The Brain Disease Model of Addiction: is it Supported by the Evidence and has it Delivered on its Promises?

mllangan1 14 Comments

Dr. Allwissend 01

The brain disease model of addiction: is it supported by the evidence and has it delivered on its promises?

Prof Wayne Hall, PhD
Adrian Carter, PhD
Cynthia Forlini, PhD
Published Online: 11 December 2014

Sign up for Lancet Psychiatry to read the full article. An overview is below.

We need a similar critique of the American Society of Addiction Medicine (ASAM)  and its affiliates on this side of the Atlantic as “addiction medicine” is slated to be approved  by the  American Board of Medical Specialties in 2016 even though the discipline falls far short of the educational and professional standards for quality practice developed and implemented by all other ABMS member boards.    According to the ABMS these 24 boards are:

“committed to the principle of examining doctors based on six general competencies designed to encompass quality care: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.”

These areas have been collectively identified by the ABMS, the American College of Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) in order to standardize graduate medical education.

Any critique of the ASAM would find a number of issues antithetical to the six general competencies which stress “learning and improvement.”   In contrast the ASAM rests on the conviction that their views are absolutely certain and patently rejects open-minded inquiry.  An academic analysis of addiction medicine  from the vantage point of the ASAM would reveal false assumptions, bias, dogmatism, and data-dredging.  It would also reveal that those claiming expertise are in fact illegitimate and irrational authority who believe in an ends-justifies-the-means approach to push forth the chronic relapsing brain disease with lifelong abstinence an d imposed 12-step recovery. These are false experts who rationalize unethical, unprofessional and even criminal behavior as zeal for the faith if it aligns with the brain disease model of addiction (BDMA)   Their viewpoints are fixed and final.

They have not been held to truly objective judging, analysis, evaluation or outside critique.  The purpose of critique is the same as the purpose of critical thinking: to appreciate strengths as well as weaknesses, virtues as well as failings. Critical thinkers critique in order to redesign, remodel, and make better. This direly needs to be done.  The evidence-base for both the BDMA and the drug and alcohol testing, assessment and treatment is poor.     They are claiming physician health programs are the crown jewel of addiction treatment– a replicable model to be replicated in other populations.  It is all hyperbole and propaganda.  In reality they are using medical assessment and treatment as tools to repress and punish doctors.  Those running the state physician health programs are typically morally disengaged bullies with Machiavellian egocentricity.   And all the congratulatory backslapping is based on a singe poorly designed opinion piece.

Science and medicine need to be predicated on competence, thoughtfulness, good faith, civility, honesty, and integrity. This is universally applicable.  What they are doing betrays the trust of society and breaches the most basic ethical obligations of not only doctors but human beings.

But no one seems to be challenging them. Why is no one questioning this self-appointed authority. If people do not start talking, writing, discussing and debating the current paradigm then what Robert Dupont describes in the ASAM White Paper on Drug Testing will be ushered in.  As with doctors you won’t know it until it hits you.    If the ASAM becomes an ABMS medical specialty then it will be too late. They will impose their authority on you as a patient and their won’t be a damn thing you will be able to do about it.

Once illegitimate and irrational authority are sanctified by the American Board of Medical Specialties there will be nothing left to do except watch the profession of medicine go up in flames.

Right now it’s just doctors and pilots.   What you need to see is that you are next.  I base that prediction on past public-policy, regulatory, administrative and medical practice tinkering as well as the documented paper trail of “research” and opinion. And even though all of this can be explained using documentary evidence, fact and critical analysis no one seems alarmed.

If you map it out you will see the trajectory is aimed at the transportation industry,  students with federal loans,  high school athletes, schools, gun owners, and eventually schools.

If you have something to lose that is affiliated with a state or federal agency they will hold it hostage if you get a positive hair, nail, sweat blood, or urine test at your doctors visit.    The positive test is the golden ticket for them and a ticket to an assessment facility in Kansas, Arkansas, Mississippi and some other places for you on your dime.    And these are one-way tickets. No return to normality available.  One way ticket.    No return flight.

