They’re screaming it from the rooftops: “addiction is a disease, and you can’t stop it without medical treatment”! But why are they screaming it so loud, why are they browbeating us about it, why is it always mentioned with a qualifier? You don’t hear people constantly referring to cancer as “the disease of cancer” – it’s just “cancer”, because it’s obvious that cancer is a disease, it’s been conclusively proven that the symptoms of cancer can’t be directly stopped with mere choices – therefore no qualifier is needed. On the other hand, addiction to drugs and alcohol is not obviously a disease, and to call it such we must either overlook the major gaps in the disease argument, or we must completely redefine the term “disease.” Here we will analyze a few key points and show that what we call addiction doesn’t pass muster as a real disease.
Real Diseases versus The Disease Concept or Theory of Drug Addiction
In a true disease, some part of the body is in a state of abnormal physiological functioning, and this causes the undesirable symptoms. In the case of cancer, it would be mutated cells which we point to as evidence of a physiological abnormality, in diabetes we can point to low insulin production or cells which fail to use insulin properly as the physiological abnormality which create the harmful symptoms. If a person has either of these diseases, they cannot directly choose to stop their symptoms or directly choose to stop the abnormal physiological functioning which creates the symptoms. They can only choose to stop the physiological abnormality indirectly, by the application of medical treatment, and in the case of diabetes, dietetic measures may also indirectly halt the symptoms as well (but such measures are not a cure so much as a lifestyle adjustment necessitated by permanent physiological malfunction).
In addiction, there is no such physiological malfunction. The best physical evidence put forward by the disease proponents falls totally flat on the measure of representing a physiological malfunction. This evidence is the much touted brain scan[1]. The organization responsible for putting forth these brain scans, the National Institute on Drug Abuse and Addiction (NIDA), defines addiction in this way:
Addiction is defined as a chronic relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain – they change it’s structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.
The NIDA is stating outright that the reason addiction is considered a disease is because of the brain changes evidenced by the brain scans they show us, and that these changes cause the behavior known as addiction, which they characterize as “compulsive drug seeking and use”. There are three major ways in which this case for the disease model falls apart:
- the changes in the brain which they show us are not abnormal at all
- people change their behavior IN SPITE OF the fact that their brain has changed in response to repeated substance use jump to section
- there is no evidence that the behavior of addicts is compulsive (compulsive meaning involuntary) (point two addresses this, as well as some other research that will be presented) jump to section
This all applies equally to “alcoholism” as well. If you’re looking for information on alcoholism, the same theories and logic discussed here are applicable; wherever you see the term addiction used on this site, it includes alcoholism.
Brain Changes In Addicts Are Not Abnormal, and Do Not Prove The Brain Disease Theory
On the first count – the changes in the brain evidenced by brain scans of heavy substance users (“addicts”) do not represent a malfunctioning brain. They are quite normal, as research into neuroplasticity has shown us. Whenever we practice doing or thinking anything enough, the brain changes – different regions and neuronal pathways are grown or strengthened, and new connections are made; various areas of the brain become more or less active depending upon how much you use them, and this becomes the norm in your brain – but it changes again as you adjust how much you use those brain regions depending on what you choose to think and do. This is a process which continues throughout life, there is nothing abnormal about it. Here, Sharon Begley describes neuroplasticity: [2]
The term refers to the brain’s recently discovered ability to change its structure and function, in particular by expanding or strengthening circuits that are used and by shrinking or weakening those that are rarely engaged. In its short history, the science of neuroplasticity has mostly documented brain changes that reflect physical experience and input from the outside world.
So, when the NIDA’s Nora Volkow and others show us changes in the brain of a substance user as compared to a non-substance user, this difference is not as novel as they make it out to be. They are showing us routine neuroplastic changes which every healthily functioning person’s brain goes through naturally. The phenomenon of brain changes isn’t isolated to “addicts” or anyone else with a so-called brain disease – non-addicted and non-depressed and non-[insert brain disease of the week here] people experience neural adaptations too. One poignant example was found in the brains of London taxi drivers, as Begley and Jeffrey Schwartz pointed out in The Mind and The Brain. [4]
Is Being A Good Taxi Driver A Disease?
A specific area of the brain’s hippocampus is associated with creating directional memories and a mental map of the environment. A team of researchers scanned the brains of London taxi drivers and compared their brains to non-taxi drivers. There was a very noticeable difference, not only between the drivers and non-drivers, but also between the more experienced and less experienced drivers:
There it was: the more years a man had been a taxi driver, the smaller the front of his hippocampus and the larger the posterior. “Length of time spent as a taxi driver correlated positively with volume in…the right posterior hippocampus,” found the scientists. Acquiring navigational skills causes a “redistribution of gray matter in the hippocampus” as a driver’s mental map of London grows larger and more detailed with experience. [4]
So, the longer you drive a cab in London (that is, the longer you exert the mental and physical effort to quickly find your way around one of the world’s toughest to navigate cities), the more your brain physically changes. And the longer you use drugs, the more your brain changes. And indeed, the longer and more intensely you apply yourself to any skill, thought, or activity – the more it will change your brain, and the more visible will be the differences between your brain and that of someone who hasn’t been focused on that particular skill. So, if we follow the logic of the NIDA, then London’s taxi drivers have a disease, which we’ll call taxi-ism, that forces them to drive taxis. But the new diseases wouldn’t stop there.
Learning to play the piano well will change your brain – and if you were to compare brain scans of a piano player to a non-piano player, you would find significant differences. Does this mean that piano playing is a disease called Pianoism? Learning a new language changes your brain, are bilingual people diseased? Athletes’ brains will change as a result of intensive practice – is playing tennis a disease? Are soccer players unable to walk into a sporting goods store without kicking every ball in sight? We could go on and on with examples, but the point is this – when you practice something, you get better at doing it, because your brain changes physiologically – and this is a normal process. If someone dedicated a large portion of their life to seeking and using drugs, and their brain didn’t change – then that would be a true abnormality. Something would be seriously wrong with their brain.
Its not just physical activity that changes our brains, thoughts alone can have a huge effect. What’s more, whether the brain changes or not, there is much research which shows that the brain is slave to the mind. As Begley points out elsewhere, thoughts alone can create the same brain activity that would come about by doing things[2]:
Using the brain scan called functional magnetic resonance imaging, the scientists pinpointed regions that were active during compassion meditation. In almost every case, the enhanced activity was greater in the monks’ brains than the novices’. Activity in the left prefrontal cortex (the seat of positive emotions such as happiness) swamped activity in the right prefrontal (site of negative emotions and anxiety), something never before seen from purely mental activity. A sprawling circuit that switches on at the sight of suffering also showed greater activity in the monks. So did regions responsible for planned movement, as if the monks’ brains were itching to go to the aid of those in distress.
So by simply practicing thinking about compassion, these monks made lasting changes in their brain activity. Purely mental activity can change the brain in physiologically significant ways. And to back up this fact we look again to the work of Dr Jeffrey Schwartz[3], who has taught OCD patients techniques to think their way out of obsessive thoughts. After exercising these thought practices, research showed that the brains of OCD patients looked no different than the brains of those who’d never had OCD. If you change your thoughts, you change your brain physically – and this is voluntary. This is outside the realm of disease, this shows a brain which changes as a matter of normality, and can change again, depending on what we practice choosing to think. There is nothing abnormal about a changing brain, and the type of changes we’re discussing aren’t necessarily permanent, as they are characterized to be in the brain disease model of addiction.
These brain change don’t need to be brought on by exposure to chemicals. Thoughts alone, are enough to rewire the very circuits of the human brain responsible for reward and other positive emotions that substance use and other supposedly “addictive” behaviors (“process addictions” such as sex, gambling, and shopping, etc.) are connected with.
The Stolen Concept of Neuroplasticity in the Brain Disease Model of Addiction
Those who claim that addiction is a brain disease readily admit that the brain changes in evidence are arrived at through repeated choices to use substances and focus on using substances. In this way, they are saying the disease is a product of routine neuroplastic processes. Then they go on to claim that such brain changes either can’t be remedied, or can only be remedied by outside means (medical treatment). When we break this down and look at it step by step, we see that the brain disease model rests on an argument similar to the “stolen concept”. A stolen concept argument is one in which the argument denies a fact on which it simultaneously rests. For example, the philosophical assertion that “reality is unknowable” rests on, or presumes that the speaker could know a fact of reality, it presumes that one could know that reality is unknowable – which of course one couldn’t, if reality truly was unknowable – so the statement “reality is unknowable” invalidates itself. Likewise, the brain disease proponents are essentially saying “neuroplastic processes create a state called addiction which cannot be changed by thoughts and choices” – this however is to some degree self-invalidating, because it depends on neuroplasticity while seeking to invalidate it. If neuroplasticity is involved, and is a valid explanation for how to become addicted, then we can’t act is if the same process doesn’t exist when it’s time to focus on getting un-addicted. That is, if the brain can be changed into the addicted state by thoughts and choices, then it can be further changed or changed back by thoughts and choices. Conditions which can be remedied by freely chosen thoughts and behaviors, don’t fit into the general understanding of disease. Ultimately, if addiction is a disease, then it’s a disease so fundamentally different than any other that it should probably have a completely different name that doesn’t imply all the things contained in the term “disease” – such as the idea that the “will” of the afflicted is irrelevant to whether the condition continues.
People change their addictive behavior in spite of the fact that their brain is changed – and they do so without medication or surgery (added 4/18/14)
In the discussion above, we looked at some analogous cases of brain changes to see just how routine and normal (i.e. not a physiological malfunction) such changes are. Now we’re going to look directly at the most popular neuroscientific research which purports to prove that these brain changes actually cause “uncontrolled” substance use (“addiction”).
The most popular research is Nora Volkow’s brain scans of “meth addicts” presented by the NIDA. The logic is simple. We’re presented with the brain scan of a meth addict alongside the brain scan of a non-user, and we’re told that the decreased activity in the brain of the meth user (the lack of red in the “Drug Abuser” brain scan presented) is the cause of their “compulsive” methamphetamine use. Here’s how the National Institute on Drug Abuse (NIDA) explains the significance of these images in their booklet – Drugs, Brains, and Behavior: The Science of Addiction :
Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive signals. As a result, dopamine’s impact on the reward circuit of a drug abuser’s brain can become abnormally low, and the ability to experience any pleasure is reduced. This is why the abuser eventually feels flat, lifeless, and depressed, and is unable to enjoy things that previously brought them pleasure. Now, they need to take drugs just to try and bring their dopamine function back up to normal.
