Addiction: Is it an illness or simply moral weakness

Recent statistics show that 22,000 people die in Britain each year through alcohol-related illness, and there are 350,000 serious drug users.
Increasingly, the answer for many is costly rehab in a private clinic, or NHS treatment which costs the State millions.
But a new book argues that addiction is not a medical condition which can be cured, but simply a question of moral weakness.
So is it right? Here, two former broadsheet newspaper editors – who both admit to having addictions – take up the cudgels.

{mosimage}Rosie Boycott says: As an alcoholic, I am always amazed and dismayed when I hear that there are still people, even doctors, who believe addiction is a moral problem and not a medical condition.
I started drinking in my late teens and carried on until I was 30, when the extent of my boozing became not only dangerous to my health but crippling to my state of mind. I stopped almost entirely for the next 22 years, falling off the wagon five years ago and climbing back on it three years ago.
Drinking is the closest thing to hell that I know. I feel it change my body and senses. But this feeling is – for someone who has never had a drink problem – wholly unexplainable.
In my 20s, I liked to drink. I liked the feeling it gave me and I liked being a girl who could drink with the boys. So far, that was my choice.
But as time went by, my relationship to alcohol changed. I found that I did not have a choice. One drink made me want another. Instead of feeling that I’d had enough, I always wanted more.
Hangovers which used to be shrugged off with black coffee could be tolerated only by downing another drink. Simply saying “no” was no longer an option. It was as though I’d been born with the potential for addiction hardwired into my DNA.
What had happened to me? It was terrifying and isolating; shaming because I could see that other people had a built-in control mechanism that told them when to stop. What had happened to mine? Scientists who have studied addiction recognise the brain of an addict is different. It perceives pleasure incorrectly.
This ‘pleasure capacity’ is a vital ingredient for survival – we need food to survive and it helps that it gives us pleasure – but at the pleasure capacity’s centre is the neurochemical dopamine.
Alcohol, heroin, cocaine – any abusive drug – share one common feature. They release large amounts of dopamine into the system. So, in the addict’s brain, the pleasure system breaks down and the drug of choice becomes your route to survival.
Choice is thus eroded. It is further eroded because the area of the brain that exerts free will – as opposed to the most basic human survival instincts – is the cortex.
In a healthy brain, the frontal cortex exerts control over the lower ‘survival’ brain. But if stress – particularly the kind associated with fear, anxiety and other symptoms of addiction – is severe enough, this situation reverses, allowing the unconscious and involuntary areas of the brain to decide on your survival strategy. In other words, the freedom of choice to behave as you wish is taken away.

The British Medical Association, after years of indecision, now classes addiction as a mental illness. So does the American Medical Association.
The figures for alcoholism, though they vary a little from country to country, remain robust across the world: roughly 10 per cent of any population at any one time is suffering.

Here in the UK, 90 per cent of all the alcohol drunk is consumed by just one third of the population. Forty per cent of that is drunk by just 5 per cent.
These figures highlight the difference between the way normal people drink and the way alcoholics drink. In fact, two-thirds of the population hardly drink.
When I drank in my 20s, surrounding myself with people who drank, I deluded myself everyone drank like me: in reality, most people consume very little alcohol.
But it is an irony worth noting that the alcohol industry makes more than half its profits from people who have – I believe – a psychiatric dependency on drink. The problem, clearly, is not with alcohol per se, but with the person who imbibe it.
Why does this all matter? Who really cares whether we classify alcoholism and addiction as a moral weakness or an illness with its own observable set of symptoms and its own known progression? Well, it does matter – and it matters very much.

While we continue to believe that alcoholism is just a moral weakness, people who might otherwise ask for help will struggle on alone, too ashamed to confront their problems.
I didn’t grow up with the wish that I would become an alcoholic. I cannot accept the idea I wished it on myself or actively encouraged it.
Yet, it is true that unlike other illnesses, which can be charted and then cured by a pill or a surgeon’s knife, the treatment for alcoholism does come down to the will and the wish of the sufferer.

Dr Michael Wilks, currently the chairman of RAPT (Rehabilitation for Addicted Prisoners Trust), who treats addicted members of the medical profession, says: “The single-mindedness of purpose of the active addict is not amenable to self-control. The addict has lost control and thus the capacity for rational choice.”
WILKS does not believe there is any serious argument left as to whether alcoholism is a disease. It’s just a debate about what sort of illness it is. It is a disease of complexities, involving abnormal behaviour.
When patients come to him, he looks for two absolute diagnostic features to distinguish heavy drinking from alcoholism. Firstly, that the person has suffered from a complete loss of control, and has often set out intending to drink a couple of pints but ended up drinking 20.

Secondly, the alcoholic is recognisable by his or her failure to learn from that loss of control: they do it again, and again, always with the firm belief that this time it will be different and their intake will be restrained.
As Wilks says, getting better is not about trying harder to control intake. It always fails, and each failure just adds to an alcoholic’s loss of self-worth and esteem.
To the outside world, the behaviour looks insane: the alcoholic grits his teeth and vows that, tonight, it will be different, I’ll just have two glasses. It doesn’t happen.
Addicts always believe they can conquer their problem, that one last effort will put them back on the straight and narrow. They are wrong.
As I found, it is only by surrendering your will, accepting that this problem is, indeed, bigger and more powerful than you, that you can make the steps towards recovery.
For me, if I want the life I have – which is a life I love – one drink will never be an option. I can see why, to some people, this seems nuts. But that’s the disease called alcoholism.

