Addiction as Disability

Case Study


I remember relaxing in my apartment one November evening, watching some mindless television while my brother was supposed to be at choir practice, and at a commercial break, hearing his key fumbling in the lock longer than normal. Eventually the door opened, and he walked over to where I was sitting on the couch. His eyelids kept involuntarily drooping, and he seemed oddly giggly. My brother sat with me for a little bit while I watched the show playing on the television, but I wasn’t watching what was on the T.V., I was watching him. He must’ve felt my eyes on him or something, because he stood up, grabbed an apple from the fridge and headed downstairs.

I knew something was up. I called one of his friends from choir and asked him if my brother had come to practice tonight. He said that you didn’t show up; my brother had told him he was sick. I hung up the phone, composed myself, and headed downstairs. I found my brother sitting in his closet, half-reading a newspaper in his lap and half-sleeping with a half-eaten apple loosely gripped in his hand. I was kind. I told him that he looked tired and asked if he wanted to get into bed. He mumbled some sort of response in the negative. I asked him if he went to choir practice. He said yes. I asked how it went. My brother explained that the choir was trying to decide on a set list for their upcoming concert. I walked out of his room, climbed back up the stairs, and tried to decide what my step would be.

I don’t know how long I was upstairs, mulling over my choices, but eventually I went back downstairs to my brother in his closet. I found him asleep with his chin to his chest, and his hand still loosely holding the half-eaten apple. Again, I was gentle when I asked if he wanted to go to bed. He still didn’t want to, but this time, I was a little more forceful and got him to agree. My brother asked me to step out of the closet for a moment, and I heard him emptying his pockets from behind the door. He opened the door and I helped him over to the bed. I helped him get out of his clothes and tucked him into bed.

My brother wasn’t exactly aware of his surroundings, so he probably didn’t even see me go back into his closet to investigate what he had emptied from his pockets. I picked up his backpack, and poured its contents on the countertop. Out came a small saran-wrapped package of probably around thirty small yellow pills: Clonazepam. Out came a small piece of black trash bag wrapped around a rectangle of a tar-like substance: Heroin. And to my surprise, out came a store-bought package of syringes. I called my Mom. She said that my Dad was on his way. I sat on the floor of my brother’s bathroom and stared at the ceiling for the forty minutes it took my Dad to arrive at the apartment.

I went upstairs and greeted my Dad at the door; he gave me a hug, and then followed me downstairs. When he first saw our Dad, I’m pretty sure my brother thought he was a figment of his imagination, or an effect of the high that he was riding. Either way, he looked as if he had seen a ghost. The moment my brother realized that our father was actually standing in front of his bed, he jumped out from under the sheets. The moment my brother heard our Dad say that he was taking him home, he ran at him. My brother screamed, punched, wrestled with our father on the floor as he tried to hold my brother down. It took my brother a while to calm down, but when he did, we went upstairs to ready him for the trip back home.

As my brother put on his coat, he asked me what I had done with the drugs. I said I flushed them. He screamed, punched, and strangled me against the wall. Before my Dad could get to him, he released his grip on me and ran out of the apartment. I went out onto the balcony, closed my eyes, and rested my head on the cold railing. I listened to my breathing for a moment, let my heart-rate slow, and lifted my head from the railing. As I wiped blood from the corner of my mouth, I caught a glimpse of my brother standing on a railing on the highest floor of the adjacent building. I screamed his name and yelled for him not to jump. Dad followed me out of the apartment. This wasn’t my brother’s first suicide attempt. They weren’t really suicide attempts, just more cries for attention; in all of these instances, he never intended to end his life. But how were we to know whether or not he meant it this time?

He stayed up there for a long time, as the bitter wind blew through all of us, but eventually we talked him down, and he left for home with our father. He was gone for two months this time. When he came back, he knew he had betrayed my trust; he said it was the last time.

My father once said that having a child with an addiction is like having a child with a disability, only you can’t tell anyone about it. My brother is a recovering heroin addict, and my experience with him has prompted many questions dealing with concepts such as responsibility, rationality, and distortion. Over the past couple of years, my parents and I have dealt with the repercussions that my brother’s addiction has had on the family; we have discussed various treatment options and gone through periods of logicality as well as emotional distress whilst trying to get my brother the help he needed. In my experience with my brother and his addiction, the matters that I have witnessed and how these incidents affected me could be compared to that of someone who witnesses a person who suffers from a disease. This being said, looking at addiction as if it were a disability might be an effective way for family and friends of addicts to understand, accept, and help the addict’s plight.