[emphasis added]
They go on that these same sorts of brain changes:
..may also lead to addiction, which can drive an abuser to seek out and take drugs compulsively. Drug addiction erodes a person’s self-control and ability to make sound decisions, while sending intense impulses to take drugs.
[emphasis added]
That image is shown when NIDA is vaguely explaining how brain changes are responsible for “addiction.” But later on, when they try to make a case for treating addiction as a brain disease, they show the following image, which tells a far different story if you understand more of the context than they choose to mention:
Again, this graphic is used to support the idea that we should treat addiction as a brain disease. However, the authors mistakenly let a big cat out of the bag with this one – because the brain wasn’t treated at all. Notice how the third image shows a brain in which the red level of activity has returned almost to normal after 14 months of abstinence. That’s wonderful – but it also means that the NIDA’s assertions that “Addiction means being unable to quit, even in the face of negative consequences”(LINK) and “It is considered a brain disease because drugs change the brain… These brain changes… can lead to the harmful behaviors seen in people who abuse drugs” are dead wrong.
When these studies were done, nobody was directly treating the brain of methamphetamine addicts. They were not giving them medication for it (there is no equivalent of methadone for speed users), and they weren’t sticking scalpels into the brains of these meth addicts, nor were they giving them shock treatment. So what did they do?
These methamphetamine addicts were court ordered into a treatment program (whose methodology wasn’t disclosed in the research) which likely consisted of a general mixture of group and individual counseling with 12-step meeting attendance. I can’t stress the significance of this enough: their brains were not medically treated. They talked to counselors. They faced a choice between jail and abstinence. They CHOSE abstinence (for at least 14 months!) – even while their brains had been changed in a way that we’re told robs them of the ability to choose to quit “even in the face of negative consequences.” [5]
Even with changed brains, people are capable of choosing to change their substance use habits. They choose to stop using drugs, and as the brain scans above demonstrate – their brain activity follows this choice. If the brain changes caused the substance using behavior, i.e. if it was the other way around, then a true medical intervention should have been needed – the brain would’ve needed to have changed first via external force (medicine or surgery) before abstinence was initiated. They literally wouldn’t have been able to stop for 14 months without a real physical/biological medical intervention. But they did…
Substance Use Is Not Compulsive, It Is A Choice
In his classic book Addiction & Opiates, Alfred R Lindesmith PhD explained the requirements of reliable scientific theories explaining the causes of things such as heroin addiction:
…a genuine theory that proposes to explain a given phenomenon by relating it to another phenomenon must, in the first place, have clear empirical implications which, if not fulfilled, negate the theory.
If the theory is that neural adaptations alone cause uncontrolled behavior, then this proposition can easily be shown to be false. I demonstrated above that in the midst of having fully “changed” or “addicted” brains, people do indeed stop using substances, so essentially, it is case closed. But the depths to which the brain disease theory of addiction can be negated go even further, because the basic theory of addiction as representing uncontrolled substance use has never been explained. Explanation of the mechanism by which substance use happens without the individual’s consent is conspicuously missing – yet such explanation is a necessary part of such a theory, as Lindesmith writes (again in Addiction & Opiates):
…besides identifying the two types of phenomenon that are allegedly interrelated, there must be a description of the processes or events that link them. In other words, besides affirming that something causes something else, it is necessary to indicate how the cause operates to produce the alleged effect.
“Here Comes the Bogey-Man” by Goya, circa 1799
There doesn’t seem to be any explanation or evidence that substance use is involuntary. In fact, the evidence, such as that presented above, shows the opposite. Nevertheless, when the case for the disease is presented, the idea that drug use is involuntary is taken for granted as true. No evidence is ever actually presented to support this premise, so there isn’t much to be knocked down here, except to make the point I made above – is a piano player fundamentally incapable of resisting playing the piano? They may love to play the piano, and want to do it often, they may even be obsessive about it, but it would be hard to say that at the sight of a piano they are involuntarily driven by their brain to push aside whatever else they need to do in order to play that piano.
There is another approach to the second claim though. We can look at the people who have subjectively claimed that their substance use is involuntary, and see if the offer of incentives results in changed behavior. Gene Heyman covered this in his landmark book, Addiction: A Disorder of Choice[3]. He recounts studies in which cocaine abusers were given traditional addiction counseling, and also offered vouchers which they could trade in for modest rewards such as movie tickets or sports equipment – if they proved through urine tests that they were abstaining from drug use. In the early stages of the study, 70% of those in the voucher program remained abstinent, while only 20% stayed abstinent in the control group which didn’t receive the incentive of the vouchers. This demonstrates that substance use is not in fact compulsive or involuntary, but that it is a matter of choice, because these “addicts” when presented with a clear and immediately rewarding alternative to substance use and incentive not to use, chose it. Furthermore, follow up studies showed that this led to long term changes. A full year after the program, the voucher group had double the success rate of those who received only counseling (80% to 40%, respectively). This ties back in to our first point that what you practice, you become good at. The cocaine abusers in the voucher group practiced replacing substance use with other activities, such as using the sports equipment or movie passes they gained as a direct consequence of abstaining from drug use – thus they made it a habit to find other ways of amusing themselves, this probably led to brain changes, and the new habits became the norm.
Long story short, there is no evidence presented to prove that substance use is compulsive. The only thing ever offered is subjective reports from drug users themselves that they “can’t stop”, and proclamations from treatment professionals that the behavior is compulsive due to brain changes. But if the promise of a ticket to the movies is enough to double the success rate of conventional addiction counseling, then it’s hard to say that substance users can’t control themselves. The reality is that they can control themselves, but they just happen to see substance use as the best option for happiness available to them at the times when they’re abusing substances. When they can see other options for happiness as more attractive (i.e. as promising a greater reward than substance use), attainable to them, and as taking an amount of effort they’re willing to expend – then they will absolutely choose those options instead of substance use, and will not struggle to “stay sober”, prevent relapse, practice self-control or self-regulation, or any other colloquialism for making a different choice. They will simply choose differently.
But wait… there’s more! (Added 4/21/14) Contrary to the claims that alcoholics and drug addicts literally lose control of their substance use, a great number of experiments have found that they are really in full control of themselves. Priming dose experiments have found that alcoholics are not triggered into uncontrollable craving after taking a drink. Here’s a link to the evidence and a deeper discussion of these findings: Do Addicts and Alcoholics Lose Control? Priming dose experiments of cocaine, crack, and methamphetamine users found that after being given a hit of their drug of choice (primed with a dose) they are capable of choosing a delayed reward rather than another hit of the drug.
Three Most Relevant Reasons Addiction Is Not A Disease
So to sum up, there are at least two significant reasons why the current brain disease theory of addiction is false.
- A disease involves physiological malfunction, the “proof” of brain changes shows no malfunction of the brain. These changes are indeed a normal part of how the brain works – not only in substance use, but in anything that we practice doing or thinking intensively. Brain changes occur as a matter of everyday life; the brain can be changed by the choice to think or behave differently; and the type of changes we’re talking about are not permanent.
- The very evidence used to demonstrate that addicts’ behavior is caused by brain changes also demonstrates that they change their behavior while their brain is changed, without a real medical intervention such as medication targeting the brain or surgical intervention in the brain – and that their brain changes back to normal AFTER they VOLITIONALLY change their behavior for a prolonged period of time
- Drug use in “addicts” is not compulsive. If it was truly compulsive, then offering a drug user tickets to the movies would not make a difference in whether they use or not – because this is an offer of a choice. Research shows that the offer of this choice leads to cessation of substance abuse. Furthermore, to clarify the point, if you offered a cancer patient movie tickets as a reward for ceasing to have a tumor – it would make no difference, it would not change his probability of recovery.
Addiction is NOT a disease, and it matters. This has huge implications for anyone struggling with a substance use habit.
References:
- 1) NIDA, Drugs Brains and Behavior: The Science of Addiction, sciofaddiction.pdf
- 2) Sharon Begley, Scans of Monks’ Brains Show Meditation Alters Structure, Functioning, Wall Street Journal, November 5, 2004; Page B1, http://psyphz.psych.wisc.edu/web/News/Meditation_Alters_Brain_WSJ_11-04.htm
- 3) Gene Heyman, Addiction: A Disorder of Choice, Harvard University Press, 2009
- 4) Sharon Begley and Jeffrey Schwartz, The Mind And The Brain, Harper Collins, 2002
- 5) Links to the 2 methamphetamine abuser studies by Nora Volkow:
http://www.jneurosci.org/cgi/content/full/21/23/9414
http://ajp.psychiatryonline.org/cgi/reprint/158/3/377
Important Notes from the author to readers and especially commenters:
On “badness” or immorality:
Please do not attribute to me the idea that heavy substance users must be “bad” or “immoral” if they are in fact in control of and choosing their behavior. I do not think this. I think that at the time they’re using, it is what they prefer, given what life options they believe are available to them – and I don’t think it’s my job to decide what other people should prefer for themselves, and then declare them bad if they don’t live up to my vision of a “good” life. That’s what the disease recovery culture does, de facto, when they present the false dichotomy of ‘diseased or bad’. To say that addiction is chosen behavior is simply to make a statement about whether the behavior is within the control of the individual – it is not a judgment of the morality of the behavior or the individual choosing it.
On willpower:
Please do not attribute to me the suggestion to “use willpower.” I have not said that people should use willpower, nor do I think it’s a coherent or relevant concept in any way, nor do I think “addicts lack willpower” or that those who recover have more willpower, nor, and this is important, do I believe that a choice model of addiction necessarily implies willpower as the solution.
“Addicts” do not need extra willpower, strength, or support, to change their heavy substance use habits if that is what they want to do. They need to change their preference for heavy substance use, rather than trying to fight that preference with supposed “willpower.”
On compassion:
Please don’t accuse me of not having compassion for people who have substance use problems. You do not know that, and if you attack my motives in this way it just shows your own intellectual impotence and sleaze. I have a great deal of compassion for people with these problems – I was once one such person. I am trying to get at the truth of the nature of addiction, so that the most people can be helped in the most effective way possible. I don’t doubt the compassion of those who believe addiction is a disease, and I hope you’ll give me the same benefit of the doubt. I assure you I care and want the best for people – and I don’t need to see them as diseased to do so. When you see someone who’s gotten themselves into a mess, don’t you want to help, even if it’s of their own making? Why should we need to believe they have a disease to help them if the mess is substance use related? I don’t get that requirement.
