There are three cases we can look at:
1) The case of recreational substance use where the only negative consequences are the result of the drug laws and not the result of drug use itself. In this case it is the drug laws which are sick, insane, and diseased, and not the drug users. We also include recreational alcohol intoxication in this category because we find the US governments definitions of moderate drinking to be insane, sick, and diseased. People who enjoy their drugs or booze without harming themselves or others need to be left alone. People who use substances recreationally are neither bad people who need to be punished, nor are they sick people who need to be treated, they are good and healthy people enjoying the exploration or alteration of their own consciousnesses. The province of the law stops at the surface of my skin.
There is a general agreement that moderate drinking of alcohol is not a disease. However, I also propose that recreational alcohol intoxication is not a disease: it is an entertainment. “Binge drinking” is a deliberately pejorative term intended to demonize recreational intoxication by associating it with out-of-control behaviors like drinking and driving or going on three day benders. However, there are many individuals who exceed the limit of 4 drinks per day (3 for a woman) and do not engage in drunk driving and do not go on multi-day benders which start with getting drunk in the morning. In fact, only a tiny percentage of people who exceed moderate drinking guidelines engage in these behaviors.
2) There are people who want to change their drug or alcohol use because it is causing them problems which they do not like. We should definitely help these people on the path of safer use, reduced use, or quitting altogether. However, telling these people that they are diseased and incapable of changing their behaviors without a “higher power” or an AA group or some damn thing is not helpful. Quite the opposite, when people believe that it is impossible to change their behaviors because they are diseased, and when they believe that they are not responsible for their actions because their actions are the result of a disease over which they are powerless, then they do not change..Albert Bandura tells us that the people who are successful at changing are the ones who believe that they can change. Therefore we should tell people that they have bad habits which they are capable of overcoming with knowledge and scientifically proven techniques. Telling people that they are powerless and will drink and die unless they attend AA for life only turns them into lifelong AA junkies ready to relapse at the drop of a hat.
3) There are sociopaths and people with anti-social personality disorder who regularly drive drunk, engage in intoxicated violence, and generally do not give a f*ck how much damage or hurt they do to other people whether they are intoxicated or not. These are bad people who need to be locked up to insure the safety of the community. Personally I would like to see the breathalyzer ignition interlock be made a standard piece of safety equipment on every car driven in the USA.
The only people who benefit from calling substance use a disease are the treatment providers who want to charge insurance companies money and the 12 step groups who want to raise attendance numbers.
It is very unfortunate that the DSM characterizes behaviors as diseases or non-diseases on the basis of popularity rather than objective scientific evidence. Hence, when homosexuality was unpopular and stigmatized in the US it was a DSM disease, but when it became an acceptable lifestyle choice it was voted to be a non-disease. Likewise the APA refuses to recognized caffeine dependence because the majority of shrinks are unwilling to give up their morning cup of coffee and their sodas.
In a proper society of free men all vices are legal, including drugs, religion, gambling, alcohol, prostitution, homosexuality, etc. People have the right to choose their own vices and to avoid the ones which they do not like or find are problematic for them personally. We recognize that it is a great mental illness to impose one’s personal moral judgments on others rather than to respect their freedom to choose for themselves to engage in behaviors which do not harm others. This disease of Puritanical Busybodyism is what needs to be added to the new edition of the DSM.
Copyright © 2012, The HAMS Harm Reduction Network