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.
AA [NA etc] are definitely cults of sickness, despair, hopelessness, powerlesssness, disease, fear and unhealthy co-dependence. These people are IN LOVE with their so called “disease.” According to most of them, they are NOT responsible for any of the bad choices they’ve made in life. You see, it’s their disease that’s choosing for them and they shouldn’t be held responsible. This is pure BS! I’ve never seen so many groups of people celebrating-even lionizing- their belief in their own continued depravity even though they’ve stopped drinking [drugging] years – even decades before. Some [most] claim that they have an “alcoholic mind” and they are in many ways, worse [or as bad] off now, twenty years later, than they were when they were actively abusing alcohol. They even take a perverse pride in this constant mention of sickness and disease.This ridiculous and juvenile disease concept oozes into every crevice of our society perpetuating harmful misinformation that hurts the very people it was intended to help. The rise of pop-psychology has clouded reasonable thought on the subject. Self-help groups, treatment, “therapy,” counselors, and groupers are severely damaging the very people they whole-heartedly try to help. Twelve-step dogma and treatment misinformation contradicts empirical evidence and rational thought, in essence, stripping patients and members of their inborn abilities of spontaneous recovery.
This is an extremely ignorant statement. Of course we are responsible for our actions while we were addicted. There’s steps to make amends for those actions and try to corrrect our living after doing so. Educate yourself. It has saved MILLIONS of lives by providing a healthy way of living and treating others. You probably have more people in your life than you think and also those that you pass on the street that are in recovery. You shouldn’t be so hurtful towards a program that wants to help get people better, selflessly, might i add. What you spoke of that “you think” recovery is all about is a complete stereotype and uneducated.
I have the disease of addiction. I’ve been clean almost 5 years. And this article hurts me. My disease is still going I just don’t use drugs or smoke cigarettes or drink alcohol but there are time when Imy almost constantly trying to do thinks that change the way I feel. I drink caffeine way faster than the normal person the I’ll eat then I’ll take a nicotine lozenge then I’ll take my meds then eat etc.. etc.. in the span of and hour I can do up to 15 things that seem harmless I even take Tylenol when I don’t really need it. Im not high or drunk but thats killing me too. I have to stay in out patient treatment or will eventually use again. I’m in fear a lot. I’ll do my daily maintenance step work and get down to zero symptoms but then the next day they all start again. This disease is cancer. I’ve even seen tuff love kill three of my friends. Out of 100 addicts I started with only 10 were still clean after just 1 year and only 2 of us are clean at almost 5 years. I lose on average 3 to 4 friendsure a year to death. Articles like this hurt people and it hurt me.
Steven Benedetto
Personally, I don’t care what anyone’s mindset is on the topic, disease or not a disease, what’s the difference? I personally believe in the disease concept because it’s the only one that makes any sense to me after struggling to stop using for 25 years by attempting to apply self-will and “just say no”. The countless number of doctors, therapists, counselors, clergy, etc… had some positive effect for periods of time but to quit for good and for all was just a pipe dream, pun intended. AA, it’s lifestyle, and faith has been the only thing that has worked for me and millions just like me. If you and anyone else are able to quit for good without it, kudos to you! AA isn’t for everybody, we get that, but why would you want to even take away an option from someone because of your own prejudices? I don’t because I wouldn’t wish the life of an addict on my worst enemy but apparently you haven’t ever suffered like the millions of us that have. If you had, you wouldn’t be crapping all over a recovery option that literally millions worldwide have embraced to become happy, clean and sober, useful members of society. Yes there are people like you that may have been able to stop for good, maybe even moderate their use, without AA or twelve step program, I couldn’t. God knows I wanted to stop without AA, I fought the program for 13 years by applying self-will very aggressively, I just couldn’t do it. Some of us are apparently “weaker” than you though so you just shit on them. Good luck with that attitude bro, I hope you’re happy but by experience you’re a pretty miserable guy for the most part and trust me, people notice. Peace!
The author of this article has no knowledge of this disease, only their opinion. The act my be a choice, but the desire is caused by the a lack of one or more chemicals that are required for thought processing. In my opinion the author is addicted to proving his opinion as fact, obviously suffering from a low self esteem.
Please, refrain from making such claims until you have clear evidence (not just stating your opinion that NIDA is providing false information, mind you), or until you have earned your MD, PhD and have performed extensive research on the matter. You clearly
have 0 understanding of basic science, let alone physiology, neurophysiology and/or electrochemistry.
This article is pure garbage.
P.s. Fuck you.
To: Jenni:::: Typical childish and moronic answer
Take this article down please. I’m a nice person. I onto want to be an addict. But I am. A clean addict. If you met me you would understand that.
You keep talking from on top of your soap box pal. You have never been addicted!
THE SOBER TRUTH
https://WWW.YOUTUBE.COM/WATCH?V=OBH1KUNLKSU
THE BUSINESS OF RECOVERY
https://YOUTU.BE/QX2QBQO9EHU
This is the most ignorant thing I have read in quite some time. How this article made it to the top of a google search page on the subject of addiction is beyond my scope of understanding. This is a careless and (I would also say dangerous) MISREPRESENTATION of scientific fact. I am not sure what happened to you that would cause you to postulate such absurd half truths as fact-toids…but I would urge you to do some research other then that which simply agrees with your absurd notions. thankfully, the “actual” scientific community is hard at work looking for answers and developing ways to treat addiction…while your child-like “insight” will simply blow away in the wind like so much unnerving drivel (perhaps that was the point? I am not sure…it is nearly impossible to take any of your arguments seriously…and at least half of the comments). You people obviously have no idea what you are talking about, and it is really sad to see people so convinced of such inanities. but alas in this time of reality tv presidential hope fulls…I suppose no level of ignorance should be surprising to me. I half expected there to be links at the bottom of your page to “Flatearthers.org” or “LochNessMonster.com” but then I realized that would scare away the “half-sensible” people that manage to stomach reading the entire page.
Another thing…it is painfully obvious that you guys need to talk to a counselor and or mental health provider (the author and most comment as well). I am sorry about what happened to you as a child and or adult…but you really should learn to deal with your issues in some kind of positive way that does not impact society or yourself in a negative way. Your lack of empathy can lead to a pathology that, fueled by an equal amount of both ignorance and arrogance, can cause disease to develop. I know you have an aversion to peer reviewed scientific journals, which is made clear by your content…but you could look that last point up and it just might save your life if you get help now. Don’t delay any longer!
I am seriously attempting to develop my own beliefs on this subject. Could you provide some references to the studies that contract those sited here? You made a lot of comments about this article being rubbish but didn’t make one specific statement against anything said. Where can I look to see evidence that addiction is a disease? I do have a problem understanding how people can be addicted to hoarding, shopping , risk taking, drinking, coke, meth, sex, eating etc and have it caused by 1 abnormality? in the brain. What actually causes all of these addictions? Since a person can’t stop eathing or buying things, how is it that they can ever live a normal life? If it’s impossible to participate in your addiction at all (1 is too many and 1000 not enough), how does an over-eater ever get better?
Thank you,
Ah, the magic of the internet… I can look something up and see what was posted by anonymous people some time ago. I do not pretend to know you or your life-circumstances, however, I was physically and sexually abused until age 9. My parents basically turned a blind-eye to the sexual abuse administered by their dealer so they could get their “shit” at a good price. My experience is not as unusual as it should be, this is happening every day. I turned to to alcohol and drugs at a very early age to numb myself from what was happening around me. I tried 12 stepping… it didn’t work! The idea that someone or something had more power over my decisions simply didn’t work for me. I had to face the fact that I was the one swallowing the pill; snorting the powder; etc. I, now, am happily married to a woman who is so amazing that I can hardly believe she exists. I would do anything; including staying dead-sober, to avoid disappointing her. No surge of dopamine is worth the disappointed look in her eyes. I attend no meetings, I ascribe my behavior to myself and no one else. However, if 12-steppting is working for you, please continue. The debate as to whether or not addiction is “disease” is for the medical community to determine. I can only say that if you find someone or something that is truly worth enduring withdrawal and sobriety, you will stop abusing drugs. “Seek, and ye shall find.”
