Bill vs. pill
Addiction deeper than biochemistry


Tuesday, April 29, 2008

One pill makes you larger/And one pill makes you small.

-- from "White Rabbit" by Jefferson Airplane

Nobody should have been surprised at the news last week that the latest "anti-addiction" pills carry with them increased risks for depression and suicide.

According to the Associated Press, "Two years ago scientists had high hopes for new pills that would help people quit smoking ... and maybe kick other tough addictions like alcohol and cocaine."

The pills -- including Chantix, specifically marketed at nicotine addicts, and others in development aimed at other kinds of addictions -- work by blocking the pleasure centers in the brain.

But now it appears that such drugs may work too well, driving some people into depression and even suicide. Some researchers say the recent results call into question the entire approach; what's the point in "curing" an addiction if the resulting life is no less (and perhaps more) miserable?

Perhaps the real flaw in the race to come up with a pill to treat addiction lies deeper still.

Scientists can now say with certainty that addictive behavior has a biochemical element, and that genetics play a role in determining who will or won't wind up with an addiction. Based on that, it makes sense that they'd be looking for yet another pill to fix us (in some cases, to stop us from taking other kinds of pills).

But ever since the founding of Alcoholics Anonymous in the mid-1930s, many, if not most, of those who work with addicts recognize that addictive behavior often is the symptom of a disease, and not the disease itself.

Twelve-step "recovery" and its emphasis on "spiritual solutions" to addiction problems is easily and frequently mocked. But the reason Bill Wilson's unusual ideas are still around today, and have been adapted for use by other kinds of addicts, is that they seem to be the most successful approach to living free of active addiction.

That's why most recovery programs still emphasize the need for addicts to look, with the help of groups or individual therapy, at the underlying "character defects" and plug into some kind of spiritual connection to stay clean: It works better than anything else so far.

"To treat addiction solely as a disease of the brain is to ignore the psychological factors that generally prompt and sustain it," wrote Mitchell S. Rosenthal, M.D., founder of the Phoenix House recovery program, in the Feb. 23 edition of Newsweek. "... Guilt, remorse and anger must be dealt with. There are relationships to repair. ... Addiction is a lifelong condition and can recur at any time."

Scientists will, no doubt, go back to the drawing board in their search for an addiction "cure." But chances are, even if they do perfect anti-addiction pills, that won't be the magic bullet for those truly plagued by addiction.

Clay Evans, guest editor for the Camera editorial board

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