Addiction is a disease

[UserGoogol]

So are all pathological criminals diseased? Should we then punish them?

Punishment has two purposes. The first is to prevent a person from doing it again, and the second is to deter other people from doing it. Neither of those purposes are really contradictory with the idea that criminality is a disease. If it works, it works. As it currently stands, we do not have an effective medical treatment for "excessive willingness to commit crime," so punishment is the best option available.

ETA: And of course, there's a difference between having a diseased mind and being legally insane.

 

[chris epic]

Punishment has two purposes. The first is to prevent a person from doing it again, and the second is to deter other people from doing it.

I think it is safe to say that time has proven that the presence of punishment, at least in America, hasn't done much to prevent crimes- people still commit murder knowing they could face life in prison or the death penalty. The same goes for preventing a person from doing it again. A person that goes to prison for drugs can find drugs easier in prison. A person that commits murder; imprisonment doesn't prevent them from committing murder again.

Ultimately, punishment has one purpose: justice- vindication for the state or the victim or the victim's family.

Imprisonment has two purposes: vindication and seperation from society.

 

[ponderingturtle]

I never said a predisposition towards violence should be a mitigating factor.

But that can pretty easily fit into the catagory of disease.

 

[Skeptic Ginger]

Mabey, does it matter? Should an alcoholic who is a drunk driver be treated differently from someone else who drives drunk?

The more appropriate questions here are, "what percentage of drunk drivers have some degree of alcoholic disease"? Because my reading suggests most if not all.

And the second question is, "what is the best way to prevent drunk drivers from driving drunk the next time"? Punishment is also supposed to deter the crime. If you assume a person has the ability to quit driving drunk without treatment, then how many will do it again after you 'punish them'? I'd say 15,000 deaths a year suggests mere criminal prosecution isn't a very effect deterrent. I think if the courts recognized how many alcoholics they were slapping on the wrist they might be inclined to take a different approach.

There is a panel of blood tests, for example, that can give you a definitive diagnosis of alcoholism. Abnormalities on a CBC and a liver panel consistently correlate with daily drinking (more than a couple drinks) and/or severe binge drinking. It should be a standard test ordered on all DUIs. The results should be used to order inpatient treatment. Set the treatment up in the jail if you like. The costs you save in preventing disease consequences would pay for the programs.

The person so detained could have work release as soon as they were stable and if employers viewed the addiction as a disease, sick leave would be more acceptable. It would save the employer money if the person could be successfully treated.

But as long as we just sentence the crime and ignore the disease aspects, we let 15,000 more people die every year.

 

[Skeptic Ginger]

For the not-addiction crowd: what evidence would convince you that addiction is infact a disease?
For the addiction proponents: what evidence would convince you that addiction is NOT infact a disease?
Would brain scan evidence settle the issue? Why and Why not?
Is there any extent to the prevelance of willfull behavior that would settle the issue? why and why not?

BTW, there is a word for people who say psychology and psychiatry are non-scientific... scientologists.

There already exists overwhelming evidence of the disease components of addiction.

What you aren't asking here is what evidence suggests we should or shouldn't hold a person responsible for the consequences of their disease?

And what evidence suggests the best approach to take with a pathology that results in harm to bystanders?


And I love that last comment. Evidence based medicine is only a little older than the evidence based premise the brain is an organ just like the liver and pancreas are organs. For a bit longer than the rest of the science of medicine, humans operated under the premise there was a mind body separation. So research into the aspects of behavior and emotion lag a bit behind, but we are at least now aware of the fact brain research is not any more unique than research into other aspects of the human body. There is a structure and an electrochemical physiology and low and behold, no mysterious 'soul' to worry about.

 

[ponderingturtle]

The more appropriate questions here are, "what percentage of drunk drivers have some degree of alcoholic disease"? Because my reading suggests most if not all.

Then we get back to a semantic arguement about what is an alcoholic and what is a disease. Hmm we have not argued over the proper definition of what an alcoholic is yet in this thread, this seems like a good starting point for it.

You could pretty easily come up with a definition of alcoholic that covered everyone who ever gets a BAC over .08 the federal limit for drunk driving

And the second question is, "what is the best way to prevent drunk drivers from driving drunk the next time"? Punishment is also supposed to deter the crime. If you assume a person has the ability to quit driving drunk without treatment, then how many will do it again after you 'punish them'? I'd say 15,000 deaths a year suggests mere criminal prosecution isn't a very effect deterrent. I think if the courts recognized how many alcoholics they were slapping on the wrist they might be inclined to take a different approach.