Dominic Lawson says: My addiction is food and my appearance gives some impression of the consequences; but because this is a confession, the hard truth must be faced.
I weigh, when I last dared to look, more than 16st, although I am no more than average height. I understand the health consequences of this – made painfully obvious when I run to catch a train: it’s at least another three stops before I’m able to catch my breath.
Despite this, I continue to eat well beyond the point at which hunger is sated. The reason is simple: I enjoy it. I adore the texture, flavour and appearance of food. When it isn’t on a plate in front of me, I enjoy thinking about it or shopping for it.
Work can make me forget about food, but when I am on holiday, it is a constant irritation to my wife – who does not share my obsession – that every day must be planned around which restaurant to go to.

At home, my bedside table is littered with copies of the Michelin guide for various countries – not the Green guides which tell you about their culture and art, but the Red ones which give detailed descriptions of the best dishes of the greatest kitchens.
I could make various excuses for my calorific cravings. I could point out that I come from a long line of overfed males. Indeed, family legend has it my paternal great-grandfather, Gustav, died because he was too corpulent to survive the surgeon’s knife.
I could argue that my mother’s family business was the manufacture and distribution of food – surely there must have been a vocational element? None of this, however, should persuade anyone to sympathise.
The truth is that, in the matter of food, I lack self-control. I know what the adverse consequences are, but I choose, as a creature with free will, to endure them rather than limit my immediate pleasure.
These thoughts have been stimulated by reading a book recently published in the U.S., Romancing Opiates: Pharmacological Lies And The Addiction Bureaucracy. Its author is a psychiatrist who writes under the pseudonym of Dr Theodore Dalrymple.

Dr Dalrymple has worked for many years in the British prisons system, and has deep experience of the causes, consequences and alleged cures of drug addiction, principally heroin.
It is a taboo-shattering, sacred cow-slaughtering, myth-destroying little gem of a book. In brief, Dr Dalrymple disputes the claim that drug addiction is an illness that can be cured by medical treatment.
He argues that, as its origins lie in frailties of character, it can only be ‘treated’ by a mixture of coercion and appeals to morality and self-interest – rather as a parent brings up children.
He points out that it is not easy – indeed, it requires considerable dedication – to become addicted to heroin, while the difficulty and duration of withdrawal has been exaggerated by fiction, both written and cinematic.
Most controversially of all, Dr Dalrymple contends that: “If there is a causative relationship between heroin addiction and crime, it is more that a propensity to crime causes addiction rather than the other way around.”

Dr Dalrymple is not relying on statistics for this observation; he conducted interviews with hundreds of the heroin addicts in the prisons where he has worked. His relatively small survey has been backed up by more detailed research in the United States.

The Final Report of the Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs concluded, in respect of young males in Chicago and New York, that ‘it is inescapable that delinquency both preceded and followed addiction to heroin.
“There was little evidence of a consistent sequence from drug use without delinquency to drug use with delinquency.”

This might seem peripheral to the issue of treatment, but it’s absolutely crucial. The conventional treatment in this country is to give heroin users the substitute known as methadone. It is argued that if the State gives them what they crave, in a monitored and aseptic fashion, then many of the social problems will be eradicated.

Dalrymple insists that what this produces is merely state-funded drug addiction, with little reduction in delinquent behaviour.
Or, to quote directly from the impassioned introduction to his book: “Every day I saw addicts who abused their prescription drugs from the clinics set up to help them, who sold them to third parties or who continued to take heroin in spite of, and in addition to, these prescription drugs.
“Who despite their so-called treatment, continued to commit crimes and who manipulated their supposed helpers in a shameless fashion… above all I observed close up the triviality of withdrawal symptoms from opiates.”
As a medical essayist, Dr Dalrymple has gained a reputation as a ruthlessly observer of humanity.

Sentimentality is the parade of emotion where little or none exists. Dr Dalrymple, as he makes clear, was driven close to a nervous breakdown as he became increasingly aware that his own observations ran directly counter to conventional wisdom as it was practiced in the hospitals where he worked.

He says: “There was a strenuous, almost outraged rejection of the idea that addiction was, at bottom, a moral problem, or even that it raised any moral questions.
“There is nothing more destructive of the human psyche than to be forced to doubt the veracity of what one’s own elementary observations demonstrate, simply because they conflict with a prevailing and unassailable orthodoxy. One is forced to choose between considering oneself as deluded, or the world as mad.”

Dalrymple’s book, despite being solely about drug treatment in this country, has not been published in the UK. It has been decided that he, and not the medical establishment, is deluded.
I discussed his book with a friend who has recovered from more addictions than it is possible to describe in a single sentence. She agreed with Dalrymple’s basic argument that addiction was fundamentally a spiritual, rather than a medical, condition.
Like millions of others, she had recovered through the ’12 steps’ method first laid out by Alcoholics Anonymous, which is used by Narcotics Anonymous and by Food Addicts Anonymous.

Spiritual self-help would, perhaps, be the pithiest way of summing up that most successful of all ‘treatments’ for addiction.
This friend was not exactly encouraging about my own weakness; she said of all her addictions, she had found food the most difficult to shake off – partly because eating is the most socially acceptable and unavoidable of pleasures.

At least I have learned something important about gluttony from Dr Dalrymple: I’d be mad to see a doctor about it.