This is my first posting so I hope I'm following the rules set forth. As part of my grade, I have been asked by my Professor to submit my final research paper here for some feedback. I would greatly appreciate anyone stopping by to take the time to read it and give me some of your reflections. I will also be providing feedback for other students as well within the next 48 hours (I'm happy to give of my time in return :)
Thank you ahead of time to anyone who takes the time to help me with this assignment. Specifically, I am well past the length requirements for my paper, which has a 12 page limit. Currently, I am at 16 pages so I am looking to lose four pages of content. If you have any suggestions about what looks like it can go, that would be great. And of course, anything else you have to offer for guidance is appreciated!
Thanks so much!
The Addiction Stigma: Finding the Grey Area Between Immorality and
DiseaseA Research Project
Professor Ryan Jones
Brianna was just eleven years old when she took her first hit of crystal-methamphetamine, hiding in the backyard shed amongst the tools and garden equipment with her next older sister who was patiently teaching her how to inhale. Just like her Father and Grandfather, and five out of six of the siblings on her Father's side, Brianna was born into a life of drug abuse and addiction. By the age of fourteen, she was smoking methamphetamine with her Father and siblings, most of whom had all done stretches in either jail, prison, rehabilitation programs, or mental institutions. Now, at 46, after winning two rounds in the ring with breast cancer, Brianna has now become to the powerful opiates she depended on to get through the physical pain of cancer treatment, and to numb the emotions that she struggled to face. After nearly overdosing twice and frequently returning to her original addiction to mix her opiates with methamphetamines, Brianna chose to give Narcotic's Anonymous a chance. Brianna now attends daily N.A. meetings as her key to sobriety and is working the program with a sponsor. Each addict in these programs has their own story of how they took the very slippery slide down the hill of addiction, suffering mental, emotional, and physical scars along the way and many coming close to death. The moral of these stories, which will be the foundation of this essay, is that addiction can, and does, happen to anyone - rich or poor, male or female, black or white - and although some of us may be hardwired with a tendency towards it, addiction does not discriminate among it's victims, especially according to their moral fortitude.
In a society that instills a need for instant gratification, it is not difficult to imagine why addiction is one of the most significant issues facing our country at present. In fact, the Substance Abuse and Mental Health Services Administration (SAMHSA) tells us that 12% of all high-school teens use illicit drugs by graduation, one in eight American's suffers from an active addiction, and just over $250 billion dollars per year are spent on addiction research, treatment funding, educational grants, state hospitals and rehabilitation centers, and educational campaigns (samhsa.gov). Drugs or contribute to an ever-increasing number of violent acts including rape, homicide, assault, suicide, domestic violence, fatal driving accidents, and prostitution. "In the bigger picture", says investigative journalist Danie Molitas, "drug abuse is blamed for broken families and weakened communities, lost wages, and soaring health care costs. Intravenous drug use is also faulted for fueling the rapid spread of HIV/AIDS, another huge and intractable problem", (Molitas, 2006). While the long-running villains of drug abuse are still going strong - heroin, alcohol, nicotine, cocaine - the more synthetic and non-traditional types of addiction are also growing in type and number as our society becomes more sophisticated. Consider internet and social media, gambling, video gaming, pornography, inhalants, ecstasy, and perhaps the biggest killer of them all, food. Despite what seemed our best efforts, (including a three-decades long, expensive but mostly unsuccessful 'War On Drugs") newer, more addictive, and more dangerous drugs continue to emerge, accessibility and attainment persist in convenience, and the compulsions take on newer and more sophisticated forms. In fact, in today's society, many of the most prominent addictions are non-substance.
Since our punishment-driven campaign of the 1970's and 1980's did not seem to squelch the issue, two models of addiction began to gain recognition as they directly opposed one another. The moral model of addiction holds that the addict can truly make a choice to stop through will power alone but fails to do so because of a personal defect - a lack of willpower, moral laziness, and a weak character. In the eyes of the moral model proponents, The Disease Model is in direct opposition to what they believe and is an attempt to get the addict "off the hook", so to speak, by attributing compulsive actions to disease rather than holding the addict responsible and accountable for their own behavior. However, The Disease Model of addiction is based upon evidence that a predisposition exists in the genetic makeup of the addict. These predispositions make the addict's brain more efficient than the average persons at establishing reward responses in the neural pathways that, as a result of the voluntary choice to use, create a chronic compulsion for the stimulus in order to produce the needed brain chemicals. This need then leads to a psychological and physiological dependence on the stimulus that the addict, literally, has no voluntary control over.
