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.
He uses the conclusions of a newspaper sciene writer over VOLUMES of research by doctors and other medical professionals as the basis for his conclusions. This is not science – it’s simply using some other writing to support HIS OPINION that it’s a matter of choice.
I’ve seen too many people affected by this DISEASE – and it’s backed up by all the major medical associations – to know that it is NOT a matter of choice. It’s hopeless idiots like you who keep people down in the gutter by stigmatizing them as simply being too weak to change. What a crock of BS.
Do you have a counterargument to any of the arguments made in the article other than irrelevant insults and what amounts to “Uh, that’s not what those other people said.”? A really good case is made in the article, and you did nothing to pick apart the logic used in it. Try again.
The reason why my takes are full of insults is because the responses to my original arguments are “FULL OF INSULTS” as well as full of bullshit!!! And furthermore….you accuse me of not presenting logical arguments and all you can come up with is AHHHHHHHH…..”Uh, that’s not what those other people said.” Show me where I said anything even close to that!!!!! My arguments are based on personal experience and scientific evidence are completely logical. Any affliction that causes physical and psychological CHANGES in the brain that cause a person to SUFFER, causes behavior and thinking problems in ANY way can be classified as a Disease. Just because it effects the brain and mind doesn’t discount this theory one bit!!! The writer of this post seems to think that the ONLY thing that can warrant the classification of a disease is something that attacks the body on a cellular level or is something that attacks us without any doing on our part. But just because we initially cause our own pain and suffering by the choice to use drugs doesn’t eliminate the long term effects of the drugs on the body and the “condition” it renders the addict. It may be a matter of choice to start and to quit using….but the ADDICTION or “DISEASE” that DEVELOPS…..again…..DEVELOPS over time cannot be denied. And hey I don’t have to create a more logical or sound argument that this writer. Researchers and scientists and psychologists as well as addiction therapists and many others have already widely accepted the disease model for decades!!!! And more and more research every day backs it up!!!!
So….If my adherence to the Disease model isn’t logical or this guys take makes MORE sense….. The Disease theory wouldn’t even exist now would it dude!!!
By the way….if you call comparing addiction to… and I quote….”choosing to be in a relationship with a mobster” or being a superhero….AS LOGICAL……..Then your idea of Logical is just as warped as Steven’s is!!! HENCE ALL THE INSULTS!!!!
I recently witnessed something that finally put this to rest in my mind. I am a person who has suffered from addiction.. I am well versed in the neurochemistry, neuroanatomy, symptoms, and causes of addition. But when a very good friend, someone I love, someone who was sober for almost five years and then has gone back to totally reasonable use of drugs, even those in that she was “addicted” to.. oh and before anyone claims she wasn’t addicted, she was called edward scissorhands but the loser screws int the joint because the effects were so bad from injecting speed balls she couldn’t move her hands.. but she has been able to do all this on will power.. so yeah its a choice, but the thing is that I thought she was mentally ill because of her behavior.. her behavior is unmistakably a mirror image of the horin=bly named “king baby” syndrome out of hazelton. I am an addict.. I work with addicts everyday as staff on bluelight.org.. This hit home like a ton of bricks.. drugs are just a failed solution at a much deeper issue.. call it what you want … disease, destructive thought pattern.. but I no longer have any doubt in my mind that the drugs aren’t the problem.. http://www.democracynow.org/2014/1/6/drugs_arent_the_problem_neuroscientist_carl
I know these do not represent unfathomable scientific proof.. but after plodding through over 30,000 pages of data.. these are some of the best things I have seen written on the subject.. is it a choice, yeah it is, but the underlying illness is what makes the choice so hard not to make.
http://www.spectator.co.uk/features/8857821/fixing-a-hole/?fb_action_ids=10201789177466318&fb_action_types=og.likes&fb_source=other_multiline&action_object_map=%5B151100521716844%5D&action_type_map=%5B%22og.likes%22%5D&action_ref_map=%5B%5D
http://debiehive.blogspot.com/2014/02/addiction-mental-health-and-society.html
I was fooled for so long and understand the illusion.. but when I see someone do the impossible.. sober up and then return to non addictive use.. but still has the symptoms of an unaddressed addiction.. someone whose strength absolutely blows me away.. and pain absolutely kills me.. its crystal clear. i I went from one of its biggest doubters to a person with not a shred of doubt.
Check out a blog…..debbiebayerblog.com and read the article on Phillip Seymour Hoffman. I think you’ll find it quite interesting.
Does the Center For Disease & Prevention (CDC) consider addiction a disease?
I haven’t been able to find anything on their site about it. Of course, the CDC talks a whole lot about diseases caused by certain addictions, but doesn’t seem to think addiction is, in itself, a disease.
If they consider addiction a disease, you’d think they’d be talking a lot about it over there.
Maybe they know better. Or, maybe they just didn’t get the memo.
Anybodfy know their position?
Regards,
Sal Pitello
Positive changes of the brain, like tennis, driving or piano skills, do not, in any way relate to something that brings on the consequences of cancer or addiction. That is a poorly thought out point and I immediately stopped reading due to your reasoning skills being disqualified by that sheer ignorance. Most diseases can be avoided if you don’t partake in something negative.. Like poor diet, not exercising, smoking… And yes, drinking and using drugs. The area of the brain that brings on addiction is what your entire personality and view of the world is built on. If the activity of the dopamine, seriotonin ansd whatnot is only brought to that of the average person by using drugs or drinking, I’d say it is comparible to low or high blood sugar and its corresponding diseases(s). Yeah, you have to take that first drink or drug to mess with your system but due to a bad childhood, a bad pregnancy, or any other contributing factor, your brain could already be off and all that first drink would do is show you a more ‘simple’ way to control the way you feel. If your body has an uncontrolled growth of cells and you have cancer and need to do something to put a stop to that, I could relate the same idea to addiction. Though it isn’t as devastating as most with cancer, addiction could be called an uncontrolled sense of self. You don’t feel right, you can’t fix your depression or your crippling anxiety (or anything else related) because your body is not producing enough serotonin and such to bring you to the level of the average person. After treating your uncontrolled symptoms, you start to feel better., just like with a lot of diseases. Yes, cancer can kill someone if the uncontrolled factors are not helped by treatment but if no amount of treatment or drug can aid in the addiction, the person will surely overdose and die, kill themselves or wind up hating themselves from behind bars. The amount of positivity and hope and determination you have with every disease also plays a huge factor in how well the treatment goes, whether you believe that or not. This includes cancer and addiction. I have seen outcomes from both sides on both issues. Thankfully, the use of therapy and psychological medicine can have a stronger impact on addiction than other diseases but there are always still those resistant to treatment I could go on forever but yeah, addiction is more than a choice and though it may not coincide with your own personal definition of disease, there are far too many factors for anyone to be able to say that it is just a battle with self-will.
Hi Tori,
Thanks for questioning my “reasoning skills” – now, do you have a coherent refutation of my points?
If not, then I would say your own admission that you didn’t read the article fully disqualifies you from criticizing the content.
Your comments are incoherent at best.
-Steven
Mr. Slate you’re twisting the results of studies to bolster your opinions. You’re also name dropping and offering your personal experience to refute studies based on empirical evidence.
The London cab driver study was among the 1st to show that our brains continue to grow and develop throughout our life time; the study is an example of healthy brain development. The study demonstrates that our experiences over time can directly shape the structure of our brains. The brain changes of cab drivers aren’t a disease because they improve functioning. Changes present in the brains of addicts are maladaptive. They impair judgement, decision making and change priorities: the addiction comes first at all costs.