See full article through the following link:

http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00126-6/fulltext

Screen Shot 2014-12-30 at 2.10.24 AM

Proponents of the brain disease model of addiction (BDMA) have been very influential in setting the funding priorities of NIDA, and by extension the bulk of publicly supported research on addiction. In 1998, Leshner testified that NIDA supports more than 85% of the world’s research on drug abuse and addiction.3 The American Society of Addiction Medicine has defined addiction as a “primary, chronic disease of brain reward, motivation, memory, and related circuitry”.4 In July, 2014, newly appointed Acting Director of US National Drug Control Policy, Michael Botticelli, launched a reformist strategy nationally, claiming decades of research have demonstrated that addiction is a brain disorder—one that can be prevented and treated.5 The BDMA has also been widely discussed in leading scientific research journals3, 6 and most recently in a positive editorial in Nature.7

In the USA, proponents of the BDMA have argued that it will help to deliver more effective medical treatments for addiction with the cost covered by health insurance, making treatment more accessible for people with addictions.1, 2, 6 An increased acceptance of the BDMA is also predicted to reduce the stigma associated with drug addiction by replacing the commonly held notion that people with drug addiction are weak or bad with a more scientific viewpoint that depicts them as having a brain disease that needs medical treatment.

In this Personal View, we critically assess the scientific evidence for the BDMA reported in leading general scientific journals and the extent of the social benefits that advocates of the BDMA claim it has produced, or is likely to produce, with its widespread acceptance among clinicians, policy makers, and the public. The BDMA is not co-extensive with neuroscience-based explanations of addiction. This review is not intended as a critique of all neuroscience research on addiction. We focus instead on the popular simplification of work in this specialty that has had a major influence on popular discourse on addiction in scientific journals and mainstream media.

images-3Conclusions

Considerable scientific value exists in the research into the neurobiology and genetics of addiction, but this research does not justify the simplified BDMA that dominates discourse about addiction in the USA and, increasingly, elsewhere. Editors of Nature were mistaken in their assumption that the BDMA represents the consensus view in the addictions specialty,7 as shown by a letter signed by 94 addiction researchers and clinicians (including one of the authors of this Personal View).74Understanding of addiction, and the policies adopted to treat and prevent problem drug use, should give biology its due, but no more than it is due. Chronic drug use can affect brain systems in ways that might make cessation more difficult for some people. Economic, epidemiological, and social scientific evidence shows that the neurobiology of addiction should not be the over-riding factor when formulating policies toward drug use and addiction.

The BDMA has not helped to deliver the effective treatments for addiction that were originally promised by Leshner and its effect on public health policies toward drug addiction has been modest. Arguably, the advocacy of the BDMA led to overinvestment by US research agencies in biological interventions to cure addiction that will have little effect on drug addiction as a public health issue. Increased access to more effective treatment for addiction is a worthy aim that we support but this aim should not be pursued at the expense of simple, cost effective, and efficient population-based policies to discourage the whole population from smoking tobacco and drinking heavily. Nor should the pursuit of high technology cures distract from the task of increasing access to available psychosocial and drug treatments for addiction, which most people with addictive disorder are still unable to access.

Our rejection of the BDMA is not intended as a defence of the moral model of addiction.65 We share many of the aspirations of those who advocate the BDMA, especially the delivery of more effective treatment and less punitive responses to people with addiction issues. Addiction is a complex biological, psychological, and social disorder that needs to be addressed by various clinical and public health approaches.65 Research into the neuroscience of addiction has provided insights into the neurobiology of decision-making, motivation, and behavioural control in addiction. Chronic use of addictive drugs can impair cognitive and motivational processes and might partly explain why some people are more susceptible than others to developing an addiction. The challenge for all addiction researchers—including neurobiologists—is to integrate emerging insights from neuroscience research with those from economics, epidemiology, sociology, psychology, and political science to decrease the harms caused by drug misuse and all forms of addiction.46