This is a Dr. saying this. Why no attacks towards him? Lol! Because you cannot. Your site and your moral judgments do not belong n recovery so quit hiding as a non-profit to avoid taxes.
To: Dr. Shmidley rightman ::: you are obviously suffering from cranial/rectal inversion … i.e. [you have your head up your ass] you offer lots of mumbo-jumbo. Many words that say absolutely NOTHING !!!!
the AA (12 step) Disease Model Doesn’t Work— It Even Does More Harm than Good ..It sets people up for failure. ..It makes matters worse than they are…It stigmatizes people for life. ..It brutalizes and brainwashes the young. ..It presents the alcoholic or addict as someone to emulate. ..It ignores the rest of the person’s problems in favor of blaming them all on the addiction…It traps people in a world inhabited by fellow disease-sufferers. … So, what lies behind the claim that alcoholism and other addictions are diseases? How accurate is it? What evidence supports it? Most important, what good does it do us to believe it? Will it really help you or someone you care about to overcome an addiction? the answer is no—that, in fact, it may do more harm than good. What’s wrong with calling a tenacious and destructive habit a disease? Three things: It isn’t true. It doesn’t help most people (and even those it does help might succeed just as well in some less costly, less limiting way). It prevents us from doing things that really would help
there is no good reason to label yourself or people you know as forever marked by an addictive “disease.” Challenging this useless folklore is the first step toward understanding addiction and doing something about it.
You clearly know nothing about the 12 step program. It has everything to do with the rest of people’s problems, not just drinking/drugging.
Hi Jake,
I would recommend that you educate yourself a bit more about 12 Step [AA] history. A good place to start would be a book by called “More Revealed” by Ken Ken Ragge. You can read it for free online here: http://www.morerevealed.com/mr/brief-aa-history.html
Good Luck,
PapaMick
Jake,
Also read this with regard to the cult of AA https://1drv.ms/b/s!AtAzyTorXAyVjAbOlYGdWHluiEVs
Thank you I was wondering when some one would stand up for the good works of the AA program and its Associated programs. I don’t know what planet these naysayers come from but I know hundreds if not thousands of people have managed to find their way through it and are now clean and sober and have been for many a year so you don’t have to believe it but the fact of the matter is it works the numbers Tell No Lie
Dave,
“Disease,” — implies that chemical dependence is primarily a function of pathology, when in fact environmental factors (dysfunction at home, stress at work), learned behavioral patterns (binge drinking, for instance), and economic disparities have been shown to play a significant causal role.
AA meetings and 12-step treatment do little systematically to train people to cope with themselves, their urges, and their environments. They inspire some – evidence says a small minority – to quit drinking. The meetings do give people a place to go for human contact where drinking is not possible. But juvenile new age rituals in which a group of laypeople – many with obvious and persistent emotional and mental problems themselves – repeat the steps and tell their personal stories offers members little psychological basis for achieving sobriety.
https://1drv.ms/b/s!AtAzyTorXAyVjAbOlYGdWHluiEVs
Mick
You could say the same about type 2 diabetes. Environmental factors (diet, exercise,etc) play a large role. A person that is genetically inclined to develop insulin resistance (the reason for type 2 diabetes) will not necessarily develop insulin resistance if they eat properly, maintain a healthy weight and exercise. Similarly, a person that is genetically inclined to become addicted to substances that act on the reward center of the brain WILL NOT necessarily become an addict. External factors simply expose the increased risk of addiction/dependence that result from various differences such as metabolism of substances, response to dopamine in the reward center of the brain and the speed at which tolerance is developed.
hi. alcoholism is a dis-ease of the mind without doubt. I am an alcoholic. during active drinking, an alcoholic is powerless over alcohol.
This is one of the most ignorant articles i have ever read. knowing much about addiction and the disease concept, i can say that 90% of this is pure nonsense and is actually harmful to the society at large.
Addiction is a choice. I have Been addicted TO various drugs since 13 Old. I am now 21, and i do realize that My habits are killing me physically and mentally. I am miserable when i am using. I feel no emotion when im sober. THE LONGEST IVE GONE WITHOUT ANYTHING IS 7 MONTHS. It does not get better, unfortunately. I would rather FEEl this crushing depression 24/7 than nothing at all. I choose to keep living and putting on a smile every day when, in reality, the only thing i want is to slip away into the darkness. I could get sober for good, BUt the pain Is easier and MORe familiar than ANYThing else. I dont even remember my childhood. I choose drugs over sobriety BECAUSe its all ive KNown. Regardless, IT is still a choice even if its hard or unfair. I am not a victim of some so called “disease”. I did this to myself. It is the path i have choosen to go down.
Hi Victor,
I have felt like this too. It can get better. If you find a way to see using less/abstaining as truly more satisfying than using, things will start to change much faster for you. When I was struggling for 5 years, I looked at going without drugs as a giant loss, even if it reduced problems – and I looked at being on drugs as at least somewhat satisfying, even though it increased the problems in my life. With this view of the options, I always went back to heavy usage. I finally stopped feeling addicted when I decided I was going to do whatever it took to learn how to exist happily without drugs. Make it a happy experiment, and you’ll be surpised at what you discover.
Best wishes,
Steven
you are insane. alcoholic insanity it’s called. get to an aa meeting Fore it’s too late friend.
HEllo Steven,
(I apologize for yelling in bold but for some reason this comment box types in all caps and bold print)
I am happy that you are happily clean/sober/not addicted. I’m happy I am the same.
your perspective on the inappropriateness of viewing addiction as a disease has left out the socio-cultural history and the underinformed culture in which aa emerged – and, unfortunately, that still very much exists.
I write as a professional and a person in long term recovery (25 years). My private practice specialty is treating addiction, and I have run IOP twice. My weekend job is at a psychiatric emergency room (where I interact with many persons with co-occurring issues). I came across your writing while preparing for a presentation at the Houston Spectrum (Addiction professionals) conference later this month.
I think your perspective is less developing a viable theory and treatment and more centered on being against aa and addiction as a disease. I have personally read and evaluated copious research that leads me to affirm that addiction is a disease; particularly alcoholism. Drugs have gotten complicated and at this point probably need to be studied and researched individually.
For my own recovery, I “chose” AA and never went to “treatment.” I still check in with the 12 step community. That said, I have observed that the 12 step community is still largely Judeo-Christian European male centered in culture and values. the 12 step community is vulnerable to cultish behavior. I discovered when I was 4 years sober and began having (what ended up being) 3 closely spaced children that aa had not caught up with the needs of parents of young children. that is when I began to develop a wider range of definition of “recovery.” My personal higher power is science. (that doesn’t always get met with comfort in a small city in texas!)
Professionally, I believe that treatment should be **Treatment** and not aa platitudes. It should not be spiritual unless the client wishes that included. I tell my clients that there are proven brain changers: laughter, exercise, fellowship, personal transformation, the perception of religious experience, meditation, yoga, good sleep, good nutrition, participating in volunterism. An actual 12 step engagement (not just going to meetings) offers people an efficient delivery mechanism of much of that list. I believe this is based in science.
