Sunday, July 7, 2013


What if...addiction isn't really a 'disease'?

Almost 26 years ago, on July 18, 1987, I made the decision to stop my addiction and begin my recovery in earnest.


I started by going to daily meetings of both Narcotics Anonymous and Alcoholics Anonymous—sometimes three meetings a day, when I was feeling particularly at-risk for relapse. From there, I gravitated into the rooms of Al-Anon, Adult Children of Alcoholics (ACOA), and Codependents Anonymous (Coda) in order to develop a deeper understanding of where my addiction began. Although I consistently struggled with feelings of not fitting in—one of the stories of my life—there was definitely something comforting about being in a room full of people who were experiencing many of the same problems as I was—and choosing the same format of recovery.

At the time, I’d had Crohn’s Disease for 14 years, having been initially diagnosed in 1973. After taking addictive medications prescribed to me by physicians for all that time—as well as some other mind-altering substances that I self-prescribed—I found myself at a massive, suicidal bottom. Those 12-Step meetings quite literally saved my life.

I think I stopped going to meetings somewhere around my 10th year of recovery. It wasn’t so much that I felt I didn’t need a program of recovery anymore—although by that time, I was quite solid in my choice to continue living the new and improved life I’d been creating for myself. I knew that if I ever felt like I needed a 12-Step meeting, I’d go to one. The same is true for me today.


In those early days, I tried to go along with everything I heard in the meetings because I really, deeply wanted to recover. But I have to admit I had trouble with some of it. The concept I had the most problem with was the notion that addiction is a disease just like other medical diseases.
The most recent argument in favor of this comes from the understanding that there is brain involvement in addiction. As captivating and useful as much of this current research is, I know that there is also brain involvement when I lift my little pinky—there is brain involvement in everything we do, that’s how we’re wired.  For me, this is not a particularly compelling argument for addiction being included in the medical model.

I have a medical illness. I can’t just say, “Gee, I think I won’t have Crohn’s Disease anymore.” Neither can someone who has cancer or diabetes or any illness like that. But we can do exactly that with addiction—and millions of recovering addicts the world over are proof of this. Addiction can be arrested and recovery is then possible.

Of course, it’s not that easy—invariably there is some difficult, uncomfortable inner work required in the process. However, in my own experience, as well as the experience of so many of my clients, going inward in this way often creates an amazing personal journey that leads directly into a much better life.
The brain studies that show how our ‘reward’ or ‘pleasure’ centers in the brain light up when we ingest something we enjoy are fascinating—and important. These centers in our brains also light up when we involve ourselves in behaviors that somehow take hold of us, such as gambling or smoking or excessive shopping. Unfortunately, many of the scientists who do these studies also tell us that because we can become biologically addicted to the pleasure we receive from these behaviors, it means we have a brain disease—with the tacit implication that we therefore have no choice but to continue.

Or at least that’s what most practicing addicts would have us believe. They do this so that they can claim they are victims to their addictions and “can’t” make a different decision about what they are—voluntarily—doing to their lives.

I use the word ‘voluntarily’ with intention, because we all know that although there may well be substances and behaviors that arouse our brain’s pleasure centers, any of us can stop whenever we ultimately make the decision to stop. If that were not the case, millions of people from 12-Step and other recovery programs would still be actively using their addiction. But they aren’t—because they have chosen not to. I have the same pleasure centers in my brain, but I’m clean and sober today because I choose to be.


For a long time, I thought I was the only one who thought that perhaps addiction was more of a choice than a disease. But as time went on, I began to receive feedback from clients who told me that they too saw addiction as a choice, not as a physical illness—and that they felt relieved to know that I saw it that way too. I was amazed that there were, indeed, others who felt the same about this as I do, and that many of them were consciously choosing me to work with when looking for an Addictions Therapist.
Imagine my surprise when I even began to find published literature that contradicted the steadfastly-held belief that addiction is a medical brain disease. What I discovered was what I already believed to be true: whatever else addiction may or may not be—a biological compulsion, a result of genetic predisposition, perhaps a pursuit learned in one’s family of origin—regardless of any of that, whether or not to use an addictive behavior is a choice.

My colleague Andrew Feldmar, renowned Vancouver, BC psychologist, summed it up beautifully:
A lot of responsibility is shirked by pretending—and other people making money from pretending—that what addicts suffer from is an illness rather than an existential choice. One cannot be NOT-free—as human beings, we are condemned to freedom. The flaw is that the helpers pretend they have choice and that the helped do not. But we are all in the same boat, there is only ‘us’—and we all have free choice.”


It is true that some people don’t end up recovering from addiction—and some of them use the ‘disease’ excuse to sidetrack themselves. “I have a disease,” they claim, “I can’t help it.”
Yes, you can help it—of course you can ‘help it’—but only if you choose to. When I discovered that I was an addict, I was actually relieved. I’d had no clue about what was going on with me, but I knew that the consequences I was struggling with had, over time, become progressively worse. Once I understood why I was doing what I was doing and how my negative choices were sabotaging my life, I also understood that I could change this way of living. At that point I was ready to be done with the miserable and dire consequences my addictions were causing.

I don’t believe that any of us start out using alcohol, drugs, or other behaviors in order to become addicts. We don’t go and sign up for Addiction 101. In fact, just the opposite is true in most cases: we think that this will never happen to us. Even if it happens to the other guy, we like to believe that we’re different, we can handle it. Our incredible capacity for denial tells us that we can continuously use mind-altering substances—or gamble or smoke or binge and purge, spend more than we have, or become glued to our computer screens—safely. And it often takes a while before we realize, beyond a doubt, that we have crossed that line into addiction. Although we did not intentionally set out to get ourselves addicted, we are still 100% responsible for what we are going to do about the fact that we have, indeed, become entrenched in addiction.

Of course, one of the roadblocks that can prevent addicts from making the decision to stop the addictive behaviors is the lack of caring. People who have been struggling with addiction for a while can lose their desire to care about their own lives, and sometimes feel that their loved ones have also stopped caring about them. They begin to wonder why they should even bother trying to make things better, finding it easier to convince themselves that they are powerless to change their lives. We have to dare to care, which requires effort, courage, and faith. Encouragement is often a vitally important part of the change process—and this is where self-help groups, family and friends, doctors, therapists, and other healers can play an integral role. If you or someone you know needs this kind of encouragement, please don’t hesitate to either give it or to reach out for it.

Ultimately, it makes no difference whether the addiction is to TV, heroin, or chocolate—there are any number addictive behaviors at our disposal. We all choose to hide from reality sometimes; that is human nature. The problematic behavior only becomes an addiction when it begins to interfere with our lives. This is what distinguishes a habit from an addictive behavior.

It’s important to remember that anyone can be a candidate for addiction, even people who have been actively in recovery for a period of time. As soon as addicts in recovery decide they are no longer going to handle life in healthy ways, off they go into that netherland of the infamous ‘slip’, which in actuality stands for “Sobriety Loses Its Priority.” Once people decide that sobriety from addiction is no longer a priority in their lives, they relapse and start to use again.

How can that be anything less than a choice?

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