Addiction Is Not a Disease

From Theodore Dalrymple:

There are cheap lies and expensive lies, and the lie that addiction is a disease just like any other will prove to be costly. It is the lie upon which Washington has based its proposed directive that insurance policies should cover addiction and mental disorders in the same way as they cover physical disease. The government might as well decriminalize fraud while it is at it.

The evidence that addiction is not a disease like any other is compelling, overwhelming, and obvious. It has also been available for a long time. The National Institute on Drug Abuse’s definition of addiction as a “chronic, relapsing brain disease” is about as scientific as the advertising claims for Coca-Cola. In fact, it had its origin as a funding appeal to Congress.

To take only one point among many: most addicts who give up do so without any medical assistance—and most addicts do give up. Moreover, they do so at an early age. The proximate cause of their abstinence is their decision to be abstinent. No one can decide not to have rheumatoid arthritis, say, or colon cancer. Sufferers from those diseases can decide to cooperate or not with treatment, but that is another matter entirely. Therefore, there is a category difference between addiction and real disease.

The pretense that a non-disease is a disease may actually hinder people from deciding to behave better: they will instead wait for their medical savior, as Estragon waits for Godot. Whether this hope is justified or not, the pretense will certainly involve much public expense, just as would fitting out an expedition to discover unicorns somewhere in the world.

To treat addicts as people to whom something has happened rather than as people who have decided to do something is to infantilize them. It is another small step in the transformation of the population into wards of government. Far from being generous and understanding, the government’s directive is a thinly disguised grab for power.

It is the same, perhaps worse, with mental disorders. It is by now notorious that the definitions of mental disorder are so loose that everyone has one, or more than one. They have spread like cars and washing machines. Nothing is easier to fake than mental disorder, especially where it is diagnosed by checklist; and where financial incentives are in place, fakery will flourish. Unfortunately, people playing a role come to live that role if they play it long enough. As my friend, Colin Brewer, a psychiatrist, brilliantly put it, misery rises to meet the means available for its alleviation.

Genuine mental illness exists, but it takes severe judgment to distinguish it from that which is merely reflexive in nature, such as whiplash injury, which scarcely exists in countries whose legal systems allow no compensation for it. (It’s the lawyers who should be sued, not the people who run into the back of cars.) The government’s proposed policy is therefore a charter for everything from human weakness to outright fraud. This, of course, is what some politicians hanker for, a people without powers of decision for themselves, a people without resilience: for then, they need the politicians to save them.


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