To Prevent Addiction
It’s everybody’s dream. Don’t just treat the illness, or even find a cure for the illness; prevent the illness. It’s a wonderful dream, and with regard to addictions it seems easy to fulfill. Don’t ever drink and you won’t get addicted to alcohol. Don’t allow cocaine in the country and no one will ever get addicted to cocaine. To quote Hemingway, “Isn’t it pretty to think so.”
We’ve got to ask ourselves, “How long have we been at this? And when is it going to work?” Surely, if this were true prohibition in the twenties would have gotten rid of much of Addiction if Addiction could be prevented by preventing use of the drug. However, as I show in Questions and Answers on Addiction, while prohibition temporarily decreased the amount of alcohol used in the US it just caused a switch to another drug. Drinking went down but not Addiction.
I keep asking my Addiction Medicine colleagues to show me one study that shows that any preventive measures aimed at Addiction as a whole have ever worked. I’ve put this challenge out numerous times to the leadership of Addiction Medicine and have yet to get a single response. I get lots of responses about preventing alcoholism or cocaine abuse, but nothing that shows prevention of Addiction as a whole.
Of course, no one has to worry about my thesis on this if they don’t believe Addiction is an illness. If they believe that alcoholism or cocaine dependence is an illness, but that they are different illnesses, then I can be safely shunted aside. It’s probably more convenient for a lot of people treating Addiction to not see the single disease. It’s hard to see your own overeating as a form of the illness while telling someone else to stop drinking.
It also helps when you’re making drug policy not to have to look at Addiction as an illness. It’s hard to get an illness to change by making a policy; it’s so much easier to have a policy about a drug. We’ve had “drug policy” for a long time in this country and spent billions of dollars to implement it. At this point one would have to conclude that either the original thesis of the policy was incorrect or that the implementation was completely botched. Generation after generation of administrations have been able to point to their predecessor and claim a botched implementation, thereby preventing anyone from having to critically look at the original premise.
So if I’m right, can Addiction be prevented? Sure, about as well as Diabetes is prevented or Hypertension. These are largely genetic, chronic illnesses with lifestyle and behavioral components just like Addiction. We can have tertiary prevention and secondary prevention, but primary prevention of a largely genetic illness is going to be hard.
What would we have to prevent to have primary prevention of the Addiction that isn’t genetically derived? We’d have to prevent anyone feeling less than anyone else. We’d have to prevent anyone from feeling isolated from others. In short we’d have to prevent bigotry, prejudice, poverty, inequality, and the list goes on. Really, it’s much easier to just shoot down drug smugglers.
But we have a lot we can do about secondary and tertiary prevention whether something is genetic or not. We can find it quickly and intervene before it gets worse. We can treat it as an illness rather than as a social problem that we hope goes away. We can make sure that people who don’t get better get more treatment, not less. But in order to do any of these things that can be good secondary and tertiary prevention of Addiction, we have to recognize that we can’t do primary Addiction prevention by getting rid of drugs and alcohol. Unless of course you can show me that study, but I’m still waiting.