THe criminal prosecution is often pretty weak. I know someone who was killed by a drunk driver and the driver was not in prison for more than a year.

So saying punishment does not work, well at the current level it doesn't.

There is a panel of blood tests, for example, that can give you a definitive diagnosis of alcoholism. Abnormalities on a CBC and a liver panel consistently correlate with daily drinking (more than a couple drinks) and/or severe binge drinking. It should be a standard test ordered on all DUIs. The results should be used to order inpatient treatment. Set the treatment up in the jail if you like. The costs you save in preventing disease consequences would pay for the programs.

But how does the relate to how alcoholics are universaly defined?

 

[Skeptic Ginger]

I didn't say there was a disease, I said there is a biological basis for human behavior. Simply we have bodies. Most addictions are based upon the same set of behaviors as paraphilias. Not all addiction will work the same way but you have the adrenaline involved, or an obsessive compulsive disorder or other mental illness(in some cases). Then there is the compulsive cycle, which is involved in the anxiety release cycle, tension about the cognitive object and then the release of that tension. Most of what keeps the addiction going is the cognition supporting it and the training of the habits.

Then there are those who have biological vulnerabilities to addiction whatever the route may be. But anyone who has heard me speak about addiction or mental illness knows that i am a firm believer in personal responsibility.

Obsessive compulsive disorders offer insight into addictions to things like shopping, hoarding and gambling.

 

[Skeptic Ginger]

Originally Posted by skeptigirl (italics)

For example, drunk drivers should IMO be given jail sentences, even for first offenses.

[Simone:] The fact that our court system chooses to treat it that way does not excuse the behavior. They should loose thier license for the second offense, period. No excuses, if they own the car it should be impounded.


unrelated rant

Alcohol is a real problem when people drive. Assault should not be a misdemeanor either. But hell we will continue to act as though cocaine is the real problem and put millions of people in prison for that and the alcohol manufacturing and distribution system will continue to support the most lethal substance of abuse.

Note the confused quote attribution, thanks. One of the drawbacks of the edit option time limit.


BTW, I share your rant.

 

[Skeptic Ginger]

For example, drunk drivers should IMO be given jail sentences, even for first offenses.


Now you know that that would be almost impossible for all drunk drivers to be given jail sentences, while its just considered a misdemeanor, 364 days in jail, most offenders pay a fine and go on their way. If they do a weekend in jail, they continue to drink, it doesn't change their ways.

Why is this impossible?

The problem is drunk driving laws do not reflect the 15,000 annual deaths from drunk drivers. IMO, drunk driving laws and sentences reflect the fact many judges and legislators as well as much of the public underestimates this fact and underestimates the role addiction to alcohol plays in DUIs.

 

[Skeptic Ginger]

Diabetes is a result of lifestyle in some cases and not the lifestyle itself. "Alcoholism" is simply drinking too much alcohol. If someone gets cirrhosis of the liver, pancreatitis, polyneuropathy, alcoholic dementia, heart disease, increased chance of cancer, nutritional deficiencies or sexual dysfunction from drinking too much alcohol then those things can be considered diseases. But "alcoholism" itself can't. Moreover, Addiction can simply be ended by not drinking anymore.



So?



So?



All of your studies do nothing but argue that addiction can be genetically predisposed to specific individuals. This doesn't mean it's a disease. CRIME and VIOLENCE can be genetically predisposed to specific individuals. Is crime a disease now? If it's a disease why punish violent criminals? After all they just suffer from a disease!

You need to separate responsibility from disease, the two are not equal. And the way you are defining disease here or the way you are viewing pathology is not the way the medical community views/defines pathology and disease.

 

[Skeptic Ginger]

He didn't argue that brain scans can't effectively study the brain. He argued that they are irrelevant to the discussion of whether addiction is a disease or not. Brain scans can show that people who are more violent tend to have differently working brains than non-violent people. Do you now argue that violence is a disease? If it's a disease then why should we punish violent criminals?

Again, this reflects a poor understanding of brain research.

 

[Skeptic Ginger]

I've seen more definitions for the word 'disease' then you can poke a stick at. But for the most part, they all have a central point;

A disease is an impeding deviation in the normal functioning of an organism.

'Normal functioning' is always the sticking point; all organisms vary, and the extent to which this variation impedes their wellbeing or way of life can be rather open to debate. Yet diseases are always an alteration of the normal functioning, which is a good place to start with exploring whether something is a disease or not.