I do wish – indeed, I have lost sleep over – the reality that AA can be quite anti-family. it has gotten a modicum better, but is still primarily shame based and punitive in orientation. it can and does become a haven for predators and predatory behavior. The visceral defense of bill w (given what is actually known about him) is unhealthy. but I have seen and read as much unhealthy information from people whose recovery is “against 12 step settings” rather than about what their recovery is.
where is the developed, nuanced, and research based thinking? (not directed exclusively at you, steven, but all recovery models and settings). I no more need to be told that “only god can solve my problem” than I need to be told that my brain *doesn’t* react with a need for more alcohol once I put alcohol in it.
I celebrate, support, and endorse happy and healthy sobriety no matter how it develops and is sustained. I believe strongly this needs to change over time, just as seasons of life change. this is not a reality aa responds to well. In my own life experience, what I do now as a 50 year old professional with only one kid still home is completely different than when I was a married mother of 3 closely spaced littles. I’ve recently experienced some health issues which has necessitated another change in continuing to keep my addiction treated. Back to healthy and happy sobriety – I’ve seen it using aa as a component of building a healthy life; I’ve seen it without. I’ve seen dishealth in aa and dishealth in those completely against the disease model and aa.
the truth is that if a person builds enough brain changing habits – and “enough” means enough to match the severity and aggressiveness of their particular manifestation – and sustains those habits, they will recover. In this regard, addiction is like any other disease. some people with diabetes, for example, can manage it with lifestyle changes such as exercise and diet. others lose limbs in spite of metformin and insulin. And so it is with addiction; no two progressions of disease are identical and no two treatment plans should be identical.
if a private client of mine is unable to stay healthfully clean/sober, we discuss the current habits being developed (or not) and we together decide what could possibly be added. one of (the many) suggestions may be 12 step involvement.
I’ve had clients completely recover in aa, na, smart recovery, church, exercise/healthy lifestyle, with treatment, without treatment. And I’ve seen people not be able to sustain recovery in those settings in spite of what I believe is a sincere desire to do so. these are the cases in which the aggressiveness of the disease is such that they may need to use many more tools that other individuals; not unlike cancer disease and treatment.
I wish you well, and I wish wellness to those who resonate with your message. I am hopeful that people who happen upon your message eventually “move on” toward building a positive life and less in reaction to whether addiction is a disease or whether the 12 step model works. I don’t insist anyone go to aa, and I equally wish people would not discourage it. clearly, it has worked for millions. for the millions it hasn’t worked for, I wish “AA” as a collective could look at that with critical eyes, but I despair I won’t see that in my lifetime.
Take good care.
By accepting the notion that people who have drinking or drug problems (or are merely identified by others as having problems) suffer from a disease that forever negates their personal judgment, 12 step programs [AA] have undermined the right of people to change their behavior on their own, to reject labels they find inaccurate and demeaning, and to choose a form of treatment they can be comfortable with and believe will work for them. At the same time, we have given government support to 12 step [AA] group indoctrination, coerced confessions, and massive invasions of privacy.
AA groups and their senior members direct and indoctrinate new members (that is, the mere 5 to 10% who continue to attend) into a strange self-abnegation and sense of guilt and powerlessness built on the promise that eventually they too can reign supreme over newer AA members! AA is a power trip for the psychologically debilitated,
Given its limited success, why do AAers love it so well? Like the addicted lover who clings to a destructive mate, the AA member who eventually succeeds in quitting drinking often accepts the devil’s bargain of giving up the core part of him or herself.
The result is not an empowered, self-controlled individual (which would be explicitly against AA’s philosophy). The result is individual preoccupied in a confused way with his/her depressed emotions and addicted actions, seeking vainly for explanations in the wrong places (God and genes) for a destructive way of life that AA does not remedy, but rather exacerbates and embodies.
The power these AA 12 step tyrants attempt to wield is to compensate for the lack of power within themselves.
AA and treatment programs derived from it are based on folklore, on religious precepts (like powerlessness, acceptance, guidance from a higher power, confession of one’s sins, etc.), there is really no “there” there. The dominant treatment model—and more than 95% of treatment programs in the United States rely wholly (usually) or in good part on the 12 steps—is an emperor with no clothes.
It appeals to a relative few, while others are forced to go along for the ride—the over one million per year who attend due to court, employer, or other types of coercion. As for the rest—the overwhelming majority of those with alcohol problems—they stay as far away from AA as possible
The sober truth
https://www.youtube.com/watch?v=OBh1kUnLKsU
THE BUSINESS OF RECOVERY
https://youtu.be/Qx2Qbqo9EhU
Hi Joanne, and thanks for your input. I want to respond to one key point. You said:
If addiction is not a disease, then “developing a viable… treatment” is impossible. You can’t medically treat a non-disease/non-medical problem. I see “addiction” as freely chosen substance use. I see these choices as the result of the same things behind all choices – people choose what they believe are their best viable options for meeting their own personal needs. In short, people we call addicts simply have a strong preference for substance use. A preference can’t be treated. It changes when the individual changes their perspective of available options – when they see it as less beneficial than abstaining or using less, then they will prefer abstinence or less use, and they will cease their problematic substance use.
My form of help is to give people information that they can use to re-analyze their options and change their preferences. As long as they think it’s a matter of disease/compulsion rather than a matter of preference/choice, then they’re less likely to proactively work toward re-assessing their preference. It may (and often does) happen accidentally while people are in the midst of fighting the disease of addiction boogieman, but I’d rather they didn’t have to get stuck in that goose chase. I’d rather they just knew directly, the truth that they are choosing, and that they can choose differently if they change their perspective.
I am against the disease model. Hopefully you now understand why. I am also against AA to the degree that they promote the disease model, but that is secondary. I don’t wish to stop anyone from having an abstinence club. I am simply against misinformation.
Let me say this again: you can’t medically treat a non-medical problem. Whatever anyone puts forth as a “treatment” even when decidedly non-medical, sends the message that the problem is medical and not directly fixable by the individual. Help is possible – but treatment is not the right kind of help for a problem of choices. Information is the proper kind of assistance that can be given when someone is looking to make new choices.
Best,
Steven
Joanne,
I love the precision logic, rationality and critical thinking skills of Ken Ragge and Steven Slate. Here is an excerpt from Ken’s book, “More Revealed:”
“By defining alcoholism as a disease and attaching each of the elements of the disease theory to that definition, it proves itself. Just like the basic assumptions about witchcraft proved to almost everyone’s satisfaction the existence of witchcraft in the Middle Ages.93
Imagine, for instance, the flu redefined as an always fatal disease. If it isn’t fatal, it isn’t the flu. Now imagine a doctor with a patient who is running a fever, coughing and headachy. If the patient should die, he can be held up as an example of the inevitable fatality of the flu. But what if the patient lives, as is to be expected? He didn’t have the flu. How could he have? The flu, by definition, is always fatal. Using such a definition makes it impossible to prove that the flu isn’t always fatal. The presence of the same virus and symptoms in those who live and those who die is irrelevant. If it isn’t fatal, it isn’t the flu.
The heart of the disease theory is the idea that people are helpless to change themselves; to manage their own lives. It denies, in the face of all available evidence, the God-given human potential for growth and change we are all endowed with. It has never been shown that convincing someone they are incompetent to change an unwanted habit or dependence helps them change it.
However, the AA/disease theory of powerlessness through physical/genetic/allergic susceptibility to alcohol does serve to create an additional dependency, a dependency on AA and expensive treatment centers. One walks in with what is usually a transitory problem and, if treatment is “successful,” the rest of one’s life is spent with the belief that, as a defective person, one must faithfully follow most of the Oxford Group precepts or die.”
