Models of Addiction

I saw this news article tonight: Disease model of addiction doesn’t work.

It’s an interview with a neuroscientist and former drug addict named Marc Lewis. He proposes that using the disease model of addiction as a framework for treatment makes the addict feel helpless and worsens their chances of treatment.

I can’t really disagree with the premise, but that’s only because it isn’t presented in a coherent and comprehensive way. It’s a simple assertion, presented without evidence, reported without discussion, and accepted without review. I can’t tell how much of that is just due to shoddy reporting… perhaps all the answers can be found in this guy’s book?

I checked his CV. Last published in 2011, no publications on addiction, lots of work on developing habits in children. That’s not necessarily a deal breaker… he could easily be writing a pop-sci book based on someone else’s research, there’s no harm in that. But now there’s no way to know if this book is based on any science without paying for it up front.

The article starts with the phrase “For decades, the mainstream approach to dealing with addiction has been to treat it as a disease that needs a cure.” Now that’s just not true. The mainstream approach to dealing with addiction has been to treat it as a sin that needs punishment. That’s why rehab is expensive and prison is free.

Now it’s true that the medical community has been treating addiction as a medical issue, even if society as a whole hasn’t joined in. And this approach hasn’t been completely successful… drug addiction still exists. But I suspect it works at least a little. With two approaches - rehab and prison - it should be possible to compare outcomes. Both the ability to quit drugs, which is relatively easy to measure but less important, and the ability to live a healthy life whether with or without drugs, which is more important but tougher to test.

Lewis’s preferred approach can be subjected to the same test. Only… does he have an approach? The article isn’t clear. He says addicts need a change of perspective and a sense of responsibility, but there’s no mention of what that means in terms of changing recommended treatments. I guess you have to buy the book for that.

So in conclusion: a guy said some stuff. Film at 11.