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Sun Jul 24, 2016, 02:21 AM

Is addiction really a disease?

This discussion thread was locked as off-topic by Stuart G (a host of the Addiction & Recovery group).

What is addiction? For the majority who have strong opinions on the matter, addiction is a disease. In fact itís ďa chronic relapsing brain diseaseĒ according to the American National Institute on Drug Abuse. This definition, born of the marriage between medicine and neuroscience, is based on the finding that the brain changes with addiction. Itís a definition thatís been absorbed and disseminated by rehab facilities, 12-step programmes, policy makers and politicians. Itís the defining credo of the addiction-treatment industry. But is it correct?

Source:
https://www.theguardian.com/lifeandstyle/2016/jul/24/is-addiction-really-a-disease

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Arrow 17 replies Author Time Post
Reply Is addiction really a disease? (Original post)
Jemmons Jul 2016 OP
progree Jul 2016 #1
Jemmons Jul 2016 #2
progree Jul 2016 #3
Jemmons Jul 2016 #4
progree Jul 2016 #5
Jemmons Jul 2016 #6
progree Jul 2016 #7
Jemmons Jul 2016 #8
Jemmons Jul 2016 #9
Jemmons Jul 2016 #10
progree Jul 2016 #11
Jemmons Jul 2016 #13
progree Jul 2016 #12
Jemmons Jul 2016 #14
Jemmons Jul 2016 #15
progree Jul 2016 #16
Jemmons Jul 2016 #17

Response to Jemmons (Original post)

Sun Jul 24, 2016, 08:28 AM

1. It's bizarre that nobody ever defines disease

Last edited Sun Jul 24, 2016, 09:12 AM - Edit history (1)

I've seen countless, endless discussions about whether addiction is a disease or not, and in all of these discussions, all of them, without exception, nobody, nobody except me, for some strange bizarre reason, asks for the definition of disease.

Addiction sure seems to fit both ordinary and medical dictionary definitions of disease. Similarly many other mental diseases like major depression and bipolar. (And all "mental" diseases are ultimately physical diseases anyway, because all cognition is entirely the product of the physical brain).

http://medical-dictionary.thefreedictionary.com/disease
http://medical-dictionary.thefreedictionary.com/Alcoholism

All the medical and psychiatric associations that I know of classify it as a disease, and I tend, as a scientifically trained person, to side with the knowledgable unless given a reason not to. I have been given none.



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Response to progree (Reply #1)

Sun Jul 24, 2016, 10:05 AM

2. Being scientific has great advantages.

I tend, as a scientifically trained person, to side with the knowledgable


Let me just take a wild stab in the dark and venture a guess that you are trained in a field of science outside the medical profession.

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Response to Jemmons (Reply #2)

Sun Jul 24, 2016, 10:28 AM

3. Rather than trying to shoot down the messenger, why not tackle the message?

Your definition of disease, and where did you get it from? (Kind of hard to say whether addiction is a disease or not if there's no definition given for it, and it's everyone's fill-in-the-blank word to use or abuse, particularly by those trying to sell a book or some new treatment.).

I offered some from a medical dictionary
http://medical-dictionary.thefreedictionary.com/disease

disease [dĭ-zēzī]
a definite pathological process having a characteristic set of signs and symptoms. It may affect the whole body or any of its parts, and its etiology, pathology, and prognosis may be known or unknown. For specific diseases, see under the specific name, as addison's disease. See also illness, mal, sickness, and syndrome.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

dis∑ease (di-zēz'),
1. An interruption, cessation, or disorder of a body, system, or organ structure or function.
See also: syndrome. Synonym(s): illness, morbus, sickness
2. A morbid entity ordinarily characterized by two or more of the following criteria: recognized etiologic agent(s), identifiable group of signs and symptoms, or consistent anatomic alterations.
See also: syndrome.


Which medical, psychological, psychiatric association declares addiction to be other than a disease?

And how does any of this fit the purpose of this forum anyway?
http://www.democraticunderground.com/?com=view_post&forum=1144&pid=1973

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Response to progree (Reply #3)

Sun Jul 24, 2016, 10:57 AM

4. I am not trying to shoot anyone.

But I will point out that scientific training in say chemistry might not take you far when dealing with economy.