Slide09

References

  1. Leshner, A. Addiction is a brain disease, and it matters. Science. 1997; 278: 45–47
  2. Dackis, C and O’Brien, C. Neurobiology of addiction: treatment and public policy ramifications.Nat Neurosci. 2005; 8: 1431–1436
  3. US Government Printing Office. Senate Hearing 105-573. Drug addiction and recovery.http://www.gpo.gov/fdsys/pkg/CHRG-105shrg49670/html/CHRG-105shrg49670.html. ((accessed Sept 26, 2014).)
  4. American Society of Addiction Medicine. Public policy statement: definition of addiction. Chevy Chase, MD. http://www.webcitation.org/62jXWo8dq; 2011. ((accessed July 15, 2014).)
  5. Botticelli, M. National blueprint for drug policy reform released today in Roanoke, VA. Office of National Drug Control Policy media release July 9, 2014.http://www.whitehouse.gov/blog/2014/07/09/national-blueprint-drug-policy-reform-released-today-roanoke-va. ((accessed July 15, 2014).)
  6. Volkow, N and Li, T. Drug addiction: the neurobiology of behaviour gone awry. Nat Rev Neurosci.2004; 5: 963–970
  7. Animal farm. Nature. 2014; 506: 5
  8. Ahmed, S. The science of making drug-addicted animals. Neuroscience. 2012; 211: 107–125
  9. Koob, G. The neurobiology of addiction: a neuroadaptational view relevant for diagnosis.Addiction. 2006; 101: 23–30
  10. Feltenstein, M and See, R. The neurocircuitry of addiction: an overview. Br J Pharmacol. 2008;154: 261–274
  11. Hyman, S, Malenka, R, and Nestler, E. Neural mechanisms of addiction: the role of reward-related learning and memory. Annu Rev Neurosci. 2006; 29: 565–598
  12. Koob, G and Le Moal, M. Neurobiology of addiction. Academic Press, New York; 2006
  13. Panlilio, L and Goldberg, S. Self-administration of drugs in animals and humans as a model and an investigative tool. Addiction. 2007; 102: 1863–1870
  14. Vanderschuren, L and Ahmed, S. Animal studies of addictive behavior. Cold Spring Harb Perspect Med. 2013; 3: a011932
  15. Volkow, N, Wang, G, Fowler, J, Tomasi, D, and Baler, R. Neuroimaging of addiction. in: P Seeman, B Madras (Eds.) Imaging of the human brain in health and disease. Elsevier, San Diego; 2014: 1–26
  16. Volkow, N, Fowler, J, Wang, G, Teland, F, and Baler, R. Imaging dopamine’s role in drug abuse and addiction. in: L Iversen, S Iversen, S Dunnett, A Bjorklund (Eds.) Dopamine handbook. Oxford University Press, Oxford; 2010: 407–417
  17. Volkow, N and Baler, R. Addiction science: uncovering neurobiological complexity.Neuropharmacology. 2014; 76: 235–249
  18. Volkow, N, Fowler, J, Wang, G, Baler, R, and Telang, F. Imaging dopamine’s role in drug abuse and addiction. Neuropharmacology. 2009; 56: 3–8
  19. Reske, M and Paulus, M. A neuroscientific approach to addiction: ethical issues. in: J Illes, B Sahakian (Eds.) Oxford handbook of neuroethics. Oxford University Press, Oxford; 2011: 177–202
  20. Kendler, K, Chen, X, Dick, D et al. Recent advances in the genetic epidemiology and molecular genetics of substance use disorders. Nat Neurosci. 2012; 15: 181–189
  21. Ball, D. Addiction science and its genetics. Addiction. 2008; 103: 360–367
  22. Satel, S and Lilienfeld, S. Brainwashed: the seductive appeal of mindless neuroscience. Perseus Books Group, New York; 2013
  23. Heyman, G. Addiction: a disorder of choice. Harvard University Press, Cambridge, MA; 2009
  24. Kincaid, H and Sullivan, J. Medical models of addiction. in: D Ross, H Kincaid, D Spurrett, P Collins (Eds.) What is addiction?MIT, Cambridge, MA; 2010: 353
  25. Robins, L, Helzer, J, Hesselbrock, M, and Wish, E. Vietnam veterans three years after Vietnam: how our study changed our view of heroin. Am J Addict. 2010; 19: 203–211
  26. Kleiman, M. When brute force fails: how to have less crime and less punishment. Princeton University Press, Princeton; 2009
  27. Bachman, J, Wadsworth, K, O’Malley, P, Johnston, L, and Schulenberg, J. Smoking, drinking, and drug use in young adulthood: the impacts of new freedoms and new responsibilities. Lawrence Erlbaum, Mahwah, NJ; 1997