You can read it for free online at:
http://www.morerevealed.com/mr/disease-theory.html
Ill just respond to the first sentiment in the article. The reason we are “browbeaten” with the fact it is a disease is because so many people choose to believe the erroneous statements made in this post and others like it. (IE…all the information referenced is over a decade old.) Addiction may be a disease you have to have in order to understand it is one, but that doesn’t make it any less real.
I am not a psychology major or a dr.what I am though is an addict. I will always have that struggle between sobriety and getting high. I know my triggers I know how to cope with stress and I know how to stay away from the war stories and other addicts and also the drugs. It’s my choice to do this it’s my choice to use or not and it is my choice how I live my life before I said I was addict. This is true but it is how I choose b to except that actual fact that gives me power over my own choices. I don’t blame the dealers or the suppliers or the doctors who try to help you kick one drug with yet another drug. I’m at fault. The stress of my own life choices bad or good led me down this road and it is my choice weather I stay on the correct one or the crooked one. Everyone trys to blame everything else on their own bad choices. Pass the blame game. I’m sorry but if you don’t want to be an addict you won’t be it’s a choice you make a conscious choice. I as an addict who has been clean now for over 28 years can testify to this fact. I walked away to slip a couple times and then learning from my mistakes corrected them. It is far too easy to blame the drug or the dealer or stress etc etc then to own your own mistakes. In this day and age the cost for drug treatment centers has boomed and people use the programs like revolving doors. Instead of standing up to what they’ve chosen to be and do. Blame society the psychology field will coddle you of course the more patience they have the more money they make. So if they can make you believe that you are powerless to Fite addiction on your own well use your imagination. You as a human are the strongest creature on earth you do what you do because you choose to do so that’s just my opinion. The clean and sober life may be a hard reality but it is a better reality
Sobriety date Dec 14, 1979 I’m an addict, currently in remission, but I’ll always be an addict. I become addicted to just about anything that has a repetitive quality and enhances my mood and as I realize that addiction I make a conscious decision about how it might alter my quality of life, then I act accordingly. I believe that my addiction is a disease and I treat it with 12 step meetings and without medication. I suspect that I would test positive for PTSD and bi-polar if I were to submit to testing but I’ve chosen not too. I go to both AA and NA but find that the NA program is a better fit, more about we are suffering from a disease and drug use is a symptom. Emphasis is one the steps and sponsors. Recovery rate is about what it was when I first started AA and all of the treatment, noodle doctors and restrictive living arrangements haven’t made much difference in my opinion. It seems that those who can truly accept and incorporate the first three steps have a very good chance at sobriety and those who fight the steps don’t. The other steps are all about getting to know our selves and learning how to deal with the reality of who and what we are (in my opinion).
PS …. Addiction is not a spiritual problem. Indeed, saying that it is has caused a great deal of pain to many. Addiction is hard enough for people, without having to think they have shallow or tormented souls.
Addiction is a mental illness. There is a God that is good and there is Satan. Addiction can be a healthy addiction. But then again, the addicted that works 8 million hours per week and is successful is considered brilliant because of money. Addiction is not a choice after you become physically addicted. You are truly possessed by the devil. You have to play counterfeit and for everyone around you they don’t have any idea and if they do they don’t care especially if they’re looking for sex. If they are family members or friends that do not use drugs but other than you they love to make themselves feel better about themselves. I was told once that the more skeletal a woman looks on the street the more turned on the man gets because she is so needy and vulnerable. So two addictions satisfy each other. People addicted to prostitutes are addicts as well. So is there a medical code for happily married males or females for hunting down people in the ghetto that obviously need money for their addiction? If that isn’t a choice then let’s check out the brain chemistry for the people that pick up beatin down half dead people indeed. Addicted to giving them money even if they don’t do much. So who is really diseased at this point? When are people going to get it? Apathy is Satan’s greatest tool. Fear is really jealousy. Sometimes people just want to get away from reality. The ones that turned a blind eye to what’s going on in the world are really retarded and I don’t mean in a critical way I’m saying that blind willingly blind. Who really cares besides the doctors the therapists the rehab center that keeps getting money left and right because of the revolving door? Insurance companies hate the idea of it being a disease. Just because your brain chemistry is messed up because of drugs or booze which is a drunk doesn’t mean you are Destined to be what God wants you to be. Remember everyone that put you down in your life are sick people and the best way is to assure that alcoholics and drug addicts are the members of society that are modern-day lepers. It’s too bad that everyone has an addiction and they will be a medical code for a diagnosis. The health industry will become more reps because there is also a cure for cancer. Addiction is a choice because it feels good in the beginning and then it gets very old. Nobody in their right mind wants to live that type of life
I have been a counsellor for almost three decades. I started out with the 12 step program and evolved into utilizing many other approaches as well in my career. I still stand by one belief that I developed early in my career: If it works keep it up, if it doesn’t, stop it! I have seen people recover with multiple approaches so I will not stop at any one approach or belief. I welcome the author’s views as they challenge the status quo in my field. “Treatment” is only marginally successful and many people “recover” on their own, through their own devices. The point is, it’s all true to some extent. There are brain chemical imbalances that occur and contribute to addictive behaviour. I was a very strong proponent of how changes in the brain contributes to it. I have also learned that we can change the functioning in our brain (neuroplasticity) thus we can choose to change those behaviours. I have seen successes in all areas including 12 step, religion, CBT DBT MI and many others, and of course, dismal failures. Currently the discussion is turning to “connection”, that recovery is not sobriety but connection (see Hari 2015, Mate 2008, Alexander 2008). I won’t stop there either. There are sociological myths initiated and maintained by the war on drugs (now over 100 years old) that have engrained false information about all drugs in our society including how we should respond (punitively and without mercy). This translates into and contributes to the day to day suffering of those who struggle with substance abuse. My current passion is about obligatory inclusion of family and other supportive peers in a “treatment” approach so that those who struggle can thrive in a supportive environment (when that is possible). Right now the majority of my current case load is homeless. You can imagine how “disconnected” they are and the rate of success that exists (not non existent but holy shit). Is this all about their “disease”, cognitive distortions, lack of connection? Maybe. But it is definitely amplified by the prejudice of our medical legal and any other social system that is currently targeting them as worthless and dispensable. So you can imagine how I see connection as an integral part of the recovery process. I think anyone who has gone through this can relate to the fact there was someone or someones there to support and help. My point overall I guess is that we really know very little about substance use, addiction and mental health and we are still learning, AND we must continue to learn and be open to new information. Once we say we know something absolutely, then we stop learning.
I agree. I look back at the ancient times…and Indians would eat mushrooms and dance around to open their minds to speak to the Gods’. I think of the Coco Plant in S. America when workers chewed on the leaves all day. I think of the opium dens in China…Did anyone ever think that forbidden fruit is what humans are striving for in the first place? I have seen too much. No one wants to beg or steal or murder for their drug. (Or look like a skeleton). Addicts are alcoholics too. Lepers of society today. Addiction is a the product of today’s societies beliefs. Explain WHY some people chose booze over marijuana. Explain why others chose heroin over cocaine.EXPLAIN WHY some will DO ANYTHING!
If this helps even just one person with their substance abuse then who are we to judge it?
While I “get” the author’s general reaction/sentiment toward what at first glance seems to be an attempt by the ASAM to encourage the abdication of all personal responsibility in addiction, the dichotomization by both sides of such a complex problem (i.e. “disease” vs “choice”) seems fairly inflexible and short-sighted. Take the use of a brain scan to illustrate the nature of addiction: each measures a finite, isolated component of brain function; none displays the whole person/complete picture because, of course, they can’t.