I cant take credit for the work of Marc Lewis, but to my mind a lot of what goes under the guise of medical science also play a part in the business model of corporations that produce medications. Which is why the same corporations will fund a huge amount of studies and publish a lot of them.

I also think that the concept of disease is quite elastic if you mix the common use and the more narrowly defined uses in different medical traditions. If you also consider that almost no mental health issues are fully understood, you have fertile grounds for misunderstandings of the significance of concepts like "disease".

In addiction theory there is a narrow version of the disease model, the patophysiological understanding of addiction, that is clearly defined but very weakly supported.

It is perhaps interesting to discuss definitions of disease. But what if you like me reject the narrow patophysiological understanding of addiction, but nevertheless find that a lot of physiology is relevant for understanding addiction. Then you dont want to reject the disease model in all cases, but neither do you want to reject the social or psychological factors that seem relevant.

I think Marc Lewis book is a good attempt at progress, but it is not very tightly argued and a lot more work is needed before we have something approaching a full understanding of addiction. There is a lot more to do before Lewis views can be confirmed or rejected by the general public. And it is not just up to him to do that work. And pretending that the eliminative materialists have all the answers strikes me as something quite ignorant.

I would also point out that I havent seen anything that makes it impossible to accommodate Lewis' view within the normal bio-psycho-social framework that dominates current psychiatric thinking. This model might not satisfy your desire for a clear cut answer to issues in mental health or addiction treatment. But it is what we currently have to work with.

You seem to be under the impression that a lot of current debate could be ended if only people were provided with a few links to a list of medical definitions. Is that something you really believe?

But we are getting a bit far from talking about meetings, sponsors and sober days and I fear that this discussion is going to be shut down soon. The "higher powers" arround here have a tendency to dislike non-AA discussions.



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Response to Jemmons (Reply #4)

Sun Jul 24, 2016, 04:59 PM

5. Yes, that is correct.

[font color = blue]>>You seem to be under the impression that a lot of current debate could be ended if only people were provided with a few links to a list of medical definitions. Is that something you really believe? <<[/font] (emphasis added by Progree)

It would be a necessary starting point to have a definition or definitions of disease. Yes, that is something I really believe. I don't know how one can ask "Is addiction really a disease?" etc. etc. as you did in the OP, without considering as a starting point a definition or definitions of disease. Then we can progress.

Otherwise, I have one thing in my head about what a disease is, or those medical dictionary definitions I provided AS A STARTING POINT, and you have some other definitions of disease in your head, or some book somewhere, and we'd be fruitlessly talking past each other forever and ever in endless mental masturbation.

Not all debates would be shut down by a clear definition or set of definitions. But a lot of silly ones that one finds on recovery message boards would end.

And just out of curiosity, would it make any difference if we used the term "malady" or "disorder" or something else? Everybody seems to agree SOMETHING is wrong with someone knowingly using a chemical in a profoundly self-destructive way. But for some reason,some people who agree that addiction is a sickness or malady or disorder goes bananas when the D-word (disease) is used. But when one tries to find out what freaks out the person about the D-word, and ask for a definition (a reasonable start to try to find out their particular hangup with the word), either the discussion ends, or insults, ducking and deflecting begin.

[font color = blue]>>But we are getting a bit far from talking about meetings, sponsors and sober days and I fear that this discussion is going to be shut down soon. The "higher powers" around here have a tendency to dislike non-AA discussions. <<[/font]

Oh, I don't know about that. I've seen discussions here about non-12-step recovery like S.O.S. and SMART and the like, and the general attitude has been to each their own, whatever works for you is great. Just as long as someone doesn't try to say one program or approach is bad for others, and another is good for others. I can talk about what works for me. It's when I start telling you what works for you is when I'd get in trouble.

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Response to progree (Reply #5)

Sun Jul 24, 2016, 06:15 PM

6. Fair points indeed.



I will note though, that:

1. The headline is not actually my wording but the headline from the Grauniad article that is linked in the OP. It also might be seen as click bait at some level.

2. The definitions that you refer to are not in any way hidden or secret. So either they dont have the desired effect or else you need to explain in a bit more detail what you think is going on.