The question is; could your functioning be said to be affected which results in an addiction? The straight forward answer is 'yes'. Now, are all addictions perversions of normal functioning? I would argue again 'yes', only on the grounds that the mind and our behaviour have no non-material part, therefore can only result from neural functioning. If this fails, even if from lack of will power, determination or desire, I would define that as a failure in function.

The problem arises because we associate pity with disease, as if we can seperate functioning from desire. If somebody is sick, it's not their fault. I can't make that association with the term 'disease' by any stretch of the definition. Therefore, whether they have control or not, it remains a disease if their functioning is impeded in some manner.

My two cents.

Athon

These are indeed some of the issues which interfere with discussion of addiction as well as some other sociopathic behaviors.

Obesity draws the same problems. We blame people for their overeating. But the science suggests that with only about 5% of obese people trying to diet succeeding, it may be akin to telling someone to hold their breath. In other words overriding a biological imperative is not a simple matter of willpower. The fact a very small number of people succeed is not evidence everyone has the same ability. For as yet undetermined reasons, that 5% have been able to reset the mechanisms which regulate their caloric intake drive.

So you have pity, disgust, blame and different definitions of disease and pathology, as well as a long tradition of viewing brain pathology differently from other pathology.

Take this news story, Brain-damaged people give insights into morality, for example. If a person had a stroke or brain trauma we would view their behavior change as pathology. But the person born with the same lack of 'a conscience' so to speak, from identical damage or insufficiency of the section of the brain in question would be seen as a criminal.

 

[Skeptic Ginger]

That reminded me, I believe I've encountered that as well. I have a friend who is a psychiatrist and when I read about this in his books it said basically that you should treat the patient as if it is a disease. Meaning, if you tell someone they are sick and lay out a treatment plan for them, they will respond to the advice more positively than telling them the only way to stop being addicted is to just start saying "no". Obviously I'm paraphrasing, but the way it was worded in the book made a lot of sense.

This is a good point but I would clarify it a bit. When we use the disease model it provides better alternatives to treatment than the immoral behavior model. And research has shown that the cycle of drinking for some people is guilt->drinking->guilt-> drinking so if we can interrupt the cycle by interrupting the guilt it does have a positive effect.


Before I get , interrupting the guilt cycle doesn't have to include absolving responsibility. There is the simple act of acknowledging the role guilt plays which has an affect.

 

[Skeptic Ginger]

About 15 years ago, I was one of the "guinea pigs" for a prototype alcohol abuse prevention program at a university that I was a grad student at. Their finding was that the percentage of cases in which only 1 of a pair of identical was an alcoholic was statistically equal to the percentage of cases in which only 1 of a pair of fraternal twins was an alcoholic.

The point?

 

[athon]

They're simple questions. Is schizophrenia a disease? Yes.

Based on what definition?

Should people with schizophrenia be punished like other criminals? No.

Why not? What is your view of the justice system? I assume it's purely retributive from your statement.

Should people who have neurological conditions which influence their behavior be free to live in society? Only if the conditions influence on their behavior doesn't make them violent.

Interesting that you used the word 'influence'. I'm glad you understand that much. So how are addicts not influenced by their physiology?

Alcoholism isn't a disease.

So you keep saying. Repitition doesn't make it true, though. Have something of substance to say or is it a case of fingers in ears, singing 'lalala'?

Give me your definition of disease, if the one pathologists use doesn't suit you.

For the not-addiction crowd: what evidence would convince you that addiction is infact a disease?

See definition for disease. Addicts have a variation in functioning which impedes normal functioning.

The word I meant to use is 'persistent'.

So, you always have a habit of using your own definitions? Pathological behaviours indicate compulsion resulting from a neurological variation.

Again, let's hear your own definition.

This is the crux of the matter. When the medical community views a problem such as addiction using a disease modal, an incorrect assumption is made by many people that disease means "can't stop yourself". That isn't what the disease model means. If I have a disease, there are many things about it I can control and some I cannot.

Well said, skeptigirl. Thanks. But I don't think Dustin will cope with that definition. He'll invent his own, thank you very much.


Athon

 

[athon]

So saying punishment does not work, well at the current level it doesn't.

Which comes to the crux of the issue. Having predispositions which influence your behaviour, be it violence, addiction, or merely not having the emotional capacity to work in society, adds a level of difficulty in being able to modify your behaviour. This does not equate being excused from your responsibility, but it does mean we are all products of our physiology.

Punishment makes us feel better for not committing a crime. It's pure retribution; do bad things and you will have bad things happen to you. The question of how it makes society safer has been questioned since the dawn of time.

The other facets of the penal system - rehabilitation and removal - aim to fix the problem by a) changing the behaviour of the individual to work better in society, or b) remove them from the social group altogether. Both have merits, but both have inherent problems as well.