People are complex. We are not all universally motivated by one thing. And even within the context of addiction, the specific “triggers”/mindsets are not identical in each situation.
I also get the *other* side of the coin: the desire (ASAM) to destigmatize and promote compassion for addicts. It seems to me that the basic flaw there is that true compassion cannot co-exist with the recognition of personal responsibility: another dichotomy. I can recognize that an addict has the *responsibility* to seek help (which he is able to do at any time) while still empathizing with the overwhelming pain associated with *both* the hopelessness/despair of addiction *and* the thought of living without the substance/behavior.
…and I can get there by imagining how *I* would feel in a similar situation. Say I have an old injury: a broken leg that healed incorrectly. It’s very painful, though I routinely take medication to enable me to “function.” The doctor tells me he needs to re-break it in order for it to heal properly, and oh, BTW, I can’t stay on the meds while he’s at it. So I have a choice. I can surrender to the Dr.’s expertise, climb onto the table, and re-experience the worst pain of my life in slow motion…or I can put it off “just one more day” while I pop another pill (or three). Oh, and when I *don’t* pop those pills, I reach the point where *all I can think about* is those pills. Life seems meaningless without them.
Sure: it’s a choice.
I wonder what *I’d* choose.
People struggling with addiction need to be taught *both* self-empathy *and* personal responsibility, in that order.
**end of soapbox speech**
This is an extremely damaging mindset to set on the public by saying that addiction is not a disease. Addiction has been classified as a disease by “most medical associations, including the American Medical Association and the American Society of Addiction Medicine.” the idea that addiction is not a disease only validates the blatant and ignorant statements made by those who are not in recovery to demonize addicts who need help throughout the world. Of course, everyone is responsible for their actions, but those actions become extremely influenced by the physical and mental need to use once addicted. The idea that addicts are completely in control of their actions when they are battling addiction is a MYTH. Explain to me why there are so many rehabilitation centers and programs that deal specifically with helping addicts in a unique way, just like any other disease. All this entire site says to addicts is that it is their fault and they need to figure it out on their own. As someone who has battled addiction for most of my life I am extremely offended by the idea that someone believes that my disease is a choice as simple as going out to eat, or ordering in. There is nothing beneficial about this site and what it stands for, it only perpetuates the ignorant idea that puts blame on the addict and the addict alone.
Bravo! I agree 100%. I too was an addict. I spent all of my 20’s and early 30’s in and out of rehab, prison, etc. for heroin. None of it worked. Ultimately, I just got tired of it. I wanted a different life. I never liked the lifestyle and avoided as much of it as I could. I just liked the drug. I never dated other heroin addicts and spent time with very few of them (unless we had more in common than heroin). The older I got, the more distasteful the whole process of “scoring” and all the other annoying bullshit became. Even in my early 20’s, when I found myself broke and in full blown withdrawal, my pride simply would not allow me to beg for a “front”. I believe it was my underlying pride that saved me in the long run. It sure as hell was not that 12 step “powerless” dogma. I despise that idea. Do I still think about heroin sometimes? Absolutely. Am I going to the go out and get it? Hell no. Moving from the west coast to the east coast helped. The whole scene is sketchy here. It’s not like you can go to someone’s house or apartment discreetly in this city. No, it’s all a recipe for arrest and interacting with shady people. I just can’t do it. That being said, let’s assume it wasn’t as sketchy out here, I still hate the idea of “needing” anything outside myself for a sense of well-being. There’s that pride again. Deadly sin, my ass. William Burroughs, may he rest in peace, said it best: “Anything that can be achieved chemically can be achieved in other ways…”
Great article Steven, AA is just another cult, another religion. As I speak, my nephew is in some center in Arizona to the tune of thousands of dollars for various addictions that people around him have convinced him he has. It may be a psychological problem but it’s not a disease. Deliberately ingesting something is not a disease, if I like to eat Zika mosquitoes is that a disease? It may kill me but I can’t help myself. Nonsense.
I’m happy if it helps people and I’m sure it does, but I never think it’s healthy to accept delusions to further a cause. I wonder how many people make a living from this con job? I also find it insidious that they work the Christian religion into it and all this stuff about how you have to give yourself up to a higher spiritual power. Two delusions are not better than one. I guess atheists are not allowed into AA, or heaven forbid, Jews, Muslims, Buddhists or Hindus….
I’m surrounded by people in AA so I rarely open my mouth. But if I hear it’s a disease one more time I might make an exception. I do my best to take the high road but it’s not easy.
I personally drink and enjoy it. I smoked marijuana for 20 years, I snorted cocaine for a couple. I quit both when I chose to. All of this I enjoyed and controlled. I picked my spots and still do with alcohol. I enjoy the mind stimulant of booze and loved the creativity inspired by marijuana. I make no apologies for this.
It’s obvious the disease model is a cult due to the emotional and childish reactions of those who oppose your thesis. As in politics and religion, many are ruled by emotion rather than reason. A major downfall of the Human species to this day.
I applaud the courage of your stance Steven. As Galileo, Copernicus, Darwin, Kepler, Newton or Einstein might attest, speakers of truth are rarely lauded initially. It’s only time that proves them right…
And no, I’m not equating you to those giants, only to the idea of elevating science, reason and rationality above feel good nonsense…
I made a decision to try meth at 47 years old. I smoked pot most of my life and used different drugs in high school and consumed alcohol socially for 5 years after divorce. I never thought I could get addicted to any substance. It took my 7 years to get off meth.
I don’t believe that addiction is a disease. I had a choice to not try meth. I stopped and got help in 12 step program of NA. I stopped because the consequences became much greater than using. I did need help from a sponsor the first year. My sponsor and the meetings helped retrain my brain to focus on living again without using. The program helped me work on myself and get my life back in order. Nothing wrong with that.
What I don’t agree with is hearing people with 5 to 30 years clean say “if I don’t stay in this program and keep working steps I will use again”. They say , ” I have the disease of addition and it wants me dead. It affects every area of my life”. Fact is I know many who have never used in their life that are as self centered , compulsive and self destructing as any addict. They have many addictions but they don’t use alcohol or drugs. No doubt if they tried drugs they would get addicted.
I caused my first divorce because I cheated on my wife. Can I blame that on the disease of addiction. No I can’t. I learned from my mistakes and never did it again. I now know I can’t use drugs in any form because I know what could happen. I do have a choice now. Not a disease.
And yes people do show up at our meetings with many spiritual problems from years of using. The guilt and shame of things they’ve done while in additive addiction. Lying, stealing, cheating and many other crimes that were committed while using. Some have lived this life since a young age. They need to learn a new way to live. They need to retrain their brain from the brain damage that using has caused. The addict needs to learn how to forgive him – herself and forgive others. To make amends for the destruction they’ve caused. How to replace destructive behavior and thoughts with positive ways to live.
These are spiritual problems not religious problems. In other words your thoughts that are programmed in your brain are the problem. This is why I believe addiction is not a disease. It can be cured with education , group therapy , 12 step programs , church etc… Giving a suffering addict more medication will never cure them. Medication can help in detoxification and keeping cravings at a minimum but it’s not a long term solution or a cure. The only solution is to change the thinking and I don’t see any benefit in telling people they have a disease they must fear the rest of their life. Addicts need to be taught that they have a choice to not ever use again no matter what. Maybe it could help addicts realize they have a choice so they don’t use the excuse of disease if they relapse. I know, I used the excuse for 5 years until I admitted to myself that I made a conscious decision to relapse after months of clean time. And I have and do pray everyday for God to give me the strength and help I need to stay clean.