Some Agreement I’ve Found From Addiction Researchers (added 6/10/14)
I began working out my understanding of the brain disease model back in 2005 as I started working on a book about addiction; published this article in 2010; and was happy to find in 2011 when I went back to work with Baldwin Research that they had arrived at a similar conclusion. The way they stated it amounted to “either everything is addiction, or nothing is” – referring to the fact that the brain changes presented as proof of addiction being a brain disease are so routine as to indicate that all behavior must be classified as addiction if we follow the logic.
I was also gratified to have found a neuroscientist who arrived at the same conclusions. I think Marc Lewis PhD and I may disagree on a few things, but it seems we may see eye to eye on the logic I presented above about such brain changes being routine, and thus not indicative of disease. Check what he wrote in 2012 for the PLOS Blog, Mind The Brain:
every experience that has potent emotional content changes the NAC and its uptake of dopamine. Yet we wouldn’t want to call the excitement you get from the love of your life, or your fifth visit to Paris, a disease. The NAC is highly plastic. It has to be, so that we can pursue different rewards as we develop, right through childhood to the rest of the lifespan. In fact, each highly rewarding experience builds its own network of synapses in and around the NAC, and that network sends a signal to the midbrain: I’m anticipating x, so send up some dopamine, right now! That’s the case with romantic love, Paris, and heroin. During and after each of these experiences, that network of synapses gets strengthened: so the “specialization” of dopamine uptake is further increased. London just doesn’t do it for you anymore. It’s got to be Paris. Pot, wine, music…they don’t turn your crank so much; but cocaine sure does. Physical changes in the brain are its only way to learn, to remember, and to develop. But we wouldn’t want to call learning a disease.
….
In my view, addiction (whether to drugs, food, gambling, or whatever) doesn’t fit a specific physiological category. Rather, I see addiction as an extreme form of normality, if one can say such a thing. Perhaps more precisely: an extreme form of learning. No doubt addiction is a frightening, often horrible, state to endure, whether in oneself or in one’s loved ones. But that doesn’t make it a disease.
I think that quote is very important, because it highlights neuronal changes that occur in the same region implicated in addiction (whereas the examples I presented earlier in the article represented some other regions).
In a brilliant paper titled “The naked empress: Modern neuro science and the concept of addiction”, Peter Cohen of The Centre for Drug Research at University of Amsterdam, states that:
The notions of addiction transformed into the language of neurology as performed by authors like Volkov, Berridge, Gessa or De Vries are completely tautological.
He essentially argues that Volkow et al take for granted that heavy drug and alcohol use is uncontrolled, identify neural correlates, and present them as evidence of uncontrollability. Yet they don’t do so with other behaviors, and he provides plenty of examples. He notes that they start with assumptions that certain patterns of behavior (e.g. heavy drug use) are uncontrolled, and others are controlled – based purely on cultural prejudices. He accurately identifies addiction as a learned behavior, or as routine bonding to a thing, and then expresses something very close to my thesis presented above (that all learned/intensely repeated behaviors result in “brain changes”).
The problem of course is that probably all learning produces temporary or lasting ‘change in neural systems’. Also, continuation of learned behavior may be functional in the eyes and experience of the person but less so in the eyes of the outsider. Who is right? We know of people remaining married in spite of-in the eyes of a beholder- a very bad marriage. Who speaks of lasting ‘neural change’ as the basis of the continued marriage? But, even when a person herself sees some behavior as counter functional, it is not necessarily seen as addiction. It may be seen as impotence, ingrained habit or unhappy adaptation. It all depends on which behavior we discuss, not on the brain.
The great points contained in this article would be done an injustice if I tried to sum them up here, so check it out for yourself at The Center for Drug Research University of Amsterdam. As with Marc Lewis, I suspect that Peter Cohen and I might have some substantial disagreements about the full nature of addiction and human behavior in general, but I think we at least agree that the changes in the brain of an “addict” do not necessarily represent disease, and more likely represent a routine process.
Writing in 2013 for the journal Frontiers In Psychiatry, esteemed behavioral and addiction researcher Gene Heyman pointed out something so painfully obvious that we don’t even take notice – no causal link has ever been found between the neural adaptations caused by excessive substance use and continued heavy use. That is, correlation is not causation:
With the exception of alcohol, addictive drugs produce their biological and psychological changes by binding to specific receptor sites throughout the body. As self-administered drug doses greatly exceed the circulating levels of their natural analogs, persistent heavy drug use leads to structural and functional changes in the nervous system. It is widely – if not universally – assumed that these neural adaptations play a causal role in addiction. In support of this interpretation brain imaging studies often reveal differences between the brains of addicts and comparison groups (e.g., Volkow et al., 1997; Martin-Soelch et al., 2001) However, these studies are cross-sectional and the results are correlations. There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug.
Did you get that? Let me repeat the words of this experienced researcher, PhD, and lecturer/professor from Boston College and Harvard who, in addition to publishing scores of papers in peer reviewed medical journals has also had an entire book debunking the disease model of addiction by Harvard University press (I say all of this about his credentials so that I can hopefully STOP getting commenters who say “but you’re not a doctor, and what are your credentials wah, wah, wah,……” here’s a “credentialed” expert who essentially agrees with most of what I’ve written in this article – so please, for the love of god, save your fallacious ad hominems and appeals to authority for another day!)- he (Gene Heyman PhD) said this, as of 2013:
There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug.
And this was in a recently published paper in a section headed “But Drugs Change the Brain”, in which he continued to debunk the “brain changes cause addiction” argument by saying:
There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug. For example, in a frequently referred to animal study, Robinson et al. (2001) found dendritic changes in the striatum and the prefrontal cortex of rats who had self-administered cocaine. They concluded that this was a “recipe for addiction.” However, they did not evaluate whether their findings with rodents applied to humans, nor did they even test if the dendritic modifications had anything to do with changes in preference for cocaine in their rats. In principle then it is possible that the drug-induced neural changes play little or no role in the persistence of drug use. This is a testable hypothesis.
First, most addicts quit. Thus, drug-induced neural plasticity does not prevent quitting. Second, in follow-up studies, which tested Robinson et al.’s claims, there were no increases in preference for cocaine. For instance in a preference test that provided both cocaine and saccharin, rats preferred saccharin (Lenoir et al., 2007) even after they had consumed about three to four times more cocaine than the rats in the Robinson et al study, and even though the cocaine had induced motoric changes which have been interpreted as signs of the neural underpinnings of addiction (e.g., Robinson and Berridge, 2003). Third [an analysis of epidemiological studies] shows that the likelihood of remission was constant over time since the onset of dependence. Although this is a surprising result, it is not without precedent. In a longitudinal study of heroin addicts, Vaillant (1973) reports that the likelihood of going off drugs neither increased nor decreased over time (1973), and in a study with rats, Serge Ahmed and his colleagues (Cantin et al., 2010) report that the probability of switching from cocaine to saccharin (which was about 0.85) was independent of past cocaine consumption. Since drugs change the brain, these results suggest that the changes do not prevent quitting, and the slope of [an analysis of epidemiological studies] implies that drug-induced neural changes do not even decrease the likelihood of quitting drugs once dependence is in place.
Read the full paper here – it’s an amazingly concise summary of the truths about addiction that contradict many of the accepted opinions pushed by the recovery culture – Heyman, G. M. (2013). Addiction and Choice: Theory and New Data. Frontiers in Psychiatry, 4. doi:10.3389/fpsyt.2013.00031
Why Does It Matter Whether or Not Addiction Is A Brain Disease?
When we accept the unproven view that addiction and alcoholism are brain diseases, then it will lead us down a long, painful, costly, and pointless road of cycling in and out of ineffective treatment programs and 12 step meetings. You will waste a lot of time without finding a permanent solution. When we examine the evidence, throw out the false disease concepts, and think rationally about the problem we can see that addiction is really just a matter of choice. Knowing this, we can bypass the rehabs, and find the true solution within ourselves. You can choose to end your addiction. You can choose to improv your life. You can choose to stop the endless cycle of “recovery” and start living. You don’t need to be a victim of the self-fulfilling prophecy that is the brain disease model of addiction. There are alternative views and methods of change which I hope you’ll take the time to learn about on The Clean Slate Addiction Site.
There are many different ways to argue against the brain disease model of addiction. I have only presented 3 basic arguments here. But beyond just addiction, many modern claims of “brain disease” are fatally flawed, in that they are founded on the logically impossible philosophical stance of psychological determinism. From this standpoint, any evidence of any brain activity is immediately interpreted as a “cause” of a particular mind state or behavior – with no regard for free will/the ability to choose one’s thoughts and thus behaviors. If you understand the impossibility of psychological determinism (or “epiphenomenalism”) then you’ll take all such claims with a grain of salt. For a detailed examination of this issue, see the following article: The Philosophical Problem with the Brain Disease Model of Addiction: Epiphenomenalism
How To End Addiction, Substance Dependence, Substance Abuse, Alcoholism, and General Drug and Alcohol Problems (updated 11/4/2015)
Due to the fact that most conventional rehab and addiction treatment programs follow the false belief that addiction is a disease, they are generally not effective at dealing with these problems – so I really can’t ethically recommend any “treatment” programs other than a run of the mill detoxification procedure if you feel you may be experiencing physical withdrawal symptoms – you can find that through your local hospital or emergency room; by asking your primary care doctor; or by calling 911 if you feel your life is in danger due to withdrawal (beware that withdrawal from alcohol and some prescription drugs such as the class known as benzodiazepines can lead to fatal seizures). But what comes after detoxification is simply personal choices, and treatment programs actually discourage productive personal choices by attempting to control people and feeding them nonsense such as the disease theory and idea of powerlessness.
If you want to end or alter your own substance use habits you need to make the choice to do so. Many readers will object to this answer as flippant, cruel, out of touch, et cetera. I realize this, but I chose to change, and in reality everyone who moves beyond problematic substance use chooses to change as well.
There is too much to unpack within what people believe is contained in the statement “choose to change.” I have tried to address some of that here in the past, but I realize this article is not the place to do that. This article’s scope needs to remain limited to the question of whether or not addiction is a disease.
My conclusion is that addiction is freely chosen behavior, and that the person who continues heavy substance use despite mounting costs still sees heavy substance use as their best viable option at the time they’re doing it – even though they recognize many costs and downsides. Choosing to change then, really means that they rethink whether heavy substance use is their best viable option. The only way I know to come to new conclusions is to re-examine the issues methodically, and this may often mean gathering new information and perspectives. Thus, the help that can be given to troubled heavy substance users is information. Helpers can provide accurate information that troubled people can use to change their perspective and come to believe they have better viable options than continued heavy problematic substance use.
