My response to a discussion group on "Is Addiction a Disorder of Choice," being discussed on the "Linkedin Addictions Professional Group.

I have not read in these comments (please inform me if I have missed them) the role that co-occurring disorders may play in relapse (self-medication). In Gene Heyman's book, "Addiction: A Disorder of Choice," the research implies that those with multiple relapses more often than not, have a co-occurring disorder also present. Try telling a person with Bipolar Disorder off his meds; that has been awake for three or four days; has attended six meetings to, "just go to another meeting." I realize having worked in this field for nineteen plus years now that a clinician has to be cognizant of "substance induced mood disorder." However, if there is documentation of substantial sober time where "symptoms" of other mental health issues are present, all the twelve step meetings in the world are not going to insure sobriety. I am not twelve step bashing, actually the meetings can still be the main modality with other treatment for the co-occurring disorder. I find that twelve step meetings such as DRA and DBSA meetings can be even more beneficial then traditional twelve step for those with substance abuse and co-occurring disorders. Again, the key is recognizing the co-occurring disorder in the first place.
As far as brain imaging goes, is the imaging the result of sustained use of a particular drug? Would this be the resultant imaging for anyone with continued use? The imaging is interesting, but how does it assist me in helping the client to help themselves to maintain sobriety? It really doesn't. Interesting, but useless from a counseling/therapist aspect.
Disease or not, the issues remain the same to be dealt with.
By William R. Drinkwater, M.Ed, LADC-I, CADAC-II - Adjunct Professor UMASS-Boston/Cambridge College