Unlike you, most addicts don’t choose to stop even though their health declines, relationships degrade or disappear, they lose their job, home etc.. Their brains are telling them that their addiction is what’s most important. Most addicts don’t make good choices even when sober, because of what’s happening in their brains. Maladaptive changes in the brains of addicts fit the AMA’s definition disease well.
When discussing the study that presented the brain scans, you give no value to the treatment participants received during their 14 months of sobriety. They simply didn’t choose to abstain by themselves, they did so with treatment, which obviously helped them. There is nothing in either study that supports the “addiction isn’t a disease” model.
12 step programs and traditional in-patient programs didn’t work for you, but they do work, especially in combination with each other. Your website reads like a well written forum rage post, which is sad considering google lists your site in the top of the “addiction not a disease” sites. I wouldn’t want people visiting your site to think that seeking treatment is pointless, but that’s basically what you’re telling people and that’s extremely unfortunate and misguided.
I would strongly suggest visiting treat programs to get a better idea of what good treatment looks like. Visit out-patient counselors too. Perhaps you’ll then be less hostile to “treatment” in general. If maintaining this website keeps you sober I wish you the best of luck!
D,
I appreciate your good-faith reply to my article, disagreements and all.
However you say that:
And you have a point – I don’t give much value to the treatment they received – because I don’t view it as “medical” in any way. I discussed this briefly in the article:
At the end of the day, the “treatment” they received was likely just a series of conversations. A conversation can be helpful, but it is not medicine that treats a bonafide brain disease. It is an exchange of ideas, in which one party may develop a new perspective on which they decide to cease using substances – or in which the individual may ignore everything which is said to them, refusing to consider any of it seriously, nodding and otherwise pretending to agree, telling the counselor what he thinks they want to hear, etc. It is up to the individual to voluntarily choose to integrate some advice, insights, or cognitive strategies expressed by the counselor into their own thinking, and if any of that stuff is correct, they will develop a new choice/preference as a result. Hopefully they ignore the stuff that is incorrect though.
As Jeffrey Schaler said:
I happen to think that as sometimes happens, these subjects saw a choice between abstinence and jail, and chose abstinence. But perhaps, something about those conversations was helpful. I do not deny this possibility. I don’t know what was said in those sessions. But I do know this: it likely wasn’t a “medical” intervention, because conversations aren’t medicine, and nothing in the article indicated that a medicine or medical procedure was used – only generic “treatment” was mentioned, which likely consisted of what we know it usually consists of…. conversations. And thus, these outcomes actually support the choice model rather than the brain disease model.
To this point:
My health declined greatly, I was arrested many times, spent many days in jail, lost many relationships, lost jobs, lost my place to live, etc – and felt like I must continue to use nonetheless, at great continued risk to my life. I went through all of that. I felt powerless. I felt helpless. But at the end of it was a new perspective and a choice to change. It was entirely of the mind – not the brain. I had to think differently about things in order to change my preferences and my actions. All those feelings of powerlessness and compulsion are real pain, and real feelings. But they’re not really the consequence of a physiological disease. They are the product of thoughts. They are the product of a set of beliefs which are a kind of trap, but which people can see their way out of, and it involves choosing to examine and see things differently. This is done in the mind, not the brain.
AND I would add, that everyone who gets past this problem chooses to do so. Everyone. Whether they’ve received “treatment” or not, whether they’re die-hard steppers or not. If they’re past it, they’re thinking differently about substances (or about their other life options; their chances of successfully changing; etc) than they previously did, and their preference has changed in some way as a result of choosing to think differently. I do not presume to be special and/or presume that those who believe in the conventional recovery culture are somehow lesser then me, and weak, or whatever. They’re just mistaken about the true cause of their change – but they carried it out by choice, just like me.
Please don’t think I’ve never visited treatment programs, outpatient counselors, meetings etc. I’m quite experienced with them.
-steven
This article disturbs me greatly. My son is almost 16, he started doing drugs at 15. He has tried many. Yes, cancer is a disease. Diabetes is as well, mental illness etc. as there is no cure for cancer although great strides are being made, there is not a way to control the symptoms as in diabetes, mental illness and others. Addiction is a mental disorder, as organic as any other. Often it is a symptom of many types of mental illness. As my beautiful, kind son told me as he was crying, I tell myself I won’t, and I do anyway. Many things in his life have gone downhill as a result. An addict has to make the choice to treat symptoms of this devastating illness. But it is never cured. I believe this article is very damaging and condescending. Witnessing a loved one go through it, is heartbreaking. And if not managed will often lead to death. So, is that a choice?
I am not an adduct so I know I do not have a lot of credit on this subject, but from what I have seen both through research and day to day experience working with and talking to addicts I feel it is a case by case thing whether or not one can just quit. For example many of you on Herr have talked about after your 3 days clean you could stop and not go back or even stop cold turkey but then others of you have said you cannot quit that easily and that no matter what you’ve tried you keep going back. I feel both sides here are correct. For some people quitting is not exactly easy but easier for them then it is for some who no matter how much they try, no matter what they do, it feels as if that addiction is controlling them and they go back. I do not feel that it is their fault though I know many of you disagree with that. If any of you would like to comment or offer feedback in my theory I find it can be helpful to see other sides and hear their counters so I will be happy to read them and respond. I just ask that you would keep it civil. Thanks for taking the time to read my opinion it is appreciated I hope you take it into consideration.
Wow. Just wow. My first problem with this article is the title. You were looking for a fight weren’t ya? That is a very bold claim! Your opinions are not facts and if you want to avoid hate in the future maybe you need to reevaluate your words. Something better would have been, “Is addiction a brain disease after all?” , but then you would have to re-write this whole article. It was a very one sided argument, and as the reader it seemed like you have never had an addiction problem, only that you do not like them!
Another issue I see with this, is the whole changes in brain statement that were made. Yes our brain changes throughout our lives, however- drugs actually kill brain cells! Why wasn’t this mentioned? Everybody knows this- I guess it would not benefit your argument, so I understand that! And I can’t BELIEVE that you compared drug addiction to playing a piano. I really got the feeling you know nothing about drug addiction! Playing the piano does not give people psychological and physical addictions along with the withdrawals.
Last, because I’m not wasting anymore of my time on this ridiculous shit anymore, when you brought up the points about the Heyman experiments, I was very offended that you took the work of an amazing project and twisted it around to make it look bad! This experiment was not for people like you to try and prove to the world that “we all have choices” (high-pitched, annoying nasal voice). Their work was for pure educational purposes, to try and come up with a cure for addiction. You may have just turned off thousands of people in the wrong direction.
Everyone is entitled to their opinion. But when you make them look like true scientific facts you look bad.
I’m curious why it is that you consider my claim that “addiction is not a brain disease, it is a choice” to be “a very bold claim”, which indicates that I’m “looking for a fight.”
It would seem to me that if your evaluation is true, then the claim that “addiction is not a choice, it is a brain disease” would be at least equally bold and “looking for a fight.”
Just so you know, they said it first. I responded.
I’ll leave it up to my readers to wade through the rest of your nonsense on their own. A 2nd grader could see through it.
Mr. Slate:
Thanks for putting it out there.
