Dominic Lawson: Addiction is a moral, not a medical, problem

Drug addiction should be treated by coercion, and appeals to morality and self-interest

Tuesday 06 February 2007 01:00 GMT

My name is Dominic Lawson and I am a food addict. My appearance gives some impression of the consequences; but as this is a confession, the hard truth must be faced. I weigh, when I last dared to look, more than 16 stone, although I am no more than average height. I understand the health consequences of this - made painfully obvious when I run to catch a train: it's at least another three stops before I'm able to catch my breath.

Despite this, I continue to eat well beyond the point at which hunger is sated. The reason is simple: I enjoy it. I adore the texture and flavour and appearance of food. When it isn't on a plate in front of me I enjoy thinking about it, or shopping for it. Work can make me forget about food, but when I am on holiday, it is a constant irritation to my wife - who does not share my obsession--that every day must be planned around which restaurant to go to. At home my bedside table is littered with copies of the Michelin guide for various countries--not the Green guides which tell you about their culture and art, but only the Red ones which give detailed descriptions of the best dishes of the greatest kitchens.

I could make various excuses for my calorific cravings. I could point out that I come from a long line of overfed males -indeed, family legend has it that my paternal great grandfather Gustav died because he was too corpulent to survive the surgeon's knife. I could argue that my mother's family business was the manufacture and distribution of food - surely there must have been a vocational element? None of this, however, should persuade anyone to sympathise. The plain truth is that in the matter of food, I lack self-control. I know what the adverse consequences are, but I choose, as a creature with free will, to endure them rather than to limit my immediate pleasure.

These thoughts have been stimulated by reading a book recently published in the US, Romancing Opiates: Pharmacological Lies and the Addiction Bureaucracy. Its author is a psychiatrist who writes under the pseudonym of Dr Theodore Dalrymple. Dr Dalrymple has worked for many years in the British prisons system, and has therefore deep experience of the causes, consequences and alleged cures of drug addiction, principally heroin.

It is a taboo-shattering, sacred cow-slaughtering, myth-destroying little gem of a book. In brief, Dr Dalrymple disputes the claim that drug addiction is an illness that can be cured by medical treatment. He argues that as its origins lie in frailties of character, it can only be "treated" by a mixture of coercion and appeals to morality and self-interest - rather as a parent brings up children. He points out that it is not at all easy - indeed, it requires considerable dedication--to become addicted to heroin, while the difficulty and duration of withdrawal has been exaggerated by fiction, both written and cinematic.

Most controversially of all, Dr Dalrymple contends that: "If there is a causative relationship between heroin addiction and crime, it is more that a propensity to crime causes addiction rather than the other way around." Dr Dalrymple is not relying on statistics for this observation; he conducted interviews with hundreds of the heroin addicts in the prisons where he has worked. His relatively small personal survey has been backed up by more detailed research in the United States.

The Final Report of the Joint Committee of the American Bar Association and the American Medical Association on Narcotic Drugs concluded, in respect of young males in Chicago and New York, that "it is inescapable that delinquency both preceded and followed addiction to heroin... there was little evidence of a consistent sequence from drug use without delinquency to drug use with delinquency."

This might seem peripheral to the issue of treatment, but it's absolutely crucial. The conventional treatment in this country is to give heroin users the substitute known as methadone. It is argued that if the state gives them what they crave, in a monitored and aseptic fashion, then many of the social problems will be eradicated.

Dalrymple insists that what this produces is merely state-funded drug addiction, with little reduction in delinquent behaviour. Or, to quote directly from the impassioned introduction to his book: "Every day I saw addicts who abused their prescription drugs from the clinics set up to help them, who sold them to third parties or who continued to take heroin in spite of and in addition to these prescription drugs; who despite their so-called treatment, continued to commit crimes and who manipulated their supposed helpers in a shameless fashion... above all I observed close up the triviality of withdrawal symptoms from opiates."

As a medical essayist Dr Dalrymple has gained a reputation as a ruthlessly unsentimental observer of humanity. Sentimentality, as we all know, is the parade of emotion where little or none exists. Dr Dalrymple, as he makes clear, was driven close to a nervous breakdown as he became increasingly aware that his own observations ran directly counter to conventional wisdom as it was practised in the hospitals where he also worked:

"There was a strenuous, almost outraged rejection of the idea that addiction was, at bottom, a moral problem, or even that it raised any moral questions... There is nothing more destructive of the human psyche than to be forced to doubt the veracity of what one's own elementary observations demonstrate, simply because they conflict with a prevailing and unassailable orthodoxy. One is forced to choose between considering oneself as deluded, or the world as mad."

Dalrymple's book, despite being solely about drug treatment in this country, has not been published in the UK. It has been decided that he, and not the medical establishment, is deluded.

Yesterday I discussed his book with a friend who has recovered from more addictions than it is possible to describe in a single sentence. She agreed with Dalrymple's basic argument that addiction was fundamentally a spiritual, rather than a medical, condition. Like millions of others, she had recovered through the "12 steps" method first laid out by Alcoholics Anonymous, which is used by Narcotics Anonymous, and by Food Addicts Anonymous. Spiritual self-help would, perhaps, be the pithiest way of summing up that most successful of all "treatments" for addiction.

This friend was not exactly encouraging about my own weakness; she said of all her addictions she had found food the most difficult to shake off - partly because eating is the most socially acceptable and unavoidable of pleasures. At least I have learned something important about gluttony from Dr Dalrymple: I'd be mad to see a doctor about it.

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