I endeavor to give accurate information here that will help people to understand that change is possible, and that they are not doomed to a lifetime of addiction. Hopefully, this helps them on their way to believing in better viable options.
About this article:
I originally published this article on September 25, 2010. I have since added some significant supporting work I was able to find over the years, and those additions are noted. Some other minor edits from the original article are not noted.
Author
Hi, I’m, Steven Slate, the author of this post and of all content on this website. Yes, I was what you would call an “addict.” If you want to know more about me, go to the About page. If you want quotes from PhDs and such (as if I haven’t given enough here already) go to my Quotes From Experts About Addiction page. Please be civil in your comments, and many of your angry comments may already be answered on my FAQs page, so maybe check that out before you scream at me.
I am also a strong believer that addiction is not a disease. I grew up with a mother who was a severe alcoholic, currently have a sister who is a prescription medication addict, and another sister who is a heroin addict. I deal with this on a daily basis. I know for a fact that it is their CHOICE. I know this because there was a time in my life where I was also addicted to prescription pain pills for a number of years. And geuss what? When things started to fall apart, and I noticed that everything around me was becoming shit because of my addiction, I chose to stop on my own. I decided I didn’t want this to be my life, locked myself in my apartment, quit my job, and detoxed myself. It sucked and it was hard, but I made a choice and made it happen. The same way I made the choice to start taking polls in the first place. I havent been addicted to pills in 8 years and have no desire to ever be again. Since getting clean, I have had surgerys which required me to tale pain medications afterwards, and I chose to take them as prescribed, and stopped taking them when the script ran out. Addiction is a choice, and I truely believe with all of my heart that these doctors and scientists telling people they have a “disease” is only fueling their addiction more, and giving them an excuse to continue.
I guess Alzheimer’s and dementia aren’t diseases either. Darn old people! Why don’t you play some crossword puzzles and keep your brain in shape so I don’t have to remind you to when to eat and bathe. This article does nothing to convince me of their argument, actually it seems to confirm it more than anything. Fact is, if addiction wasn’t labeled a disease then the help and treatment that’s available now wouldn’t be available. We’d all be hopeless on the street stealing and prostituting ourselves because society has given up on us. We’re good people who get caught up on bad situations. Hopelessness is rampant in the addicted mind. Shame and guilt only help to perpetuate these negative behaviors. Most addicts blame themselves plenty for all their poor choices. Compassion can go a long way.
I guess meditation must be a disease too. There are a lot of peer-reviewed studies showing that changes in the brain occur from meditation practice. Yeah, right. Folks, it’s called “brain plasticity” and that term refers to brain changes resulting from expeirence. The brain changes from just about every experience, whether it be meditation, taxi driving, falling love, addiction, etc. Addiction is an experience which in turn causes changes in the brain.
Obviously, the brain changes as a RESULT of an activity, so Nora Volkow confuses the issue by claiming brain changes from drug use are a disease.
However, many disease proponents point to a genetic predisposition to addiction, but curiously only to alcoholism. While it is possible that some races, like Chinese or American Indians, have difficulty metabolizing alcohol, that still doesn’t mean they have to do it, so it doesn’t prove that wanting to get f*cked up is a disease.
It seems more likely that this supposed alcoholic disease pattern seen in some families is in fact a learned behavior, just like poverty, lack of education, child abuse, etc. Kids learn from their parents how to drink, and those who don’t think for themselves can just repeat their parent’s mistakes.
Thanks Kelly. I know there are some studies that show a genetic predisposition to alcoholism (and possilbly drugs and process addictions too). But predispositions are not destiny; there ultimately is a choice involved.
I know you understand this Kelly, but I just wanted to follow up for other readers.
I am a recovering addict who has been clean for over 3 years. I had to have help to get that way. While I am no expert, and don’t subscribe to either side of the theory that addiction is a choice or not, do think this: It is known that chemical changes take place in the brain with addiction. When that chemical change has taken hold, why can’t that chemical change somehow take away one’s ability to make a choice? I mean, there has been a profound chemical imbalance that affects one’s behavior. I’m just asking. Thanks.
Exactly!
Clay, I understand where you are coming from. I went to a rahab to break my dependence on alcohol. However, the ultimate choice and decision to go to rehab was mine and indicitive of my decision (choice) to stop what I was doing. I see the rehab more as a timeout to break the cycle I was in, not that they “cured” me. It was all my doing, not the rehab, the counselors, the therapists nor some supernatural being. The rehab turned out to be 12-step based (they told me it was not on the phone) so I put my foot down and told them I did not sign up for a 12-step program. My counselor worked with me and found some SMART Recovery meetins for me to go to and excused me from 12-step attendance. I enjoyed them but no longer go since their meetings are not a for-life thing. I also found a Buddhist temple near the rehab and started attending. I believe that helped too. IMO, it is my personal growth that keeps me abstinent and gives me better choices than to drink.
I think at first addiction is a choice. At first smoking is a choice. These are choices made. We often don’t make good choices since we are human and often these choices are done based on peer pressure, etc.. However, after those choices are made for whatever reason I do believe the disease model sets in. When I was a teenager I chose to do drugs. I had no problems with drugs or my chemical processes in my mind prior to that crappy choice. However, ever since that dreadful day addiction had had my card. Smokers don’t smoke with the chance knowing they might get cancer. They smoke for other reasons. However, once they start smoking it is hard to stop and overtime their chances of getting a disease like cancer increases. I know for a fact I had no disease at first. It was a choice. I also know how hard my body has had to fight with opiate abuse. It is a battle I haven’t won yet. Sure feels like a disease to me, at least it does now.
I agree Derek. Not to be disrespectful……of all the people here who claim to know all there is about addiction….whether you had an addiction problem or not…..most of your information comes from books. Books that you made a choice to read. Biased books. Not one of you here has the letters PhD, MD or any other professional connotation.
I have an MD after my name, and I don’t think addiction is truly a disease. Most of my colleagues feel the same way, although we won’t say it when not behind closed doors. If we said what we really thought, the Steppists would try to get us fired for turning their sacred cow into a cheeseburger.
When I asked my HMO’s chemical dependency program therapists, in a group meeting, whether you need God to be sober, they said “no”. Many of the people in that group did not even go to any 12 step meetings, and the therapists didn’t care. This is a major HMO in the state in which I live.
I wish my family would think like you. There are too many enablers and too many addicts who get upset if you don’t treat them like they have some disease in my family. The addicts never get better and just use the enablers and both get angry at the rest of us who try to tell the addict they have to change their own behavior. The reasonable people are considered the black sheep, because they don’t want to go along with the ruse any longer.
I agree completely. Furthermore, I have attended many AA meetings and never does the speaker claim that their alcohol or drug use is compulsive. Generally it’s just a reaction to stressful events, or they are just trouble makers who like to do drugs. Once they learn to deal with stress (or just finally decide it’s time to grow up) then they stop drinking and drugging. In my opinion, AA is a drinking club designed to look like a group of tee-totallers. They go back to the booze when it’s convenient. For example, if they are stressed at work, instead of getting a new job they drink too much and get to work late. Or if they are angry at their wife for getting old, or if they want to pick a fight at a bar. When someone says, “AA is the only thing that ever worked for me”, it means that they have learned to use alcohol as a tool to manipulate and hurt others, and often have relapsed many times.
I heard you on BlogTalkRadio today. Thanks for your work and this great resource!
Thanks!
I found this website about 2 years ago while doing a research paper. Interesting theories abound here, including mine. I don’t subscribe to any theory regarding whether or not addiction is a disease or not. That, I do believe, is the basis for this site. I am a recovering addict, with over 3 years clean. Addiction ruined my life. I was one of those who did not have the willpower to quit on my own. I have used the 12 step rooms, and they have helped me immensely. I did not use them as a crutch, but instead, used them as a source of support and encouragement to get, and stay sober. What I have noticed here in this site, is that many addicts have shared their experiences with their own PERSONAL journeys of recovery. Those who believe that addiction is not a disease belittle, criticize, chastise, and degrade those who have found help in the 12 step rooms of recovery. Saying they (we) have no willpower, are losers. It may or may not be true that addiction is a brain disease, but I do know this: One doesn’t choose to become an addict. Who the hell would want that life? Who the hell are you to tell someone that their truth is a lie? Have you been in their shoes? Is it their life your leading? That is just wrong. Personal life experiences are just that: Personal. That means each experience is unique to that individual. So how can you all generalize your beliefs about what YOU THINK is right (maybe that is right for you), but it does not apply to the person you are criticizing. Opinions are like assholes: Everyone’s got one. So, if a person succeeds in recovery by going to, and believing in, 12 step programs, who’s to say they are wrong? They are now being productive members of society, not a burden on public agencies, and not out pillaging and plundering. It seems to me that nobody respects the other’s opinion here…and that goes for both sides of the coin. So why doesn’t everyone stick to the topic of this site and not tell someone what has worked for them is wrong. It worked. For them. They should know.
You seem to have missed a MAJOR point of this website: the numbers show that !2 Step programs AREN’T effective. No amount of presenting argumentum ad populum fallacies will change this.
The fact that 12 step programs are or are not effective is completely irrelevant. What is relevant is what works for some people, and not others. I am by no means trying to promote 12 step programs as “the” road to recovery. I totally understand the purpose of this site…it is a place for people to present their cases as it pertains to whether addiction is a brain disease or not. While visiting this site from time to time, I do see a lot of discussion on just that. However, I also see a lot of people sharing their own personal experiences of their journey through addiction and into recovery. If someone shares their feelings, and it involves something other than willpower to get sober, say 12 step recovery, they get slammed. People call them names, tell them they are weak, or that they are losers. Yes, I have seen that. People have done that to me here. So what if you got sober on willpower alone. Good for you…..I mean that. But, what if you are without that needed willpower, are weakened emotionally, and you need to seek help outside of yourself? That doesn’t make you any less deserving that someone who is opposite of them. The issue that I have with some people who comment on other’s posts is that they think that if they can do something a certain way, well, why can’t someone else?
They don’t seem to recognize that like them, every other person’s journey through addiction, and into recovery, is their own personal journey. Nobody owns that except for the person living that experience. If willpower works for some…Great. More power to them. If 12 step programs work for others, why should their power be diminished because of somebody else’s beliefs? Why should it matter how a person got sober? We all don’t travel the same road for a reason…..we are individuals.