These discussions can get quite incendiary. In my experience, debates about whether or not addiction is a disease are rarely debates about whether or not addiction is a disease—they are usually not-so-thinly veiled attempts to either assign or duck responsibility for behavior. The last time I discussed this issue with anyone was with a young man from AA in his late twenties, who had armed himself with as much of the latest research as he could, much of it already mentioned on this and other sites. As a biochemist with a strong understanding of the difference between scientific models and clinical metaphors, pointing out the difficulties in each of his arguments came rather easily. I must admit to a certain immature giddiness on my part until, the last arrow flung and finding no target, he broke down into tears, sobbing “But believing that this is a disease is the only thing that got me to stop drinking.” As I said, that was the last time I discussed this issue with anyone.
“No man is happy without a delusion of some kind. Delusions are as necessary to our happiness as realities.” Christian Nestell Bovee
I think we may be close to ending this endless debate by finally identifying what addiction is. Here is a great article that just came out exploring this subject..
http://www.substance.com/why-stanton-peele-got-nora-volkow-all-wrong/
This link provides a more in depth explanation and also has other pertinent information on addiction.
http://www.bluelight.org/vb/threads/687452-The-Brain-and-Addiction
HA! All I have to say is this……YOU CHOOSE TO PICK UP THE DRUG! You were not BORN addicted to the drug. SO stop making excuses for your addictions! You shouldn’t have made a DUMB ASS DECISION to TRY a DRUG that you KNEW damn well could lead to being an addiction. HELLO!!!!!!
Sooo… babies that are born addicted to crack, or heroin (and other opiates) actually CHOSE to pick up the drug? That makes them a ‘dumb ass’ as you call it. Interesting theory, but fail.
What you just described are cocaine/opioid DEPENDENT babies, not ADDICTED babies. Addiction has a psychological component that dependence does not. The two terms aren’t interchangeable, so I guess you failed.
This is, quite possibly, the worst research paper I think I have ever read. Just complete garbage all the way through. Nothing but exaggerated claims that never actually get connected factually together. Try getting this peer reviewed dude and you’d be exposed for the fraud that you are. The internet brings out all the crazies, gotta say.
Try peer reviewing something with unsupported criticisms such as “Just complete garbage all the way through.”
Do you have any detailed criticisms of specific claims? Or do you just enjoy spouting arbitrary insults?
Steppists resort to garbage like this when they don’t have a factual leg to stand on, so to speak.
I am so over joyed to hear that there is actually someone out there that shares the same views as myself, i have never had any addiction , but am a daughter of a mom who has had drug addiction for well over 30 years. the doctors just tested her brain yesterday at interfaith medical center in brooklyn ,n.y. verdict is organic brain syndrome. so looked it up , and same ole same ole… then came across this wonderful article. my theory,, if someone can dig a hole, then they can most certain get themselves out. step by step… it is such a great reward that they can give themselves, if they are willing to do the work… it takes a lot of cunning and energy wasted toward negative things,, they can turn it around and make it positive… no one wants to take personal responsibility … i can say my mom never taught me anything,, but i would be lying ,, she did , she taught me how not to act.. i really did learn by watching her nod out on the couch… we all have choices to make,, let us think on the consequences of a decision ,,before we make one..she is threatening to leave there tomorrow…!
Addiction is frustrating, non sensical and a never ending cycle of crap. Having spent 10 years with an alcoholic who had hopscotched through life onto various substances he eventually stopped drinking for 5 years. It did not end. The behaviors of this diseased mind continue EVEN WITHOUT THE SUBSTANCES. This was what convinced me it was a deep rotted psychological malfunctioning of the brain. This man in the end was diagnosed with PANCREATIC CANCER, have already developed an addiction to opiates from back issues, that in retrospect I am convinced he was deliberately exasherbating so his supply of drugs would not dry up. He ended up having to have his lower spine fused together. Then like I said he was disgnosed with the “killer” cancer. A year after being treated by one of the most famous, reputable clinics in North America I discover he is “stock piling” his drugs, getting them from his back doctor and this “famous clinic” and not telling either what he was doing. He has Hepatitis C and now has to have his stomach drained of fluids every couple of week, he is clear…would you believe of cancer, he has virtually no mobility due to his back, he is a walking wreck and 99.9% of it is due to the fact that he was and always will be an addict with an extremely diseased brain. Nothing these people do makes any sense, they can actively engage in killing themselves and still be in denial nad telling you that “you” have the problem. It is horrible. Addiction is like being possessed by a devil, a parasite, that feeds off your life, your spirit and that of anyone it can latch on to and it sucks you dry until you are a withered raisin. Every see a heroin addict, exactly what they look like, raisins……sucked dry of life. I hate addiction and it is hard to not want to get away from every addict whose path you cross as they will destroy you as they are being destroyed but the simple fact is, they have an extremely diseased mind that without and amazing program and the help of an excellent team of mental health advisors trained in addiction that can lead that person throught the maze of psychological , behavioral, spiritual, emotional, physical..to name a few, dmages that have been done by substance abuse and almost deprogram and reprogram that person to understand their minds and fight their addiction daily, they will relapse. There but for the grace of something bigger than me go I. Thank God I have the strength, self disciplne, weak stomach, guilty conscience, sense of responsiblity to not need to drown myself in a bottle if my problems get overwhelming, oh I have had biggggg problems to overcome. I wade in the water too deep I know when to turn around and come in, I know when too much wine is too much, wouldnt dream of popping pills to avoid facing something. Think how nice it would be to not have to deal with the problems but just have something in me that has stopped me from ever going too far. Addicts dont have that. Its like a death wish. Its like a walking insanity. I have no medical degrees or research to back it up only experience of living with an addict, forms of comparison and a lifetime of observation…….addiction is a disease alright. God forbid you have an accident or illness and have to be treated long term with pain killers. Always be careful what you say as as much as I believe addicition is hereditary I also believe it can effect anyone and that stuff alters your brain, of course it does. Then come back and say its not a disease when your life is being destoyed by a substance you cannot stop taking becuase it has gained control of your mind. Would not wish it on ayone and would not wish living with them on anyone either.
Substance Use Is Not Compulsive, It Is A Choice
There doesn’t seem to be any 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
I DO Not think addiction is a brain disease.. but for me personally i was a cocaine baby, and from 12 fed ritalin i didnt want but at that age i dont consider that a choice.. then like most people in this world they try a drink or a drug.. from then on i was hooked immediately. continued to drink, hard drugs anything… I dont know you mean in this article are you saying addiction is a choice or recovery is a choice.. because for some people i never had the choice to moderate my drinking..i have tryed to believe.. i could and used moderation management still didnt work.. i tried to train my brain to moderate. i didnt work for me..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. … i dont like it when people bash aa program or other programs some one could see this and end up not going to aa when it could be the thing that ends up saving thier life… aa is very effective is you take all the suggestions.. sponser meeting steps service… i see alot of articles saying aa does not work… its because so many people go into aa and dont even do the steps… anyway i do like your article and agree with a lot of it good writing…
Hi Kenny,
You said: “I dont know you mean in this article are you saying addiction is a choice or recovery is a choice”
I am saying that all of it is a choice – to use or not to use, to use a little or a lot, or to never use again – it is all freely chosen behavior. As well, the thoughts that create your desire for substance use are a choice too – you can choose to stop believing it feels great, or that you need it to self-medicate, or whatever particular benefits you believe you get from substance use. You can choose to stop believing all of that, and as you commit to that belief, your desire will go away. But regardless of whether you have the desire or not, you are never out of control of your substance use.
