Updated: Aug 29
“we will figure this shit out” is from a commenter in the youtube debate I discuss in this article. Feel free to comment on this post if you, too, would like to join the figuring out.
youtube comment: “Addiction is such a vague term” reply: “Disease is also a vague term…we can spend hours picking apart words and meanings”
It is a truth universally acknowledged, that an author who wants to remain in possession of her sanity must avoid reading the comments section of anything she writes. If the internet is a neighborhood into which one might enter to tell a truth about something personal, if I may borrow again from Jane Austen, an author must accept that her words are taken as the rightful property of some one or other of the many trolls lurking in the deep recesses of the intertubes. Here at Points, we screen comments in order to keep nasty, provocative, or derailing comments out of the mix (this post being the exception), but elsewhere, they flourish like kudzu.
Perhaps it was morbid fascination that drew me to explore some of these cesspools pockmarking our information superhighway, so I donned my emotional hazmat suit and clicked my way in to the comments sections.
In the interest of balanced investigation, I read through three sets of comments. All three original texts (two personal essays and a youtube clip) were about drug courts as the newest intersection between legal and medical models of addiction treatment.
I don’t even know how to interpret this shirt’s commentary on drug court.
Despite the occasional ad hominem attack, the comments sections contained some interesting debates about the meaning of addiction and treatment. While those of us who write about addiction as academics have reached an often abstracted perspective on the fundamental divisions between moral, legal, and medical theories of addiction, the comments sections indicate that the public is still very much invested in the debate about what, exactly, addiction is. They also offer some useful insights into the useful residue of past conceptualizations of addiction.
The Texts or, “therefore, worthy doctors, as there seems to be room for further discoveries, stand aside, and allow me to come forward and lecture upon the matter” — Thomas De Quincey
In the first article, “I Detoxed from Heroin in Jail,” published in The Daily Beast, Tracey Helton argues that treatment centers have “all but disappeared, leaving prisons as the catch all” for drug addicts who fall into a “treatment gap,” which means they do not have the finances or insurance to pay for treatment. Helton describes a harrowing experience in 1998, when she was locked up in the “kick tank” with nothing but a mattress and a bag into which she could vomit. After five days in the tank, Helton asked the court to let her go into treatment. Jail should not be the point of entry for those desperate to access care, she argues, because opiate addiction and withdrawal constitute a “life-threatening condition” and because those who do withdraw in jail are at an increased risk of overdose upon release.
The second article, “The Failure of Catch and Release Drug Treatment Court,” published by The Fix, describes a Ellen Sousares’s experience as she watches her son – a long-term heroin addict – go in and out of jail for charges related to his addiction. In particular, Sousares criticizes “flash incarceration,” which involves short terms behind bars to provide motivation for a person to agree to enter treatment, which is what appears to have happened to Tracey Helton. Although Sousares’s son was offered a reduction of his sentence in exchange for entering treatment, he was unsuccessful at maintaining sobriety because he was released back onto the streets while theoretically entering treatment. The court system, she argued, “failed to consider . . . that my son struggles with a severe, life threatening disease.” After the trauma of being locked in a cage, he unsurprisingly reached for the substance that soothed him. He overdosed, but survived. His mother soon discovered that he was lucky; many others do not survive that initial post-incarceration overdose. Indeed, often-fatal overdose appears to be the unintended consequence of flash incarcerations, largely because basic harm reduction tactics (“taste” the drug in a small dose first; carry naloxone to reverse overdose; use with a friend) don’t have any place in a court-mandated recovery directive.
The debate. The lady and the moderator don’t get much chance to talk, what with the Idiot and the Ass dominating things. Think I’m overstating it? Give it a watch, then, and get back to me in the comments section.
