Dr. Joseph Beck, psychiatrist and addiction
specialist, wrote an article for the Sun-Times News Group titled,
"Addiction doesn't always involve drugs
, alcohol." I confess to thinking, as the author (in 1975) of Love and Addiction
, "I'm glad someone got psychiatry
But what does this mean to Dr. Beck? (Please note this is not Dr. Aaron Beck, the founder of cognitive behavior therapy for depression.)
While it's true that chemical dependency on drugs or alcohol remains the leading cause of addiction in the United States, a growing number of individuals are battling addictions to compulsive shopping and spending, food, sex, gambling, video-gaming, the Internet and more.
Addiction is a chronic disease that requires dedicated medical management, and is one of the most underserved chronic illnesses in the United States.
So, let's see - the first paragraph says compulsive shopping and sex are addictions just like compulsive substance use is. That was my point in Love and Addiction. (By the way, I would point out the mathematical error when Dr. Beck claims drug and alcohol dependency is "the leading cause of addiction in the U.S." - more than "compulsive shopping and spending, food, sex, gambling, video-gaming, the Internet and more." Really?)
The second paragraph says that, according to Beck, they are all chronic diseases requiring "dedicated medical management." I can just picture a rock star hooked up to an IV machine as he recovers from his latest affair with the likes of Paris Hilton, Heather Locklear, Pamela Anderson - whoever. And I can see millions of husbands looking at their shoes as they imagine what they would do if confronted with a willing, nude version of some Hollywood hottie.
And that's where the average American parts company with Dr. Beck: "That's no disease," they shout in unison. Just like eating oodles of hot fudge is no disease. It's an excess -- yes it can be extremely self-defeating - even to the point of endangering one's health. Yes, it can be fueled by the negative consequences from previous such indulgences. That's addiction.
But is that a medical disease? Hasn't this kind of addictive, self-destructive cycle been around since the bible? Haven't we all experienced doing more of something we know is bad for us because it temporarily pleases us? There, in a nutshell, is my argument that addiction is not a disease, but rather an experience people seek in order to allay negative feelings (like anxiety or depression) and to give them a false sense of control in their lives, and which can become insanely self-fueling.
And what if we say it is a medical disease? For Dr. Beck, that means it is uncontrollable, inbred and genetic, can never be reversed, is not subject to interpersonal and setting factors like stress and exposure, and cannot be cured by improving coping and situational control such as through teaching problem solving skills, contrasting behavior with personal values, changing social networks to comprise moderate users. Too bad, Dr. Beck -- because those are the most empirically effective treatments for addiction.
In 2003 William R. Miller and his colleagues rated forty-eight kinds of treatment by combining the results of 381 controlled trials that had compared the effectiveness of a treatment with either no treatment or with other alcoholism therapies. The treatment with by far the best score was 'brief intervention' - followed by motivational enhancement, community reinforcement, and social-skills training. The least effective treatments were found to be general alcoholism counseling and education, ordinary psychotherapy, and confrontational therapies, followed by twelve-step interventions and AA (ranked 37th and 38th) - the very treatments most utilized in the U.S.!
So Dr. Beck's disease theory of addiction - that followed by the American Society of Addiction Medicine - endorses the least effective ways of treating the problem. And I thought medicine was about empirical effectiveness!