The Black Eyed Peas vocalist Fergie recently spilled her guts to Oprah about a past problem with drugs, specifically crystal meth. She says she got into a state of paranoia, walked into a church, had a conversation with God, and decided to stop using drugs.
Meanwhile, addiction “experts” often describe choices about substance use as emanating from neurological deficits, altered brain pathways, and dopamine levels.
Would Fergie, or anyone really, ever describe their experience of both using and quitting in these terms? Would it make sense? Would it be helpful for someone to correct Fergie about her explanation of her change (that she made a deal with God to quit) and replace it with some neurological explanation (“the prefrontal cortex of your brain became activated and blah blah blah”)?
I heard a researcher tell a story about a man who had been trying desperately to quit smoking for 50 years, but kept going back to it. He had a heart attack one day, woke up in a hospital bed, and promptly asked his daughter to get him a cigarette. She responded by saying, quite seriously, “if you ever smoke again I will never talk to you again for the rest of your life.” He never smoked again for the last 10 years of his life.
This same point was made in the telling of this story – does it make more sense to describe such a personal change in terms of brain events, or does it make more sense to describe it in terms of what really happened? – i.e., if the man says his relationship with his daughter was more important to him than smoking, shouldn’t we just stop there and believe him? And is it accurate or more helpful to discuss it in terms of brain activity?
The premise is that the defective brain (or brain that’s been altered by chemicals) is somehow causing this man to be unable to quit smoking. So what happened when he had that interaction with his daughter? Did all of those changes instantly come undone, and his brain returned to a state that doesn’t cause smoking? And if so, how did that change happen? Did it happen all at once? Did it happen milliseconds before he decided to forego that cigarette? Was it just a coincidence that a massive brain change happened at the same exact time that he had this interaction? Or, was it that he changed his thoughts, made a decision, and stuck to it. Or did the thoughts change the brain? If so, it still doesn’t point us to saying “you need to change your brain” – it points us to saying “think about your options and make a choice.”
What if we told this man, “your brain is changed, it’s causing you to smoke”, and he believed it. That would surely hamper his ability to weigh his options and choose, because he doesn’t think he has that ability. In the brain disease model, brain activity comes first, and thoughts are simply a byproduct of that. You don’t choose your thoughts in the brain disease model – they’re simply thrust upon you, because you are a robot in a mechanistic condition.
Personally, I was taught about my faulty brain in treatment programs, and I proceeded to make my problems worse after every program. I eventually went to some people who said “you are choosing this because it brings you a little bit of happiness, but you can make choices for greater happiness if you try” – and then I promptly ended my drug problem after 5 years of nonsensical struggle in “treatment” programs. Would it be better to discuss my personal change in terms of brain activity? What if those people hadn’t presented me with the idea that I could choose greater happiness, but instead provided me with more explanations about how my brain was causing my behavior. Personally, I don’t think I would’ve changed. Was I just another case of massive brain changes coincidentally happening at the same time that I chose a new thought process?
Most people who are successful in 12-step programs don’t even describe their personal changes in terms of brain either. They’ll tell you how they surrendered their will to God, and he relieved them of the desire to drink. Whether there is a God and he did that for them or not, the point is that they believe that is what happened. The point is that they went through a thought process where they decided to take on what they thought was God’s path for them. Here too, brain activity, whether it’s changing or not, seems irrelevant to initiating this process, or explaining the process in hindsight. These people chose to think differently, and this changed their behavior.
None of these cases seem to be initiated by brain activity, and certainly there is no surgery done on the brain to cure addiction. Somewhere out there, there seems to be some minority of people who say they were helped by medications for addiction that effect the brain. I’m not here to argue with that, except to say that regardless of all the tales of doom and gloom, most people get over addiction, and the vast vast majority of them have “reasons” for these changes, rather than “causal” explanations for their changes based on brain activity. I think this points to addressing reasons and other matters of thought, much more than any strategy of trying to change the brain first and hope it somehow causes different behavior.
Behaviors are chosen freely for the value and meaning the individual freely assigns to them.
Great, Fergie found a cure for a made up disease by talking to an imaginary friend.
