Blowing Smoke

Clinical psychiatrist Reznicek is calling for a "tectonic shift" in the way the nation, from individuals to the government, deals with drug addiction. Noting the failure of the war on drugs and the apparent ineffectiveness of rehabilitation, Reznicek debunks the notion that addiction is a disease. Drawing on research, 20 years in psychiatry, and his own struggle with substance abuse, he asserts that the "disease model" is dysfunctional, excusing behavior and providing assistance and benefits to abusers, including health care, disability payments, and other subsidies. He sees a false dichotomy that portrays the disease model as compassionate and any rejection of that model as mean-spirited. He begins by exploring the historical perspective on addiction from the temperance movement to eugenics to the current disease model. He goes on to examine the science behind the disease model, arguing that rehab treatment is "akin to ideological indoctrination" into the model itself. Reznicek concludes by advocating for legalization of drugs, with harsh social consequence for addicts, and offers recommendations of how addicts can break their habits. A controversial but fascinating look at the causes and treatment of addiction.

Critiquing the current disease model for diagnosis and treatment of substance abuse, Reznicek (psychiatrist and longtime critic of this model) reviews the history, and function in various contexts, of use of alcohol and other drugs. He analyzes trends that led to the prohibition movement and conceptualization of drug abuse as a mental-health problem recognized by the medical and psychiatric fields (and legitimized by neuroimagery and classification of chronic alcohol/substance abusers as eligible for Social Security Disability benefits). Reznicek also discusses recent research and government approaches to control that have resulted in large-scale incarceration with little to show by way of rehabilitation. He argues for strong involvement of all family members--families can successfully curb or prevent a relative's substance abuse--and advocates clear consequences and rewards, including regular urinalysis for adolescents (urinalysis seen in this context as preventive, not punitive). Reznicek's call for family involvement echoes the work of respected family therapists, who have largely abandoned the rehabilitation model and the flawed insurance-reimbursement system. Many practitioners will find his critiques controversial, but Reznicek offers an important, cogent summary of the difficulties society faces in an era of medicalized, criminalized, yet pervasive substance abuse. His call for a paradigm change is a provocative challenge. Summing Up: Highly recommended.

Drawing on his experience as a psychiatrist dealing with substance abusers, Michael Reznicek dares to question the medical profession's claim to special expertise in this area. He cogently explains how the disease model of addiction and the medicalization of drug use undermine freedom and responsibility, reinforcing the disastrous prohibition of politically incorrect intoxicants.

Many critics of the war on drugs advocate a "public health" approach to substance abuse that emphasizes "treatment" for the "disease" of addiction. In Blowing Smoke, Michael Reznicek shows how such language reinforces the logic of drug prohibition by implying that people cannot help themselves. Drawing on his experience as a psychiatrist, Reznicek dares to question the medical profession's claim to special expertise in this area. He highlights the weak scientific basis for the government-endorsed understanding of drug addiction, cogently explained how the disease model undermines freedom and responsibility. Instead he recommends viewing addiction as a bad habit that can be curbed with right social and economic incentives, which for the most part means getting government out of the way so that it neither makes drug use more dangerous than it would otherwise be nor insulates addicts from the consequences of their choices.