Disease model of addiction doesn’t work

The science is settled, as they say: Drug addiction is a disease, not a moral failing. Fortunately, science has developed safe and effective evidencebased treatments for this disease. How’s that working out for us?

It certainly has been a boon for the rehab industry. Drug treatment is big business. Parents drain their retirement accounts and take out second mortgages to pay for their kids’ time in rehab. Between 2003 and 2015, annual federal spending on drug treatment more than doubled, from $5.2 billion to $12.5 billion. (That’s not counting spending by state and local governments, or private spending.)

During that same period, annual deaths from drug and alcohol-induced causes also soared — from 49,410 to 88,574. What’s wrong with this picture? When a treatment is 100 percent effective, the index condition should disappear, as smallpox disappeared after the introduction of the smallpox vaccine. Clearly that is not what is going on here.

So what are we getting in return for this multibillion-dollar outlay? Trying to get a straight answer to that question is like trying to wrap your arms around an 800-pound marshmallow. Anyone who has waded through the morass of literature that has accumulated around this subject will find it fraught with uncertainty. Many studies rely on outcome data reported by the rehab centers or the addicts themselves, and reported success rates vary wildly — from as low as 5 percent to 100 percent. Those percentages also may include only those people who successfully complete the program, obscuring the fact that many of those who enter treatment do not successfully complete the program, followup periods often are short, and there is no agreed-upon definition of a successful outcome. In fact, some definitions of a “successful outcome” are modest: three consecutive weeks of abstinence, in one study.

In short, there is little reason to believe that the priciest rehab center is any better than the Narcotics Anonymous meeting in your local church basement — or for that matter, than just getting fed up with the addiction lifestyle and deciding you want something better.

So what is the solution to the problem of addiction? Perhaps part of the solution is to accept there aren’t always tidy solutions to this messy, complicated, frustrating business we call life. And let’s stop telling addicts that addiction is a disease they are powerless to do anything about without high-priced professional help. This assertion always is justified with a lot of neurobabble, but it is contradicted by one incontestable fact: Millions of people have walked away from addiction to illegal drugs without any professional help. If you include alcohol and tobacco (and there is no reason not to include alcohol and tobacco), the number rises to the tens of millions.

The National Institute on Drug Abuse assures us that “addiction is a chronic, relapsing brain disease,” but they don’t mention it is also a condition most of its sufferers grow out of. In addition, they tell us “It is considered a brain disease because drugs change the brain; they change its structure and how it works.”

When a person learns the behaviors of drug-seeking and drug-taking, does the structure of his brain change? Sure. It also changes when someone learns to play the piano. So, is learning a disease? Or is it a disease only when you disapprove of the behavior that has been learned? Ah, but that’s a moral judgment, and we don’t make those anymore in regard to addiction. But perhaps we should.

The disease model of addiction denies our nature as moral beings capable of foresight and volition — precisely the qualities that are needed to overcome addiction or any other self-defeating behavior. A study by researchers at the University of New Mexico found that the only reliable pretreatment predictor of relapse was a belief in the disease model of addiction.

“Heroin tightens its grip,” the headlines cry, as if heroin were a being with hands and a brain and free will, and the addict a mere inert powder. On Wednesday, Maryland Gov. Larry Hogan dedicated $10 million a year in new funding to fight heroin abuse and signed a declaration of emergency to make more resources available to fight the so-called epidemic.

The proponents of the disease model love to talk about “harm reduction.” Since their viewpoint has become accepted wisdom, overdose deaths have skyrocketed. In this city alone, there were 481 overdose deaths during the first nine months of 2016, eclipsing the 291 deaths during the same period the year before. One wonders how much more “harm reduction” our civilization can survive.