3. Talking past each other is a real possibility and something a bit of common terminology can perhaps prevent. We agree so far. But I just dont find that a set of vague and varied definitions of a complex concept like "disease" is really going to make a big difference.
What I would consider a more fruitfull starting point would be the pathophysiological theory of drug addiction. This is the view that chemical effects of addictive drugs change the brain of an drug taking person to make that person addicted. And it thus provides a clear pragmatic test of viability: Can you find such chemical effects of addictive drugs or not?

Im not sure if this theory would cover your view or not.

This is best short representation that I can find:
"These consequences of drug use are thought to contribute to the maintenance of drug use and to the reinstatement of compulsive drug use that occurs during the early phase of abstinence. Even, however, after prolonged periods of abstinence, 80-90% of human addicts relapse to addiction suggesting that repeated drug use produces enduring changes in brain circuits that subserve incentive motivation and stimulus-response (habit) learning. A major goal of addiction research is the identification of the neural mechanisms by which drugs of abuse produce these effects. "

Quoted from the abstract of the paper:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939016/

You will note that the last sentence points to the fact that the theory is so far just a hypothesis until the case can be argued that specific neural mechanisms are involved in producing addiction.

The authors go on to say "We will provide evidence that the repeated administration of cocaine and alcohol up-regulates the dynorphin/κ-opioid receptor system and that pharmacological treatments that target this system may prove effective in the treatment of drug addiction."

That might get closer, but it is still not a closed case. And it is just one article. Which means that so far there is no wide scientific consensus for the theory. It might still hold water, but we are not there yet.

It should also be noted that Wolfram Schultz, the leading expert on dopaminergic networks has so far not endorsed the patho physiological view of addiction. And if you read his work on dopamine you will find that rather than making people drug seeking addicts, changes to the dopamine system will change your risk preferences, your motivation and sense of opportunity. Which supports the view that addictive drugs can screw up your brain 7 ways from sunday without making you an addict in the narrow patho-physiological sense. And it might still screw you up enough to make it more likely that you take drugs out of desire, desperation or other non specific reasons rather that because of specific causes.

This link from non-specific brain changes to less stable emotional function and from there more emotion focused coping (drug taking and other), is for me the main phenomenon that produces additional tendencies towards drug taking. But you will note that this bundle of causes is mixed with other kinds of causes like stress, habits, physiology and social situation and that causes that originates in drug taking have no special status in the downstream effects produced.

In this view it is easy to see how changes to the brain, stress, cognitive problems like negative automatic thoughts, anxiety, lack of sound sleep and a host of other causes can work together to nudge people towards mood repair, emotion focused coping and thus drug taking. There is thus physiology involved, but not in a way that is specific enough to make the physiology an expression of "disease" and not by far something that is narrowly caused by addictive drugs.

4. "Each to their own" is a something that I can embrace with no hesitation. I just like to discuss in an open an honest way. Which is to say that I trust the facts to be an improvement over opinions, either mine or others.

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Response to Jemmons (Reply #6)

Sun Jul 24, 2016, 08:11 PM

7. Uh oh, the dreaded "D" word again, in quotes

Last edited Sun Jul 24, 2016, 08:51 PM - Edit history (1)

[font color = blue]>> There is thus physiology involved, but not in a way that is specific enough to make the physiology an expression of "disease" and not by far something that is narrowly caused by addictive drugs. <<[/font]

Oh, if it isn't "specific enough", then its not a disease. Well, we're getting somewhere, maybe. I haven't seen any definition of disease that involves "specific enough" or that excludes "cognitive problems like negative automatic thoughts, anxiety, lack of sound sleep and a host of other causes", as causation, symptoms, or contributing factors, but that's OK.

Why are you so obsessed with the topic? What do you want from us?

In my experience, a lot of anti-A.A. people think that the "disease concept" is part of A.A. and therefore go on an endless jihad to discredit it. Usually some pretty rough-hewn types that have the strangest concepts of what a disease is or isn't, if you pin them down on it. They share with you a contempt of definitions. As in insisting that "X" is not a "Y" and then refusing to define or explain what "Y" is, in their mind, and just going on and on about cognitive factors, willpower, environment, etc. Silly.

(BTW, I can't find the disease concept or anything like that in the Big Book or the 12 X 12 anywhere - I searched an electronic version of both for the word disease. And BTW I'm no fan of A.A.).