  28. Ahmed, S, Lenoir, M, and Guillem, K. Neurobiology of addiction versus drug use driven by lack of choice. Curr Opin Neurobiol. 2013; 23: 581–587
  29. Alexander, B, Coambs, R, and Hadaway, P. The effect of housing and gender on morphine self-administration in rats. Psychopharmacology (Berl). 1978; 58: 175–179
  30. Hall, WD, Gartner, CE, and Carter, A. The genetics of nicotine addiction liability: ethical and social policy implications. Addiction. 2008; 103: 350–359
  31. Gartner, CE, Barendregt, J, and Hall, WD. Multiple genetic tests for susceptibility to smoking do not outperform simple family history. Addiction. 2009; 104: 118–126
  32. Roberts, N, Vogelstein, J, Parmigiani, G, Kinzler, K, Vogelstein, B, and Velculescu, V. The predictive capacity of personal genome sequencing. Sci Transl Med. 2012; 4: 133ra58
  33. Button, K, Ioannidis, J, Mokrysz, C et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci. 2013; 14: 365–376
  34. Ioannidis, J. Excess significance bias in the literature on brain volume abnormalities. Arch Gen Psychiatry. 2011; 68: 773–780
  35. Ioannidis, J, Munafò, M, Fusar-Poli, P, Nosek, B, and David, S. Publication and other reporting biases in cognitive sciences: detection, prevalence, and prevention. Trends Cogn Sci. 2014; 18: 235–241
  36. Hall, WD, Gartner, CE, Mathews, R, and Munafò, M. Technical, ethical and social issues in the bioprediction of addiction liability and treatment response. in: A Carter, W Hall, J Illes (Eds.)Addiction neuroethics: The ethics of addiction research and treatment. Elsevier, New York; 2012:116–138
  37. Lingford-Hughes, A, Welch, S, Peters, L, and Nutt, D. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol. 2012; 26: 899–952
  38. Ersche, K, Williams, G, Robbins, T, and Bullmore, E. Meta-analysis of structural brain abnormalities associated with stimulant drug dependence and neuroimaging of addiction vulnerability and resilience. Curr Opin Neurobiol. 2013; 23: 615–624
  39. Hyman, S. The neurobiology of addiction: implications for the voluntary control of behaviour. in:J Illes, B Sahakian (Eds.) Oxford handbook of neuroethics. Oxford University Press, Oxford; 2011:203–217
  40. Goldstein, R and Volkow, N. Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications. Nat Rev Neurosci. 2011; 12: 652–669
  41. Volkow, N, Wang, G, Fowler, J, and Tomasi, D. Addiction circuitry in the human brain. Annu Rev Pharmacol Toxicol. 2012; 52: 321–326
  42. National Institute on Drug Abuse. Drugs, brains and behavior: the science of addiction. Washington, DC. http://www.drugabuse.gov/publications/science-addiction; 2007. ((accessed July 15, 2014).)
  43. Nutt, D and Lingford-Hughes, A. Addiction: the clinical interface. Br J Pharmacol. 2008; 154: 397–405
  44. Volkow, N and Li, T. Drugs and alcohol: treating and preventing abuse, addiction and their medical consequences. Pharmacol Ther. 2005; 108: 3–17
  45. Lingford-Hughes, A, Watson, B, Kalk, N, and Reid, A. Neuropharmacology of addiction and how it informs treatment. Br Med Bull. 2010; 96: 93–110
  46. Kalant, H. What neurobiology cannot tell us about addiction. Addiction. 2010; 105: 780–789
  47. Koob, G, Lloyd, G, and Mason, B. Development of pharmacotherapies for drug addiction: a Rosetta Stone approach. Nat Rev Drug Discov. 2009; 8: 500–515
  48. Cahill, K, Stead, L, and Lancaster, T. Nicotine receptor partial agonists for smoking cessation.Cochrane Database Syst Rev. 2011; 2 (CD006103.)
  49. Rösner, S, Hackl-Herrwerth, A, Leucht, S, Lehert, P, Vecchi, S, and Soyka, M. Acamprosate for alcohol dependence. Cochrane Database Syst Rev. 2010; 9 (CD004332.)
  50. Minozzi, S, Amato, L, Vecchi, S, Davoli, M, Kirchmayer, U, and Verster, A. Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database Syst Rev. 2011; 4 (CD001333.)
  51. Kosten, T, Domingo, C, Shorter, D et al. Vaccine for cocaine dependence: a randomized double-blind placebo-controlled efficacy trial. Drug Alcohol Depend. 2014; 140: 42–47