The third text is a “debate” between former Friends star and recovering addict Matthew Perry, and “Burkean conservative” Peter Hitchens, who believes that drug users/addicts should be prosecuted in order to deter others from trying drugs. The debate rapidly became a clash between a former TV star who expects – based, most likely on previous interviews with fawning Hollywood reporters – to direct any conversation in any way that suits him and an exceedingly patronizing professional jerk who revels in his gleefully nasty social Darwinism. The two initially discuss drug courts.
it’s “all documented alcoholism proof”
addiction is just some “fantasy”
Perry asserts that courts “interrupt” the course of addiction and helped him recover (when asked to provide any evidence, he counters with “myself”). Hitchens claims that courts “don’t make much difference” and rapidly devolve into places where judges wear “track suit bottoms and [are] nice to the defendant” instead of punishing him/her as s/he so rightly deserves. As some poor Baroness tries to insert actual facts into the debate, Perry and Hitchens descend into a debate about what addiction actually is. According to Perry, addiction is an “allergy of the body” which is “all documented alcoholism proof.”According to Hitchens, there is a “fantasy of addiction in which people lose all power over themselves” and any such talk of “alleged addiction” as an “allergy” is “just pseudoscience.”
The “debate,” I note ruefully, is doomed from the start because the opportunity to figure out whether drug courts work or not is fundamentally impossible with these two lunkheads. Did the idiot who blithely trots out non-sequiturs with the arrogance of the newly converted and asks for extra time so he can “just give him one quick put down?” convince anyone of anything? Or did the pompous jerk who derives some sort of masochistic pleasure out of alienating everyone he meets, asserting cranky blanket statements with no regard for history or fact win the day? Hitchens might be a “maroon” and Perry an “unshaven fool,” but they are both too arrogant to see that neither of them make any sense and they would do well to listen to the nice lady with the data and facts.
The Comments, or, “you’re just a person who’s talking who’s wrong” – Matthew Perry
The comments section for “I Detoxed from Heroin in Jail” begins with a discussion of the economics of addiction. According to the commenters, jailing addicts is a waste of money because treatment is more cost-effective, yet we invest in locking people up because there is such a great profit margin. A doctor weighs in to note that treatment is also a lucrative industry if the addict has health insurance. Indeed, the doctor notes, the courts help treatment providers make money by mandating that “many of the poor schmucks that get DUI arrests” enter treatment. The same doctor also notes that there is not much money to be made prescribing medication for detoxification mediation (He charges $200 for “initial consultation” and $75 a month thereafter, not including the cost of the medication itself, but no one seems willing to pay him for his prescriptions. He appears untroubled by any sort of cognitive dissonance). Eventually, the conversation shifts from economics to the real issue at hand: what is addiction anyway? Is addiction a disease or a crime? Does the 12-step treatment method represent a disease model or a religious/moral one? Is medical treatment a cure or simply a palliative intervention?
The tension between literal and figurative language is present throughout the conversation. One commenter points out that the author is wrong to say that withdrawal is “life threatening” since that description applies to the dangers involved in active use, not in withdrawal, which is not actually life threatening. “You think you’re dying, you want to die,” writes irksome, but you are not dying. When irksome adds that addiction is a “treatable illness” and not a crime, OneBadStud replies, “Absolute piddle. Heroin addiction is a habit, not a disease” and therefore, the addict “needs no coddling, no lavish treatments.” Practical Girl replies, “your judgment . . . is the sort of craptology that costs our society billions each year.” We would do better, she continues, to think of addiction as a disease similar to Type 2 Diabetes, which is caused by a person’s actions but must nonetheless be treated medically. It is as useless to expect an addict to recover from addiction by sitting in a room with other addicts just as it is useless to put a person with Type 2 Diabetes in a room “with other obese/sedentary people with poor eating habits in order to get healthy.” They need medical treatment and encouragement to find more healthy ways to live.
“Are you attempting a metaphor?” asks OneBadStud.
“[N]o, that isn’t a ‘metaphor,’ it’s a simile,” Practical Girl answers.
“A simile is an approximation where a metaphor is a equation but we’re not going to quibble about it . . . You assume I’m sympathetic with Type 2 diabetes as well. I don’t favor expensive treatment for them, either” types OneBadStud.