Some people think a disease has to be permanent to be a disease, but I haven't found permanancy in the definition of disease.

Some people think "well its not a disease like malaria", and therefore, its not a disease (yes gobsmack).

Some people think disease has to have a simple physical explanation. That if it's complicated, and/or involves cognitive, environmental, social factors, then it is not a disease. Somehow.

You still didn't answer my question -- do you think addiction is a malady, a disorder, a sickness, something-fucking-wrong, whatever, but not the dreaded D-word, and why?

And, do you think bipolar disorder, major depression, schizophrenia and other so-called "mental diseases" are diseases or just disorders or something other than the dreaded "D-word"?

To me, addiction fits with every definition of disease that I have seen, so I conclude it's a disease.

YMMV.



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Response to progree (Reply #7)

Sun Jul 24, 2016, 08:59 PM

8. Disease or not would seem to be the topic

Oh, if it isn't "specific enough", then its not a disease. Well, we're getting somewhere, maybe. I haven't seen any definition of disease that involves "specific enough" or that excludes "cognitive problems like negative automatic thoughts, anxiety, lack of sound sleep and a host of other causes", as causation, symptoms, or contributing factors, but that's OK.


I think what happened was that your expectation was that I didnt like to have a narrow definition as a basis. But in fact I dont find your suggested definition of disease to be narrow enough to be of any use. Which makes a few odd misunderstandings likely.


Why are you so obsessed with the topic? What do you want from us?


I try to avoid insulting adjectives. Please reciprocate.
Besides that: Addiction is a huge factor in making life unnecessarily hard and painful for a lot of people. I dont find that I am "obsessed" about it, but it is something that I like to find better answers for. "Each to their own" as you know.

You still didn't answer my question -- do you think addiction is a malady, a disorder, a sickness, something-fucking-wrong, whatever, but not the dreaded D-word, and why?


I have tried to explain my position, but perhaps it is not easy to understand. Perhaps scientific training helps, but cognitive brain science gets really complicated really fast if you are not used to the concepts.

If you read the linked article (Shippenberg) you will get a sense of the discussion as it currently is.

If you just want to know what most people think, then addiction as disease is right on the money. But that view hasnt got much solid science backing it.

My view a bit simplified: I tend to think that severe and deep stress is a huge factor in most cases, but other causes can be dominant in other cases. I dont think that drugs causes addiction by way of chemistry as opposed to just being another stress factor.

Lewis is one of many who currently doubts the "addiction as disease" view. But this position is also only slowly maturing into something solid.

And, do you think bipolar disorder, major depression, schizophrenia and other so-called "mental diseases" are diseases or just disorders or something other than the dreaded "D-word"?


This is something that will be uncovered in the next 50 years or so. Nobody really understand how the brain works at this point in time. And the subject is way off topic here.

To me, addiction fits with every definition of disease that I have seen, so I conclude it's a disease.

It would seem that we have to agree to disagree.

Where this will be important in real life is when you make choices about how to help yourself or loved ones. Do you give in to "the inevitable"? Do you rearrange your life to take care of vulnerabilities. There are practical implications to these very different views.

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Response to Jemmons (Reply #8)

Sun Jul 24, 2016, 09:21 PM

9. More answers....

Im not anti AA. I dont know enough about AA to really have an informed opinion. I know that they are not currently offering an effective and acceptable solution for any and all addicted people. And I dont believe that they have a solution that solid science cant find a better alternative to.

I have a deep respect for faith and I dont share the arrogant attitude towards religion that you find in some academics and a lot of scientists. If people can find value in a faith based method im all for it. I dont think that AA was intended as solid science and I also dont think that AA by a miraculous chance event has managed to become solid science quite unintended.

I think that science will have a better solution in the long run, even if it might not be the case right now.

I understand addiction from a cognitive science point of view. That means the usual bio-psycho-social model as a starting point, but perhaps with more emphasis on the biological part than most psychologists and more on psychology than most psychiatrists.

I grew up with addiction as a constant companion and that might color my thinking, but im surprised that anybody would not find addiction the most interesting you could ever talk about.

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Response to Jemmons (Reply #9)

Sun Jul 24, 2016, 09:51 PM

10. Motives.....

Some people think a disease has to be permanent to be a disease, but I haven't found permanancy in the definition of disease.