The only exceptions are of the type you raised – if someone forces you to use, as you were forced to use ritalin as a child; or as soap opera characters are often kidnapped and forced to take drugs. But this is obviously not what we’re talking about when we talk about addiction. We’re not talking about people taking substances under the coercion of another person. And I should mention that no one can force you to be “addicted”, because being addicted doesn’t exist.
There is no evidence that AA “works” for anyone. See this review of the research: http://www.ncbi.nlm.nih.gov/pubmed/16856072
Furthermore, people who attend american treatment programs (of which upwards of 95% of them push the twelve steps and meeting attendance), or 12-step meetings alone, have no better rate of recovery than those who don’t get any help at all. Do you know what that means? It means that those programs ARE NOT EFFECTIVE. See this research: http://www.thecleanslate.org/self-change/substance-dependence-recovery-rates-with-and-without-treatment/
AND, AA attendance has been shown to increase binge drinking rates, when compared to CBT or no help whatsoever: http://www.thecleanslate.org/alcoholics-anonymous-increases-binge-drinking-brandsma-study/
So, I am not afraid of people reading this and deciding not to go to AA. They lose nothing by not going, and in fact, they may save themselves a lot of trouble by not going. If you want to go, and you enjoy it, that’s great for you and I have no desire to stop you. But I do want people to have the truth about “addiction.”
moron
That’s a compelling argument, Terry. Thanks for your constructive addition to the discussion.
Hey thanks for the reply steve.. im not sure if your being sarcastic to terry or a agreeing.. I may be a moron though.. what do you mean , because being addicted doesn’t exist… one more thing you said Furthermore, people who attend american treatment programs (of which upwards of 95% of them push the twelve steps and meeting attendance….. in another article you say 95 percent of people leave aa in the first year so some times your stats really dont add up…..so what do you think i should do.. im 10 months sober… i dont believe in the aa thinking… i want to drink normally… so i just believe i can drink normally and choose to and get drunk once in awhile.. because ive tried that way.. can you explain why i havent been able to moderate like you said.. because you said it is very plausible…
Kenny,
That 95% of rehabs use the 12-Steps (in the form of 12-step based counseling methods, promoting meeting attendance and the steps as a necessary “aftercare”, holding meetings in house, or by bringing attendees to meetings) – in no way contradicts or is incompatible with the fact that 95% of new AA attendees drop out of AA within a year. How exactly do these two separate facts not “add up”? One is saying something about methods used in treatment programs, which is true and verifiable by published US government research. The other is saying something about how many people remain in AA for an extended period of time, and is backed up by AA’s own research.
Also, yes I was being sarcastic to Terry. He responded to me by calling me a moron. It is clearly not a compelling argument, because it’s not an argument at all – it’s just name-calling. It achieves nothing. It shows that Terry likely has nothing to back up with whatever disagreement he has with me.
your still didnt answer my question about the moderation thing..
So, I think your question is “why haven’t I been able to moderate?” Correct me if I’m wrong.
My answer to that question is that you are 100% capable of using substances at whatever level you wish – high levels and high frequency; high levels and low frequency; low levels and high frequency; low levels and low frequency; or not at all – all options are available to all people. There is literally nothing that proves people cannot control their level/frequency of substance use. Again, there is no research that proves this.
The research that is available proves that people are in control and can make different choices when they see fit.
You have been capable, but you either haven’t truly wanted to use moderately, or you’ve changed your mind about it along the way.
That you made a choice you later regretted (heavy substance use) in no way proves a disability. You only explain it as a disability because you’ve been taught to do so, and it’s convenient to do so. If say, you decided to have only two drinks, and then had several more drinks, then that simply means that you changed your mind along the way, and decided more drinks would make you happier. I can’t tell you the full extent of what’s going on in your mind at such times – maybe you still believe the loss-of-control rhetoric, and this has created an expectancy effect within you that makes you feel as if you must keep drinking. Or maybe you’re having an abstinence violation effect, where you’ve invested so strongly in abstinence and counting your sober days, that you begin to feel loss and regret and say “fuck it, I already ruined my sober time, I might as well go all the way with this.” Or maybe you really just love getting drunk, and you don’t like a mild buzz. I really do not know everything that goes on in your mind, but I do know this: you are freely choosing each drink or hit, because you think it’s your best available choice – even if you regret it after the fact, and then describe it as a loss of control to save face, or make sense to yourself of the fact that you spent your whole paycheck, or pissed off your family, or whatever.
You are choosing each drink or hit because you prefer it to any potential alternatives. If you change your mind about the value of these highs versus the value of other things, you will change your substance use. But if you retain the same lust for substances, you will act out the same style of using substances again and again.
Do not take anything I have said here as a recommendation to drink or use substances at all – I do not recommend it. I am simply describing the thought processes and facts surrounding this topic.
-Steven
You are a refreshing voice in a sea of negativity. People LOVE to define themselves by what they are AGAINST rather than what they are FOR, and that way of thinking is responsible for creating a huge self-reenforcing feedback loop. When you tell yourself that you are addicted to something, and you change your patterns of living in order to avoid being tempted by “the thing”, you give that thing just as much control over yourself as if you were still abusing the thing. An easy example is dieting. “I’m on a diet so I don’t eat sweets”. Well guess what you’re going to think about and talk about all day long? SWEETS. The fact that you think about it all the time doesn’t prove that you are addicted to them, it proves that YOU decided to give sweets control over you. The answer to pretty much everything is power. When you tell yourself that you are powerless, that something or someone has control over you, you are a slave to it/them. When you make the conscious decision to be the one who is in charge of you, and you work on that every single day… when you take responsibility for everything single thing that happens to you… when you decide that you are no longer a victim…. then you cannot become addicted to anything.
No one wants an addiction. And to be honest, people are weak, addict or not. To say it’s a choice, to have an addiction, means the individual can just stop.