Ahhh so it’s basically as easy as deciding whether you want to have the maple brown sugar oatmeal for breakfast or the apple cinnamon. Crazy that a lot of people are choosing to die and lose everything in life. If only they’d choose the maple brown sugar! Lol. Can’t the same also be applied for depression? People are choosing to be depressed? And any brain imaging evidence is false because the brain has neuroplasticity? And saying, hey buddy, haven’t you, you know, tried choosing to not be depressed?
Hi Frank – I haven’t said it’s that easy. In answer to your breakfast example, I’ll point you to this post from a few years ago where I addressed this angle: Choices Come In All Shapes and Sizes.
Here’s an excerpt:
I would liken quitting a pattern of substance use more to quitting a job or career, or leaving a relationship. It’s more complex than choosing what breakfast cereal to eat, it’s more consequential to our lives, it’s a more deeply developed preference. Choosing differently requires some deep thought and re-assessment of your options. Nevertheless, once you really figure out that moderation or abstinence is the more satisfying option for you, it takes no effort to change. This, again, is like quitting a job. How do you quit a job? You say “I quit” to your boss, and then you don’t come back to work. All of the effort is in figuring out if you really want to quit or not. So it is with quitting substance use – all of the effort is in figuring out if you really want to.
It makes me sad to see so many people enter into quitting by thinking they “have to quit” – feeling coerced or obligated to quit. Hating quitting. Seeing quitting as miserable. These are the quit attempts doomed to failure. When you find a way to see quitting as more rewarding than continuing, that’s when it lasts.
Best,
Steven
This is disgusting. All I have to say is, if it was your child of loved one who suffered from this devastating BRAIN DISEASE you wouldn’t publish this type of misinformed, delusional, worthless writing.
What if it was me “who suffered from this devastating BRAIN DISEASE”? Would I publish this then?
These emotional attacks never stop. Try considering the fact that I’m trying to help people by publishing this. That doesn’t mean you have to agree, because of course the motives of the author don’t determine the truth of the piece. However, giving that benefit of the doubt allows for constructive debate.
Yea man you are totally off on this one. I understand you took a lot of time to research and write this article but its just wrong. I work in an addiction treatment facility. Spend a day around recovering addicts and you will know without a doubt that addiction is definitely a disease. This line alone tells me you don’t completely understand “there is no evidence that the behavior of addicts is compulsive (compulsive meaning involuntary).”
Get in the field if you want to have an actual educated opinion. Reading blogs and articles will only take you so far.
Thanks, I’ll go spend a day around recovering addicts. In fact, I’ll hop in my time machine and go back to 2002-2005 when I spent every waking moment of my life doing it, 2 years of which were working in a residential facility that helps addicts. Or I could just do it tomorrow, when I go to work, and have meetings all day long with people who are addressing their substance use problems, as I’ve also been doing in an office setting since 2011.
http://www.huffingtonpost.com/entry/vivek-murthy-report-on-drugs-and-alcohol_us_582dce19e4b099512f812e9c?ncid=fcbklnkushpmg00000032 But were you an addict? Look at the link and tell him he has no idea what he is saying Lol
You are making an appeal to authority. I can appeal to authority too, if that’s all you need to convince you of a particular conclusion on a controversial issue. Here are many highly educated people in the field who disagree with the surgeon general’s recent pronouncement of the tired old myth that addiction is a disease: http://www.thecleanslate.org/addiction-is-not-a-disease-quotes-from-experts/
Here is an article where my colleague Stanton Peele PhD pushed back on the surgeon general’s report: http://theinfluence.org/the-surgeon-generals-addiction-report-repeats-old-bromides-heres-what-he-ought-to-be-telling-us/
Here is a great journal article that pushes back on several myths about addiction, by Gene Heyman PhD of Boston College and Harvard: Addiction and choice, theory and new data
The history of medicine is one of countless grave errors. The medical establishment has made great advances over the past century, but they are not infallible. On addiction, they’ve gotten it wrong. He has no idea what he is saying.
Mr. Slate,
How long have you been an addict? Do you have first hand knowledge on addiction or are you going off of what others say “addiction” is? While you might think addiction is a choice I disagree. My addiction started way before I picked up my first drug. I was four years old. How much choice does a four year old have? Please explain? It started with me stealing money from my uncles cash box that he had from a gas station he managed. That’s where it started for me. Do you think this disease is a choice? A choice is a decision. A disease is not a choice. Is cancer a choice? People that predisposed to a disease have a greater chance of contracting that same disease. I have suffered from this disease for forty-six years. Until you have field tested this disease I think all you can do is ride other peoples coat tails. Oh by the way. The 12 step program has saved my life. Of course, since it is anonymous you do not hear of the success of the program. I see hundreds of addicts have success. And while many relapse that is not a defeat. As long as that person continues forward and has the support of other addicts he/she has a chance. One addict helping another is without parallel. Psychiatry, religion, or institutions were not effective. I tried without long term success with all those. Now am clean for 22 months and about to receive an Associates degree. All due to a 12 step program. Imagine that?
😂😂😂 Howard that is the funniest thing I’ve hear in a long time. Your ” disease ” started at when you were 4 years old. You stealing money from your uncle at age 4 is not a disease is called being a kleptomaniac, which is a impulsive disorder. Kleptomania is a mental illness in which a person has a strong desire to steal things.
Addiction is not a disease it’s a mental illness. I get that you think and believe it is a disease. Can you tell me what kind of doctor is treating your disease? No you can’t because you’re not seeing a doctor, you’re going to 12 step meetings which is basically group therapy, anyone with a brain knows that group therapy falls under psychiatric/mental health. So please stop comparing yourself to someone who has cancer. People with cancer don’t have a choice.
LOL! What makes you the upmost authority on addiction? You’re make a moral judgement not a medical fact. The “authority” happens to have a pretty good degree in his field, so what is your degree? Appeal to 46 yrs in addiction. Not by choice Steven I was 4 years old what kind of choice did I have? I cannot wait for your response. I am sure you have a PhD in child psychology as well?
Jackie? or it is Doctor Jackie? Just want to address you by the title you most certainly deserve. Uhm that is how addiction starts Jackie compulsive behavior. Or maybe the surgeon general has his wires crossed as well?
Addiction is not a disease. It’s a mental illness called Substance Abuse Disorder(DSM-5 which is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition)
There is a difference between disease and illness. A disease is defined by abnormalities of the structure and function of the bodies organs and systems. A illness refers to how a person is feeling.
Example: a person with Bipolar Disorder has a mental illness not a disease. Because for it to be a disease the “structure and function” of the organ(brain) must change. The structure of a Bipolar brain doesn’t change, only the function(mood) does. Mood has to do with how a person feels(illness), therefore it’s an illness not a disease. Same with an addict, the structure of the brain doesn’t change only the function does.
So let’s look at what is meant by “structure and function”. I’ll start by using an example of a house. The structure of a house is the foundation, walls and roof. The function of a house is the working parts inside the house, electrical, plumbing, A/C and heating. So let’s say the A/C goes out and is not working. Does the non working A/C change the structure(foundation, walls, roof) of the house? No, it does not, but it did change a functional part inside the house.
The brain is divided into three sections, the forebrain, midbrain and the brain stem or hind brain. These are the structural parts of the brain. Within the structural parts of the brain there are 4 major lobes, the frontal, parietal, occipital and temporal lobe, and there is the cerebellum. Each of the lobes has different functions. Such as the frontal lobe functions are thinking, memory, behavior and movement. Temporal lobe functions are hearing, learning and feeling. The parietal lobes functions are language and touch. The occipital lobe function is sight. The cerebellum functions are balance and coordination. Let’s not forget the brain stem functions which control breathing, heart rate and temperature. So when someone uses drugs or alcohol it effects the functions within the brain, like thinking, behavior, memory, movement, sight, language, breathing, heart rate, feeling etc. It’s doesn’t change the structure of the brain. The forebrain, midbrain and brain stem look exactly like they did before drugs or alcohol entered the body, but it does change how the brain works(functions).