So, to Richard, the MAJOR point of this website is NOT to show that 12 step programs are not effective. Whether or not addiction is a disease of the brain ( the MAJOR point of this website), it should not matter how a person gets sober. The question is a scientific one; disease or not? Not the way you or anyone, me, he, she or them got sober, but to maybe understand how the addiction process works and gain a better understanding so all can make an informed, educated, and individual choice as to how they get, and remain sober. By the way, those fallacies you mentioned, are not fallacies. As long as it works for just ONE person, it can’t, by definition, be a fallacy.
In argumentation theory, an argumentum ad populum (Latin for “appeal to the people”) is a fallacious argument that concludes a proposition to be true because many or most people believe it. In other words, the basic idea of the argument is: “If many believe so, it is so.”
This type of argument is known by several names, including appeal to the masses, appeal to belief, appeal to the majority, appeal to democracy, argument by consensus, consensus fallacy, authority of the many, and bandwagon fallacy, and in Latin as argumentum ad numerum (“appeal to the number”), and consensus gentium (“agreement of the clans”). It is also the basis of a number of social phenomena, including communal reinforcement and the bandwagon effect. The Chinese proverb “three men make a tiger” concerns the same idea.
No Richard….you missed the point. Not anywhere did I say that 12 step programs were more effective or not effective than whatever. What I have been saying all along is if that someone thinks that 12 step programs are helping them, and they stay sober……why tell them that they are wrong for doing so?? Some people can do it with out any outside help….and others can’t. We are all not the same for christ sake. So if you think that eating with your left hand is evil (the ancient Egyptians thought that the left side of the body was inhabited with evil spirits) and it doesn’t work for you…realize this: It works for others. Same as 12 step programs. Whether the evidence proves otherwise statistically is not important. If people get help in the 12 step programs….that is important.
Actually Richard, a 12-step program has been very effective for me the past 10 years I have been clean. Thanks for letting me share 🙂
Richard, thank you for that interesting information. Really, I mean that. My comments could most likely have been taken as aggressive. I apologize if they were. I guess I was just in sync with so many other’s comments when they are challenged with an opinion that is different than theirs. I too, am guilty of that from time to time. Again, thanks.
Clayton your comments are truly remarkable and you are a better man than I for taking the high road with these debates. Thanks for speaking for me on issues I was feeling but not communicating well on.
You have to apprehend that all of these individuals that are part of a “caring community” have their own agenda and motives for pushing the notion that street drugs are just a medical problem rather than a moral or ethical problem. I never sold drugs but it wasn’t until a long time after I stopped using them that I realized that I was part of a death industry.
See, my father, for example, wonders why don’t we just legalize drugs. We may end up there, but he doesn’t see it the way I do because he has never been on a crack binge or strung out on meth or lived nine years in Vegas and understand street life the way I do.
Some addicts, like heroin users can function and hold a job on a maintenance dosage of smack but how about crackheads? Crack is an inhalant. How are they going to hold jobs? Every 15 minutes they have to go to the crack (break) room and get a tune up? Or herd em together in a giant holding pen on the edge of town and air drop the shit into the compound? Do ordinary working people want to support that kind of “disease?”
Perhaps there could be developed some kind of replacement drug that would hold the crackheads. I’m talking about cocaine here because that is the only drug that I used that I would use up whatever was there, use all of it and then go out chasing for more. I did better on meth for functioning.
On the other hand I have been taking medication for 16 years now for bipolar disorder and that stuff saved my life. And yet there are armchair experts in AA who would tell me to use a higher power to cure my mental illness. I spent a little over a year in AA and I have now 9 years and two months and I’m glad I didn’t listen to those people, the same way I don’t listen to opportunistic doctors mewling about love and compassion. You KNOW these guys have an ulterior motive when they talk about disease and they are so deeply dishonest as to never doubt their self serving lies for one instant. Anybody that does not hold people accountable for their mistakes in life, in this world, is robbing people of their dignity and humanity and at the same time being duplicitous and deeply unethical their own selves. Here is the major difficulty here; responsibility is not blame. Telling addicts that they are victims of a disease and by implication that they are not and cannot be held responsible for their actions isn’t just bad medicine it is also means that these people will never get a chance to grow past the infantile state that is addiction.
This is a truly fantastic article by Mr. Slate. What I don’t fully understand is why so many 12-steppers are so hostile. Why do they feel the need to attack Steven with ad hominems? Is it because he brings to light some uncomfortable truths? Maybe they should go for a 12-step walk off an 11-step pier.
I think some people want to call addiction, especially to less socially approved drugs (opiates, cocaine, amphetamines, ect), a disease because they think people will be less judgemental. However this is not the case, calling addiction a disease INCREASES stigma and discrimination against addicts. Why? Because people perceive those who cannot control their behavior as scary, even if “its not their fault.” If you care about reducing the stigma of addiction stop calling it a disease.
Aside from Stanton Peele’s books, for another good critique of the “disease” of addiction see Peter Cohen’s The Naked empress: Modern neuro-science and the concept of addiction. (Link at http://www.cedro-uva.org/lib/cohen.empress.html).
Thanks for the compliment, and thanks for the link to that paper. It’s a valuable piece of support for my analysis of the brain disease model.
Steven —
Thank you for this website and the courage you have demonstrated to expose the myths of addiction. I have been looking for material to assist me in dealing with some personal behavioral issues that I would like to change and the information I have found at your site is most helpful. What I find alarming is that the concept of “addiction” as is continually dramatized in our society indeed takes away from the fact that we humans are free agents and have brains for something else other than to fill the hole in our skulls. Thank you for plain talk on this issue.
While I AM a follower of Christ and trust in His ability to assist me in my endeavors, you have reminded me through your posts and writings that I am not at the mercy of the world’s perceptions that what we term “addiction” is a disease of body or mind; it’s a choice. I am NOT a victim. And while we may experience discomfort “getting out the poison,” that that is merely a process of giving the body, brain and soul a chance to heal from the poisons we volitionally feed it.
I agree with you that our perception of “addiction” is skewed by the medical/rehab community, the media and in many ways, the fed. Thank you for reminding me that I am not at the mercy of any of them and I am not at the mercy of anything, except my own choices. Now, I get to do the work to get myself back in line, and I will let God sort out the rest of it. 12-stepping is definitely is not for me.
Warm regards,
Dee
I firmly agree.. My name is Paul and I am the director of my local chapter of Reformers Unanimous. To many people listen to the lie of society that addiction is a disease. I myself was an addict. I am no longer. It is not a disease, it is a Spiritual Heart Condition and a choice that with the “RIGHT” treatment can and will be helped. I also do not believe in the once an addict always an addict belief. This is yet another lie society. If you need help and you are tired of trying to find the “RIGHT” help please go to http://www.reformu.com. I thank the individual who wrote this article, I don’t know if you are a Christian but you have the right mindset on this matter. God Bless You.
I was wondering if anyone, who has been classed as an alcoholic at some point in their lives, can actually drink in moderation now? Maybe that could provide some sort of evidence that it is possible?
I was told I was an alcoholic, I drank 24/7 for the last 3 years of my drinking hell, prior to that I drank a lot – daily, just not 24/7 and I always experienced blackouts and was never happy until I passed out in a drunken stupor. I was hospitalised on numerous occasions, put on a drip, went to an AA rehab, lost my job and my partner. After my last drinking bender in 2010 my life and mind changed. I was out of the alcoholic fog and able to focus on what was going on in my life, in my brain, in my thoughts. With the help of CBT and various other counselling, I managed to sort out my mind to become a happy person – normal again. I was not born an alcoholic and with these new tools I received from therapy, I was now able to have the occasional glass of wine. I no longer have to drink to obliterate all of the demons that were in my mind in the past. I CAN and DO control what alcohol I can consume. I always used to have to drink round the clock, I had the DT’s and now, I wake up the next day and just carry on life normally until another social occasion takes place and I then go out and have what I want to drink which is nowhere near in the region of what I used to have. Three glasses of wine usually.
Maybe I am in the minority though. I know so many people who have not been able to do this and they have tried but unfortunately the drink seems to have been too overpowering for them.
But how come I am now able to drink normally after once being classed and lived as a hopeless alcoholic. Has my ‘disease’ now gone?
