_________________________________________________________________ VOLUME 2, ISSUE 1 PSYCHNEWS INTERNATIONAL January 1997 _________________________________________________________________ SECTION C-2: PSYCHNEWS DISCUSSIONS II -------------------------------------------------------- Note: In the PsychNews Discussions series, we invite independent articles on current events and comments on PsychNews International articles. The following contribution is a reply to the Fifth Column by David Essex in the PsychNews International 1(7). The article can be retrieved at http://userpage.fu-berlin.de/~expert/psychnews. Please send your articles to the PsychNews Int'l mailbox: pni@badlands.nodak.edu, cc'd to fu03c2dj@zedat.FU-Berlin.de -------------------------------------------------------- POSTSCRIPTA TO AN UNSCIENTIFIC POSTSCRIPT Michael Lyvers As an addiction researcher I agree with David Essex on some of the points in his column, "An Unscientific Postscript" (vol.1 issue 7), but found many things to disagree about as well. Essex was right to criticize the irrationality of 12-step programs and current drug laws, the misguided zealotry of some 12-step advocates, and the absurdity of forcing nonaddicts to "admit" their "addiction" (as in the example Essex gave). Essex is also right to demand that the "disease model" be supported by scientific evidence. However, he seems to implicitly support a "free choice" view of addictive behavior which has even less scientific evidence behind it than the "disease" view. He also implies that most drug effects are due to beliefs rather than pharmacology - the popular "expectancy" paradigm. Tell that to someone who's had LSD put into their drink without their knowledge! Psychoactive drugs definitely affect the brain, and they do have pharmacological effects which are far stronger than expectancy effects when a sufficient dose is taken. For example, in my own research, subjects were led to believe that the drinks they were consuming consisted only of tonic water. However, once the effects of alcohol kicked in, ALL of them saw through the deception and said they were drunk. Pharmacology 1, expectancy 0! Essex stated "A biological predisposition isn't sufficient for a disease classification" and used left-handedness as an example of a biological non-disease. But diseases all have some pathological aspect to them by definition. Left-handedness is clearly not a pathological condition, whereas a person who feels distressed that they can no longer control their own behavior clearly IS in a pathological state (whether there was a genetic predisposition or not). Homosexuality was also mentioned, but that, too, in and of itself, is not a pathological condition and therefore does not constitute disease. When Essex quotes Valliant as saying that addiction treatments are "no better than the natural history of the disease," it should be recognized that the two populations being implicitly compared here - those who seek treatment for their addiction vs. those who quit on their own - are really quite different in a fundamental way. Those who seek treatment typically have tried to quit on their own, but could not. They presumably have a worse problem than those who were able to quit on their own. The two groups are just not comparable. Essex wrote that "the dominant preconceptions about drug habits....may actually erode people's inclination to improve their behavior." Maybe so, but is there any evidence whatsoever to support this hypothesis? Essex described a friend, a drug abuse counselor, who claimed that kids used the "one drink makes a drunk" idea as an excuse for their excessive drinking. So what? People come up with all kinds of excuses for their behavior. Those kids just conveniently used the material at hand. Thus, as with Essex's criticism of the disease model, one can ask: Where's the evidence here? Essex also claimed that "drunk drivers who are referred to treatment are more likely than the untreated to repeat the offense." Again, are these two groups really comparable? Why was one group referred to treatment while the other was not? Could it be that the former group had more of a problem than the latter group? Such considerations make Essex's case against treatment seem weak. But I agree that the efficacy of addiction treatments needs to be more firmly established. The record thus far does seem rather poor in the long term. Much recent evidence supports the notion that certain drugs produce lasting changes in brain regions controlling appetitive motivation, and that such changes underlie the compulsive drug use displayed by addicts. This does not mean that the drugs themselves are "demonic substances" but it does suggest that caution is warranted with them. And it does indeed support a "physical disease" view of addiction. Michael Lyvers, Ph.D. Department of Psychology Bond University Gold Coast, Queensland 4229 Australia Mike_Lyvers@hydrus.its.bond.edu.au