The subject of addiction as disability has been debated over the years, but has become a hot topic most recently since the enactment of the Rehabilitation Act of 1973 as well as the Americans with Disability Act (ADA) of 1990. Stated in section three of the ADA, an individual has a “disability” if he or she: (1) has a physical or mental impairment that substantially limits a major life activity (major life activities include personal care tasks, speaking, breathing, thinking, learning, working, manual tasks, walking, seeing, and hearing) of the individual; (2) has a record of such impairment; or (3) is regarded as having such an impairment. It is by relating addiction to this definition that has brought about the controversy as to whether or not addiction can be defined as a disability. Section 504 of the Rehabilitation Act further provokes this controversy by claiming addiction as handicap and protecting addicts – like other handicapped individuals –when an employer discriminates because of the handicap.

In this case study, I examine the various ways that addiction has been framed as a disability to determine the advantages of such a framing. I study primarily case law, studies of philosophy, psychiatry, and psychology and use these to extract meaning from my own experience with addiction and with framing addiction as a disability. Ultimately, I believe this study will illustrate that putting addiction in terms of disability helps the family and friends of an addict empathize with their loved one and better understand the burden of being addicted.

In the evaluation of case law, there are two prominent cases with opposing outcomes that should be considered: Davis v. Bucher and Raytheon Co. v. Hernandez. In the case of Davis v. Bucher, Woolworth Davis, Salvatore D'Elia, and Herbert Sims Jr. claimed they were denied employment solely on the basis of former drug use, without regard to their qualifications, present rehabilitative status or the nature of the job for which they had applied. The federal district court to which they had brought their claim decided that Philadelphia’s policy of rejecting all job applicants with a history of drug abuse violated section 504 of the Rehabilitation Act of 1973. The court also held that individuals with history of drug abuse, including current members of rehabilitation programs, were handicapped within the sense of the Rehabilitation Act.

In the case of Raytheon Co. v. Hernandez, Joel Hernandez worked for Raytheon for almost twenty-five years when in 1991, he took a drug test which came back positive for cocaine. Instead of firing him, Raytheon allowed Hernandez to voluntarily resign. In 1994, Hernandez reapplied for his old position but was deemed unfit for rehire. Hernandez filed a suit against Raytheon, claiming that Raytheon discriminated against him by not rehiring him because of his record of drug abuse. In this case, the Supreme Court was asked to decide whether the ADA grants special rehire rights on disabled employees lawfully fired for breaching workplace conduct rules. The court ruled in favor of Raytheon, holding that Hernandez failed to establish a prima facie case of discrimination and even if he did, he failed to show that Raytheon’s non-discriminatory no re-hire policy was an alleged reason for discrimination.

Taking these two cases into account, it is difficult to establish what knowledge is to be gained from both of the different rulings. On one hand, the court of Davis v. Bucher emphasized the need to make some allowance for rehabilitative failure so that addicts have a reasonable opportunity to overcome their addictions. On the other hand, the court of Raytheon Co. v. Hernandez highlighted that it is common sense to expect an individual who makes a choice to accept the consequences of that choice. The legal framing of addition as disability is and will probably remain highly contested, but that’s not the point I would like to focus on; the addict knows what he is doing and chooses to do it, but as family members, as friends, we want to say that he is not in control of his behavior, and it is in this dilemma that framing addiction as disability that society can benefit from.

I remember studying so hard for my Roman History mid-term one October night, waking up the next morning, and in the midst of putting on my make-up hearing the most disturbing groans coming from my brother’s room. I slowly treaded down the hallway, paused right outside his closed door, and listened once again to the strange howling noises he were making. He called my name. Again, he called my name, louder this time. I carefully opened the door to the sight of him rocking violently back and forth on his bed.

He was pale, covered in sweat, and he begged me for some of his Suboxone. He told me that he had already taken sixty dollars out of my account and was planning on taking out more when he drove down to Denver in a friend’s borrowed car to buy some heroin. But withdrawal symptoms were getting the best of him. He pulled my ATM card and his friend’s car keys out of his pocket and handed them to me. I called Mom. She told me to give him his medicine, and that she and Dad would be on their way to the apartment. I gave him his medicine, and sat with him while he dry retched over the toilet time and time again. I rubbed his back and told him everything would be okay while I missed my mid-term exam.

Mom and Dad arrived at the apartment after forty minutes and took him home. He was gone for only three days this time. When he came back, he sat me down, and told me that he would never betray my trust again. He said it was the last time.