  52. Hartmann-Boyce, J, Cahill, K, Hatsukami, D, and Cornuz, J. Nicotine vaccines for smoking cessation. Cochrane Database Syst Rev. 2012; 8 (CD007072.)
  53. Hall, WD and Gartner, CE. Ethical and policy issues in using vaccines to treat and prevent cocaine and nicotine dependence. Curr Opin Psychiatry. 2011; 24: 191–196
  54. Paul, S, Mytelka, D, Dunwiddie, C et al. How to improve R&D productivity: the pharmaceutical industry’s grand challenge. Nat Rev Drug Discov. 2010; 9: 203–214
  55. Djulbegovic, B, Hozo, I, and Ioannidis, J. Improving the drug development process: more not less randomized trials. JAMA. 2014; 311: 355–356
  56. Prinz, F, Schlange, T, and Asadullah, K. Believe it or not: how much can we rely on published data on potential drug targets?. Nat Rev Drug Discov. 2011; 10: 712
  57. Tsilidis, K, Panagiotou, O, Sena, E et al. Evaluation of excess significance bias in animal studies of neurological diseases. PLoS Biol. 2013; 11: e1001609
  58. Hall, WD. Stereotactic neurosurgical treatment of addiction: minimising the chances of another ‘great and desperate cure’. Addiction. 2006; 101: 1–3
  59. Luigjes, J, van den Brink, W, Feenstra, M et al. Deep brain stimulation in addiction: a review of potential brain targets. Mol Psychiatry. 2012; 17: 572–583
  60. Stephen, J, Halpern, C, Barrios, C et al. Deep brain stimulation compared with methadone maintenance for the treatment of heroin dependence: a threshold and cost-effectiveness analysis.Addiction. 2012; 107: 624–634
  61. Rouaud, T, Lardeux, S, Panayotis, N, Paleressompoulle, D, Cador, M, and Baunez, C. Reducing the desire for cocaine with subthalamic nucleus deep brain stimulation. Proc Natl Acad Sci USA.2010; 107: 1196–1200
  62. Carter, A and Hall, WD. Proposals to trial deep brain stimulation to treat addiction are premature. Addiction. 2011; 106: 235–237
  63. Baltuch, G and Stern, M. Deep brain stimulation for Parkinson’s disease. Informa Healthcare,New York; 2007
  64. Rose, G. The strategy of preventive medicine. Oxford University Press, Oxford; 1992
  65. Carter, A and Hall, WD. Addiction neuroethics: the promises and perils of neuroscience research on addiction. Cambridge University Press, London; 2012
  66. National Institute on Drug Abuse. Fiscal Year 2015 Budget information—congressional justification for National Institute on Drug Abuse. Rockville, MD. http://www.drugabuse.gov/about-nida/legislative-activities/budget-information/fiscal-year-2015-budget-information-congressional-justification-national-institute-drug-abuse; 2014. ((accessed July 15, 2014).)
  67. White, V, Hill, D, Siahpush, M, and Bobevski, I. How has the prevalence of cigarette smoking changed among Australian adults? Trends in smoking prevalence between 1980 and 2001. Tob Control. 2003; 12: ii67
  68. Pierce, J, Gilpin, E, Emery, S, White, M, Rosbrook, B, and Berry, C. Has the California tobacco control program reduced smoking?. JAMA. 1998; 280: 893
  69. Hall, WD, Madden, P, and Lynskey, M. The genetics of tobacco use: methods, findings and policy implications. Tob Control. 2002; 11: 119–124
  70. Doran, C, Hall, WD, Shakeshaft, A, Vos, T, and Cobiac, L. Alcohol policy reform in Australia: what can we learn from the evidence. Med J Aust. 2010; 192: 468–470
  71. Miller, P, Carter, A, and De Groot, F. Investment and vested interests in neuroscience research of addiction: why research ethics requires more than informed consent. in: A Carter, W Hall, J Illes (Eds.) Addiction neuroethics: the ethics of addiction research and treatment. Elsevier, New York;2012: 278–301
  72. Courtwright, D. The NIDA brain-disease paradigm: history, resistance, and spinoffs. BioSocieties.2010; 5: 137–147
  73. Nutt, D, King, L, Saulsbury, W, and Blakemore, C. Development of a rational scale to assess the harm of drugs of potential misuse. Lancet. 2007; 369: 1047–1053
  74. Heim, D. Addiction: not just brain malfunction. Nature. 2014; 507: 40