Two interesting things happen in this debate. The first is that the disease theory of addiction is explicitly recognized an example of figurative language rather than simply a medical term. Unlike many of the more well-recognized advocates of disease theory, Practical Girl and OneBadStud remain aware of the fact that it is more accurate to recognize that addiction is like a disease than it is to say that it is a disease because all such arguments by analogy (in which one thing is said to be equal to the other through a few points of similarity) ultimately fall apart. Suggesting that the disease theory of addiction is more properly a simile (through the use of “like” or “as” rather than the equation implied by “is”) recognizes that all such claims remain more figurative than literal. In her distinction between metaphor and simile, Practical Girl articulates the need to maintain a division between addiction and diabetes, an insight frequently lost in this newest obsession with discovering addiction’s biomarker in the brain. After all, one could easily confuse addiction and learning if one starts looking for myelenation and other such changes in the brain as evidence of either. In his casual dismissal of both addiction and Type 2 Diabetes, OneBadStud goes one step further, returning addiction to a metaphorical relationship to disease only through his dismissal of both.
(He might have some good ideas, but I should note that OneBadStud is as obnoxious and reactionary as his moniker implies. I daresay he enjoys this role, perhaps aspiring to an alliance with Mr. Hitchens. “I realize I’m speaking to a complete ignorant who’s happy to stay that way, but you should perhaps know the facts before you shoot your ugly mouth off,” concludes Practical Girl, sputtering a bit like Matthew Perry. Ahh, the internet – so insightful and yet so ridiculous).
Upon arriving in Venice, Othello hopes that every man will celebrate, “some to dance, some to make bonfires, each man to what sport and revel his addiction leads him” (II ii lines 3-5)
The second interesting thing that happens is that OneBadStud calls addiction a “habit.” That’s old school. Really old school. In fact, addiction is linked to the word “habit” in its initial documented use. The Oxford English Dictionary offers the first example of “addiction” appearing as a term to describe the compulsive use of a substance in 1906, when members of the American Medical Association wrote, “It matters little whether one speaks of the opium habit, the opium disease, or the opium addiction.” The fact that the AMA dismisses these three terms as interchangeable suggests that they have all existed prior to this reference and makes clear that the implied meaning of addiction (habit, disease, or addiction) is unimportant. As usually happens, the term “addiction” had circulated earlier in anxious public debates about people’s addiction to the use of cocaine. This earlier appearance of the word “addiction” represents a bridge between its etymological origins and its current meaning. Before it was attached to substances, being addicted to something simply meant that a person was devoted to it, as Othello recognizes when he tells his soldiers to follow their addictions.
Referring to an addiction to the use of a drug implied that people were devoted to using something rather than dependent upon it, much less suffering from a disease. “Habit,” which is how some users described their experience with opiates into the 1950s, reflected the fact that people did not always think of themselves as suffering from a disease, but rather as unable to quit a habit. Calling addiction a “habit,” then, is to remove it from the realm of the medical and return it to an earlier meaning of the term itself. Doing so denies the addict any sympathy since a habit is more the consequence of weak will power than it is of any biolochemical disease. It also grants them the agency to change their ways without becoming the objects of expert medical or legal discourse. If those who hang out in the comments sections of The Daily Beast are still debating terms that went out of vogue decades ago, then the meaning of addiction is still very much up for grabs.
The comments on “The Failure of Catch and Release Drug Treatment Court” follow a similar course, debating whether addiction is a crime or a disease. There is an initial move to disengage drug use that remains under control from addiction, which is the sort of condition that leads people to break the law. Clarabelle12 argues that drug use isn’t problematic until it leads to crime, in which case, it’s the law breaking that puts someone in jail, not the addiction itself. She is on the receiving end of a number of “you’re-an-idiot” comments for this observation. Others argue that the law has nothing to do with it, no matter what, because addiction is a disease. Breaking the law, they conclude, is not the issue. Clarabelle12 sticks to her guns, pointing out that someone driving while drunk is breaking, the law and if that person is addicted, s/he should not then be excused from culpability. Commenters explore various definitions of addiction, adding the “mental hijack” theory to the usual criminal and medical ones. The mental hijack theory returns commenters to that contentious issue of free will. If someone’s brain is hijacked, then how do they avoid using drugs in front of the police? And if someone’s addiction to cigarettes is like a terrorist pointing a gun at their will power, how does a smoker sit through a three-hour meeting?