These two formulas are among several other theories as to the origins and dynamics of addiction, all with insight to offer. Still, a comprehensive approach is needed. Each theory has it's own contribution to make in the search for the cause and cure and it would behoove us as a society to not cast aside any of them in disagreement, but rather draw upon the lessons of each one. Since addiction affects every area of being, treatment calls for the consideration of every area as well. If we can acknowledge, as a society, that the moral implications of addiction development are but one small contributing factor, we can make progress toward removing the barriers of shame and guilt associated with seeking help. This can be accomplished by educating, raising awareness, breaking stereotypes, and ultimately, inspiring empathy for the plight of the addicted.
A History of Addiction
As the substances and compulsive behaviors of addiction grow increasingly sophisticated, so follows the medical, spiritual, social, and scientific explanations of the affliction. The set of behaviors we call addiction, now medically established as a chronic disease, were once grouped either with those labeled "criminally insane" or those thought under demonic possession. The influence of societal trends and ever-shifting norms is evidenced in the contradictory nature of addiction trends over time, as well as the varied theories we have devised to make sense of the affliction. Consider these contradictory trends: some of the most controlled and abused substances of our time were once a medicine-cabinet staple, as in the case of opium, heroin, and cocaine; the story of the Prohibition of alcohol and it's modern-day version starring marijuana; and, just when you think there could be nothing left we could make ourselves slaves too, there is still gambling, pornography, video gaming, Internet and social medias, food, shopping, and yes, even plastic surgery. As a matter of fact, it is addiction that fuels large portions of the American economy - the same affliction, but with many new faces. So many, in fact, that long since the times you could sprint to your local pharmacy for a bit of heroin, we have developed a highly bureaucratic system for the composition, manufacturing, and distribution of addictive, but medically necessary substances - hence, the term "controlled" substances. What was once a pharmaceutical category of a few notorious items, is now a library of synthetic substances that are increasingly more powerful than their predecessors. With drugs like Dilaudid, which is ten times stronger than morphine and twenty times more addictive than Heroin, common sense calls for sophisticated regulation. The United States Drug Enforcement Agency, established in 1973, classifies medicinal substances on a schedule of abuse potential vs. medicinal value. Schedule I drugs, for example, cannot be prescribed within the United States, have a high addiction potential, and very little to no medicinal value (dead version.doj.gov). These are drugs like heroin, ecstasy, and LSD, that we usually only associate with poverty, crime, or last night's episode of Law & Order. Schedule II drugs include mostly narcotic pain relievers, including Oxycontin, oxycodone (Percocet), Fentanyl, Dilaudid, and Methadone, as well as the stimulants Adderall, methamphetamines, and cocaine. All schedule II drugs are highly addictive, yet very medicinally valuable (could you imagine having an invasive surgery without the aid of narcotic analgesics?). Schedule II drugs are also among the fastest-growing causes of drug abuse, addiction, and accidental overdose - after all, these drugs are morphine-based and are given to you by a trusted family professional - both factors that can provide the spark needed to ignite an addiction. Schedule III drugs include those of medicinal value whose addictive properties may be bit less potent. These include hydro-codone (Vicodin), weight loss stimulants, morphine, and anabolic steroids. Schedule IV drugs, including anti-anxiety medications such as Valium, prescription sleeping aids such as Ambien, and cough medicines containing codeine, are of lower abuse potential and have a good amount of medicinal value; whereas, schedule V substances are your basic over-the-counter pain relievers, anti-inflammatory medications, and most other substances that have accepted medicinal value but no value, whatsoever, to the addict.