I completely agree with this. I got into an argument with my ex husbands mother about this topic. She calls her sons drug addiction a disease and says he has no choice. Well he is currently sitting in jail for the next year because he lies and consumes drugs regularly instead of taking care of his children that are wondering where the hell their daddy is . He also stole 15 thousand dollars from his boss and got away with it. Calling drug addiction a disease is a total cop out excuse that gives addicts justification to not take accountability for the poor decisions they have made. we all know that these drugs are addictive and extremely harmful as many of them are illegal for a reason. the fact the people are knowing putting themselves in this position is probably because of some emotional wound or abandonment issues. The thing is, doing drugs wont fix that, making choices to change what you don’t like about your life is a much more effect use of your time. The whole mentality of an addict is that they are victims in a world that is out to get them. Its always one excuse after another to why it is someone else s fault. Anyone who tells the person they care about who is an addict is being an enabler and only making matters worse. what we should say is you put you here you can get you out so get your game face on because what ever you put into it is what you will get out of it. changing your perception to “what the hell am I doing? I am better than this! I want more out of my life, no one is going to give it to me, i need to get it myself”. then the next step is stop thinking so much about your self and start thing about ways you can help others. there are people in the world who have real diseases go help someone in need
I quit drinking the first time at the age of 21. I didn’t even know what AA was to consider going? I decided I wanted to quit because I was abusing alcohol and I made some poor choices. I relied on my own willpower, asked God for some help, and quit. No celebrating a sober date, didn’t remember when it was and didn’t care, got on with life and it was no big deal. Fast forward 30 years-After not drinking for 30 years I drank again and once again abusively. However, this time it was to forget about a failed marriage of 30 years and the death of loved ones within a very short period of time. Decided I didn’t want to live that way after 11 months of drinking heavy and decided to cut down and drink in moderation, only this time I had bad withdrawals . Dr. suggested rehab and not knowing what I was getting myself into, I said yes. 12-Step (AA Based) taught me I had a progressive fatal disease and I was powerless. If I wanted to get well I had to work the steps, get a sponsor, and attend the 90/90 meetings of AA. At first I didn’t buy into it, after all, hadn’t I quit rather easily without all this 30 years ago? After much brainwashing, I temporarily bought into this nonsense of addiction being a disease. I was severely depressed because of my divorce after 30 years and the loss of my father and other loved ones. Rehab did absolutely nothing to address the whole reason I picked up again. Graduated rehab and began my 90/90 days of boring repetitive meetings. Heard the same stories repeated over and over, including all the “How I Hit Rock Bottom and Whoa is Me,” stories. Experienced the controlling sponsor who said my sobriety comes before my family, witnessed the 13th stepping going on around me, was reminded of alcohol constantly being that was all we talked about, and heard all the scare tactics, including “Jails, Institutions, and Death.” In this kind of atmosphere, with my real problems still not addressed, I grew much more depressed. Relapsed big time, tried to kill myself with alcohol and pills, almost ended up dead and nearly arrested, but after a trip to the hospital I ended up in an institution instead. As they say in AA, “It Works if You Work It.” I was working it, the problem is the program wasn’t working for me. Of course when I said something to that degree, I had to be reminded by my fellow AA Zombies that I probably wasn’t working the steps properly, I must not have done a thorough inventory, or “Oh, My Gosh, I must be keeping Secrets!” No, as it turns out, AA was keeping secrets! Decided to do some research as I noticed the cult-like tendencies of this program. Was horrified of what I discovered. Mr. Bill Wilson was the “King of the 13th Step,” AA was formed from the Oxford Group Movement (a cult), he stole the copyright to the Big Book (screwing the 30 some other people who helped write the book out of their money), the men he built his theologies on such as Carl Jung, Frank Buchman, and Emmitt Fox, are accused of being cult leaders and based on what I read, I believe it. The Wilsons had a Spook Room in their home where along with Dr. Bob and his wife they held séances and you can find this information on sites favorable to AA, such as the Wilson family home, Stepping Stones. Then there’s Dr. Jellinek, the father of the Disease Theory, who may not be a doctor after all as he was kicked out of college for skipping class too much and it appears from documents that his credential appeared to have changed. Fraud! The deceit continues today as our court system sends criminals to AA meetings instead of prison as a plea deal at times. As a result we now have rapists, child molesters, and other violent criminals in the rooms and due to the whole anonymity issue, none of us have to know until it’s too late, which has been the case for far too many. After these discoveries, I decided to read the book I should have been reading all along, the Bible. Numerous passages in the Bible indicate that drinking in moderation is not a sin, however, the state of drunkenness most definitely is and is referred to as foolish. Now for something to be both foolish and a sin, it must be based on behavior and choice. The Bible talks plenty about the sin of drunkenness and in no place does it indicate it to be a disease. If your a Christian, do you really think God would judge us for having a disease? Bingo there’s my answer! Said goodbye to those I thought were my friends in the rooms of AA. Quickly learned they were not my friends as they lost my phone number, stopped saying hi in passing, and removed or blocked on FB. I guess your only a friend if you remain a sheep within the herd. On a positive note, I finally got some real help for my depression from a counselor not associated with the 12-Step program and I’m not depressed anymore and as a result I’m avoiding “Jails, Institutions and death.” I’m starting to get over my anger at being lied to by what passes as recovery in this country. By the way, the good ole USA is the only country in the world that accepts the “Disease THEORY of Alcoholism.” Kinda makes you wonder! I’ve given God the credit he deserves for my recovery and I’m enjoying life again. They say AA has saved thousands! Could it be that those who really want to get well remain active in a program that convinces them they have a disease that only AA can cure and their more than happy to take the credit. How many has AA destroyed? How many marriage have been destroyed due to a spouses new addiction to the program or 13th Stepping? How many people have been killed, raped, or had children molested as the result of a program that takes no responsibility for supporting criminals sent to AA? Finally, how many people died through suicide or attempted it like myself because of the failure of 12-Step rehabs to address the real problem or because some Nit-Wit Sponsor who thinks their a doctor tells their Sponsee, no anti-depressants for you, that’s not sobriety? Both AA and The Disease Theory of Alcoholism are based on lies, if you want to find the truth, close the Big Book and open your Bible.
I don’t know if anyone’s said this or not, but aside from all the geek-speak, and neurological/physiological/psychological discussion, there’s one more simple fact that this whole article overlooks. ADDICTION CAN KILL YOU. Using the ‘taxi driver’ example is ridiculous. Any ‘disease’ that can kill, maim, injure, hurt, even just negatively affect you, is simply that. A disease. Using an example that does not lead to death by overdose (you can’t overdose on taxi driving, but you can overdose on water, just to remove the people who might say “just don’t CHOOSE to do it”) is completely and wholly irrelevant. Here’s an idea – stop drinking your coffee, your tea, your ‘health drinks’; stop eating your carbohydrate-riddled foods, stop constantly returning to this page to make sure you get your point across – because if you don’t, you’re choosing to be addicted to them, by your own admission of what you think addiction is.
Thank god for this website!
I am in a drugs and behavior class in college, and everyone has just accepted the disease model without any second thought. I was getting concerned that I was the only one who felt this way.
Used to abuse the shit out of some morphine, however, coke is now what I currently enjoy, mainly due to the fact I have not found a smack dealer. I honestly do not see why I cannot use any type of drug I wish, if I’m free and all. I do not care about consequences, if I die, then shit, I’m dead. I use for the high, the euphoria, the sense of calm. Been in and out of rehab, been through NA, CA, AA, etc., still use. I realize the stigmata, the consequences; they mean absolutely shit to me. Just want to use, to ‘self-medicate’, what, who gives a fuck? (I don’t, for damn sure) Death honestly is the last high I can attain, and it’s natural. So, I say fuck ’em, I’ll use whatever, whenever, and have zero regrets. If, financially, I cannot afford the hard drugs I like, I’ll go through the motions of PAWS, with the intent to do more when the opportunity arises. Get off my fucking g back, let me grow papaver somniferum, and have what life I’ve freely choosen to live for the short interim it may last (but given my luck, I’ll live for fucking ever). Do not care if addiction is a diseaseof the mind or choice gone wrong, just want what I want and can’t see why it can’t be that way.
This website was obviously created and written by someone who has never struggled with addiction. Ignorance at its finest.
Your comment is willful ignorance at its worst. There is an “about” tab, and “FAQs” tab, where you could’ve quickly gotten some info about me, the author of everything on this site.
http://www.thecleanslate.org/about-2/
http://www.thecleanslate.org/faqs/
Megan’s post was obviously created by someone who lacks even the most rudimentary of reading and/or debating skills. Steven’s years of being an addict are a matter of record and are clearly posted on this site. But you knew this already; you just didn’t like his conclusions and like a good little Stepper drone, resorted to ad hominem arguments rather than attempting to refute his point. Because you can’t.