14 thoughts on “The Brain Disease Model of Addiction: is it Supported by the Evidence and has it Delivered on its Promises?”

  1. I’m starting to realize that most disease-model critics still believe that addiction is a disorder (e.g. Peele and Svalavitz), and so they think my view (‘addiction is a lie’) is ‘extreme’ even if they don’t say it publicly. So I can expect little more than criticism of AA and NIDA (disease model proponents). That’s ok. If my claim that the ‘disorder delusion’ is maintained by AA and NIDA brainwashing (and their arms in media and law enforcement) then we will be disabused of it by their destruction.

    Liked by 1 person

    Reply

    • Well I think your viewpoint coincides with my belief that the majority of those coerced into this Hell don’t have what they claim. I’m enjoying my “disease” right now in the form of an Old-fashioned that I will drink over the next hour and then go home. I’m sure these dimwits would call for a 3 month incarceration for doing so. If you look at these doctors they are notable for being control- freaks and lack of imagination. These bitter dregs have simply come together under the common theme of “recovery” and for the first time in their lives felt a sense of power and control and they enjoy it. Bargain basement fussbuckets who think they have secret knowledge and now want to mandate it on all of us. I know they are following my blog as most of them used their own names when doing so. Cheers Like-Minded Docs and that includes the Prohibitionist dinosaurs, the sociopathic profiteers and the plain dumb dumbs who buy into the remedial level pseudo psychology and readers digest logic and are being used by the psychopathic profiteers one PBR away from another malpractice suit. A toast to you – doctors who are living proof that you can be too smart to understand AA but you can’t be too dumb.

      Liked by 1 person

      Reply

      • Oh you bet they are reading your blog. However their industrial strength machinery for monumental self-deception reassures them that ‘this too shall pass’. LOL. But the worst is when they pull this shit on children. I’m not much for ‘government solutions’ but seriously that should be illegal!

        Like

        Reply

        • It won’t pass ! We need to force them to answer the questions and show the rest of the world their silence is not taking the “higher ground.” They are silent because when faced with a direct clear question they cannot answer it and crawl back under the bottom barrel simple-minded rock from whence they came. Our job is to shine a light on the whole charade. We need to throw a bucket of water on these quacks and shoe the world they are nothing but a band of snake oil carnies pulling a three cars montee and pretend experts.

