heaped on his shoulders over all the years.
Families are the unknown victims of addiction and it's often a great relief for them to find out that addiction is a disease -- with a treatment. Lee Taylor, the Family Programme Coordinator at Castle Craig Hospital says (in this video) that addiction "is a family illness...a very secretive illness, kept behind closed doors...they are guilt ridden when they come: fearful, anxious, helpless, confused...they're lost. They've tried everything, they've lied, covered up, paid off dealers, cried, shouted, pleaded, they've made idle threats which they never carry out."
The disease model has resulted in a treatment methodology that works. The 12 Steps methodology used by AA has evolved into a complex, intensive, residential, medically supervised, holistic treatment programme that is known as the "Minnesota Model" (named after the first major treatment centre at Hazelden in Minnesota).
The other problem with Mr Thompson's view is that he equates alcoholism and serious drug addiction with modern "obsessions" to iPhones and cupcakes -- and this increases the chance that addiction treatment will not be taken seriously by the health services. Already we have a problem: the guidelines for the National Treatment Agency and the National Institute for Clinical Excellence fail to recognise the implications of addiction being a brain disease. This means that addiction tends to be viewed as an old fashioned social, criminal and moral problem -- as it was before WW2.
Mr Thompson admits that he was an alcoholic and that he has been sober for 18 years. I can't help wondering if his idea that we are all addicts is not related to his need to make addiction seem like a normal, everyday phenomenon that everyone has. Is he is diminishing the value of alcoholism by comparing it to everyday obsessions? I wonder if this is a form of denial?