Some people think "well its not a disease like malaria", and therefore, its not a disease (yes gobsmack).

Some people think disease has to have a simple physical explanation. That if it's complicated, and/or involves cognitive, environmental, social factors, then it is not a disease. Somehow.


So you are listing reasons people rely on for thinking that addiction is not a disease. And you might think that im looking for any obscure reason to move addiction out of the disease category.

You will know though that a lot of people will do this in order to get addiction back into the crime category. So that we can lock up more people.

The way that you feel about that might color your perception of people like Lewis (or me) who tries to move addiction into a social or psychological category. So what we can treat addiction with better success.

The odd thing though, is that I dont have a strong ulterior motive for doing it. I am just not in the narrowly medical camp. I just dont find the science convincing. And I think that stress does a lot more damage than what we normally would think. And I dont trust the medical industry to solve a lot more than their own financial worries.

I cant speak for Lewis but I think that he is pretty close to that position too.

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Response to Jemmons (Reply #8)

Sun Jul 24, 2016, 11:53 PM

11. "Do you give in to 'the inevitable'?" - is that what you really think classifying addiction

Last edited Mon Jul 25, 2016, 01:23 AM - Edit history (3)

as a disease is all about?

[font color = blue]>>But in fact I dont find your suggested definition of disease to be narrow enough to be of any use.<<[/font]

So give us your definition, rather than ducking, weaving, and dodging. Mine comes from a medical dictionary. I would have included narrower definitions, but there weren't any.

Where does your definition (if any) come from, and who subscribes to that definition, other than using it as a strawman to bash the "disease theory"? Or is it just some notions in your head about what you think a disease is?

You asked us in your OP whether addiction is a disease. You seem obsessed (sorry) to me with whether addiction is a disease or not. I'm not saying you are obsessed, or wrongly obsessed with addiction. But rather whether it is a "disease" or not. Not just this thread but just about all the others you've started in this group. Without any definition, all this discussion about whether addiction is a disease or not is meaningless pseudo-intellectual twaddle.

I still don't understand the hang-up on the D-word. Especially when you don't define it. You can't categorize X as a Y or not a Y until you have some kind of definition of both.

[font color = blue]>>I try to avoid insulting adjectives. Please reciprocate.<<[/font]

You've made your share of insulting put-down statements if not any bad single adjectives. Some people are obsessed with the disease thing, and if itís a bit too strong of a word to fit you, I'm sorry, but IMHO its pretty darn close.

[font color = blue]>>If you just want to know what most people think, then addiction as disease is right on the money. But that view hasnt got much solid science backing it.<<[/font]

Depends on the definition of disease, and whose opinion is being asked etc. etc. Quite a royal statement and yet you don't even offer a definition of disease. And I don't know any medical or psychological or psychiatric associations that think addiction is not a disease. You dismiss that as just being about money. But often the anti-disease people are trying to sell a book or a program.

[font color = blue]>>My view a bit simplified: I tend to think that severe and deep stress is a huge factor in most cases, but other causes can be dominant in other cases.<<[/font]

I don't doubt social and psychological factors are a big part of it.

[font color = brown]>>And, do you think bipolar disorder, major depression, schizophrenia and other so-called "mental diseases" are diseases or just disorders or something other than the dreaded "D-word"?<<[/font]

[font color = blue]>>Nobody really understand how the brain works at this point in time. And the subject is way off topic here.<<[/font]

I'm just seeing whether you think so-called mental diseases are diseases, and what distinguishes them from addiction other than the presence of a chemical. I don't agree its "way off topic here". They all fit my "uselessly" broad definition of disease. Since you don't have a definition, I have to prod and probe to find out what constitutes a disease in your mind.

(From #10) [font color = blue]>> The way that you feel about that might color your perception of people like Lewis (or me) who tries to move addiction into a social or psychological category. So what we can treat addiction with better success.<<[/font]

Again, I have seen no definition of disease that doesn't allow for a major or even primary role for social and psychological factors. (Again that's why I asked about the "mental diseases". I am a big fan of cognitive techniques, Rational Emotive Therapy, etc. I quit smoking and drinking by carrying around cards with rational statements, like "if I have just one, I'll want the next one even more than the first, so by having "just one", I won't satisfy any craving but rather make it worse".