I was an addict for 17 years and was taught the disease concept from the start of it all. I have been sober for 2.5 years and I no longer believe addiction is a disease. It makes sense that after using drugs repeatedly over a period of time will change our brains chemistry but also after abstaining from drugs for a period of time will change it back. After being clean for 8 months was when I started to notice the desire to use was less powerful. Then after about a year I had no desire to use drugs at all. I also believe that just abstaining and allowing your brain to return to normal may not be enough. Like the article said, if you don’t have something in your life that makes you happy or gives meaning, then getting high might feel like the best option to “fill the hole”. I give all the credit to Jesus for giving my life meaning and happiness as well as the ability to overcome a habit that is both powerful and dangerous. The good news is that addiction is not a disease and that you do not have struggle with it for the rest of your life.
I truly have a hard time with this article. I am an addict and when I was in my heavy use phases…It did NOT matter how hard I tried to self-talk (or choose) my way out of using. The cravings were simply TOO OVERWHELMINGLY INTENSE. The threat of loosing family and the pain it was causing them, the health risks etc… did not matter. It finally took me blacking out, crashing my truck and landing in jail for six months that finally forced the issue and got the ball rolling. And even when I got out…my brain still wasn’t fully healed and I relapsed a couple times landing myself back in jail for another 6 months. Now however, my brain is more capable of functioning normally, allowing me to make better CHOICES. You have to get healthy first….and that takes time. Recovery is a process….its NOT A SWITCH (CHOICE) YOU FLIP. Plenty of ignorance in this article…I’m afraid!! God Bless!!
What sort of medication or surgical procedure was used to heal your brain?
Did you quit before the medication/surgery – or after it?
Wikipedia—
A disease is a particular abnormal, pathological condition that affects part or all of an organism. It is often construed as a medical condition associated with specific symptoms and signs.[1] It may be caused by factors originally from an external source, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases. In humans, “disease” is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases usually affect people not only physically, but also emotionally, as contracting and living with many diseases can alter one’s perspective on life, and one’s personality.
So addiction IS a true disease because is causes dysfunction. Whether you call it a disease or disorder….it “affects” the normal functioning of the person. Unlike cancer that suddenly attacks the body….it becomes a disease (or disorder) that develops over time with chronic use. And just like cancer……. most of the time, IT REQUIRES TREATMENT!!!!!
To answer your question, I began taking antidepressants immediately after my last relapse. I sought more intense psychological help when I realized “I COULDN’T DO IT ON MY OWN” like you claim I could have. And “time” along with physiological and psychological treatment is what healed my brain. But dude…if you think severe addiction doesn’t change your brain chemistry or that you develop patterns of behavior that are almost impossible to break with sheer will power…than you are deluded. Furthermore….everyone is different and situations are different. If you are able to just all of the sudden “say no” and quit cold turkey….good for you. But it is not that easy for most. If it was simply as easy as just saying “NO”…..millions and millions and millions would be able to quit after the first trauma, hardship or downfall etc… and there would be no need for “TREATMENT CENTERS”. Most need some sort of intense intervention….and yes in some cases…medication. But time to get right mentally and heal is key. You seem like an arrogant and self-righteous chap as well as very shallow!! I Bet you can’t quit that cold turkey!!! LOL
Hi Ryan, I would like to explain how I see that addiction is not a disease, but a choice. Compare it to cancer for example. If someone has cancer they can’t wake up in the morning and choose to not have it. It takes chemo therapy to get rid of it. With addiction you have the choice everyday whether or not to use or get high. I’m sure you have probably made the choice to not use for days, weeks and months or more consecutively. Now here is the part that I think a lot of people don’t understand. The fact that addicts still have desire and cravings even after months of sobriety probably makes it feel like your going to be that way for the rest of your life, especially when you have doctors and groups like A.A telling you that. According to the article the brain does go through some changes after you have used chemicals for a prolonged period of time. These changes are not abnormal and can even be seen in peoples brains that are not addicts. The good news is that the brain chemistry that has been changed due to use of chemicals will change back after abstinence and replacing your obsession with alcohol or drugs with something you consider to be more important. The problem with the disease model and therapy groups is that they teach you that your stuck with having the cravings. Just having in your mind that addiction is a disease and that you must rely on an A.A group or even a higher power can be a stumbling block in getting your brain’s chemistry or thought process changed to where you eventually won’t have the cravings anymore. If you noticed in my first post that I do give credit to God for my recovery, but not that he performed some miracle and healed a disease. It’s because I believe God created us as intelligent and capable human beings. Anyway I don’t have a perfect interpretation of every aspect of addiction, just thought I would share my opinion.
I respect your honesty. But as with cancer….you need TREATMENT to attempt to cure it correct? So why doesn’t this apply to addiction? And your brain imaging argument doesn’t hold water as” the effects are “experiential” and the physiological “symptoms” cannot be seen on a computer screen. They are felt!!! Like PTSD….there is “disorder” taking place in the brain. I suffered with it as well and I COULD NOT simply choose to stop those symptoms. PERIOD!!! Again I needed treatment to help my brain begin to heal functionally. Now…it is true that one can choose to quit using and persevere through the discomfort and anguish until they are functioning again, But, when you define disease…..you can call it what you will. Intense cravings are caused by a physiological “dysfunction” of the body. Do you consider Diabetes a disease? Well how do most people develop diabetes? You got it…poor eating “HABITS”, Like using habits. There are many things we can choose to abstain from….including drugs and alcohol. But there is “OVERWHELMING” evidence that chronic use “changes” a persons body and in most cases….one needs Treatment of several kinds…medical and psychological. Do you consider Schizophrenia a disease….this person cant wake up in the morning a choose to not have it either…right? We are splitting hairs as to how we define disease. You seem to think it is only limited to those that are organic (other than mental).
Lastly, you mentioned the Lord. I lean on the Lord as well. But here is a tidbit to consider….We are ALL FALLEN in a Cursed world and if you are familiar in ROMANS 7:15-20 I do not understand what I do. For what I want to do I do not do, but what I hate I do. 16 And if I do what I do not want to do, I agree that the law is good. 17 As it is, it is no longer I myself who do it, but it is sin living in me. 18 For I know that good itself does not dwell in me, that is, in my sinful nature.[c] For I have the desire to do what is good, but I cannot carry it out. 19 For I do not do the good I want to do, but the evil I do not want to do—this I keep on doing. 20 Now if I do what I do not want to do, it is no longer I who do it, but it is sin living in me that does it. What does this say to you? God Bless
Ryan I understand that we are fallen but God does not want us to live in a constant struggle with addiction.
Romans 8:2 says-because through Christ Jesus the law of the Spirit who gives life has set you free from the law of sin and death.
The famous words of Jesus in John 8:32 “Then you will know the truth, and the truth will set you free.”
When I stopped going to 12 step meetings and treatment centers where the disease model is taught is when I noticed that the desire wasn’t there anymore. I believe the truth that set me free is when I started believing what that verse and others really say. Before I just took them for granted. I know it is a struggle in the beginning but if addiction is a learned behavior then it can be forgotten or un-learned. What I mean is that there should be some scientific evidence that shows that the brain returns to the way it was before the substance use started. Can you help us with this Mr. Slate? I apologize if you have already answered this question in a previous post.
Cancer vs addiction? That’s easy…if someone holds a gun to your head and says, “if you put that needle in your arm, I will shoot you”, despite the miserable withdrawal, most people would chose not to put the needle in their arm. Can’t strongly suggest to a cancer patient to not have cancer anymore. Thanks again for making our job easier shit for brains.
