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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.

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               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