Or in short hand: "3>2>1" which means I'll want the 3rd one even more than I wanted the 2nd one, and I'll want the 2nd one even more than the first one.

And although I'm no fan of the A.A. 12-steps, I do give A.A. a big thumbs up for creating a social environment where people can spend time and have fun with others soberly.

[font color = blue]>>Where this will be important in real life is when you make choices about how to help yourself or loved ones. Do you give in to "the inevitable"? Do you rearrange your life to take care of vulnerabilities. There are practical implications to these very different views.<<[/font]

Uhh, explain how. Do you think someone who thinks of addiction as a disease "gives into the inevitable"? That's the rough-hewn type logic I see on other message boards. That's the old "if its a disease, its permanent and incurable, so what the fuck" working definition that some people seem to have, but matches no medical definition of disease that I know of.

Most people think that diabetes is a disease, but very few diabetics that I know of use it as an excuse to do nothing and just drop dead. Most diabetics take insulin and try to maintain a healthy diet, for example.

Likewise, [font color = blue]"Do you rearrange your life to take care of vulnerabilities"[/font]. Oh fuck no. Since I believe I have a disease, therefore, I moved into an apartment above a bar, and keep a full liquor cabinet. Do you really believe that's what thinking of addiction as a disease leads to?

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Response to progree (Reply #11)

Mon Jul 25, 2016, 01:43 AM

13. You might find that you leave quite a bit on the table

Last edited Mon Jul 25, 2016, 03:48 AM - Edit history (2)

"Oh fuck no. Since I believe I have a disease, therefore, I moved into an apartment above a bar, and keep a full liquor cabinet. Do you really believe that's what thinking of addiction as a disease leads to? "

Finding a healthy context to live in is a good start. But if you also map out the factors that will make it more likely that your desires and limbic activity will suppress influence from you long term goals and PFC activity, you get a brand new set of levers to pull. A lot of these have nothing to do with any known disease. They are not closely related to causes of addiction, but are compensatory in nature. That is you compensate for a given weakness by enhancing some other aspect of function. This leads to less "giving in". And it presupposes a detailed map of vulnerabilities and more importantly of opportunities for improvement.

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Response to Jemmons (Reply #8)

Mon Jul 25, 2016, 12:49 AM

12. Shippenberg

(From #8)[font color = blue]>>If you read the linked article (Shippenberg) you will get a sense of the discussion as it currently is. <<[/font]

(From #6)[font color = blue]>>http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2939016/<<[/font]

Would reading the abstract and conclusions be sufficient? And if we both agree that there's more to addiction than that, would we be somewhat more on the same page?

But would agreeing that there's more to addiction than that prove that addiction is not a disease somehow? But merely a sickness, a malady, a disorder?

Myself, I have a big interest in understanding what the brain is like before the addiction begins, or in the very early pre-addiction stages (recognizing that some people are hooked from the very beginning). Why do some people manage to moderate or quit before things get too far along, while others just progress and progress?

The Shippenberg link seems to be more about those who are deeply ravaged by the chemical, when the neurotransmitters and receptors and all that get fucked up.


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Response to progree (Reply #12)

Mon Jul 25, 2016, 03:13 AM

14. Pre-addiction stages are very interesting

Myself, I have a big interest in understanding what the brain is like before the addiction begins, or in the very early pre-addiction stages (recognizing that some people are hooked from the very beginning). Why do some people manage to moderate or quit before things get too far along, while others just progress and progress?


This is indeed where things get interesting.

And there are several ways that people can be vulnerable or less so.

Some are related to diseases. For instance the link to diabetes:

Additional evidence that low glucose reduces drinking
restraint comes from studies showing that people with
diabetes are more likely to have alcohol-use disorder than
people without diabetes (e.g., Goodwin, Hoven, &
Spitzer, 2003; Rehm et al., 2003). To be sure, the link is
a correlation, and the causal arrow could point in either
direction. However, several studies suggest that alcohol
use does not cause diabetes (e.g., Saremi, Hanson,
Tulloch-Reid, Williams, & Knowler, 2004; cf.
Wannamethee, Shaper, Perry, & Alberti, 2002), and so
diabetes might lead to excessive alcohol use if, in fact,
diabetes and alcohol use are causally related. Thus, low
glucose and poor glucose tolerance might undermine
efforts toward restraining alcohol consumption.


