I recently saw NIDA director Nora Volkow on TV talking about what a triumph we are having convincing people that addiction is a disease and not a moral failing. Nora, let me tell you this: the "moral model of addiction" is a straw man invented by disease theorists in order to promote disease theory. The "moral model" never had any real existence in reality. What I really wanted to ask Nora Volkow when I saw her was, "How much heroin is it all right to use without getting called an addict?"
Here is the crux of the matter--they key problem with disease theory: ALL RECREATIONAL DRUG USE IS CONSIDERED ADDICTION. AND ALL RECREATIONAL ALCOHOL USE THAT EXCEEDS USDA LIMITS OF 2 DRINKS PER DAY FOR A MAN (AND ONE FOR A WOMAN) IS CONSIDERED ADDICTION!!
This is great news for the addiction treatment industries which are concerned with making billions for treating the mythological disease of addiction. It is also great news for the prison industries which are concerned with making billions by warehousing recreational drug users. It is terrible news to the taxpayers who wind up paying for this treatment or this incarceration. It is also terrible news for the occasional drug user. There is evidence to suggest that many treatment programs make occasional drug users into addicted users and prisons also increase and worsen drug use.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) ought to be better renamed The Field Guide to Popular Morality in the United States. The way to morally condemn a behavior in the United States today is to label it as a disease--a mental illness. Don't like recreational pot smoking? Then call recreational pot smokers "diseased addicts" and incarcerate them in so-called treatment centers which take away their right to freedom of religion and indoctrinate them with a 12 step god instead. The same with recreational gambling, heroin use, alcohol intoxication--you name it.
When a behavior is unpopular we vote that it is a disease and when it becomes popular we vote that it is not a disease. Homosexuality was a mental illness until the mid 1970s when the American Psychiatric Association voted that it was not longer a disease and it got removed from the DSM.
The evidence shows us that the majority of drug users are recreational users, not compulsive users. Even the majority of heroin users are recreational rather than compulsive users. The two most addictive substances in America today are caffeine and nicotine. But we do not find any evidence of a disease of nicotine addiction in the DSM-I which was published in the 1950s when smoking was really popular. But by the time smoking became hated and demonized in the 1980s we see that the APA voted to make smoking a mental illness--an addiction--when they put out the DSM-III.
There are probably more caffeine addicts in the US than there are addicts to any other substance. Just try and get people to give up cola, coffee, tea and all the other caffeine containing beverages for a week. They cannot do it. But there is NO category for caffeine addiction in the DSM! Why not? Do you think the psychiatrists are crazy enough to vote to take away their own favorite addiction? Hell no!
Although it is true that there are some people who use drugs compulsively--the real question in the end is why do we want to force them to stop if they don't want to? Why must we force our morality on others against their wills? Why isn't there a category in the DSM for the mental illness of the control freaks like Richard Nixon who created these insane drug laws in the first place?
Surely the drug laws cause more harm than the drug users--and the folks who made the drug laws are far crazier than the drug users.
it costs billions of dollars to keep people in prison or to put them through 12 step programs which do not work. By way of contrast it costs mere pennies to supply a junkie with prescription heroin--heroin is very cheap to manufacture and could be covered by Medicaid. Moreover--they chance of OD with pharmaceutically pure heroin is nil compared to street heroin--so we would save countless lives.
They have heroin maintenance clinics in Switzerland and some other sane countries. Why can't we see a little sanity in the US as well?
Szalavitz (2010). Does Teen Drug Rehab Cure Addiction or Create It? http://www.time.com/time/health/article/0,8599,2003160,00.html
Zinberg N. (1986). Drug, Set, and Setting: The Basis for Controlled Intoxicant Use.