When someone has cancer they see an Oncologist, someone with heart problems see an Cardiologist, someone with torn ligaments, broken bones see an Orthopedic surgeon. If someone has a problem with their brain(brain tumor) they see a Neurologist. I’ve yet to see anyone who is an addict go to a Neurologist. An addict goes to AA/NA/CA meetings which is basically Group Therapy which fall under psychiatric/mental health. Addiction is a mental illness/disorder not a disease.
Once people start treating addiction for what it is, a mental disorder/behavioral problem and learn how to cope/deal with the underlying issues that caused them the use in the first place. They will keep using. They might have periods of sobriety but it won’t last because they aren’t dealing with the true causes of their behavior. Go seek professional help, not people in AA 12 step meetings who think addiction is a disease.
So, when I am making the “choice to stick a needle in my arm to keep from becoming sick and want to kill myself no matter how much junk i have in my pocket that’s a choice? You’re right it is a mental illness which is like a blood disorder, diabetes, cancer patient. Those that are pre-disposed to addiction fall under the same umbrella as a pre-disposed person to cancer where it is in their genes. Moral judgement is all you’re doing Jackie.
http://www.huffingtonpost.com/entry/vivek-murthy-report-on-drugs-and-alcohol_us_582dce19e4b099512f812e9c?
To all the (recovering) addicts that have left negative comments on this post. Go and drink some cement and harden the fcuk up. What small, feeble, little minded, self absorbed people you are. Addiction is NOT a disease it is an inability to say NO.
Society in general is collapsing and addiction is directly responsible for this downfall, It may be an addiction to substances, cash, power or mothers old saggy titty, but it is still an addiction (lack of willpower) not a bloody disease.
It is my personal opinion anyone involved with the illicit drug trade should be shot and left to rot where they fall and I will admit that may be a bit extreme for some, but it is still my opinion.
Society is sick of supporting all the minority “help me” groups and very soon thing are going to get really rough for anyone who has a “problem”. Get yourselves straight and clean before the revolution comes- before you go off half cocked look up the meaning of revolution and revolt.
I do not condone violence at all but I will defend myself and others against any threat real or perceived and I am not the minority . Many heavy drug users commit crimes against hard working, honest people to support their habits, how long do you think this state of affairs will last before general society rebels.
If you don’t believe it will happen look into humankind’s past. Rome fell, the Inca’s are gone, the Aztecs are missing and countless other civilizations have fallen before us, and many of them more advanced socially than what we are now and they all failed because of weakness in one form or another.
Wake up before it is to late.
To all of those that have left positive messages I applaud your bravery to fight against this scourge on our societies. If more people stood up and said NO we would not have the problems we are having now.
Where does that inability to say no come from Einstein? I haven’t seen anyone that sees a shrink stay clean? I have been doing this dance 46 years. You have no Idea wtf you’re talking about so quit riding coat tails and try addition first hand before you pass a moral judgement. That is all people who say it is not a disease which stands for dis-ease. Go preach to the law makers who say addiction is a choice. Are the addicts in prison getting help? Pfft! You are clueless just like the law makers. Say No? How long have you been an addict smart guy? Never?
Nobody goes to jail for being “addicted.” It is not against the law to be “addicted.” Claiming to be “addicted” actually gains you leniency for many crimes, such as theft, robbery, shoplifting, drunk driving, fraud, and buying illegal drugs, or breaking various laws regarding alcohol – I know, since I gained leniency for such crimes when the system persuaded me to think of myself as addicted.
What country do you live in Steven? Oh maybe California is why you say that. If you get caught with drugs? You go to jail. If you ask for help? They tell you 3 to 6 month waiting list. So, you go back to stealing or what ever you need to do to keep from becoming sick. Unless of course you get caught shop lifting chainsaws at Home Depot then and only then do you get service. From the local P.D.. Then you get a bond that you cannot make and receive a public defender who gets paid $500 for your case beginning to end. So, he could careless if you go to prison or not. He gets his $500 dollars from the state for your case. Since the stack charges, meaning through every stupid charge they can possibly think of and turn a shoplifting case with a possession charge into Grand larceny because they have a video of people stealing chainsaws and because you have a scale in your pocket ro keep from getting ripped off by the other bad choice makers as you call us they turn the possession charge into a trafficking charge, which each carry 12 years a piece. Do you consider that not going to jail for being addicted or do you believe that was the person who is charged just making more bad choices? I can own what I have done to make sure my drugs were never to run out, but to add all the rest of the bs? You need to quit drinking Steven because it is affecting yours and Jackies thinking who by the way has probably drank in college and tried weed when she was at the football teams train parties and drinks wine until oblivious has set in and has no idea what addiction is. You say you have been an addict? You’ve lived on the streets Steven?Oh methadone and sub-oxon are cures for heroine? Yeah because alcoholics can quit at anytime says the man who thinks drinking is ok. I cannot even have a drink because it opens my DISEASE of addiction all over again Steven. That’s right. One is too many and a thousand is just getting stated. That’s the choice I have if I pick up any drug or substitute one for another. My addiction is not a cup cake festival. I prayed for death Steven, that’s probably where you were too when you used a religon based institution to clean up then bash AA or 12 step programs. Now what?
YOU STILL SUFFER FROM ADDICTION STEVEN! YOU DRINK ALCOHOL! THAT IS A DRUG!
In these 2 comments, I see you apparently believe that simply possessing drugs is equivalent to being addicted (and that being punished for possessing drugs is the same as being punished for addiction). And you believe that using the drug ethanol is equivalent to being addicted to ethanol.
I don’t think anyone is ever addicted (as in compelled to use substances without choice); instead, I try to say people use substances “problematically.” But assuming I agreed that there was a state called addiction, do you really believe that any use of a substance indicates that one is addicted? Or are you just trolling super hard right now?
http://www.huffingtonpost.com/entry/vivek-murthy-report-on-drugs-and-alcohol_us_582dce19e4b099512f812e9c?
appeal to your authority and I will appeal to mine. Credible
? Both maybe..you have yet to respond to my comment on you drinking?
I did respond, when I said this:
[ethanol is the active drug in beverage alcohol]
You claimed, that simply by the fact that I drink, that I am suffering from addiction. Remember? You said this:
That’s just plain silly. That’s why my response was to ask whether you really believe that using a drug at all qualifies one as being addicted. Is that really what you believe?
I’m sorry but this is probably the most ridiculous thing I’ve ever read. This is obviously written by someone who has never been in active addiction, or probably never even been close to someone who has been. It undoubtedly started out as a choice, but you have no idea how fast that changes. Until you’ve been 4 days into a cold turkey attempt and understood the feelings, thoughts, pain, and the desperation that most of us experience, you really have no right to preach an article that you seem to know little or nothing about. People can study up and show you all the “scientific” research they can about this, but without physically experiencing it or at the very least having a loved one go through it, you’ll never quite know. This type of article honestly does more damage to someone seeking help than good. Literally the most ignorant and down right offensive thing I’ve read in a long time…. But then again what would I know I’m just a recovering drug addict.