From
http://www.ncbi.nlm.nih.gov/pubmed/18453466

So this points to some people getting into addiction because an underlying vulnerability that is physiological in nature. Not because they have disease that makes people desire alcohol, but because their general ability to withstand desire is compromised to some degree and the balance between the prefrontal cortex (aka PFC) and the limbic brain tilts towards less cortical and more limbic control.

In this case you do have a disease, just not a disease that always lead to alcoholism.


ADHD also seem to predispose people for addictions. And ADHD is not just a sign of dysregulated glucose. So it doesnt make alcoholism a disease, just one of many negative effects of something else gone a wrong.

Sleep disorders also seem to predispose people towards addiction:

"Age-related sleep deficiencies may encourage the use of alcohol to promote sleep, while increasing an older person's susceptibility to alcohol-related sleep disturbances"
http://pubs.niaaa.nih.gov/publications/aa41.htm

But this is a case where it is hard to see what is cause and what is effect. While sleep disorders can motivate drinking alcohol, alcohol can produce sleepdisorders.

There are many more examples of things that predispose people to alcohol addiction. They all seem to affect your chance of having the pcf dominate the limbic brain in order to abstain.

Which leads to the tentative suggestion that addiction is based on a relative weakness of the PFC.

But this is where a disease model of addiction is a bit of a problem: PFC function is something that is easily disturbed by so many factors that it doesnt make much sense to call weak PFC function a disease. A bit of stress and the PFC shuts down. A bit of malnurishment and the PFC shuts down. A bit of infection and the PFC shuts down. A weak PFC function is a sign of a million different things that could all be causes if their own way.
There is also the the fact that you can compensate for weak PFC function in a lot of non medical interventions. Like stress reduction or by training people to use certain coping strategies.

When you find more and more ways that a bad balance between the PFC and the limbic brain (desire) can come about, it make less and less sense to see addiction as a disease. As some of the causes are diseases, that need not bother you, but it might.
I think the disease model will make it harder to understand addiction because it is hard to square the disease concept with some of the factors that will make your pcf function weak and might cause addiction.

But it is worth looking at the requirements for PFC function. If you need a million things to go right in order to have good PCF control, then there is a million things that can go wrong. But if you start sorting out what is necessary and what is sufficient causes of good PFC function, you might get somewhere. Then you can then have vulnerabilities, compensation and enough PFC function to stay on a chosen course. But this focus goes a bit beyond diagnosing a disease.












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Response to progree (Reply #12)

Mon Jul 25, 2016, 03:28 AM

15. There are also pre-addiction stages that relates more closely to the limbic structures

Last edited Fri Jul 29, 2016, 12:38 AM - Edit history (2)

There seem to be huge differences in how much endorphin that different people produce after drinking alcohol. You cant measure this in the brain of a live person because of ethical considerations. But as the brains of mammals are comparable in most ways you can get a good idea of what is goin on by looking at say rodents brains. This is from a variety of rat-brains being subjected to alcohol while thier endorphin levels are measured directly in the brain.

?w=634

"The consumption of a moderately high dose of alcohol by
persons who describe themselves as voluntary drinkers enhances
the release of ~-END and ACTH to the bloodstream.
In contrast, alcohol intake by nondrinkers is followed within
15 min by a decrease in the plasma concentrations of these
substances to below basal levels, with maximum decreases appearing
after 30 min. "


http://hera.ugr.es/doi/15024970.pdf


If this can be confirmed, it would explain some of the variance and why some are prone to alcohol addiction and why some are just not. But this kind of sensitivity might be an unintended consequence of a trait that has great benefits in another context. It could be correlated with better pain management and/or stress management. And again not a sign of disease. Just something that can go wrong when you introduce alcohol into the natural environment.