This article had me at first with the basic premise of drug addiction not being a disease, because anybody who is addicted to drugs CHOSE to take those drugs. Unless you are a teenage girl getting pimped and shot full of drugs by your pimp on the street(which happens in every city in every country in the world, sadly enough), I dont feel a whole lot of sympathy for drug addicts, and I’m an addict of sorts myself, altough heroin and crack arent my DOCs thank god. Im 18 years old and I’ve been addicted to both chew and cigarettes since I was 14. I started smoking pot at age 14, and at 16 it went from a weekend treat to a fullblown lifestyle. Now sometime if Im outta bud its hard to sleep and eat. I know they say weeds not addictive, but that is a lie. Im physically addicted as shit and I dont like it. I keep telling ymslf that I need to just stop and slow down, but I feel like I just love it too much. And im afraid of wat would happen to be honest. Im really high right now on pot, xanax, and methamphetamine that my doc precribes me for my add. Most people getadderall, but for some reason my doc gave me desoxyn (meth), and its got me a little bit hooked and i dont even like it because I have adhd. Sorry this was so fucked and long but im flyinn. If you take aything from it though, ADDICTION IS NOT A DISEASE, ITS A CHOICE, BUT ITS IS EXTREMELY REAL AND IF YOU FUCK WITH DRUGS IN AN IRRESPONSIBLE MANNER, YOU WILL REAP THE CONSEQUENCES. AND TO ANY PARENTS, this is coing from a tenn whos been on adhd meds prescribed since 9th grade. If you give your child adhd meds like adderall or ritalin to help them in school, make sure they dont abuse it, because its a slippery ass slope and soon its stops working. I barely graduated and Im the luckiest guy ever to still be attending a very good college in the fall. But Im worried about y career there and how long ill last. Fuck drugs. dont pop molly and start sweatin its not worth it i did it a lot this year cus i was like im a senior fuck yeah who cares. and now im having memory issues and i feel dumber overall. i got a 1980 on my sat, and a 32 on my act and now i think i wold probably get a 1600-1750 at the most. I have trouvle focuing now even in conversations with friends. sont do molly. its man made devil shit my friend took that and acid one noght and i was there and he thinks hes possesed now and it happened like a month ago. he thinks cps are after him and shit. Im sorry for my rant but I needed to get this out thesre for people to know. from a fuck up, get-high who didnt give a fuck but now really wishes he did. peace out yo reppin the seatown
This article had me at first with the basic premise of drug addiction not being a disease, because anybody who is addicted to drugs CHOSE to take those drugs. Unless you are a teenage girl getting pimped and shot full of drugs by your pimp on the street(which happens in every city in every country in the world, sadly enough), I dont feel a whole lot of sympathy for drug addicts, and I’m an addict of sorts myself, altough heroin and crack arent my DOCs thank god. Im 18 years old and I’ve been addicted to both chew and cigarettes since I was 14. I started smoking pot at age 14, and at 16 it went from a weekend treat to a fullblown lifestyle. Now sometime if Im outta bud its hard to sleep and eat. I know they say weeds not addictive, but that is a lie. Im physically addicted as shit and I dont like it. I keep telling ymslf that I need to just stop and slow down, but I feel like I just love it too much. And im afraid of wat would happen to be honest. Im really high right now on pot, xanax, and methamphetamine that my doc precribes me for my add. Most people getadderall, but for some reason my doc gave me desoxyn (meth), and its got me a little bit hooked and i dont even like it because I have adhd. Sorry this was so fucked and long but im flyinn. If you take aything from it though, ADDICTION IS NOT A DISEASE, ITS A CHOICE, BUT ITS IS EXTREMELY REAL AND IF YOU FUCK WITH DRUGS IN AN IRRESPONSIBLE MANNER, YOU WILL REAP THE CONSEQUENCES. AND TO ANY PARENTS, this is coing from a tenn whos been on adhd meds prescribed since 9th grade. If you give your child adhd meds like adderall or ritalin to help them in school, make sure they dont abuse it, because its a slippery ass slope and soon its stops working. I barely graduated and Im the luckiest guy ever to still be attending a very good college in the fall. But Im worried about y career there and how long ill last. Fuck drugs. dont pop molly and start sweatin its not worth it i did it a lot this year cus i was like im a senior fuck yeah who cares. and now im having memory issues and i feel dumber overall. i got a 1980 on my sat, and a 32 on my act and now i think i wold probably get a 1600-1750 at the most. I have trouvle focuing now even in conversations with friends. sont do molly. its man made devil shit my friend took that and acid one noght and i was there and he thinks hes possesed now and it happened like a month ago. he thinks cps are after him and shit. Im sorry for my rant but I needed to get this out thesre for people to know. from a fuck up, get-high who didnt give a fuck but now really wishes he did. peace out yo reppin the seatown
How bout when you when you hurt your back and your doctor gives you 100 mcg of fentanyl and you don’t know what the hell it is? Does that count too?
Matt
Food addiction seems to be different from other addictions in two ways. First, people must eat, so the person struggling with food cannot just quit and forget about their chosen substance. Second, they say they are addicted to sugar, and sugar is in almost everything, so the craving is constantly restarted. Third, they deal with cravings all the time. I have several people close to me who get mad when I forward them any addiction as choice articles. They say I don’t understand them, their cravings, the constant struggle. These people are of healthy weight; however,it is a daily struggle for them.
I am really curious about this, and any input is appreciated!
if you eat whole foods and don’t eat wheat or refined sugar then that physical craving for sugar should stop. if the person needs sweet things they can eat fruit. lots of people lie about a lot of things so they can keep doing what they want to do and pretend like its not what they want to do, so you feel sorry for them, so they can control and manipulate you to get whatever it is they want out of you, whether its attention or money or whatever else.
I never thought that when I grew up I wanted to become a drug addict but I did. Like my two brothers before me I fell into addiction. My brother just died two months ago, OD. I saw what it did to them but still CHOOSE to do it. No one made me no one forced me. We all have a choice in life, to pick up, not to pick up, to call our drug dealer or not call our drug dealer. Its not a disease its a choice, we may be chemically dependent on drugs because we chose to do them time after time, day after day after day, no one forced us. Us as addicts say we have a disease so we can blame the disease for us being addicts and not our choices to pick up the drug.
After 5 years doing the 12 step programs, I am coming to believe how much the disease concept is a cop out. Now, what do I do for support groups? Are there “it’s a choice” support groups?
Oh, also, hell hath no fury like when a person goes into a 12 step substance abuse program and starts saying “it’s a choice” Especially with the old-timers.
Here’s food for thought: before a drug like crack became so readily available, what did people do to alleviate the “disease”? I spent the first 45 years of my life, not craving any type of cocaine, regardless of its form. No craving whatsoever. But once I was introduced to it…wham….the addiction took hold….the physical addiction, that is. Physical addiction brought on by choosing to continue to use. Sorry, NA, but I break the disease model, just by this exerpt from my life history.
Relevant to some of these threads: when people say at the 12 step meetings…..”I tried everything, and nothing else works.” That’s misleading and possibly dangerous. Why? Because the majority of what is said in 12 step programs is designed to help the newcomer. In a way, this is limiting newcomers to the erroneous concept, that they might as well save themselves the wasted effort of searching for other sources to become addiction free. For example, I see medical doctors (psychaiatrists) to address other issues, which, by the way, could be helped by neuroplasticity concepts I am seeing. Many of these newbie 12 steppers have organic mental illnesses as well and HAVE to be treated first for any hope of succcessfully getting substance abuse free.
I’ve been bucking alot of the stuff said in 12 step programs. They have yet told me to leave (as the principles won’t let them 🙂 ) Now, I go to try to confirm to myself that the disease model is the wrong approach, I have yet been disappointed.
Greetings All! I have made several comments over the last couple of years. I respect people’s idea that addiction is not a disease of the brain. There is plenty of evidence to support that. I also respect, and believe that it is a disease of the brain. What has become a center of discussion here is what works for different people. Not necessarily addiction per se. Now, if someone can put down a drug/alcohol, and never turn back, my hat is off to them. Some people can do that. Some people can’t For anyone to say that just because they can do something is reason good enough for someone else to do the same has absolutely no understanding of human psychology. It would be like because I can bat a ball out of the ballpark, why by god, you should too. It just doesn’t work that way. People who use the rooms of 12 step recovery have found a way to put down that drug/alcohol. It doesn’t matter if you found another way. Who cares what works as long as it works? I think the people reading posts on this site would be better served if there was no bashing or downplaying anyone’s course of sobriety. Each person’s journey is their own. Have some respect for them as you would expect it for yourself.
Bravo! I couldn’t have said it better myself! at least someone gets it!
Hi Clay,
There’s something wrong with your formulation.
Batting “a ball out of the ballpark” is doing something. It is an act based on skills gained through practice, strength training, etc.
To not use drugs or alcohol is ‘NOT doing something.’ You can’t compare a behavior to the absence of a behavior. It takes no skill to not do something.
This is where the disease concept has truly destroyed rationality. We’re so convinced that there is a thing called addiction with a life of it’s own that takes skill and strength to battle, that we take it for granted and don’t even realize when we’re comparing a behavior to an absence of behavior.
We use phrases like battling addiction; overcoming addiction; triumph over addiction; fight addiction; succumb to addiction; etc, so much that we forget that the term “addiction” really just describes an active pattern of behavior – a series of active choices – and that its opposite is literally the absence of such choices. It is not an entity to be battled or to succumb to. It is not a disease. Nobody lacks the ability to NOT carry out a complex behavior such as finding, acquiring, and using intoxicating substances. What we call addiction is not like a sneeze, a blink, a reflex, or a twitch – it’s a complex behavior carried out over time. To continue “addiction” takes ability and strength – to discontinue it requires no such thing.
-Steven
Yeah. Ok. You got me on that. The point being is that everyone does not have the same capabilities as the other. Some people can put down that drug, with willpower alone. Some cannot. This site has lost it’s direction. You’ve made your arguments about whether addiction is brain disease. Some agree. Some do not. The point that is being missed here is, does it really matter how and why and what someone does to get and stay sober? Stop bashing those who need, or even think they need help. Good on those who do not. Stop degrading those who do. I’m unsubscribing from this site primarily you belittle the human spirit.
That statement is like one of those loaded questions – such as “When did you stop beating your wife?”
How can you throw something like that out there in good conscience Clay?
I do not bash troubled people. I’d love to see the examples of where you think I’ve done such a thing. And I certainly DO NOT belittle the human spirit. On the contrary, I have great respect for the human spirit. I think people have free-will – the power to choose their thoughts and behaviors. I do not think they are powerless over their own choices. When do I bash people and belittle the human spirit? Is it when I say that people can make different choices and change and improve their lives? Is that when I belittle the human spirit and bash people? Is it when I warn them to stay away from people who would teach them self-defeating scientifically unfounded beliefs that run counter to what we know about human psychology?
Did I belittle you when I congratulated you on your personal successes? Because that’s what I did. You were expressing some very self-contradictory things that I probed slightly, but I decided to just wish you well after you reiterated them, instead of pursuing an argument. http://www.thecleanslate.org/myths/addiction-is-not-a-brain-disease-it-is-a-choice/#comment-6498
I didn’t tell you to leave AA, or that you were weak for attending AA, or that you should get sober in some other way – or any of the other things I get accused of here.
It should be noted though, this isn’t a support group. This isn’t an AA chearleading forum. This site is about the nature of what we call addiction, and what we should do to help people with it. There is active debate about these concepts here, and if debate or disagreement about these concepts is considered to be bashing and belittling, then I don’t know what to say in response to that sentiment.
It matters what gets pushed as the truth about addiction. I’m sick of people telling me I’m not allowed to have an opinion about it.
Also, just to reiterate for other readers – my point in the last comment had nothing to do with baseball. Let’s not get stuck on that, as I now see that’s a possibility from Clay’s reaction.
The idea that:
misses the point. It continues to view addiction as being an entity with a life of its own – it views addiction as a force that people need an ability to stop. I’m not saying some people have the ability. I am saying that it is not an issue of ability, because “addiction” is activity – it is a series of choices. Its opposite takes no ability, no “will-power”, no effort. Its opposite is the lack of the choice to use substances (or less choices to use substances, in the case of “moderation”). Viewing it this way, there is no such thing as those who can stop it or those who can’t stop it. It is not a bear attacking you in the woods. It is not a boulder rolling down a hill.
It is not a thing to be stopped, or “put down.” There is the choice to use substances, and when people make that choice at high frequency/quantity despite high costs, we call it addiction. To do the thing we call addiction, takes effort and is an active choice/set of choices. To not do it, is to simply not do it – that requires no effort, no special skill or ability.