As we follow the evolution of addiction theories, we note the submittal of these proposed formulas, or "models" , which sought to assign the base of the addiction to some difference in spiritual, moral, developmental, intellectual, social, economical, or neurological factors in the addict. We can see some of these models at work in historical events - the temperance model attributes blame to the drug itself (the basis for the Prohibition period of alcohol), the psychological model attributes drug abuse to the "addictive personality", a disorder of character that can only be treated by the "restructuring" of the personality through psychotherapy (Kenyon, 1994); or the social model, which views the social characteristics of the addict and societal factors as paving the way towards the addiction. Still, there is a model based on most every factor it seems - the family model analyzes the family dynamics and their role in the development of compulsions, while the spiritual model theorizes that some spiritual defect renders the addict powerless and dependent upon their drug of choice, rather than God.
Perhaps the most organized effort to reflect the principles of a proposed model of addiction has been the War on Drugs, an anti-drug campaign led by President Ronald Reagan in the 1980's, which has been criticized for accomplishing little more than increasing the stigma associated with addiction by criminalizing the addict. This campaign may have led to the arrest of over 250 thousand drug addicts and dealers in the first year alone (drugwarfacts.org), however, it failed to devise a system for rehabilitating the offenders or ending societies reproduction of more addicts and more addictions. As we sift through the attempts to efficiently control substances of addiction, the lesson appears to be that rather than focusing on the object of addiction, it is the compulsive behavior we seek to control, lest society will surely always have something bigger and better which we may graduate our addiction to. We see two predominant models left standing in the scrutiny of modern-day society - one supported by a general moral consensus influenced by current values, and another backed by an abundance of scientific and medical data.
The dividing line between the two contemporary viewpoints of addiction cannot be drawn anywhere decisively. To some degree, both models are present in the consideration of the addict in almost all circumstances. The medical and scientific community understands the addict's actions as a result of the faulty genetic hardwiring in the reward center of the brain; whereas the community, in general, sees only the decision made by the addict to keep "picking up," so to speak. However, the two extremes of this dilemma are increasingly finding common ground as the neurological data regarding addiction becomes common knowledge. The initial instigating force behind The Disease Model of addiction occurred in 1935 with the establishment of Alcoholics Anonymous, a twelve-step sobriety program based on the premise that the addict suffers from a "chronic, incurable, disease that, if not treated, is always fatal" (W.S.O., Inc.). The next breakthrough for the cause came in 1957, when the American Medical Association officially accepted addiction as a form of "chronic and relapsing disease" (physicians news.com). In the following decades, science and medicine would produce innumerable studies whose results would continue to support The Disease Model, including the mapping of the addiction gene. Still, the moral model of addiction, given it's basis on moral ideas rather than facts or data and the stereotypes perpetuated through judgment, has had the most consistent presence. In fact, it is the one remaining model that stands in direct opposition to The Disease Model, despite the abundant scientific support of the genetic and biological basis of addiction.
When considering the evolution of addiction, however, one comes to realize a significant factor at play that seems to have been overshadowed by the morality vs. disease controversy. There is no question that the face of addiction in our society wears many masks, the new and improved versions more frequently based upon the non-substance compulsion mentioned earlier such as gambling, Internet and pornography, plastic surgery, adrenaline, and social media. Not only do these trends indicate that addiction is a much more brain-oriented affliction that first suggested, one cannot help but see something reflected in regards to our society as well. In fact, when we compare American addiction statistics with those of other contemporary societies, America takes the lead. In regards to prescription pain killer addiction alone, American's consumes 80% of all opiate medications with a whopping 99% of all Vicodin prescriptions alone (Kloth, 2011). Although the consideration of this trend could be the basis for another research project in itself, what it indicates is that American society is somehow becoming very adept at bringing addictive tendencies to fruition. Perhaps all one addictive gene needs to manifest is some type of stimulation or reward, and with the instantly-gratifying, bells-and-whistles type of society we live, the addict would appear to have a new dealer: society itself.
Stigma as the contribution of the moral model
In dissecting the moral model of addiction, we find that although moral reflection should be a key component of recovery, most of what this model has served to do is to further the stigma that addicts are, in general, "bad" people. In fact, because the model has served to perpetuate stereotypes and hasty generalizations of the addict, thereby preventing many addicts from seeking and receiving help, the model is not used by recovery or rehabilitation centers. Since the argument is based on a moral idea, it's appeal is mostly emotional - that is, we are encouraged to feel outrage when an addict blames his destructive or irresponsible behavior on drugs, disbelief when the addict claims that willpower is simply not enough, and that a focus on moral fortitude can cure any behavioral dysfunction. However, when we apply critical thinking to this premise, none of these emotions seem reasonable, justified, or logical, when applied to the concept of addiction. In fact, the moral model of addiction contradicts the very definition of addiction.