I think the experts are just trying to find ways to help people. If the brain mechanisms and chemistry can be identified maybe methods can be devised to compensate. Doesn’t suboxone or methadone help in some cases. According to the Nesarc study, alcoholics choose to quit at a net rate less than 2% per year and choose to moderate their drinking at about a 3% per year net rate. Relapse is about 3% per year for abstainers, nearly 12% per year for controlled drinkers. That means about 5% per year quit and 3% relapse to net 2% and 15% per year become moderate drinkers to net 3%. The median time for remission is about 14 years. 10% of the population reported alcohol addiction at some point in their lives so 5% (10 million people) are addicted for 14 years or more. Is it really just a question of choice? There seems to be powerful forces at work here. Since only 25% of the sample in the study ever received treatment or attended an AA meeting we can’t contend the recovery culture is holding back most alcohol addicts. Some studies show about 70% of alcoholics have tried to stop but failed. So what is going on?
Let me ask you this – if there is no “disease” of addiction & it’s all about behavior & belief (people who believe they have this “disease” end up behaving badly & believing they can’t improve their own behavior), how does that help them? Would it be perhaps more helpful if instead of this message of predestined inability to control behavior coming from TV shows, fiction, government & magazines, the message going out was: you have as much control over your behavior as any of us & if you think you drink too much, you could just drink less?
Also, do you realize that most of the “professionals” are basically people who screwed up their lives, took to the idea that they have a “disease” that renders them unable to control their own behavior & go into “addiction counseling” as a profession with their main credential being “I *know* addiction, look at how I screwed up my life.” The theories & practices of the “addiction treatment” community are all developed by people who’ve angered or hurt people close to them, perhaps got in trouble at work or with the law & basically lived very short-sighted existences until they got in enough trouble that claiming to have no control looked like a good “out”. It’s not scientists who discovered the “disease” or the “treatments”.
Sorry, “addiction” has about as much science behind it as phrenology – another belief system that was very popular in western society, that people thought explained their behavior & had overtones of predestination (you’d be born with the bumps that said when traits you had or lacked) while being sold ads a way to improve one’s life thru self-knowledge.
Hear, hear!
This website brilliantly synthesizes the science of addiction to an unpopular conclusion: Addiction is not a disease – it’s a choice. Everything we know about addiction comes from science. Certainly eradication of the disease ‘concept’ could vastly enable the recovery of many addicts or at least not retard the natural processes which at this time are the only effective paths to recovery. Many of the research scientists have reservations about the disease ‘concept’. Some are outright hostile toward that ‘concept’. Some who ave made significant contributions to our understanding of addiction have misinterpreted their findings as indicative of a diseased state. “There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping a manner of living which demands rigorous honesty.” (Alcoholics Anonymous page 58).
What do we know about addiction? Scientific inquiry has shown that it is driven by systems in the brain like all learned behavior. Unfortunately, evolution has left us with a drive for substances which aren’t good for us except in extreme moderation. Addiction is a serious public health problem that costs billions of dollars each year. While natural remission is common at least 20 -30% never recover. As I discussed in my previous post, approximately 50% of alcohol addicts (10 million people) continue to abuse alcohol for at least 13 years – enough time to do a lot of damage. Relapse is common. We hope science can laed the way out.
It can be argued that natural remission is the only way out. The psychiatrists have tried and failed as have the law, religion, psychology, pharmacology and AA. Many claim to have been saved by these methods but none can demonstrate outcomes above the natural rate. Those who recover have one common trait: something changed in their life or their thinking and they were then able to moderate or quit. We see many cures or therapies tauted. Books are written, methods explained. They seem to have the statistical proof some even seem to make sense. Desperate people seek desperate means. Millions change hands. The recovery rate remains the same.
I have my own ideas. Addiction looks like a habit. It follows the paterns of behavioral psychology. It is governed by the same biology as all other habits. Addictive substances, like habits, are rewarding. When we repeat the behavior often enough and then stop we have withdrawal which is best relieved by ingesting the substance. Many believe habits are easier to replace rather than eliminate. But would this approach work with others? Can it be taught? I wouldn’t even know where to begin.
Science has led the way throughout modern history. Phrenology has long been discredited and with effort we can discredit the disease ‘concept’. But phrenology was correct to assume that specific subsystems of the brain (phrenologists called them organs of the brain) are responsible for our thoughts, behavior, actions and mechanisms. Phrenology was incorrect to assume these ‘organs’ could be explained by examining the vagaries of the skull. Alchemy has long been discredited for proposing a chemical method to convert one element into another. But nuclear physics has proven the conversion of elements is possible. In nuclear fusion, hydrogen and lithium are converted into heavier elements. In nuclear fission, uranium and plutonium are converted into lighter elements. Addiction science, especially neurobiology, will discover new methods and one day eradicate this scourge.