          Like

        • Jeepers, it is illegal. My shrink said to me, actually admitted her “hospital” demanded that she drug me with anything that would stop me from writing. She then changed my diagnosis mid-sentence, then changed it again. I would assume to forcibly drug someone with no valid “illness” is certainly illegal. I fired her. But it got worse. To threaten me repeatedly, accuse me of whatever fiction they could dream up, abuse…anything. I escaped by the skin of my teeth. My place was illegally searched, I was given drugs that the other Julie Greene (spelled differently) in Watertown took, with no apology (I refused them) even though the shrink admitted he was were wrong. That was Patrick Aquino at Mount Auburn. Why not just ask me? About eight months after that, I went to CVS Pharmacy in Watertown, spoke to the mgr and told her “Please check date of birth and address next time.” Never mind the shrink should have. They also handed me a single dose of 600 mgs Lamictal. I didn’t take Lamictal, hadn’t for years. You know what that does to someone who has just had kidney failure and weighs under 80 pounds? Spat ’em out just in time. In the end, even the nephrologist was doing it. He threatened based on a nonexistent “abnormal” blood level. Maybe he had the wrong chart in front of him. Who knows? That was Adam Segal at Harvard Vanguard. Dang, I got out just in time. I think my foot might be broken, by the way. Good thing I am not in the USA.

          Like

      • Yeah, I used to wish for breast cancer. Know what that gets you? About 500 brand new female friends who love you no matter what (unless you get to stage 4, of course). Know what anorexia gets you? Every single friend you ever had runs away, refuses to allow their kids near you, won´t return your calls, and will avoid you on the street, too. Unless you start talking recovery talk and praise some shrink or “treatment center” that saved you. Well, then, as long as you keep singing their praises, you can collect your regular checks from said “treatment” center i.e. prison for kids. Still, if you are skinny you are hated anyway, treated like a criminal. We need to stop discussing human rights with anyone or we will get automatically called “paranoid.” Every time you say “right” you get docked. Can you imagine what would have happened to Thom Jefferson and Ben Franklin? Wow, a whole damn war based on paranoia. Let’s shoot up some fireworks, eh? “They” follow my blog, too. I love it, love ruining their reputations cuz they sure ruined mine. Do you get bullies? My friend says one of mine is undoubtedly a former provider. I badmouth ’em all, I name names, really don’t give a poop now, I’m outa there. Hope you are, too, far away like me.

        Like

        Reply

  2. I am not an alcoholic, decidedly, though I’ve actually tried to become one. It’s hard to believe anyone would want more after about two tablespoons of the stuff. I get either turned off by the taste, or I lose interest. My friend was a gutter drunk and died 35 years sober at the age of 72. We often discussed alcoholism at length. I had attended AA many times with various buddies of mine over the years. One day, I heard if a person is truly alcoholic, the difference between that person and a tea-totaler like me is not in the brain at all, but in the way that the liver deals with alcohol. It sounded plausible, that the liver did something to the level in the blood to make the person crave more. This debunks the brain theory but at the same time explains why it runs in families and runs rampant among groups such as Northern Europeans and American Natives. I would suppose that too much alcohol, whether one is “addicted” or not, damages the liver either way. I used to cry and cry and hope I could be an alcoholic instead of having an eating disorder. That way, I’d be allowed into AA, get free coffee, tell lots of jokes, and enjoy the club till I got tired of it.

    Liked by 2 people

    Reply

  5. Hi Michael;As always,interesting reading. I’m pleased that so many industry types appear to read you materiel. After all,these are important issues,and our opinions should count. I can also agree with some of Julie’s experiences. Even though I only spent 2 days in the treatment part of the “like-minded” facility,reading the notes and diagnoses several months later was eyeopening. One thing was patient will learn to eat normally. Well,I went out of there with a bleeding duodenal ulcer(duh). Revisionest history. Beth

    Like

    Reply

  7. Reblogged this on Disrupted Physician and commented:

    An academic analysis of addiction medicine from the vantage point of the ASAM would reveal false assumptions, bias, dogmatism, and data-dredging. It would also reveal that those claiming expertise are in fact illegitimate and irrational authority who believe in an ends-justifies-the-means approach to push forth the chronic relapsing brain disease with lifelong abstinence an d imposed 12-step recovery. These are false experts who rationalize unethical, unprofessional and even criminal behavior as zeal for the faith if it aligns with the brain disease model of addiction (BDMA) Their viewpoints are fixed and final.

    They have not been held to truly objective judging, analysis, evaluation or outside critique.

    Like

    Reply

Leave a Reply

Fill in your details below or click an icon to log in:

Gravatar
WordPress.com Logo

You are commenting using your WordPress.com account. ( Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. ( Log Out /  Change )

Cancel

Connecting to %s