Firstly, in order for the moral model of addiction to be a credible and reliable measure of human behavior, we must not only be able to apply it to all forms of addicted behavior, we must be able to consider the model just as applicable to all "moral" behavior as we do to addiction. Anyone who has been through the misery, shame, and powerlessness associated with an addiction understands that the consequences of these are not the same as, say, the laziness in searching for a job, or parking in a handicapped spot at the market, for example. The shame and misery is a consequence of the powerlessness the addict feels at the hands of the drug that is powerful enough to make the addict choose behavior that violates every one of his morals. Clearly, the moral model has already lost any credibility it may have had through definition alone. The definition of addiction is the compulsion to repeat the rewarded behavior despite the consequences, which almost always include the violation of one's morals. Therefore, a theory based on a immoral addict is clearly post hoc, as this is the result, not the cause.
Secondly, since the moral model is based upon the premise that addiction is, in fact, immoral, we must also be able to apply this premise to all forms of addicted behavior, and all addictive behavior is not considered immoral in our society. For example, the addiction to food has caused obesity in up to seventy-percent of Americans, an affliction that, while still stigmatized, is not often associated with immorality in our society. Third, the data simply does not support the theory that moral lacking is the culprit behind addiction when, in fact, many moral, upstanding individuals, by society's standards, find themselves slave to addictions. When society tells us that addicts are weak, immoral, and dishonest people at their core, just how likely is it that an addict will step forward to ask for help? If we view addiction from purely a moral standpoint, just what types of services will we be able to offer for rehabilitation rather than punishment? Just how does the moral model account for the more than four-hundred genes that have been located and linked to addiction?
While it certainly is not being suggested that genetics determine our course or that our morals as individuals or as a society do not offer us guidance, the acceptance of addiction as a neurological disease of the brain is simply an established fact. Still, while it is also true that not every person who is genetically predisposed will become addicted, it is simply the factor that seems to make the difference for those who are unable to control their use through willpower alone. The facts that have established addiction as a genetic and neurological-based brain disease are quite strong: as an addict, your child has an eight times greater risk of becoming an addict; identical twins are 50-60% more likely to mutually suffer from addiction than non-identical twins (Kenyon, C.A.P., Dr., 2006); and, as we have established, the very neural pathways and genes for addiction have both been identified. Although the initial choice to use may be voluntary, the neurological pathways that are eventually forged with continual use give way to an involuntary and biological compulsion for the drug. Each drug establishes a route within the part of the brain responsible for "reward" - those brain chemicals which make us feel warm, fuzzy, content, elated, or euphoric, to differing degrees. Scientists have long understood that drugs like marijuana and heroin activate the reward center of the brain by mimicking the natural neurotransmitters in the brain that produce contentment.
While the 1957 decision by the American Medical Association claiming alcoholism as a brain disease may have put some controversy to rest, it also gave rise to more questions surrounding the scientific and medical phenomena of addiction - each answer found seemed to give birth to new questions. For example, if addiction is a brain disease established by the neural pathways put in place by the drug, how does the same result with addictions that have no ingredients? Scientists are now aware that it is not the substance itself that changes brain chemistry but, in fact, it is the series of choices themselves - the reward circuitry within the brain becomes fixated on a particular action. Now scientists are questioning if an alcoholic can pass on the addiction gene to a child that may develop a gambling addiction, for example. Finding the answers to these neurological patterns is the hope behind finding innovative treatments for the medical community.
