This book has given me a new and different perspectives of addiction. The author is an addiction physician and bioethicist with history of alcohol and amphetamine addiction. He was admitted into a rehabilitation centre for doctors during his psychiatry residency. Now he is an assistant professor in the Division of Law, Ethics and Psychiatry, Columbia University.
I like his 4 approaches of categorization:
“As I studied the many attempted responses to the problem of addiction, I came to distinguish between four broad approaches that have recurred throughout history. A prohibitionist approach has sought to control addiction through punishment and other law enforcement strategies. A therapeutic approach has argued that addiction is best handled as a disorder to be treated by the medical field. A reductionist approach has sought to explain addiction in scientific terms, often seeking biology-based cures. And a mutual-help approach has sought community healing and grassroots fellowship and sometimes, but not always, spiritual development to recover from addiction.”
His points on heritability of addiction:
“Biology does matter, but it is only one of many factors influencing addiction, along with environment and even choice. Genetic research is also not strong enough to explain who gets addiction, or why. The heritability of addiction (meaning the degree of the variation that can be attributed to genetics) ranges from about 25 percent to 70 percent a significant figure, to be sure, but this finding means that genetic influences are on more or less equal footing with environmental ones: one's prenatal environment, family life, trauma history, social environment, and much more. As one geneticist puts it, "Research into heritability is the best demonstration I know of the importance of the environment."”
He believes the explicit target of addiction treatment is not simply remediating pathology, but a sweeping and much more challenging project of reshaping one's very identity.
However :
“Science will help develop new treatments and demonstrate what works and what doesn't, and this is tremendously important, but after that, more work will still be needed. We will still be human beings with intention and agency, and we will need to make decisions about what we choose to value in this one brief life. We will still need to grow and change not after addiction or beyond addiction, but with it, because addiction is a part of us.”
There are many important resources other than medical and rehabilitation treatment needed for recovery :
“We have a better sense today of the concrete factors that support recovery from addiction: physical resources like money and housing, personal resources like knowledge and skills, and social resources like family and other relationships. Some researchers have summarized these factors as "recovery capital," and the economic implications of that term suggest what is missing in a response to addiction that focuses only on medical treatment.”
This statement is really an eye-opener:
“By accepting that addiction has been and will continue to be a part of human life, we can abandon dreams of eradicating it and free ourselves to look instead at the full variety of interventions available to help. The primary goal should be not victory or cure, but alleviating harm and helping people to live with and beyond their suffering in other words, recovery. If we want to break the cycle, we must take the best of each of these approaches-medical, social, spiritual, and so forth and apply their lessons in a truly holistic balance, while always being sure to let the history spark humility and openness to multiple perspectives”.
According to him, he is still in recovery. This is a five stars book about addiction.
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