Addiction: Disease or Habit?


I chanced upon this article, Addiction is Not a Disease, by Laura Miller in Salon.  It describes how addiction used to be considered a moral failing, then was reconsidered as a disease with the rise of 12 step programs, and now neuroscientists are thinking it’s more of an extreme habit.

Miller bases her article on the book Biology of Desire by Marc Lewis, a neuroscientist who is a former addict himself.  He posits that addicts have a “particular ‘emotional wound’ the substance helped them handle, but once they started using it, the habit itself eventually became self-perpetuating and in most cases ultimately served to deepen the wound.”

The disease model has been supported by the fact that addicts’ brains are different.

“The changes wrought by addiction are not, however, permanent, and while they are dangerous, they’re not abnormal. Through a combination of a difficult emotional history, bad luck and the ordinary operations of the brain itself, an addict is someone whose brain has been transformed ….

“More and more experiences and activities get looped into the addiction experience and trigger cravings and expectations like the bells that made Pavlov’s dogs salivate, from the walk home past a favorite bar to the rituals of shooting up. The world becomes a host of signs all pointing you in the same direction and activating powerful unconscious urges to follow them. At a certain point, the addictive behavior becomes compulsive, seemingly as irresistibly automatic as a reflex. You may not even want the drug anymore, but you’ve forgotten how to do anything else besides seek it out and take it.”

The good news is that habits can be unlearned.  AA and NA and other 12 step groups do work for a lot of people.  Others may need cognitive behavioral therapy, or meditation, or something else, or all of these things.  It’s kind of like how I fought long-term depression by trying everything, until something broke through.

I’m all for understanding the causes of things, in case that knowledge points to new solutions.  I’m also big on measuring success to discover what works.  This article in Scientific American basically concludes “we don’t know” whether AA works because (in my lay language) it’s too loosey goosey to study with the gold standard of the randomized clinical trial.  It works for some people and not for others, and there are probably as many reasons for both outcomes as there are members.

On a long drive a few evenings after reading the article about how addiction is not a disease, I caught this one-hour podcast about the history of Alcoholics Anonymous.  I knew most of the story already, how two chronic inebriates, Dr. Bob and Bill W., found each other and developed the AA program based on something called the Oxford Group, which had gotten started in England and which was overtly religious.

The story is poignant.  Both Bill and Bob were headed for early graves.  Instead, they met each other.  Talking about their problem with someone who also had it worked some magic that no amount of nagging by their wives or warnings from doctors could.  Bill’s wife Lois and another recovering alcoholic’s wife, Anne, founded Alanon, to help them recover from their own insanity caused by living with alcoholics.

There are lots of “gurus” out there who will tell you that you have to go to AA or Alanon every week for the rest of your life, or that you have to give up every mood-altering substance—from heroin to caffeine to sugar—or that “real” meditation is only done in the early morning, for a minimum of 45 minutes, sitting in the lotus position.

I say, be open to trying a variety of solutions, and equally willing to stop using things that aren’t working.  Why would you want to limit your options when you’re up against something that could make your life miserable, kill you, or land you in prison?

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