Definitions, to be of any use, are supposed to narrow things down by identifying the essential characteristics of a thing that differentiates that thing from other things. You have provided a definition of “disease” that is so broad that it could literally include any state of affairs with negative consequences. And I quote:
I’ve seen this about a billion times, and frankly, I’m disgusted by it. If you have any level of comprehension, you should understand that this is describing the metaphorical use of the term disease. Thus, you shouldn’t attempt to use this definition when discussing whether or not addiction is a medical disease – i.e., a condition involving malfunction on a cellular level – i.e., the physical parts (tissues/organs/what have you) of a living being not working how they normally should work.
Under the definition you provided, I could say for example that choosing to be in a relationship with a drug dealer or a mobster is a disease. Would such a relationship lead to “dysfunction” in your life? If you consider having to live a lie; exposing yourself to arrest; being complicit in crime; etc to be “dysfunctional” then bingo – such a relationship is a disease. But even if it’s not a relationship – maybe you were born into a family of criminals – this unchosen circumstance can cause dysfunction; expose you to potential injury; etc – and thus it is a disease.
Or perhaps you chose a college major in which there is little potential job opportunities or where the potential pay for such jobs is so low as to have you living in poverty. You’re also in debt $200,000.00 – which you will never be able to afford to repay. Is your secondary education a disease? Under the definition you’ve provided, yes it is most definitely a disease.
Do either of these “conditions” fit what we think of when we hear the word disease? No, they don’t. We wouldn’t think that medication or surgery were the proper solution to either of these conditions. We would think that they were particular choices with particular consequences for which the people involved would have to make new choices to remedy the consequences if that is what they desire. In the case of being born into a family of criminals, we would think the person was dealt a bad hand in life, and that they’re disadvantaged, and will have to make the tough direct decision to distance themselves from their family if they want to cut down their exposure to risk. We wouldn’t think they’d need a medical doctor to solve their problem though.
Summing up – your definition of disease is so broad as to be useless in the quest to understand the nature of addiction. If you want to say it’s a metaphorical disease, go ahead and do so, and own that – don’t try to have your cake and eat it too by fitting addiction into a metaphorical definition and claiming that it’s proof of a biological reality.
-Steven
Dude, that is the wykpedia definition!!!!!!!!!!!!!!!!!! We are not talking about the first time someone chooses to try drugs or after several times or even a few years “chooses” to set it down. We are talking about the “condition” that one can develop over long periods of time that create Disease like symptoms and require disease like treatment. That is the “condition” of addiction. Once an addict has gone so far, it becomes a Disease. Tell a 20 year Heroin addict….”hey, you should be able to just say no”!!!! NO……..THEY NEED MEDICAL TREATMENT!!!! And dude…..does being in a relationship with a drug dealer or mobster change your brain chemistry? Does it cause cravings to hang out with more mobsters? NO!!! That is the dumbest example of attempting to prove that my argument is too broad!! Really dude??? Really??? And the college example too? WOW dude….that is the most amazingly stupid line of reasoning I have ever heard. You might as well have said….”because I read a lot of books….I have the disease of readers sclerosis”. WE ARE TALKING ABOUT THE “PHYSIOLOGICAL” CONDITION, PHYSICAL SYMPTOMS, BRAIN DAMAGE, CHEMICAL IMBALANCE ETC……………………..”CAUSED”……………….”AND BECOMES THE RESULT”…………..OF CHRONIC USE!!! IT DOES NOT MATTER HOW SOMEONE “DEVELOPS” A DISEASE………….WHETHER FROM THIS, THAT OR THE OTHER!!! You want to explain to me why you say that it can only be “cellular”. Who made that RULE? CTE…that boxers and football players develop is a Disease that can have “PERMANENT” symptoms. Just like Alzheimer’s disease!!!! Chronic users can have permanent symptoms and damage as well. Besides, Who are you or anyone to say “WHAT” is a Disease or what isn’t. The definition is “BROAD” for a reason. Any condition that changes the normal functioning of the body….and this includes the MIND (or brain) for long periods of time until death or cure could be called a disease. Is the term “disorder” better for ya? NOT ONE HUMAN BODY ON THIS PLANET IS “PERFECT” and void of problems. Therefore….Quite frankly….the list could even be broader!!!Your arguments are weak as hell……as there IS TONS OF SCIENTIFIC EVIDENCE THAT CHRONIC USERS DO DAMAGE TO THE CELLULAR STRUCTURE AND CHEMISTRY OF THE BRAIN and therefore……………THEY “NOW” HAVE A DISEASE!!!!!!!!! And YES, many millions of times over…. they are helped with medication!!! I WAS!!!!! And lastly….To say that a Disease can only be called a Disease if “SURGERY” is required…..is laughable!!! Sorry, But I am a recovering addict of over 20 years and at points in my life …….I WISH I could have simply CHOSEN to quit. But It doesn’t work that way bro!!! I needed help!!! Sorry If I was a little abrasive!!! God Bless……..
Hi Ryan,
If you think that Steven’s comparisons above were bad, check out this article he wrote. He compared addicts to heroes. Makes sense, right? He’s a lunatic!
http://www.thecleanslate.org/addicts-choose-negative-consequences/
Matt
No. Just, no. I’m not even going to say anything else about how ridiculous this article is, since so many people have made CORRECT points already on how it is indeed a disease. I will, however, say how appalled I am at the general lack of compassion for other people’s obvious suffering. I’d have to say most of those who are arguing against the facts of the disease have probably not had any level of experience with addiction, or at least not as much as they’d like to believe. I’ve met other addicts in recovery who don’t believe that it’s an addiction and that’s all well and good for them. Hell, if it works for you then great; as long as your healthy and happy. But telling other people they’re wrong about how they feel they should get help is not okay. If I listened to the people spouting this nonsensical “weak will power” BS at me while I was still in active addiction, then why would I have gotten help? It would have been solely my problem to fix since it must be all my own fault. Sure, I MUST have wanted it to ruin my life. There are no pros to living like that. Why would someone choose to continue doing so if it were really up to them? There are definitely more scientific, peer-reviewed, FACTUAL findings on the subject; but others have already presented them (mostly to closed minds and deaf ears), and really it all comes down to the question of why someone would choose to destroy their own lives if it really were a choice. It’s not. Plain and simple. If you want to believe its a choice, that’s fine. But please, PLEASE don’t put other people down who might otherwise seek help for their addiction if you hadn’t made them feel so guilty and helpless about themselves.
Hi Zach,
You said:
I just searched this page for the terms “will power” and “willpower”, and found 29 instances of these terms (your comment containing one). Although I didn’t do an exact count (I skimmed the instances of the terms), it appears that this concept is mentioned a few times by people who quit without treatment; a few times by those who say it takes willpower; and the majority of times it was mentioned appear to be from those who take issue with my article and the view that addiction is a choice.
Oh yeah, there are also 3 instances of me using the term “willpower” in this article. The first appears in this quote:
The other two appear here:
I think those two excerpts clearly show my opinion that this is not an issue of willpower or weakness. I’m not sure of why I need to keep being accused of making this a matter of willpower or weakness – except for the fact that other people are projecting their own false dichotomy onto my presentation.
Onto another issue – you said:
The point of saying “addiction is a choice” is that the behavior is in direct control of the individual at all times, and the belief system that motivates the behavior is also within control of the individual. You can choose different beliefs and you can choose different behaviors. You are autonomous in this respect – nobody can do these things for you. The most someone could do to make your behavioral choices for you is to lock you up in a cell where your choices are limited.