An article by Bennett Foddy and Julian Savulescu makes the claim that addiction is neither a disease nor a lack of willpower, but rather, it is a “strong appetite” for a gratifying behavior that supplies the addict with pleasure. Foddy and Savulescu provide an anecdote to support their assertion: “A heroin user, once wealthy enough to buy drugs in a clandestine, safe manner, finally runs out of both money and heroin. She is not any less addicted than before, but she must devise new methods to obtain the heroin. This is not a habitual process; it is not muscle memory. It is not even much like a person with an impulse control disorder, who might overindulge if a bowl of peanuts is left too close to hand. Rather, it is goal-directed problem solving. The heroin user's problem, if she has one, is not that she has frontal damage (although she may). Her problem is that she has a strong, recurrent, appetitive desire for heroin.” It is from this argument that I remember my brother saying multiple times it was the last time and recall the numerous times that my brother lied for various reasons in regard to his drug use; it was his “appetite” for heroin that compelled him to lie to me and my parents. I can also understand and accept Foddy and Savulescu’s point through my previous story of when my brother went through withdrawal. Having run out of his own money, his strong “appetite” for heroin drove him to steal my money in order to obtain the heroin; but it is in his choice, although driven by withdrawal symptoms, to tell me about what he had done wrong that complicates my understanding of his decisions and leads me to questions of responsibility.

A study by Michael Louis Corrado further inspects this idea of responsibility and addiction by approaching the subject of addiction in three different ways. The first is what he calls “rational addiction”, in which addictive behavior is like any other kind of behavior; an addict would relinquish his addictive behavior if it would benefit him to do so. The second is what he calls “addiction as duress”, in which the addict maintains addictive behavior in order to evade withdrawal symptoms. Both of these approaches on addiction come from ideas of rationality. In the first, the addict is “rationally pursuing an increase in pleasure”, while in the second he is “rationally avoiding pain”. This idea of rationality makes sense to me, as I know that my brother is an incredibly intelligent, rational person; for his addiction to be placed in terms of rationality, I can in some way understand his choices as an addict even if I don’t agree with them and view them as bad decisions. Corrado’s third approach on addiction is what he calls addiction as distortion, in which the addict may be entitled to an excuse for his behavior because the addict’s relationship to reality is distorted. These three ideas of addiction taken into account, Corrado also presents the idea of addiction as “defect of will”, in which though the addict knows the action the action he ought to take, he cannot follow course; “he could make the choice, but it would be unreasonably difficult for him to do so”. Corrado’s concepts regarding responsibility and addiction help us to understand the addict’s behavior and humanize the addict himself.

Taking all of this information into consideration, it is evident that both sides to the debate of addiction as disability have valid points, and that there isn’t a clear answer as to whether or not addiction is indeed a disability. However, I purposefully end my examination of the subject with Corrado’s study in order to provide us with a way to understand the burden of the addict. It is here that I must again recall my father saying that having a child with an addiction is like having a child with a disability, only you can’t tell anyone about it. With regard to the sentiment that “you can’t tell anyone about it”, public attitudes toward addiction range from fear and loathing to pity and condescension; I believe that this is due to a public lack of understanding when it comes to addiction. By analyzing addiction in terms of disability, an outlet for knowledge and acceptance is created; the addict is humanized and his burden (and the burden of those close to him) is realized.


Video





This video provides a first-hand look at an addict, and the double life that she leads.Viewing this video might help the public understand and accept the struggle of the addict, especially since it is such a young girl.

















This video reveals the life and outlook of heroin addicts. They share a belief that there is no way out, that heroin use is not recreational, but a part of their lives that has consumed their former lives before heroin.
















This video is a trailer for the movie Pleasure Unwoven, in which Dr. Kevin McCauley
advocates for addiction as disability by educating the viewer about the Disease Model
of Addiction. McCauley's idea is that "if addiction is a proven to meet the criteria of
other treatable medical conditions like diabetes or a broken leg, then instead of putting
alcoholics and addicts in jail, we should put them in treatment".








Sources


Corrado, Michael Louis. "Addiction and Responsibility: An Introduction." SpringerLink. N.p., 1999.

Foddy, Bennett, and Julian Savulescu. "Relating Addiction to Disease, Disability, Autonomy, and the Good Life." Project Muse. N.p., 2010.

Henderson, Reese John, Jr. "Addiction As Disability: The Protection of Alcoholics and Drug Addicts Under the Americans with Disabilities Act of 1990."
HeinOnline. N.p., 1991.

Ward, Timothy P. "Needing a Fix: Congress Should Amend the Americans with Disabilities Act of 1990 to Remove a Record of Addiction as a Protected
Disability." HeinOnline. N.p., 2004-2005.

Wasserman, Dr. David. "Addiction and Disability: Moral and Policy Issues." Informa Healthcare. 2004.