AMERSA “spicy” debate: Is Addiction REALLY Like other Chronic Illnesses? “Yes”: it has a biological basis “No”: it is typically not chronic “No”: it is not like illness because the factors that influence drug use in addicts have little or no direct influence on disease symptoms Evidence: –Everyday speech (idioms) –Research findings

Everyday expressions that distinguish addiction from chronic illnesses “kicking the habit” “going cold turkey”

Is addiction a chronic disorder? These findings are derived from National Comorbidity Surveys (NIMH, NIDA) and National Epidemiological Survey of Alcohol and Related Syndromes (NIAAA, DHHS)

Why do we say that addiction is a “chronic” disorder, when the data say otherwise? Our understanding of addiction is based largely on clinical experience But most addicts do not seek treatment Hypotheses: –Drug use persists longer in clinic populations –Clinic populations tend to have additional problems that interfere with recovery

Is addiction like other illnesses? A distinguishing feature of illnesses is that the symptoms are involuntary How to measure “voluntariness”? Behaviors vary in the degree to which they are susceptible to the influence of ideas, values, costs and benefits (consequences). One possible continuum: –reflexes –satisfying an essential biological urge (hunger, thirst) –whether to play tennis, read a novel or write a new paper

Thus, we can test whether addiction is like other illnesses Do ideas, values, costs, and benefits influence drug use in addicts? –That so many addicts quit on their own suggests “yes” Voluntary behavior is not a synonym for free will We are investigating a causal relationship

Information and Smoking Does expert opinion (information) influence drug use?

Historical influences and addiction

Choice-based voucher treatment: Cocaine dependent users Incentives, prosocial activities, and drug use in cocaine addicts

Summary: Most addicts stop using drugs and usually do so without professional assistance The primary factors that bring drug use to a halt are those that influence choice: familial concerns, economics, values We cannot make a similar summary for “chronic illnesses” Choice is critical to the distinction between disease and nondisease. Thus, addiction, is not “Really like chronic diseases” This doesn’t make addiction less of a problem, but it does help us frame the problem

Remission as a function of whether clinic treatment determined subject recruitment

Suspended MDs and Pilots: Random Drug Tests and Threat of Loss of License

Do all psych disorders have high remission rates?

What accounts for these differences?

Common themes in biographical accounts: Stories are laced with explicit and implicit values: –“I wasn’t put on earth to be an addict” –“I wanted my parents to be proud of me again” –“I didn’t want to embarrass my children” –“I was sick of the hassles” Ordinary concerns: –Fear of arrest –Finances and occupational concerns –Familial relations –Taking stock: “hitting bottom,” “conscious weighing of costs and benefits”