It's no simple problem. But understanding that our behaviours, through all of the extremes, are born in our physical wiring (both congenital and developed), might help us come to some solution which actually works.

Athon

 

[Skeptic Ginger]

Then we get back to a semantic arguement about what is an alcoholic and what is a disease. Hmm we have not argued over the proper definition of what an alcoholic is yet in this thread, this seems like a good starting point for it.

I was replying to:

For the not-addiction crowd: what evidence would convince you that addiction is infact a disease?
For the addiction proponents: what evidence would convince you that addiction is NOT infact a disease?
Would brain scan evidence settle the issue? Why and Why not?
Is there any extent to the prevelance of willfull behavior that would settle the issue? why and why not?

So the point of your reply loses me. Defining alcoholism is not as difficult an issue as you suggest. It's a matter of sorting out the people who got drunk at a college party and drove drunk from the people who drink on a regular basis and have an addiction, even one not fully developed. There is no sense sending the idiot who didn't realize boilermakers could have such a rapid affect to inpatient treatment for alcoholism.

Give me a medical history and two tubes of blood and I can tell you if you have an alcohol problem and to what degree you have it. And that makes for nice objective criteria to base a diagnosis on.

You could pretty easily come up with a definition of alcoholic that covered everyone who ever gets a BAC over .08 the federal limit for drunk driving

We have come further in alcoholism research than this.

THe criminal prosecution is often pretty weak. I know someone who was killed by a drunk driver and the driver was not in prison for more than a year.

So saying punishment does not work, well at the current level it doesn't.

You won't get an argument from me here. But if we are going to up the sentences (which we should) doesn't it make sense to use the research we have and make that time in jail as productive as possible?

Besides, I can tell you there is also plenty of research that consequences are not on the mind of the relapsing addict.

But how does the relate to how alcoholics are universaly defined?

What do you mean, how does it relate? We do manage in medicine to develop universal diagnostic criteria for diseases. How would it not relate?

 

[Skeptic Ginger]

Here is one example of the research into laboratory tests for level of alcohol use. There are more tests than these, some more sensitive and specific than others. A medical practitioner can make a pretty good call on this disease with current knowledge. Add the history and blood tests to the fact you have a person with a DUI and an accurate diagnosis is well within the capability of modern medicine.

Comparison of the combined marker GGT-CDT and the conventional laboratory markers of alcohol abuse in heavy drinkers, moderate drinkers and abstainers.

RESULTS: GGT-CDT (5.35 +/- 1.08) in the heavy drinkers was significantly higher than in the reference individuals (3.30 +/- 0.37). The sensitivity of GGT-CDT (90%) in correctly classifying heavy drinkers exceeded that of CDT (63%), GGT (58%), mean corpuscular volume (MCV) (45%), aspartate aminotransferase (AST) (47%), and alanine aminotransferase (ALT) (50%), being also essentially similar for alcoholics with (93%) or without (88%) liver disease. When comparing the data using either moderate drinkers or abstainers as reference population, the sensitivity of GGT-CDT, CDT, and ALT remained unchanged whereas the sensitivity of GGT, MCV, and AST was found to show variation. CONCLUSIONS: GGT-CDT improves the sensitivity of detecting excessive ethanol consumption as compared with the traditional markers of ethanol consumption. These findings should be considered in the assessment of patients with alcohol use disorders.

 

[Skeptic Ginger]

...

Well said, skeptigirl. Thanks. But I don't think Dustin will cope with that definition. He'll invent his own, thank you very much.


Athon

Than you and you're welcome. Perhaps we should ask Dustin if he harbors some bitterness about alcoholism or addiction for any particular reason or is he just disgusted with drug users in general?

 

[chris epic]

The more appropriate questions here are, "what percentage of drunk drivers have some degree of alcoholic disease"? Because my reading suggests most if not all.

I disagree. Getting pulled over for a DUI is literally luck of the draw. I have driven 100s of times drunk and have gotten two DUIs. Most people tha get DUIs were just in the wrong place at the wrong time.

I am in an alcohol class weekly per my DUI sentence. In a room of about 25 of us, about 4 or 5 say they are alcoholics, the rest are college students that just shoudn't have driven that night, but admit they don't believe they have alcoholism. Of coarse they could be lying, in denial, or haven't reaped enough consequences in their life as a result of drinking, but for the most part, they don't seem to fit the profile.

Its one of the first questions I ask them "do you think you have a problem with drinking?" and most of them say no. But it isn't like its hard to be honest with everyone in there.