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Andrew Dettman


By The Authors Pen

This extract is from the book ‘Management of the Addicted Patient in Primary Care’ Pomm & Pomm, published by Springer in 2007:

Spectrum of Addiction

“One of the most difficult concepts for many primary care physicians to accept is that addiction is a disease. This thought naturally dispels the idea that people who experience the diagnosed disorder of substance dependence have a choice.

Actually once addiction is manifest in an individual, willpower is no longer a viable hypothesis. At this point, “saying no” does not work (although people diagnosed with substance abuse might still have the ability to choose). Basically, there comes a time when the psychosocial, genetic, biophysiologic and the individual’s coping mechanisms have set the stage for a switch to be turned on that starts the disease process, a process that cannot be cured but that can definitely be arrested and brought into remission. When the disease of addiction manifests in the body, it is no different from any other disease:

  1. The illness can be described;
  2. The course of the illness is predictable and progressive;
  3. The disease is primary; that is, it is not just a symptom of an underlying disorder;
  4. It is permanent; and
  5. It is terminal. If left untreated, it results in premature death.

In fact, the American Psychiatric Association began in 1965 to use the term disease to describe alcoholism, and the American Medical Association followed suit in i966. In 1983, the American Society of Addiction Medicine published a policy statement relating to alcoholism being a primary disease. Essentially, all major specialty organizations that work with the drug/alcohol-addicted population are now in agreement about the disease model of addiction.

We might not know the etiology, but science has not determined the exact etiology of most diseases, including the more common ones, such as hypertension and diabetes mellitus. Yet we do not blame hypertensive or diabetic patients for their diseases in the way that we blame alcoholics/addicts for their illnesses, it seems so much easier to be less judgmental when treating the other types of patients.

Until you accept the disease model of addiction, it is much more difficult to see your patients who are suffering with chemical dependency through objective eyes. As a primary care physician, especially because you are on the front line, you may be more prone to feelings of frustration and anger when confronted with an individual you believe can just “put the substance down.” Thoughts such as “why doesn‘t he or she just stop” or “l can’t believe he or she continues using drugs despite all he or she has been through” can interfere with appropriate intervention and treatment planning. Although many professionals are susceptible to the same feelings, the primary care physician often sees this type of patient much earlier in the course of the illness, and a significant relationship may have already been developed (unless a drug seeker has just dropped by for your professional services). In addition, beyond the rela- tionship with your patient, you often have a relationship with the family and have also been influenced by their denial system.”

A view from 1987

By The Authors Pen

A view from 1987 …

Written in 1987 by Anne Wilson Schaef in “When Society Becomes an Addict”.

“Our society is deteriorating at an alarming rate. As we watch the news and read the newspapers, we are increasingly made aware of corruption in high places, financial collapse, and a lack of morality in settings ranging from preschools to meat packing plants. We fear that our children will be stolen by child pornography rings, and we hear of our “healers” taking sexual advantage of their clients. Our planet is being destroyed by acid rain and pollution, and nuclear holocaust is a very real possibility. Hunger and wars rage over the planet.
…. Those few individuals who notice and draw attention to these growing problems are met with massive denial.
…. Much of what we know about our society can be compared to what the blind persons knew about the elephant. As that old story teaches us, an elephant is more than just ears, a tail, or a trunk, it is more, even, than just an animal. It is also a process within a context. It is born, it lives, and it dies. This is a process.
The context of our elephant – our society – is the fact that the system in which we live is an addictive system. It has all the characteristics and exhibits all the processes of the individual alcoholic or addict. It functions in precisely the same ways.
…. This awareness that society has an addictive disease is what is missing from other explanations and treatments of the problems we are having today.
…. In addition, most people who look at the system are too close to it and too involved in it to see it clearly.
…. In order to perceive the Addictive System for what it is, one must be in it but not of it. In other words, must be recovering from its effects. There are people who fit this criterion. Historically, however, the main curing agent for addictions has been anonymous – Alcoholics Anonymous, Al Anon, Overeaters Anonymous, Gamblers Anonymous, and so on. As a result, the people who have the most accurate perceptions of our system have often hidden this knowledge in anonymity….”

The Word, Its Diction Chamber and Its Prince’s Kiss