Joe, this was another brilliant and insightful post. Every single theme/paragraph that you cover is so true!! How did you arrive at your conclusions, and did you go to rehab/12 step? (forgive me if you mentioned this in a prior post)
Sorry, Joe, “everything we know about addiction comes from science” is factually untrue. “Addiction” is a concept first developed under the name “alcoholism” by a con man who prior to developing AA as a way to get money & status without working had pretended to be a stockbroker.
For decades science has chased supposed root causes of “addiction/alcoholism” in the mechanisms that cause allergies, in the brain, in the genes, in dopamine &/or serotonin levels. When they think they’ve found something, there are headlines, When the claim doesn’t pan out, it is quietly shelved.
To clarify then addiction doesn’t exist? No one ever gets addicted to anything? That’s a radical idea but try to sell it to anyone. And if my statement ‘everything we know about addiction comes from science’ is factually untrue where does our knowledge come from? What are the root causes? The drive for substances is real and it exists in certain brain circuits. Physical dependence is real and it exists in certain brain circuits. Hereditary linkage is established fact but precisely what is inherited can’t be pinpointed as of now. Attitudes about substance use and enviroment are also contributing factors to decisions to use or abuse substances. It is a fact that natural remission occurs over time. It is a fact that no ‘treatment’ has been shown to be effective. All of this knowledge comes from science. The theme of this website, Addiction is not a disease it’s a choice, was derived from science. If certain organizations or people draw erroneous conclusions about the science it’s up to us to set the record straight.
A hundred years ago, everybody – from writers to law enforcement to entertainers to scientists – believed in phrenology, and were absolutely convinced that the bumps on human beings’ heads could be read & interpreted. This meant that society had agreed on these concepts: 1. that people’s traits were fixed at birth, 2. that these traits caused the shape of the brain/skull to be formed in ways that could be reliably read. People who got phrenology readings swore by their accuracy. People who gave readings were convinced of their ability to give accurate readings. Western culture pretty much convinced itself that self-knowledge & knowledge of others via the bulges of the skull was a reliable way to understand people’s character & behavior.
Does that not sound just like “addiction”? People think they’ve found a way to diagnose & describe how they or others behave, via a systems that takes as an assumption the idea that human beings’ reactions to alcohol/drugs are fixed at birth.
There is a physical process called habituation in which humans become so accustomed to ingesting a substance that suddenly stopping can cause a period of physical discomfort – usually lasting for days to weeks. but, interestingly, during the 1960s (before 12 steppism had drenched out society) scientific studies showed that people who were using heroin overestimated how severe their withdrawal symptoms would be.
Just because people believe a phenomenon exists doesn’t mean the phenomenon exists. You can talk all you want about heritability & brain circuits, but if the pheonomenon you are describing is a Made Up “disease”, it’s still just a Made Up “disease”.
I don’t believe addiction is a disease. 12 step ‘treatment’ programs don’t work. I agree habituation is a physical process and maybe the researchers can determine just how this works and develop ‘treatments’ that will help. While it seems to be good advice for the addicted, the choice model of addiction doesn’t tell us much about the process of addiction. The choice model assumes people will eventually ‘just say no.’ I say too many people stay addicted and suffer severe consequences before they find a way out and long after they’ve decided they had to get their addiction under control. When studied closely, many people who have resolved their addictions commonly had a change in life circumstance that came before they decided to quit being an addict. They may say they just decided to quit but usually there were other factors that pushed them along.
The research scientists sometimes ‘go off the reservation’ and draw conclusions their experiments don’t support. The worst of these is the disease concept. Years ago society decided addiction wasn’t a sin or the result of demonic possesion. Calling it a disease was the only option left since according to society addicts certainly weren’t acting rationally. Later the idea of habituation came forward because it could be supported by scientific evidence. When science began to look into the brain and determine what processes were functioning some said: “hey look it’s a disease process”. But no it’s not. It’s just habituation and it looks like all other habituation except (perhaps) in it’s intensity. But even in it’s intensity, from the neurological perspective it looks like certain powerful habituations like food seeking and sex.
Again, I support the scientific research because addiction costs us all hundreds of billions of dollars each year and because so many addicts just can’t seem to say no.