The fact that a behavior or series of behaviors has high costs or risks involved does not prove in any way that it wasn’t or wouldn’t be freely chosen by someone. This argument you have made is foolish, although I don’t fault you for it, since it is in common use in the addiction-as-a-disease rhetoric. Rather than repeat a lengthy discussion on it, I’ll just say this – there are plenty of behaviors we consider to be freely chosen that also come with high risks and costs (even fatal costs). And I will provide you with a link to my discussion on this topic here: Why would someone choose to be “addicted” when they know it will cause so much pain? I hope you’ll read it.
-Steven
Steven….”belief system that motivates behavior is also within control of the individual”………… HAS NOTHING TO DO WITH ADDICTION!!! Again you are flat WRONG!!! My thoughts or my beliefs can motivate me to want to quit all they want…but when brain chemistry and cravings and physiological conditions are involved…. this makes it a “medical issue”….not a “thinking” or “belief” issue. Again….dude…YOU ARE WRONG!!! You are tired annoying…..and should give up your pushing your “beliefs” and “opinions” on the subject and the world….because that is ALL THEY ARE….”OPINIONS”……………..BACKED UP WITH NO SCIENTIFIC EVIDENCE WHATSOEVER!!!!
Mr. Slate, I congratulate you on using critical thinking skills and on applying the scientific method to support your position. I agree with your analysis and I have yet to see any scientific evidence that “addiction” is a disease, almost by definition it is NOT. If nicotine addiction is a disease why are clinical interventions so less effective than simply quitting cold-turkey? Since a VAST majority of ex-smokers, millions of them I might add, had no “treatment” whatsoever and “treated” people almost always relapse it strongly supports the contention that it is a choice. I think clearly profit-motive (smoking cessation products are big bu$$ine$) and industry lobbying is the primary driver of the “di$ea$e” classification of this phenomenon. Alcohol and drug “treatment” has been hijacked by religious cult-like dogmatic “step-programs” that insist one give oneself up to a “higher power” to overcome their “disease.” What other disease is treated by prayer? NONE, ZIP, ZERO! In fact, it is illegal to withhold treatment of a child on religious grounds. Why is that? BECAUSE it’s all bunk and we would have dead kids lying around on the streets of America if that was allowed. They want to indoctrinate you into their religion and have no reservations about taking advantage of you in a seemingly defenseless state. If it was really a disease a religious treatment program (step-program) would be the very last choice in treatment. All evidence I’ve seen shows that these religion-based treatment programs are an absolute abject failure and likely do more harm than good to many participants (especially those forced to attend by courts).
I think this is clearly a complex issue (primarily because of the human toll it takes on individuals and our society) but likely rooted in basic biology. Drugs, such as alcohol or nicotine, provide an altered state of mind and the propensity to seek mind-altering states in the human animal (and other animals as well) has long been documented throughout recorded history and archeological findings show it has always likely been true (ancient Egyptian mummies with drug metabolites in their system for example). Clearly marijuana co-evolved with humans and likely alcohol has been used far into prehistoric times as well. After initial exposure to these “fun” mind-altering chemicals (with “spiritual properties”) they become reinforced (classified as “reward”) in the brain, dopamine and other substances reinforce this reward feedback mechanism in the brain. We thus return to these “drugs” and form a desire to experience their effects again (the “high”). At some point in time, depending on the biological state of the organism, the use of these chemicals become destructive and the individual abuses them – inducing pain – eventually horrific pain in some individuals. However, great pain can be MUCH more tolerable than living without the distraction the drug provides and we don’t want to be left alone to suffer internally, inside one’s own brain, like a horrific prison. This is what we call addiction. The harm from the drug is not enough to overcome the pain of NOT taking the drug. Evidence shows that many, possibly most of us, prefer NOT to be left alone inside our mind. It must be escaped no matter the consequences (to some individuals) and thus this leads to highly destructive addictive behaviors and the (apparent) inability to stop.
The following research appears to support this hypothesis:
http://www.sciencedaily.com/releases/2014/07/140703142154.htm
Bio retard guy…. (sorry I shouldn’t have said that)….But I did….LOL
“Yet to see any scientific evidence” huh? Let me guess….you haven’t looked!!!!!!! Dude…. prolonged drug abuse can change brain structure and function!!!! What the hell do you people not get with this FACT!!
http://www.sccgov.org/sites/dads/Presentations/Documents/The_Science_of_Addiction.pdf
http://www.nlm.nih.gov/medlineplus/magazine/issues/spring07/articles/spring07pg14-17.html
http://www.issues.org/17.3/leshner.htm
http://www.attcnetwork.org/explore/priorityareas/science/disease/
“If nicotine addiction is a disease why are clinical interventions so less effective than simply quitting cold-turkey?” BRO…YOU SERIOUSLY JUST PUT NICOTINE ON THE SAME LEVEL AS HEROIN OR METH AMPHETAMINES OR ALCOHOL? I guess that’s why you got the RETARD blast!!! LMFAO…..
“What other disease is treated by prayer? NONE, ZIP, ZERO!” Oh really wise guy????? Apparently you have never heard of “healings” before. Oh…that’s probably because you don’t believe in God ehh? And that somehow makes you an expert on the power of prayer huh?? Again…. uncontrollably Laughable!!!! Ask any of the billions and billions and billions of believers past and present if the power of prayer hasn’t healed them in one way or another!!! There wouldn’t be such a thing as “prayer” if it wasn’t REAL and GOD wasn’t real!! Furthermore…… the method of “treatment” (anti-depressants, AA, Prayer, detox, psychotherapy etc…) that is employed for the disease of addiction……. does not in any way discredit it being a disease. People can recover from all kinds of other conditions as well with abstinence and prayer and therapy and whatever….like PTSD…… but it is still A DISEASE AS WELL!! However with severe addiction (especially heroin or opiates and severe alcoholism)…..it usually requires “medical” and psychological treatment. A disease bro…. is ANY CONDITION THAT DISRUPTS THE NORMAL FUNCTIONING OF THE BODY!!! This includes the brain (mind).
“Drugs, such as alcohol or nicotine, provide an altered state of mind and the propensity to seek mind-altering states”…… WHAT????????? Nicotine is a mind altering drug? What like Crack? Since when? Man….Again you compare nicotine to alcohol? Dude….you really are deluded aren’t you!!! They are not even CLOSE to having similar effects on the brain.
P.S…..could you please site where you got all this rambling nonsense from? Cause you sure as hell didn’t get it from any medical professionals!!
You seriously sounded like you just “mused” all of what you said!!
Ryan
Nicotine is one of the most addictive substances on the planet.
“Tobacco use causes more deaths each year in the United States than
AIDS, alcohol, cocaine, heroin, homicide, suicide and motor vehicle
crashes combined”
Here are a couple jokes around this..
Why do people quit crack before tobacco, because quitting crack is easier.
Why do people quit herion before tobacco, because quitting herion is possible.
Addiction is a psychological drive to use a substance or engage in an activity that have stimulated the mesolimbic reward pathway. Physical dependence is when a person has to take a substance in order to feal “normal” due to neurotransmitter down regulation and its resultant tolerance.
Here is a great audio book, written by an esteemed medical professional from John Hopkins.
https://www.youtube.com/watch?v=lVB_tan-gig