This debate also suggests another interesting observation: many people, these commenters recognize, are able to use drugs without becoming addicted. Even addicted people, some propose, have moments of control. This recognition of the fact that addiction is more nuanced than simply a crime or a disease opens up the possibility that a person in the throes of addiction – whether that means committing a crime like driving under the influence or suffering the pain of withdrawal – deserves our sympathy. Reaching for an analogy, suantang compares the belief that someone must become drug free before accessing treatment to telling “a dying man injured in a car crash that you won’t give him any oxygen until he starts breathing for himself.” Midway though, cmwilk offers another analogy, observing that the criminal justice system “’thinks like an addict,’ looking for a quick fix or mood changer for its problems!!!!”
The comments on the Perry/Hitchens debate migrate from the BBC clip, which has disabled comments, to a shorter clip of the initial video, where close to 600 people weigh in. There are multiple flame wars containing at least 50 comments, many in response to a troll who answers to Goldenstein the Juden. His/her comments have been deleted, which leaves me to imagine exactly how many comments there were initially, and how caustic they must have been; s/he must be exceptional at the art of trollery because the responses left behind border on the hysterical.
This commenter debate is well aware of rhetorical authority (“you’re appealing to authority, mate. That just doesn’t wash”), perhaps because youtube is the most lawless and anti-authority site of the three. People debate whether a doctor or a person with a PhD or an addict is more qualified to speak. “The AMA is a respectable organization and . . . if doctors cite the AMA, . . . I think I’m gonna side with them over some pompous ass with no evidence to back up his claim” is answered with, “have you ever tried drugs? because if you haven’t.. then you are speaking on something you know nothing about.” Because this is youtube, there is also a commenter who argues – repeatedly – that the AMA cannot be trusted as a reliable source because they advocate circumcision. “Please stop mentioning genitals,” plead a number of people. Eventually, the conversation returned to the subject at hand, mostly. Once again, people struggle to figure out what addiction is – a disease or a crime or something more complicated. This attention to what constitutes authority, pathos or ethos (there is no real logos here) highlights the fact that the commenters have not even decided who can speak on the subject, much less what, exactly, the subject is.
In 1980, Peter Conrad and Joseph W. Schneider published Deviance and Medicalization: From Badness to Sickness. In the book, they argued that many social issues – including mental illness, homosexuality, abortion, and addiction – transform gradually from moral failings, to illegal acts, to diseases. In other words, the models used to address these social issues go from religion to law to medicine. While this transition appears to move people from pariahs to criminals to sufferers of illness, it also gradually disempowers them, obscuring acts of free will and making them dependent on the authority of doctors. Although this book is over thirty years old, many people are still very much mired at the intersection of these three modalities, as reflected in the comments sections of all three texts. It is disconcerting to read people still advocating for the disease theory of addiction when history has already demonstrated the pitfalls of such a theory. Of course, that discomfort pales in the face of arguments that addiction is a crime that must be stamped out by harsh punishment and zero tolerance. Have we already forgotten the Reagan era? Do we not see the failure of Thailand’s move to execute all drug dealers and users in the early 2000s? According to one report, there are 33 countries that make drug use a capital offense and I will wager that most of those countries still have people using and selling drugs.
Amid this well-trod debate, however, are moments of useful insight. It would be good for all of us to remember that addiction is not something simple that can be described with a simple helping verb like to be. Addiction is not a crime or a disease or a habit or anything else we want to say it is. Rather, addiction is like all sorts of things, including a crime, a disease, a habit — and all sorts of other things. While it is easy to dismiss the sort of people who find their way to the comments sections – and I leave this project with no desire to return to that cesspool – we would do well not to dismiss the fact that, for many people, the meaning of addiction is still very much up for grabs and that perhaps there is more to say about this most basic matter.
Comments for this post will not be screened. It seems only fair.