I’m sorry, but there is no such phenomenon of addiction. There are people who take drugs, some legal, some not, for nonmedical recreational reasons. The vast majority of the people who take drugs for nonmedical reasons are otherwise law-abiding & when they are too broke, go without drugs, just like law-abiding film buffs might skip going to the movies when they are broke. Other people use drugs and live selfish, hurtful & even criminal lives. In addition, throughout history & in current times, there are selfish, hurtful & criminal people who never make nonmedical use of drugs.
I don’t buy the claim that “addicts can’t say no”. If they were truly unable to control their behavior at all, how come their lack of control never causes them to spark up a doobie or a crack pipe at their work stations in full view of the boss, or right next to a cop? How come the vast majority of people who claim they “can’t control themselves” get violent with vulnerable “loved ones” – spouses &/or kids – not some random bigger guy they run into on the street? Anyone who can control their behavior enough to hide what they are doing for long periods of time has the control of their behavior to control their behavior. Our society has been allowing people the excuse that they don’t have control of their behavior because defense attorneys, & by extension, courts, have pressed the claim that people who do things that harm other people – theft, assault, fraud, cheating on a spouse – are unable to control all kinds of complex, and often clandestine, behavior because “addiction” has caused them to not have control of their behavior, & everybody is supposed to accept their self-diagnosis that they’re too “diseased” to control their behavior. But, really, to defraud strangers, cheat on your lover, steal from your employer or mug someone requires an awful lot of purposeful, deliberate behavior.
Also, drugs do not permanently change the function of a human brain – they change function during the period of time when the concentration of drugs is sufficient to affect brain function. The idea that drugs cause people who don’t have any drugs in their system can cause that person to be unable to control their behavior is more balderdash developed by Bill Wilson, the con artist who created AA. There is no science to back up his claims.
Scientific investigation of addiction would be no more useful than scientific investigation of phrenology.
“How come the vast majority of people who claim they “can’t control themselves” get violent with vulnerable “loved ones” – spouses &/or kids – not some random bigger guy they run into on the street?”
Yes, yes, thank you.
It’s insane how many people accept this reasoning. It not only leads to ill-intentioned people getting a free pass, it leads the vulnerable to believe that there’s something wrong with them. Because even if they tell themselves, “He can’t control it,” down inside they know he can, so they’re effectively telling themselves that they deserve it.
P.S. There is a real, scientifically proven concept that is far more useful in explaining why so many people believe that they are suffering from a “disease” that causes them to be unable to control their behavior not only while their blood contains sufficient drugs to have an effect on their brains, but also when they have no drugs in their bloodstreams at all. That concept is Learned Helplessness. When people are told that they can’t do something – especially something they don’t particularly want to do – they can be convinced that they are unable to do that thing.
Stopping an addiction, or leaving any rut, requires courage to reinvent yourself. People reinvent themselves all the time: they leave a bad marriage, they leave a dead-end job, they start working out and getting in shape, they go back to school, they stop an addiction. It is so obvious now. What causes that desire to reinvent oneself? It takes a catalyst, which can be external or internal, plus COURAGE.
Courage is not talked about enough. It is a lack of courage that keeps all kinds of people from simply asking someone on a date, or applying for a new job, or asking for a raise that is deserved. Anyone in a deep rut needs a double dose of courage, because the change required is so great.
That’s how I did it. I had the desire for more, plus the courage to reinvent myself.
Kelly, you changed your behavior for the better. The behavior you did before was behavior, calling it “addiction’ serves no purpose.
I call it addiction because that’s what it was, to me. I was physically addicted to those pills and I would go into withdrawals if I waited too long to take more. If I went more than 4 hours without taking more, I would feel physically uncomfortable.
Kelly, I’m glad you took action to improve your life.
The physical aspect of what you describe is called habituation. The rest of “addiction” is a collection of memes that have no basis in fact.
This is an interesting dialogue. When I want to be of service by sharing what I went through, what would you suggest as a more descriptive accurate term? (I should tell people I was habituated to pills, and how is that any different from telling them I was addicted?)
Hi Kelly,
Thanks – I find it interesting, too. Thanks also, for an interesting question.
What term to use? I would say “using drugs” & “stopped using”. It’s accurate, and doesn’t require, use or promote memes that encourage inaccurate ideas about disease, loss of control, powerlessness, life-long struggle or religious-based “treatment”. It also gives the credit, for the change you made in your life to you – where it belongs.
Cool!
Thanks.
I think was you accomplished is cool & wish you the best.