Look, I have made some bad analogies here. I have ranted and even whined a bit. And yes, Steven, you did congratulate me on my success. And I thank you for that. It’s not you in particular that I aim my, for lack of a better word, distraught-ness at. Way too many times I have seen people share their vulnerabilities with this site, and too many times have been “beaten down” by those who do not agree with them, in the way that they got or stay sober. Nobody is created equal….in the mental and emotional arena. I applaud those who have the mental capability to make a conscience decision to stop using drugs. Some do not. I just want for those people who think that because willpower works for them, give some validity to those that lack the willpower or mental strength to do so. I just wish that everyone could give credit where credit is due, and not lessen the experience of those less fortunate than themselves. I did make a conscience decision to stop using, through the help of 12 Step Programs. For me, I needed that emotional and supportive boost. After 4 + years of being sober, I find myself questioning whether I need to keep my “membership” in those groups. To be honest, I don’t think I could have gotten where I am without them. Which brings me to this summation. If I needed some help at the beginning to “motivate” me, and say, for instance you did not, but, we both remained sober…what’s the difference? The outcome is the same. I do respect the opinion of all who contribute here, even though I may not show it. It would be really very cool if everybody respected everyone’s opinion. Good night everyone.
To say that not using drugs is the absence of doing something and therefore takes no willpower is so inexplicably absurd I don’t even know where to start. It is clear that you have not experienced, nor have you worked with anyone who suffers from an addiction or compulsion. Abstaining from drugs is ABSOLUTELY “doing” something. You are using willpower to resist an intrusive and incredibly powerful urge to do something that stimulates the reward pathways in your brain. This argument proves beyond a shadow of a doubt to me that you have no understanding of what addiction really is.
Use your logic for a change. If an alcoholic or addict could simply “stop” participating in a behavior, why would they resort to the — according to your beliefs — infinitely more difficult task of going to 12-step meetings, engaging in treatment, attending therapy, etc? If people could just not do it, it wouldn’t be a problem.
Let’s do another thought experiment using your logic: According to you, not using drugs should be just as easy as not murdering puppies since they are both an absence of behavior. If both are equally “easy,” why is there an addiction epidemic and not a puppy-murdering epidemic?
Steve,
It is not better than you comparing addicts to soldiers, or skiers, or a woman that saved Jews in WWII. That was the dumbest article I’ve ever seen.Your a damn hypocrite!
Have a wonderful day,
Matt
Ahh, another person who regularly insults and bashes me, then accuses me of the same.
“Serenity now!!!!”
To those who want to read “the dumbest article” Matt’s “ever seen”, please follow this link: http://www.thecleanslate.org/addicts-choose-negative-consequences/
Ohhh…Are somebody’s feelings hurt? Hey because you know how to create a hyperlink, I read it again! Dammit…The article still sucks!
Matt
Matt, I thought love and tolerance was your code? Better dust off that Big Book and knock out a 10th step. All that rage will get you drunk seeing as resentment is the number one offender. Sucks when that shaky foundation starts to crumble, huh?
Z,
I didn’t catch much rage in the comment. Not sure how you read it It was more of a joke. ha ha…Anyways, thanks for the advise, but what is a 10th step???
Matt
Hi Steven,
I’m a fan of the site and agree with a lot of what you say here, but I do disagree with your statement that is takes no ability/effort to not do something. Even if addictions are “merely” deeply ingrained habits, they can still be very difficult to break. Take cigarette smoking for example, even people who have given up the habit for years sometimes crave a smoke during periods of intense stress. The craving can be intense and can feel like a battle.
Similarly people with OCD who spend half their day washing their hands (or whatever) may find the anxiety over germs overwhelming. It can require a significant effort to resist the desire to do something, especially when that activity reduces anxiety and produces pleasure (at least in the short term, even if it causes greater anxiety and distress in the long term).
While I personally do not consider addiction a disease, there are certainly aspects of addiction that are disease-like. I suppose to some degree the debate over whether addiction is or is not a disease is partly semantics and arguing over the definition of disease.
My view of addiction is that people, for reasons that are poorly understood, sometimes develop strong emotional attachments to certain activities, using drugs being just one of these (others potentially addictive activities include eating, gambling, religion, nationalism to name a few). Breaking these bonds can be a traumatic and difficult process, and when the person refuses to break this attachment despite significant negative consequences we call it addiction. This does not mean that the addict lacks free will (as the NIDA brain-disease model implies).
This article shows that you have absolutely no odea what you’re talking about. I feel so sorry for you.
When you say he has no idea what he is talking about, do you mean he doesn’t cite the research well? Because I thought he pointed out the evidence pretty clearly. If you want addiction to be classified as a disease, don’t get all huffy when the research doesn’t support your worldview.
when the CDC takes it out of the book, ill believe this article… until then… rant all you want…ps what credentials do you have besides being well spoken
I am not a doctor, if that’s what you’re asking, although I could cite several MD’s and PHD’s who agree with my stance. I don’t expect any of my readers to accept my arguments on authority, or the opposition’s arguments/assertions on authority. I hope my readers will exercise their own judgment on the validity of the disease model. I hope I’ve raised points that help you to think it through and find the correct answer.
-Steven Slate
I am an opiate addict and I thought your article was inspiring, it gives me hope that one day I will be free from all of this. I made a mistake, and it is very discouraging to think that I will never be the way I used to be before drug addiction, or that I’m destined to be an addict for the rest of my life.
Most the comments lead a lot to be desired addiction does respond to medication. To compare addiction to a taxi driver as the article does, major loosing of association. A majority of drug addicts and alcoholics want to be diapered and told there.
Science has proved it is a brain disease it is genetic, so you people keep argue right to your dirt nap. The choice you have is to seek treatment or not.
So if it’s genetic, which genes are involved?
My father has been an alcoholic for as long as I’ve been living, 22 years. He has consistently flung himself at alcohol repeatedly throughout this time. Despite this I can honestly say that it’s not a disease from my own observations. Everytime he drinks there is a motivator to drink that is not the alcohol itself. For him its women. He is the kind of person that needs companionship, which in itself is not a bad thing. However, in his case, being in a romantic relationship is as vital as breathing. My dad is truly obsessed with “having a woman” as he’s described it several times to me. I’ve checked his computer a few times and have seen search histories for at least a dozen dating sites, and in the recent past he’d go out on dates with a new girl every other day. My reason for saying this is that every time he meets a “nice woman” he ultimately ends up drinking with them. When he is “happy” drunk he has a tendency to dote on his partner too much and after a while they end up dumping him. Its at this point he enters his destructive phase, both externally and internally destructive. He flies into drunken rages about how each woman is psychotic and started treating him like crap when the truthis he is the one that goes nuts and starts treating everyone horribly.
Its because of these facts that partially convince me it’s not a disease. Sure the alcohol changes how he thinks and what actions he takes, but when he’s not drinking? There are no chemicals influencing his obsession over women are there? The alcohol can’t send his brain messages when it isn’t in his body right? Are there severe physical changes to his brain that specifically cause him to grab his wallet, climb into his car, drive 3 miles down the road to walgreens, and buy the booze?
Saying alcohol directly causes a disease in the brain that generates these actions is proposterous. My father is fully aware of himself when he seeks out relationships because it is a learned behavior for him. He makes the choice to consume alcohol when he meets with his girlfriends, not because the “bottle calls to him” but because he made the choice and accepted the drink with a perfectly clear head (aside from romantic urges). My entire family has met with him on several occasions, and even set up meetings with former alcoholics and AA groups. He’d go a few times and then say “I don’t have the time. Too busy.” He has enough time to go on all of these dates though right? So he obviously made the choice to date instead of help himself.
Alcoholism isn’t a disease. Saying it is a disease is just a mask and a cop-out so alcoholics don’t have to confront the real issues behind the alcohol.
Your Brain on Drugs: Imaging of Drug-related Changes in the Central Nervous System
http://pubs.rsna.org/doi/full/10.1148/rg.323115115
The addicted human brain viewed in the light of imaging studies:brain circuits and treatment strategies
http://www.cogsci.ucsd.edu/~pineda/COGS175/readings/Volkow.pdf
Imaging the Addicted Human Brain
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851068/
If type 2 diabetes is a disease then Addiction is a disease.. as people with type two diabetes are choosing not to loose weight and make other life style changes that could “cure” them.. I really dont see what choice has to do with a disease. People choose to get diseases all the time and people choose to fail to address and even promote diseases all the time. After all the person who continues to eat poorly, not take medications, and not exercise is choosing to promote their heart disease.
” I really dont see what choice has to do with a disease. People choose to get diseases all the time…….” LOL.
Is that glaringly self-contradictory or is it ME thats dyslexic ?
If a person chooses to overeat, not exercise, not address their obesity then IMO they are choosing to get and keep type 2 diabetes. If a person chooses to have tons of unprotected sex with untested partners then IMO they are choosing to get STD’s.
sorry and I think the mainstream recovery community and the fellowships are so stuck in the dark ages its sick.. it is well beyond time that they pull their head out of the mysticism and move forward with real science.. we once thought the world was flat, but we know batter now. That being said addiction is definitely a disease.
Dear Steven,
Thank you for your website. Although I do not agree with all of your opinions, I believe you have created an important forum for the discussion of addiction.
Behavior is a function of the brain. Abnormal function of the brain can always be linked with abnormal structure. A neurological correlate can be identified with every psychiatric pathology. Abnormal structure leads to abnormal function. The brain is an organ like any other in the body. When specifically talking about addiction, this has been shown on more than just imaging studies. This has been shown at a molecular level amongst various neurotransmitters, receptors, and electrophysiological properties of specific neural networks. There are to many peer reviewed scientific articles describing this to even point to a particular citation. This points toward the disease model of addiction. In addition, metanalysis of monozygotic twin studies show a high correlate of addiction to particular substances; suggesting a genetic basis (The Genetics of Addictions: Uncovering the Genes. http://focus.psychiatryonline.org/article.aspx?articleID=50718). Indeed this can be seen in families where alcohol and drug abuse are rampant. This could perhaps be dismissed by saying it’s more because of nuture rather than nature. An individual became susceptible because of high exposure. This is becoming dangerously close to sounding like it’s contagious, although not in the traditional sense. We are again straying back toward the disease model.
I do agree with your opinions on choice. Following through with an addiction is a choice. However, unlike any other organ in the body, we can change the structure of our brain – as you clearly pointed out in the Maguire et al. paper on taxi drivers. We can alter neurological structure via psychological function. If it can be done through AA, NA, St. Jude, St. Joseph, St. Thomas, the Bible, the Bhagavad Gita, or standing on your head while singing show tunes then it’s all good. But why do addicts do it in the first place? Why is there that lack of control? Why would someone choose that in the face of adversity? I know you mentioned earlier that in your active addiction you continued to use because you liked it. But why did you like it more than the next person? When things were going so wrong right before you went to rehab why did you keep on using? Why could you not make the right choice? Moral deficit?
