Back to the Future (Episode 3)

Back to the Future (Episode 3)


[mistaking his microphone for a flip phone – sounding like an old man] “Hello oh this piece it drech. [normal voice] Alright. We
ready? Welcome back. Last time we talked about
some assumptions: drugs cause addiction and addiction is cortical. And today I
wanted to talk about where one of those assumptions came from: drugs cause
addiction. To do that let me go back to 1981. I just got to medical school, had no
idea was gonna be a psychiatrist.In fact I was gonna be anything but a
psychiatrist. And I had one lecture that year on psychiatry, at least one I
remember anyway. The lecturer came and said, “I wouldn’t blame you if you thought
psychiatry was bull. It’s been so subjective and so theory-driven that it
really doesn’t have much science in it.” But that year, 1981, psychiatry got a new
book, the Diagnostic and Statistical Manual of Mental Disorders Edition 3. And
this book, he said, turned psychiatry from bull to science. “Wow,” I thought, “I’m part
of history. This is great. I’m watching it happen.” And this book
really was amazing. It was a great breakthrough. It had something very
special to say about addiction. It created specific behavioral criteria for
two diagnoses, substance abuse and substance dependence. The dependence was
pretty much what we thought of as addiction, and the abuse was pretty much
what we thought of as just people doing stupid things with drugs and alcohol. The
criteria were all behavioral, and they all had to do with
the substance. There were no non- substances included. And all the drugs
that were included were separated so you could have cocaine dependence or alcohol
dependence or cannabis dependence or poly drug dependence. But you couldn’t
have a drug dependence unless you were taking the drug there was no such thing
in this book as having addiction before you took the substance. The concept of a
brain disorder, pre-existing, called addiction, that is actually a primary
brain disorder, doesn’t even fit in the paradigm in DSM. It didn’t fit 1981. it
doesn’t fit in 2018. It just doesn’t go in the paradigm. So that’s how we got
here to this understanding or this assumption that we all have in our world
view that drugs cause addiction. This is the definition of addiction 99.9% of
people who treat addiction are using, the definition in that book. There is another
definition available. The American Society of Addiction Medicine has a
completely separate definition of addiction. We’ll go more into detail
about that in a future episode, but I just wanted to let you know there is an
alternative and it’s a lot more consistent with what you’ll be hearing
from me then the paradigm in DSM. So in this episode we talked about the
assumption that drugs caused addiction and, I said that that’s not a great
assumption when you’re trying to treat the disease because it gets you to focus
on the drug instead of the brain which is where the disease actually is. Now as
bad as this is for clinicians, it’s even worse when politicians get focused on
this assumption. We’ll talk more about that next time.
I hope you’ll join me. Until then, be well

One comment

  1. Caught your talk at the LP convention on Youtube. I was struck by the focus on the mid-brain as the locus of the issue. I am not a professional in this area but have been influenced recently by the lectures and books of Jordan B. Peterson. He talks about serotonin (and lobsters) and how it affects, I think, the mid-brain. Are you familiar with him? Comments?

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