Isn't it possible that the issue is in the difficulty in classifying people as "addicts" instead of concluding that most addicts just grow out of it? The alcoholics in my family do not grow out of it. To a man (or woman) they just deteriorate over the years and it is a very sad thing to watch. It seems possible that what the author had and what my family members have are two different afflictions.
>Moreover, if addiction were truly a progressive disease, the data should show that the odds of quitting get worse over time. In fact, they remain the same on an annual basis, which means that as people get older, a higher and higher percentage wind up in recovery. If your addiction really is “doing push-ups” while you sit in AA meetings, it should get harder, not easier, to quit over time.
Clearly the author is questioning the progressive nature of addiction but not considering the well known issue of defining addiction. Furthermore, to my understanding the "progressive nature" of the disease is not referring to the difficulty in quitting but rather the severity of the abuse of the substance.
It is always very dangerous and misleading to argue about abstract categories as if they were real things outside of the minds that make them. "Addiction" the label we use for a category we impose on the objective reality we observe. The OP is questioning the utility of that categorization based on more extensive observation of that objective reality.
In particular: there is evidence that the population we now group into the category "addicts" may in fact include two sub-populations, one of which "ages out", one of which does not. We currently have a "lumped model" of addiction, which associates certain additional features with the phenomenology we use to assign something to the category.
For example, if we find a person who is a chronic user whose use is negatively impacting their lives and who seems unable to stop, we are going to label that person an "addict". But the members of that category also get assigned other attributes for free. In particular, the current model of "addiction is a disease" says that anyone who fits the external phenomenology is also never going to get better without "treatment", or at best is very unlikely to do so.
But that association of "uncontrolled harmful use" and "its a disease" is a purely theoretical construct that may be wrong.
For comparison: I once worked on the genetics of a particular type of cancer that had two very distinct outcomes but which presented identically in a clinical setting. A physician I worked with described it as being incredibly frustrating, because she could literally see two patients in the same day who were apparently in the same condition based on histology, stage of the disease, everything, but ten years later one would be watching his daughter graduating from high-school and the other would have been dead for nine years. Simply because the diseases looked the same by some measures did not mean they were the same thing.
So it could well be that the same external phenomenology is present in two quite different conditions. It would be extremely silly to argue that one is "really" addiction and other is not, because "addiction" is just an abstract category we created to subsume different instances of similar phenomenology. We could call one grue and the other bleen, for all the difference it would make.
The possibility of two quite different underlying conditions presenting similar symptoms is one that has been realized often enough to be worth taking seriously, and when it occurs in things like the cancer described above no one ever makes the argument 'well X sounds like it is really cancer type Y to me'. Yet when the question of addiction comes up, many people say precisely that, and I am at a loss to understand why.
Extremely well-said. I've observed different kinds of addictions in people, and I'll be damned if I'd ever think of classifying them in the same way, even if that's what a typical psychologist would do.
Epidemiologcially, similar symptoms that progress to different outcomes is one of the key tools in understanding the underlying mechanisms of a disease, so to say "you can't reliably classify based on outcomes" is incorrect. Sometimes you can, sometimes you can't, and it is always worth asking the question "how come?" when you get very different outcomes from the same disease-causing agent.
In the general case there are four possibilities:
1) the different outcomes arise because of a difference in the individuals involved (this is useful for exploring treatment options: is there any way to make people with bad outcomes more closely resemble people with good outcomes?)
2) the different outcomes arise because of a difference in the disease-causing agent (this is useful when allocating treatment resources and preparing patients if the outcome is likely to be bad.)
3) some interaction between the first two factors
4) some other external factor is at play (you're a smoker, another patient is not.)
As I mentioned in another comment, I've done work on cancer genetics where the goal was to find out why some patients with what appeared to be the same disease "simply fell apart" (in the words of one of the physicians) while others lived relatively long and healthy lives). There certainly was a belief that we could classify the disease based on the outcome, and that belief motivated some fairly difficult research, but no one called it unreasonable because we had similar examples in the literature (Kahn's work on small round blue cell carcinoma being a famous case in point: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1867426/)
So: when you have populations with different outcomes, it is both reasonable and routine to ask if you have different conditions, despite superficial similarities in clinical presentation.
Yes, I agree this is an important point that author missed out on. There is a wide belief that there is physical addition which will affect anyone who makes a mistake of using too much of a powerfully addictive substance, then separately there is a mental disease of addition, which doesn't require an addictive substance. The main study this is linked to only addresses abstinence of a single drug. Abstinence != recovery is a very widely held belief.
> Clearly the author is questioning the progressive nature of addiction but not considering the well known issue of defining addiction.
'[I]t is hard to argue that we “weren’t really addicted.” I don’t know many non-addicts who shoot up 40 times a day, get suspended from college for dealing and spend several months in a methadone program.'
>Moreover, if addiction were truly a progressive disease, the data should show that the odds of quitting get worse over time. In fact, they remain the same on an annual basis, which means that as people get older, a higher and higher percentage wind up in recovery. If your addiction really is “doing push-ups” while you sit in AA meetings, it should get harder, not easier, to quit over time.
Clearly the author is questioning the progressive nature of addiction but not considering the well known issue of defining addiction. Furthermore, to my understanding the "progressive nature" of the disease is not referring to the difficulty in quitting but rather the severity of the abuse of the substance.