https://www.psychologytoday.com/articles/200405/the-surprisi...
The reason that addiction treatment programs find it so hard to treat 'addicts' is that they're dealing with the small subset of people who, for one reason or another, can't quit on their own. It's sort of the opposite of survivorship bias.
You can say addicts are irreversibly damaged, but there is little excuse for the authorities to sit idle while new people become addicted.
If the aim is to reduce harm to addicts, and the people around addicts, and the victims of crime perpetrated by addicts then authorities need to start treating addiction as a public health problem, with support from criminal justice around acquisitive crime.
Treating addiction as a criminal justice problem clearly, unambiguously, does not work.
In other places it has for example opiate use in China is 5x less than in the US.
Seems like there are many reasons why that might be true.
What I find irritating about these scientists crusading for "real science" and denouncing AA is that not a one of them would have the first clue how to get through to this type of alcoholic personality. All their ivory tower rhetoric just washes right off their back.
What I'm saying is AA is uniquely suited to this personality type in a way that no other program is.
However I've started to come to think of addiction notice a disease onto itself, but as a symptom of some other underlying "dis-ease", clinical or otherwise.
If anything, the debate over whether addiction is a disease underscores the fact that the people having the debate have a very narrow definition of "disease". If addiction isn't disease, then what is it?
One could argue, all that means is that "it" is addiction that one can't manage on one's own.
Emotions are not super well understood, and I think they are at the root of addiction. If you are chronically unhappy, drugs let you feel good. You start feeling better because of the drugs, and lose the ability to respond to negative emotion in a healthy way. Healthy emotional balance lets people make good choices and fix bad problems. Being chronically unhappy - perhaps as a result of unresolved mental injury - will hamper a persons ability to make good choices, just like being keep in darkness for a log time will make your eyes way too sensitive to handle normal light.
Show me someone who is addicted to drugs, and I'll show you someone who is unhappy about something other than the drugs. The addiction just makes the underlying problem worse.
If you can learn to fix the underlying problem, then fixing the addiction itself is much easier.
Once you are knee deep in drugs, your life becomes awful which gives you more reason to keep using the drugs. It's like a local minimum, or an AI that learns to manipulate it's model of the world, because that's easier than manipulating the world itself.
I suspect that actually curing addiction, or many other mental diseases, will require not just changes within, but also changes externally.
The sooner society can rid it's self of the blame culture, and adopt the more pragmatic 'solve the problems' culture, the better.