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.
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 –
Ex addict? You will be an addict until you die Steven or whom ever you claim to be. What are your credentials sir? Nada, nothing you have none. and as for being a coward I do not hide behind a made up name. And as far as pussy goes wtf do you know? What were you addicted to? You have some miracle cure? Listen to the way you speak down to people? You are making a moral judgement period. you are not an ex drug addict or you’d have compassion for those that are you egotistical self centered narcissistic puke. Mick? bumper stickers?Here is your bumper sticker. Get used to it
http://www.huffingtonpost.com/entry/vivek-murthy-report-on-drugs-and-alcohol_us_582dce19e4b099512f812e9c? Go look at that bumper sticker. Read it and weep punk. You have no credibility and if you do you haven’t stated what qualifies you as an addict. Drinking is active addiction. You attack 12 step programs as well I am sure. Had you ever been an alcoholic or addict you would have an open mind but as far as I can tell you ride coat tails as well. And it’s kind of funny how Steven Slate commends your fat mouth. Maybe you’re Steven Slate and are hurt by the truth that was brought to your attention and in order to maintain your credibility you hide behind a stage name. You are a spineless no ball having moral judgement maker that probably still drinks and thinks there is no problem with that. So Fuck OFF! Get a life or come back when you have been where I have fucking jerk!
If, as you say, “drinking is active addiction” then approximately 172 Million american adults are addicted to alcohol. That’s how many report drinking in the last year, according to the most recent data available.
https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
https://www.reference.com/government-politics/many-adults-live-usa-b830ecdfb6047660
Sorry, but simply drinking at all doesn’t make you an alcohol addict in any reasonable person’s book.
But you were an addict right? You took a magic pill to be healed? Or you just stopped cold turkey like pappamick did and never returned to active addiction ever again? You are not a reasonable person if you were using drugs and then returned to using them again Steven? Regardless if it is once a week or once a month.
Howard, that is your ideology speaking – it is the myth of the chronic incurable disease speaking. I’m not here to keep pouring out the gory details of my story; you can hear some of it in my TEDx Talk posted on the front page, and in the About page.
The fact is that over half of former alcoholics become moderate drinkers. AA and rehabs tell you they don’t exist, or that they were never “real alcoholics” because they use an unfalsifiable definition of addiction to disqualify any evidence that goes against their dogma. Loss of control doesn’t exist. Anyone can use substances at safe levels if they truly want and choose to.
Let’s talk about your insistence that using only once a month is unreasonable. What makes it inherently “unreasonable?” People consider substance use an addiction when it comes at a high cost. If drinking once a month is not coming at a high cost, why should we stigmatize it as “addiction?” What’s the point?
This view, that you should never drink again, comes from a moralistic temperance movement inspired organization: alcoholics anonymous. They basically consider alcohol use to be a selfish sin. Believe in that moral code all you want – but please don’t try to codify it into an objective model of addiction that you claim is a disease. This is like people designating homosexuality a disease. It’s just offensive moralizing, and mixing religion with science.
That was the Surgeon Generals words not mine Steven. I am not a member of Alcoholics Anonymous. I am an NA member though. I have no concept of other peoples God as I stated before. You do not have to spill your story here or any where else. Fact of the matter there is I do not consider you a credible source. You have a counter argument that I use in an argumentative writing paper and you have no way to prove your point because your point is a moral judgement. You and all these others that claim to be addicts or ex addicts throw a lot of blame to the personal choice. Had you ever been in any type of rehab they would never have told you “oh it’s ok to drink moderately Steven” I don’t care where you went. Maybe you have some super secret I have no idea. Do you not think that if I could have stopped when I continued getting into legal trouble over and over and over I would have stopped using? I could not stop. Had you ever been sick from Heroine Steven you and would know exactly what I am talking about. Had you drank like those that die from liver disease you would relate. You cannot relate because you have never been there. Your site was recommended to me because everything you say is a fallacy. It is a moral judgement you are making not a medical fact. My therapist gave me your site. She’s not an NA member or focuses on a 12 step program. She doesn’t even buy what you say and that’s hard to believe because she tries anything that will help an addict. You tearing addicts down because you and your cronies think you are some much better and stronger than everyone else but show me nothing about yourself to qualify anything you and your followers say. Now you use sexual identity to compare? That is apples to oranges Steven. Your theory holds no water period.
Central to today’s Alcoholism Movement is Alcoholics Anonymous and the disease theory of alcoholism. Modern disease theory is based on the results of one 1945 survey.The survey consisted of 36 questions thought important by AA members. It was distributed to AA members through an AA magazine, The Grapevine. The AA editors of the AA magazine then chose E.M. Jellinek to compile the results. Although Jellinek had some misgivings due to the obvious methodological deficiencies, he felt there was also a great advantage,
“[A]ll subjects were members of Alcoholics Anonymous. …[I]t is difficult to get truthful data on inebriate habits, but there need be no doubt as to the truthfulness of the replies given by an A.A. …”
It seems that the AA members made an excellent choice in the person to compile their data. Jellinek already held their positions as “truthful” and their members as the only creditable source of information about alcoholics.
Out of the 158 questionnaires received, 60 were thrown out either for being incomplete, from women or for having multiple responses on one questionnaire. Without ever investigating non-AA members and without ever checking the results experimentally, the 98 responses from AA members to an AA survey, compiled by an admirer of AA, were used as the factual basis for a disease of alcoholism. This is the present day “science” of alcoholism which supports the disease of alcoholism as espoused by the alcoholism treatment industry and Alcoholics Anonymous
1945? wtf? Seriously? get modern Mick!
That’s the point, Howie. The “Modern disease theory” is based on that 1945 survey. Sheesh man, learn how to read with comprehension.