The ultimate test of these models is their application to recovery. Today, the twelve-step programs based on the original Alcoholics Anonymous concept prove to be the most successful long-term treatments for all types of addictions. Other programs, including inpatient and outpatient, seek treatment through medications, psychotherapy, and cognitive and behavioral therapy, while the anonymous programs take a spiritual approach that sees the addict as a lifelong sufferer. So far, these programs have shown considerable long-term success, provided that the addict works the twelve steps with a sponsor and sees his affliction as a lifelong process. Beginning with the original establishment of Alcoholics Anonymous in 1935, these programs, or "fellowships" as in the case of Narcotic's Anonymous, have moved mountains in terms of advocating for the acceptance of addiction as a disease while laying foundation for the spiritual healing the addict needs from the past they leave behind. The twelve-step principles have proven so successful in the treatment of drug and alcohol addiction, that the concept has been applied to most other notorious addictions of our time. In the 1950's, the first permission was granted by the founders of Alcoholics Anonymous to utilize the Twelve Steps and Traditions and Narcotic's Anonymous was established. Since then, we have seen the emergence of twelve-step groups catering to many of the up-and-coming addictions. Among them are Overeaters Anonymous, Sex Addicts Anonymous, Gambler's Anonymous, Workaholics and Shopaholics Anonymous, Codependents Anonymous, and even Emotions Anonymous. These programs are successful because they incorporate the best principles of both the moral model and The Disease Model of addiction since they are both factors in the recovery process, rather than pitting the two views against each other. In fact, while the first step of these programs is admitting to powerlessness over addiction, the addict works his way to step numbers four and five, which include a moral inventory and an amends process for the wrong they perpetrated through their addiction. Indeed, the Alcoholics Anonymous motto is: "We are not responsible for our addiction, but we are responsible for our recovery". (W, Bill, The Big Book of A.A.)
Through the attendance of several local A.A. meetings in my area, I was able to observe the dynamics of the anonymous approach, gather information from addicts with first-hand experience, and hear the amazing stories of addiction and recovery. According to the Meeting Chair, the moral focus of this program is not to lay blame for moral lacking at the addicts' feet, but to give the addict a new sense of self and power. In fact, the "anonymous" programs hold responsible the drug itself (the temperance model), as well as the genetic "allergy" to the drug (The Disease Model). Furthermore, in the handful of meetings that I attended in order to observe the defining characteristic of an addict, I witnessed a group of people that seemed anything but morally bankrupt. In fact, many of these addicts seemed like some of the most loyal and devoted friends a person could hope for when battling an addiction. Many of them had responded to each other's early morning crisis calls or had been there at all costs for their fellow addict when a craving grew out of control. I did not look around and see what my stereotypes had taught me to envision - that is, I did not see weak, dirty, or fidgety individuals who looked strung-out - I saw many clean-cut, professional, respectable, and very welcoming individuals. If anything, it seemed as if their common thread made them sensitive to human sufferings and needs, although we can expect active addiction to look a bit different. Perhaps the best point of these programs is reached when the addict has completed his steps and is then responsible for helping another addict find the same peace.
Regardless of what model of addiction you subscribe to, you can be sure about one thing: the addict suffers greatly from his affliction, whether self-inflicted or not. Those of us who choose to the "grey" area of addiction would no sooner turn our backs on the suffering of someone who is dying from lung cancer from a lifetime of smoking, an individual who is so lost and distraught that they consider taking their own life, or someone who is dying of heart disease from a lifetime of poor eating habits. Essentially, all of this human suffering comes from the same place - people do not have the skills they need in order to cope with the world properly. Anywhere there is human suffering, we have a responsibility to attempt to find the cause of the suffering and do everything in our power to cease it. Even then, when we have built our programs of recovery, the addict may not come. There will always be, so it seems, some moral stigma attached to the addict. So far, the only thing this moral viewpoint of addiction has served is to give yet another reason for the addict to turn on himself.
The first and best route to recovery is through education and the adoption of a holistic approach to addiction. If there is anything learned from this research, it is that addiction is a disease of the whole body, mind, and spirit, and because the anonymous programs approach treatment from all of these aspects, they are successful. Given the dysfunction that is rampant in our society, it would make sense that addiction continues to grow as an issue among us. The more we educate society as to the genetic and biological foundation of addiction; the more we approach the treatment of addiction from a holistic approach, the less stigma there will be. The less stigma there is, the more addicts will come forward sooner in their addiction. With all this said, the truth still remains that an addict must be miserable enough to want to change. The bad news is that some addicts never recover - mostly those who have unlimited resources to their compulsion and have no little to no support. However, the good news is that, ultimately, we can take our power back, we do have free will and the ability to change, we can learn new ways of coping, and we can show others how to do the same.