Here's the follow up to the article:
The big problem with 'addiction is a disease'
In Saturday’s Post our Joseph Brean discussed a labour arbitrator’s ruling that the municipality of Waterloo will have to rehire a drug-addicted nurse who stole narcotics and falsified medical records. If you read Joe’s piece, you’ll remember it. The crux of this ruling was that the municipality, as an employer, has a duty to accommodate the wayward nurse’s disease of drug addiction. It was discriminatory to fire her, it turned out, just because she had betrayed the most fundamental and explicit obligations of her profession. The theft and the faked paperwork were symptoms, and ought to have been treated as such.
A labour arbitrator is not the same thing as a judge, nor is he like the panel in a human rights tribunal. His job is to enforce the terms of a written work contract: he does not make general rules for all of us. So in that limited sense, this news story is not of any wider interest. The nurse’s plea in the hearing may not be available to anyone else. (Especially, one suspects, after management makes its decision on whether to use that arbitrator again.)
It was discriminatory to fire her, it turned out
But we naturally read the story as an example of trying to apply the notion of addiction as a disease to a real-life decision. Because we all know, deep down, that this concept is a tricky one.
Waterloo Region recruited experts who are willing to insist, against the weight of medical dogma and popular culture, that addiction is not a disease. Their take is that it is, rather, a feature of personality reinforced in our biological hardwiring by the power of habit. This was bound to be an uphill fight, although the minority view seems to me to have flourished somewhat in dark corners of medicine in the past couple of decades.
Experts for the conventional side of the argument insisted in the hearing that “to view addictions as bad habits stigmatizes these conditions and makes it harder for people to get help.” This would seem to settle the question, unless you notice that it is an essentially social assertion. It amounts to saying not that addiction is a disease in some objective sense, the way typhus is, but that it is just more convenient, or perhaps polite, to treat it like a disease.
My colleague Brean observes, even as he and the experts are emphasizing the social reasons to regard addiction as a disease, that there are also good nonsocial ones: he asserts that the idea “is more than just a sympathetic metaphor that reflects a desire to help rather than judge.” (Oh no! Not that!) For one thing, we know addiction is inherited — not just handed down within families, but truly passed along in the DNA. The problem there is that pretty much every measurable feature of the human personality, from IQ to introversion to food preferences, is inherited in precisely the same sense. Cheap gene sequencing has shown us that voting tendencies are inherited: which ones, I wonder, might count as diseases?
Addiction, Brean adds, “can respond to systematic, biological, medical treatment, just like cancer or the flu.” But surely the whole issue with addiction is that there is, in fact, no pill for it. There are chemical devices that can help by diminishing the pleasant neurological effects of the harmful habit, but they never seem to make much permanent headway in medical practice despite everyone’s understanding that addiction is a disease. And no one ever administers them without large helpings of therapy and “support.” This is, for some reason, not required with Tamiflu.
The whole issue with addiction is that there is, in fact, no pill for it
Since everything about us is ultimately physiological, maybe it is the social criterion that really decides this issue: maybe addiction is really a disease because we have decided that it is, and that’s all. But this leaves us with an obvious gap in the labour arbitrator’s reasoning. Not all nurses who are genuinely addicted to Dilaudid are necessarily going to steal it or forge requisitions for it.
If addiction is a disease, and if these ostensibly unethical behaviours really are just disease symptoms, I have some bad news about the hopes for “destigmatization” and social acceptance that the advocates of the disease model express: they are worse than futile. If addiction is merely a powerful, biologically ingrained habit, anyone might choose to hire, or associate with, or assist someone who has it — perhaps on the basis of the patient’s own assurances that they are fighting to be well. If addicts just have a disease that foreordains that they will steal from you and lie to you, well, that’s very different, isn’t it?
https://nationalpost.com/opinion/colby-cosh-the-big-problem-with-addiction-is-a-disease
The big problem with 'addiction is a disease'
In Saturday’s Post our Joseph Brean discussed a labour arbitrator’s ruling that the municipality of Waterloo will have to rehire a drug-addicted nurse who stole narcotics and falsified medical records. If you read Joe’s piece, you’ll remember it. The crux of this ruling was that the municipality, as an employer, has a duty to accommodate the wayward nurse’s disease of drug addiction. It was discriminatory to fire her, it turned out, just because she had betrayed the most fundamental and explicit obligations of her profession. The theft and the faked paperwork were symptoms, and ought to have been treated as such.
A labour arbitrator is not the same thing as a judge, nor is he like the panel in a human rights tribunal. His job is to enforce the terms of a written work contract: he does not make general rules for all of us. So in that limited sense, this news story is not of any wider interest. The nurse’s plea in the hearing may not be available to anyone else. (Especially, one suspects, after management makes its decision on whether to use that arbitrator again.)
It was discriminatory to fire her, it turned out
But we naturally read the story as an example of trying to apply the notion of addiction as a disease to a real-life decision. Because we all know, deep down, that this concept is a tricky one.
Waterloo Region recruited experts who are willing to insist, against the weight of medical dogma and popular culture, that addiction is not a disease. Their take is that it is, rather, a feature of personality reinforced in our biological hardwiring by the power of habit. This was bound to be an uphill fight, although the minority view seems to me to have flourished somewhat in dark corners of medicine in the past couple of decades.
Experts for the conventional side of the argument insisted in the hearing that “to view addictions as bad habits stigmatizes these conditions and makes it harder for people to get help.” This would seem to settle the question, unless you notice that it is an essentially social assertion. It amounts to saying not that addiction is a disease in some objective sense, the way typhus is, but that it is just more convenient, or perhaps polite, to treat it like a disease.
My colleague Brean observes, even as he and the experts are emphasizing the social reasons to regard addiction as a disease, that there are also good nonsocial ones: he asserts that the idea “is more than just a sympathetic metaphor that reflects a desire to help rather than judge.” (Oh no! Not that!) For one thing, we know addiction is inherited — not just handed down within families, but truly passed along in the DNA. The problem there is that pretty much every measurable feature of the human personality, from IQ to introversion to food preferences, is inherited in precisely the same sense. Cheap gene sequencing has shown us that voting tendencies are inherited: which ones, I wonder, might count as diseases?
Addiction, Brean adds, “can respond to systematic, biological, medical treatment, just like cancer or the flu.” But surely the whole issue with addiction is that there is, in fact, no pill for it. There are chemical devices that can help by diminishing the pleasant neurological effects of the harmful habit, but they never seem to make much permanent headway in medical practice despite everyone’s understanding that addiction is a disease. And no one ever administers them without large helpings of therapy and “support.” This is, for some reason, not required with Tamiflu.
The whole issue with addiction is that there is, in fact, no pill for it
Since everything about us is ultimately physiological, maybe it is the social criterion that really decides this issue: maybe addiction is really a disease because we have decided that it is, and that’s all. But this leaves us with an obvious gap in the labour arbitrator’s reasoning. Not all nurses who are genuinely addicted to Dilaudid are necessarily going to steal it or forge requisitions for it.
If addiction is a disease, and if these ostensibly unethical behaviours really are just disease symptoms, I have some bad news about the hopes for “destigmatization” and social acceptance that the advocates of the disease model express: they are worse than futile. If addiction is merely a powerful, biologically ingrained habit, anyone might choose to hire, or associate with, or assist someone who has it — perhaps on the basis of the patient’s own assurances that they are fighting to be well. If addicts just have a disease that foreordains that they will steal from you and lie to you, well, that’s very different, isn’t it?
https://nationalpost.com/opinion/colby-cosh-the-big-problem-with-addiction-is-a-disease