Let’s talk about ignorance for a second. Ignorance is stating this…
…when there’s a mini Author Bio at the bottom of the article that says otherwise and features links to an About Page that goes into more detail, and an FAQs page that goes into more detail on the author’s experiences. Both of those pages are also the first to links in the menu bar at the top of every page on this site as well. And just last week, a few days before you made this comment, I also added a video of me speaking, in which I tell a little bit about my experience with heroin withdrawal. So don’t tell me about ignorance. If you wanna make a substantial point then why don’t you try arguing against the points that are actually in this piece instead of trying to shoot the messenger.
Yeah, I’ve been through heroin withdrawal, hundreds of damn times. And I say addiction is not a disease. AM I RIGHT JUST BECAUSE I’VE BEEN THROUGH IT??? After all, that the case YOU are making. And if it’s a sound argument for you, then it should be a sound argument for me. But it’s not a sound argument in either case. It’s just one little piece of the puzzle. I don’t make a simple appeal to experience or authority like that, because it’s not a real argument. Argue the points and evidence I’ve presented to demonstrate my conclusions, or don’t comment, because y0ou add nothing with these sorts of comments. Literally nothing.
What were you addicted to Steven? By the way if you are drinking alcohol? That’s a drug period. So you still practice in active addiction.
TO Howard Griego,
You have your head up your ass, Howard Griego. You are a COMPLETE moron. Try reading material other than bumper stickers, fortune cookies and comic books. Howard you are a COWARD. I would call you a pussy but I don’t think that’s allowed in this forum.
Mick
-ex-alcoholic/ ex-addict –
Sorry but having been through this with family members and just this week a young neighbor girl I have found in each case their us brain diseas involved. In each case it was discovered that all were diagnosed with behavorial issues..depression, OCD, BI-POLAR, ADHD. Once treatment started recovery was much easier and they are still successful after 10 years. I read reaseach that indicated 65% of addicts suffer from underlying mental health issues. And if memory serves me right in 1985 Congress passed a law that required all health insurance carriers to treat addiction as a disease.
you might have a point to your theory if your arrogance didn’t get in the way.
God bless all those that can stop cold turkey..many cannot. All people respond differently…find the right program is key…family…support.
all people that are diagnosed with cancer will not respond to the same treatment if you get my point. Whatever it is losing one mother father daughter or son is not an acceptable chance or price to pay.
Amen! I have made a change after 46 years of suffering. These people ride coat tails. They have no first hand experience.
Addiction isn’t a disease, it’s induced and a choice. Anyone that thinks it is, is week minded. And ya’ll might want to go visit your nearest Children’s Mercy Hospital these kids have a “disease” they didn’t go to the local liquor store, or to the corner drug dealer. They don’t go out and drive drunk, or steal from the ones the love…they my friends have a disease.
Thanks for letting me post. Happy Thanksgiving!
Monica
Soooooo…. The surgeon general is incorrect also? http://www.huffingtonpost.com/entry/vivek-murthy-report-on-drugs-and-alcohol_us_582dce19e4b099512f812e9c?ncid=fcbklnkushpmg00000032. Only you have the real answers huh lol righttttttttt smh
Yes, the surgeon general is incorrect. You are making an appeal to authority. I can appeal to authority too, if that’s all you need to convince you of a particular conclusion on a controversial issue. Here are many highly educated people in the field who disagree with the surgeon general’s recent pronouncement of the tired old myth that addiction is a disease: http://www.thecleanslate.org/addiction-is-not-a-disease-quotes-from-experts/
Here is an article where my colleague Stanton Peele PhD pushed back on the surgeon general’s report: http://theinfluence.org/the-surgeon-generals-addiction-report-repeats-old-bromides-heres-what-he-ought-to-be-telling-us/
Here is a great journal article that pushes back on several myths about addiction, by Gene Heyman PhD of Boston College and Harvard: Addiction and choice, theory and new data
The history of medicine is one of countless grave errors. The medical establishment has made great advances over the past century, but they are not infallible. On addiction, they’ve gotten it wrong.
You keep referring to psychiatrists Steven, The very people who’s pocket book takes a hit if the disease of addiction is recognized as such. It is about the dollar for them.
the surgeon general is incorrect? Lol! you have a degree Steven?
Drug and/or alcohol abuse is a chosen behavior. It’s that simple.
You’re wrong as ever Tom.
YOU HAVE NO CLUE AS TO WHAT YOU’RE TALKING ABOUT!
No, you guys don’t understand. For some people addiction is a disease and a mental disorder. Yes, we all have the propensity in our bodies to have addiction. But some people brains are hardwired to succumb more to that trigger. Just like any other diseases, it can be hyperactivity in this part of the brain. That is why some people may be able to stop their addictions cold turkey and why some people need other methods. Yes! We do all have the brain piece that makes us all have addictions. But in some people this center of the brain is developed stronger and needs more than just self help to get over it. Like a person who has constant anxiety or ADHD, Autism or Bipolar Disorder. Yes, we all have the capacity to have these disorders, but there are only some that when they were born these activity centers in the brain weren’t developed fully correctly which causes them to have these disorders. Same with addiction. Yes, we all have addiction, but for some they have an Addiction Disorder. It is a mental disorder and therefore a disease.
I don’t know any other way to explain it, but if you can’t understand that you need to just quit your argument because you are wrong.
Gary,
It appears that you may work for a treatment center, from the link you included in your comments. If this is true, I find it wholly irresponsible that you “don’t know any other way to explain it” (“it” being your *assertion* that some people are compelled to use drugs and some people aren’t) other than the 188 word paragraph you posted above. In said paragraph, you make a few assertions, for example, that there is “hyperactivity” in some part of the brain, but you make no attempt to explain a chain of causation by which this results in people being compelled to use drugs with no choice in the matter. With all due respect, you should just quit if you can’t do that. I can explain the claims I make beyond baselessly asserting them. You have offered nothing of substance here.
-Steven
Coming from a person with manic depression, anxiety, panic and attention deficit is disorder who is also an alcoholic and drug addict, all I can say is getting cancer at this point would be a blessing, not to wish it on anyone and certainly not to dismiss the pain and horror of those who get any terminal illness but coming from a real person, a kind, loving caring, exceptionally caring person who truly would give herself for anyone and anything, I do wish I could trade my afflictions for cancer. I would prefer to die with my love ones holding me and loving me and even feeling sorry for me instead of being angry and belittling me and being ashamed of me and probably giving up on me well before my death so that I am left alone and scared, maybe homeless in the streets, probably homeless because I believe in god and fear being condemned to hell for ending my suffering in life as well as my loved ones who will inevitably have to live with the guilt of turning their backs on me anyway in the name of tough love because who wants to enable an alcoholic even if it might possibly be a disease but by your accounts it’s a choice! Yes, you are right, I chose to spend every second of my day getting messed up because I chose that over spending every second in sheer panic and fear, wishing death over the pain I constantly feel inside my head, wondering and praying to god to please make me normal only it never works, i still feel fear, I can only explain this fear like, think of yourself on a plane, pretend you’re on flight 93, the one on 9/11 that didn’t hit the towers, how would you have felt those seconds, minutes, or more? Now imagine feeling like that all the time, from the second you wake up in the morning til you go to bed, tell me you wouldn’t need something to calm you or help you sleep at night and then imagine waking up the next day and you are still on that plane about to crash and every single day after and after and it never ends no matter how much you pray and on top of that you know your hurting everyone you love but that they don’t blame terrorists, they blame you, everything you feel no matter how bad, bad enough that you want to end your life, you know all the world blames you for feeling that way. People say they wouldn’t wish cancer on their worst enemy, I wish I could trade my mental illness for anyone’s cancer in a heartbeat but I wouldn’t, because I would never want to give what I have to them even if it meant they would live