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Response to Jemmons (Reply #15)

Thu Jul 28, 2016, 12:24 AM

16. The scientific method (a diversion)

From: http://www.democraticunderground.com/11441220#post10

[font color = blue]NMDemDist2>quoting Dr. Silkworth "Obviously, he decides to take a drink again some time before he actually takes it. He starts thinking wrong before he actually embarks on the course that leads to a slip".<[/font]

This from one draft annotated version (mine) of the Big Book, p. 35-36 (Chapter 3):

"Our first example is a friend we shall call Jim. .... Yet he got drunk again. We asked him to tell us exactly how it happened. This is his story: "I came to work on Tuesday morning. I remember I felt irritated that I had to be a salesman for a concern I once owned. I had a few words with the brass, but nothing serious. Then I decided to drive to the country and see one of my prospects for a car. On the way I felt hungry so I stopped at a roadside place where they have a bar. I had no intention of drinking. I just thought I would get a sandwich. I also had the notion that I might find a customer for a car at this place, which was familiar for I had been going to it for years. I had eaten there many times during the months I was sober."

Fine fine bulletproof thinking so far. I always eat in a bar in case a prospective customer might come over to my table (sneak preview: )

"I sat down at a table and ordered a sandwich and a glass of milk. Still no thought of drinking. I ordered another sandwich and decided to have another glass of milk. "

How healthy! And he's not sitting at the bar, so no problem.

"Suddenly the thought crossed my mind that if I were to put an ounce of whiskey in my milk it couldn't hurt me on a full stomach."

No quarrel with me -- an ounce of whiskey is much safer on a full stomach than an empty stomach, I always say.

"I ordered a whiskey and poured it into the milk. I vaguely sensed I was not being any too smart, but I felt reassured as I was taking the whiskey on a full stomach. "

Again, much better than on an empty stomach. This is the *Principle of Harm Reduction*.

"The experiment went so well that I ordered another whiskey and poured it into more milk. "

Yes, the scientific principle of cautious experimentation.

"That didn't seem to bother me so I tried another."

More data collection. More hypothesis testing. Checking one's results over and over. Not hurrying into publication prematurely.

"Thus started one more journey to the asylum for Jim. "


HUH! I don't get it.

===================================================================
[div style="display:inline; font-size:1.37em; font-family:monospace; white-space:pre;"] and patient

[div style="display:inline; font-size:1.37em; font-family:monospace; white-space:pre;"]... cunning, baffling, powerful^! -- BB p. 58


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Response to progree (Reply #16)

Fri Jul 29, 2016, 12:25 AM

17. This is interesting!

I read the lay out as the gray boxes being the original content and the rest being annotations by you.

The quoted text formulates a critique that is quite sophisticated: Can you really expect to have effective rational self control if the standards that you hold your behaviors up against are not fixed or stable?

You make a reference to "scientific principle of cautious experimentation", but this is really more about scientific thinking being used in a context of rational self control, as when you measure your behavior in comparison with a chosen standard. This is off course where the inexperienced person will fail: When your strategy is just to "say no" if the option is not within chosen standards, you will fail if and when your standard change because your brain state has changed because your current context has changed.

SÝren Kierkegaard was one of the first people to voice a critique like this when he contrasted rational conclusions with faith based convictions and found that rational conclusions would always be weak and crumble in the face of existential challenges.

So there is a long history of being skeptic about ration self control. More recently we got a bit of empirical evidence for the point. Dan Ariely has shown that standards for whom to exclude as a potential sex partner will change as you get more and more aroused. LeDoux' new understanding of the emotional brain talks about how a survival circuit can "monopolize" brain resources and thus reconfigure the way that you react or act.

In this sense science is now slowly coming around to a point that religious people have favored for a long time. But then again not quite: Where religious thinking will often recommend that you strengthen your faith by religious practice, science is still looking at ways to overcome the pitfalls of rational self control.

But most people dont really think about this. Most people just instinctively follow one or the other path for good or for worse.

I live in the big gray area where we look at ways to make rational self control less vulnerable to state changes as the brain sees a different environment.

Other people find success in shoring up their faith and reliance on the use of faith based convictions.

There are yet no final answers to what is the best option. As much of what goes on is just seeing through programs of rational self control and tweaking your ability to do that as much as possible. But as Brexit, Trumpism and a a lot of other developments have shown, a lot of people are trowing out the rule book as they are more and more frustrated with their results.

This will lead to a lot of unorthodox choices, but it might also lead to a more keen interest in alternative to rational self control either of the faith based variety or indeed in a scientific exploration of stability measures for a rational self control exercised in a brain that can change its configuration as the environment changes.



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