When rats learn to self administer cocaine, they love it. Can’t get enough of it. They’ll do it to point of seizures if possible. However, if you pair those self administrations with a nasty foot shock, most stop. But some (around a third) don’t.. Some keep on going. Why? Moral deficit? Are they just dumb? If you rescue the hypoactivity in the prefrontal cortex via optogenetic stimulation then they stop seeking the cocaine when it’s paired with foot shock. With a minor change in structure they stop exhibiting the pathological behavior of compulsively seeking cocaine in the midst of negative consequences. They become like the others. The brains of those rats vary from the average rat, and so does their behavior (Rescuing cocaine-induced prefrontal cortex hypoactivity prevents compulsive cocaine seeking. http://www.nature.com/nature/journal/v496/n7445/full/nature12024.html). The brain of an addict varies from an average persons. This is merely one neurophysiological pathway abnormality that can be found in an addict. Other abnormalities have been described, and I’m very sure that more will be discovered.
Addiction is not merely about choice. People (or animals) want to choose the best thing. It is very similar to schizophrenia or depression in that addiction is about distorted thinking. Addicts think they are making the right choice. I need to get my act together. I need to quit. But, in order to take the first steps in getting my act together I need to get high. I need to get high right now.
I don’t look at the disease model of addiction as a means to absolve an addict from blame, but a means to better understand the neurobiological basis of behavior. I believe treatment of the active addict or those in recovery is important. But the study of addiction as a disease allows us to understand how all people tick. Preventative medicine is the best medicine. Your father’s family died to alcohol related incidences for five generations. Who cares if it’s genetic or up bringing? An early diagnosis may prevent a further tragedy. There’s a saying that says the sins of the father will be visited upon for seven generations. That may be true, unless you actively decide to be the seventh generation.
It’s good that you’re making a collection of literature that supports your hypothesis. Be forewarned, do not be married to your hypothesis. Read what other people are saying on the other side of the issue. I hope I’ve provided some insight.
Kind regards,
Tharanee
I have been reading and receiving comments here on this forum for about 3 years. Most of the information and experiences I find here are informative and enlightening. What first caught my attention to this website was the name in the title: Addiction is NOT a brain disease, it’s a choice. At the time, I was writing a paper on the subject. While there are both proponents, and opponents of this theory, there are just as many if not more opinions. While it is controversial, there is scientific evidence on both sides of the story that each “theory” is correct. What cannot be determined as correct or incorrect are people’s own individual experiences. I have been free of drugs and alcohol for over four years. At first, I thought AA and the like were the only answer. I have mixed feelings as to whether addiction is in fact a disease or not. I have found through AA that support from others can be invaluable. I have used AA over the years as such, and also a social network to be around other sober people. One thing that troubles me with some of the posts here is common when one is strongly opinionated, and that can be on both sides of the table. I believe it is important that we each recognize that, contrary to common belief, we are all not created equal. Some people have a greater potential for being more intelligent than others. Some have a propensity to being physically stronger than their counterparts. Others are, for a lack of a better term, and certainly not meant to be derogatory, “weak minded”. That, in most medical circles, can be considered as mentally challenging. The willpower that someone possesses to quit cold turkey is certainly an envious trait, and, one to be admired by some. The lack of willpower does not make anyone a loser, pussy or any of the other negative names placed upon people not like others. An experience of being able to put down a substance without any outside help is just that, an experience, that is owned by that person. On the other hand, someone who is at some sort of disadvantage not to do so, has an experience that is just as valid as anyone else. On both sides of the fence are people who get on their “soap box” and preach that their way of thinking is the only way. Each side needs to think about the individual, and their own personal experiences. I don’t have all the answers, and I don’t claim to be all knowing. What I do know is that it is wrong to demean or put down someone when you have never walked in that person’s shoes. I think that if everybody here, no matter what your experience has been, sticks to information and opinions that are motivating and positive, may actually be able to help someone in need instead of inhibiting one from wanting to get better.
I like what Clay M had to say. We are all individuals. I am 50 something and have seen people who have literally lost everything and still use drugs. Tell me why a person would want to live a life full of heartache, homelessness, incarcerations, loss of physical health, loss of mental health, hospitalizations, stigma, all just to get high? I believe it is a disease just because I have seen it in my own family. A wonderful kind, giving, handsome, intelligent person lost in drugs. Sorry, I just do not believe they would do this by choice. Like someone else said, if you had a family member or someone you cared about who was addicted you might change your mind on the disease thing. Just saying………
Hi Robin,
I’m the author of this article and everything on this site. Thanks for reading. I personally engaged in a freely chosen pattern of behavior that most would call “addiction.” I was definitely losing it all. I understand your point, I’m sure people that I must’ve been totally “out of control” of myself – and I even felt that way at certain points. But when I finally decided to stop the madness, it was when I realized that:
A) there had to be a happier way of life than I was living
B) I was CAPABLE of living that happier lifestyle
Part of how I changed my behavior after 5 painful years in and out of treatment programs who were teaching me to feel powerless and out of control, was that at the end of it, someone taught me that I was in full control, and that I was pursuing what I thought was my best feasible option for happiness (staying high on intravenously injected heroin and cocaine as much as possible, or on alcohol or other drugs when those weren’t available) at the time. The word “feasible” is important. Part of why I believed shooting coke and heroin all the time was my best option for happiness was the fact that I didn’t really believe I had better options available, or that I would be capable of successfully pursuing those other life options.
Does this mean I was diseased or mentally ill? Well, even though I was diagnosed with several anxiety and mood disorders including bipolar, I don’t think I was really mentally ill. What I suffered from was a limited perspective, low self-esteem, and a belief that I was incapable of change and growth. When I changed that perspective, I was able to stick to the decision to abandon heavy substance use, and pursue a better life for myself. I was never physically unable to change, nor was I out of control and compelled – I was choosing behavior that I believed was my best feasible option for some level of happiness in my life. The reason I personally know this is the case is because it was sort of my original belief before I got into the recovery culture, and because when I looked back at my previous cycles between abstinence and extreme substance use, the abstinence always felt like a miserable torture – like being deprived of any reason to live. The insanity of heavy use, with all of it’s easily predictable painful consequences, was far more satisfying than abstinence at that point in my life, from the perspective I held at the time.
I have now stopped that behavior for 12 years, and have been drinking at extremely low levels and frequency, problem-free, for almost 8 of those years. I don’t “manage my disease”, I don’t go to meetings, I don’t avoid “triggers”, and I feel no pull to resume my former behavior at all. I do not think of myself as a “recovering addict”, “addict”, or even “recovered addict” – because part of my change was changing my belief system, to know that I was in control of my own behavior the entire time, and in the future. Yes, I suffered horrible withdrawal symptoms whenever I would stop using heroin back then, but I was in control of my behavior nonetheless. I was never an “addict” because addicts – defined as people who can’t control their drug and alcohol consumption (or other such behaviors) don’t technically exist. Addiction is just a construct of the recovery culture – a construct created with the best of intentions to explain puzzling behavior and attempt to help people – but a faulty construct nonetheless.
You said:
I’m glad you asked in this way, and I understand the thinking. It seems to make sense. However, it rests on a premise that you may not realize. I have an article that explicitly address this at the following link: http://www.thecleanslate.org/addicts-choose-negative-consequences/
The solution for our loved ones, is to help them broaden their perspective on what potential lifestyles they might be capable of living. And in the meantime, we should also respect that their lives are their own, they always work hard to pursue exactly what they believe is their best feasible option for happiness, and that even if that is heavy substance use, it doesn’t make them bad people. It’s their life, they get to choose how to live it. This isn’t to say we should tolerate people stealing from us and using us and otherwise violating other people’s rights, but those behaviors are separate from substance use itself.
Thanks again for visiting the site,
Steven Slate
Steven,
You mention that you had to stop the madness, yet you disagree with a personal diagnosis of mental illness. Madness is synonymous with insanity, and by it’s very definition a mental illness. Any diagnosis made during active addiction is immaterial, because it is masked by the drug use. I’ve heard it said that addiction is but a symptom of underlying causes. The fact that you suffered from limited perspective, low self-esteem, a belief that you were incapable of change or growth, and seeking drug use as the best feasible option for happiness sounds very much like straight forward depression. I believe relieving your depression helped you break out of the destructive cycle of drug use, which most (definitely not you) call addiction.
There is no definition that can be found anywhere that addiction does not fill every aspect of. You cling to the opinion that imaging studies of addicts vs. normal individuals are irrelevant. However, these are the only studies we can do in humans. We are not ethically allowed to damage portions of peoples brains and see if we can make them into an addict, no matter how much I would like to. But it’s been done time and time again in animals (Neurocircuitry of Addiction.http://www.nature.com/npp/journal/v35/n1/full/npp2009110a.html). What needs to be done is to redefine disease so that it excludes addiction. Let me do it to Webster’s. Disease: A condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms, except addiction. There! Done!
You state that addiction is just a construct of the recovery culture, but addiction was on the lips of clinicians in 1914 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2301059/pdf/brmedj07197-0028.pdf) well before the recovery culture was even a glimmer. Indeed, at this time most doctors would have agreed with your opinions. However, times change and science pushes our knowledge further. The Dalai Lama once stated, “If science proves some belief of Buddhism wrong, then Buddhism will have to change. In my view, science and Buddhism share a search for the truth and for understanding reality. By learning from science about aspects of reality where its understanding may be more advanced, I believe that Buddhism enriches its own worldview.”
You state that you are not an addict, because you can control your drug consumption. You mention your 8 years of drinking as proof. But you mention before that alcohol was only usually an option when your drugs of choice were not available. I’m not sure your brain is wired specifically for alcohol like some alcoholics. Perhaps some field research is in order. Buy a month supply of heroine and cocaine for extremely low level daily consumption. Opioids and stimulants are commonly used in low levels as medicine. Most people, who aren’t addicts, have no trouble stopping. You of course, not being an addict, should have no difficulty with this.
I hope I’m not coming off as to aggressive. It’s just that I’m very passionate about neuroscience and this topic in particular. I really enjoy your website. You help bring these topics to the forefront.
Kind regards,
Tharanee
P.S. Please don’t buy a month supply of cocaine & heroine. I would rather see you live a fulfilling life in (what I believe to be a little ignorant) bliss, than return to the desolation of your past.