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/drugs etc. does serve to create an additional dependency, a dependency on AA/NA etc. 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/AA/NA/12step precepts or die — the only reason to claim to have a “pretend” disease is to escape accountability for one’s bad choices -It’s cowardly, Howardly.
Mick
#celebratinglife and #livingstrong with no chronic brain disease…
But that is where you are twisted Mickey. If I go to jail because of my addiction is that not accountability? The Surgeon generals report that I furnished has every reason that you have offered to be inadequate Mickey. I might know because I am reading it. I have made changes and am now in college. Do you think I would have been able to go to school during active addiction? I am currently 76% done with an Associates degree thanks to NA. I have never read where one is not responsible in that program? In fact I am held accountable for my actions and responsible for my own recovery. A drug and alcohol (which is a drug) rehab where I acquired the tools of recovery and NA has help me sharpen those tools. Not only that, but has made me into a productive member of the society in which I live. I had no experience on how to live life on life’s terms. Maybe that was because I was abandoned as a child and raised myself. Sounds pretty cowardly to me. The decision I made was to believe that there is something greater than myself. I question that in my first trip through the 12 steps. I was told to use gravity as a power greater than myself in which to believe not another persons concept of God or any other religious factor. Alcoholics Anonymous uses God in there format and to each his own. If it works then use it. If it does not? Find something that does or die. Plain and simple Mickey. I owe my life to the rehab and NA. I have gratitude for that program. I have tried getting clean before. Actually even went to prison. Better drugs in there than on the streets. My addiction is a disease of the mind. What ever you believe is up to you. I was trapped in addiction for 46 years not a decade, but damn near half a century and through NA I am clean and leading a productive life. I have empathy for those still sick and suffering and my sole purpose is to give back to the program what was so freely given to me. I do not need money. Just deliver a message of recovery to anybody that seeks it. Have a nice night Mickey. Give Minnie my best.
The most important “medical” reason for considering alcoholism a disease is that people do sicken and die from habitual over-consumption of alcohol. When it is pointed out to believers in “the disease” that patterns of alcoholism much more closely resemble habits and compulsions such as nail biting and compulsive gambling, the invariable response is that it is a disease because it is fatal. Of course, car accidents, war and the failure of parachutes to open during free-fall are all fatal too. Are they diseases because they are fatal? Calling something a disease implies a medical remedy. Of course, medicine does have a proper role in all these things. After a car accident, during a war and, in rare instances, after hitting the ground, medical experts are the ones to call upon to take x-rays, give transfusions, set broken bones and carry out other tasks for which they have special training. The same applies to people who have poisoned themselves with alcohol. The results of their behavior may well call for medical assistance. But there is no more medical treatment for the behavior of excessive drinking than there is medical treatment for careless driving, overambitious world leaders or improperly folded parachutes.
The general public accepted the disease theory more out of compassion rather than a concern for the semantic argument of what is a disease and what isn’t. Proponents of the treatment of alcoholism as a disease argued that people with drinking problems should be helped, not jailed. It made sense and still does. The problem and failure has been the nature of the “help.”
BRAVO!!!
🙂
Why didn’t you address what I said Steven? Because you can’t. You have to ride coat tails like you are doing here.
BECAUSE THEY CANNOT STOP! DISEASE! Fuktard
so how’s that 12 step live and let live bs working for you, there, howard?
Queue up the music to “Psych” for Howard Griego … https://youtu.be/Me-VhC9ieh0
People like Howard [chronic brain disease 12 step folks] are Losing Touch with Reality or more pointedly, have lost touch with reality and their Feelings Have Replaced Facts. But…. Facts don’t care about your feelings. So, given its limited success, why do AAers/the Whimpering “fake Brain disease” 12 steppers love it so well? Like the addicted lover who clings to a destructive mate the AA/12 step member who eventually succeeds in quitting drinking/drugging often accepts the devil’s bargain of giving up the core part of him or herself.
The debate is NOT open and science is NOT about a “standard” of consensus of opinion. Addiction is not a disease nor is it a “spiritual” problem. People who know better are tolerating this BS just to be polite or, more assuredly, to keep making money off of families in crisis. The dollars just keep rolling in to treatment centers, sober living homes, 12 Step support groups, sobriety book authors, addiction podcasters and 12 step blog writers—so why kill the golden Goose by telling the truth that addiction is NOT a disease? Nobody likes people who say “I’m right and you’re not.” We’ve all learned to be diplomatic, so nobody’s feelings get hurt. Even when we’re completely certain we’re right, we realize it’s good manners to say, “I’m sure there are ways you’re right, too,” or, “No doubt we both have something useful to contribute to this.” But science is different. The scientific enterprise is about getting closer to the truth, by discovering or creating new understandings, and discarding older ones that we know are misguided. In science, we cannot patiently accommodate mistaken ideas because it’s good manners. Some people may still believe that the Earth is flat. Yet it would be very bad science to say, “Hey, no problem. We can both be right! Let’s make a theory that the earth is round and also sometimes flat. Everyone will be happy.”
PS It’s impossible to have a “Diseased Mind.” I think Howard is confusing his physical brain with his non-physical mind.
Third, prolonged, repeated misuse of any of these substances can
produce changes to the brain that can lead to a substance use disorder,
an independent illness that significantly impairs health and function
and may require specialty treatment. Disorders can range from
mild to severe. Severe and chronic substance use disorders
are commonly referred to as addictions.
Call it what you like Mickey. Did you look at the link I gave you? Probably not. Check it out. This is a piece that not only was researched by way more medical officials than Steven Slate has on this blog site or what ever. Also peer reviewed.
Howard, you just said in your own words that addiction is substance use disorder. Do you understand what that means? Let me explain to you what it means.
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) please look it up. Substance Abuse Disorder is in the DSM-5 which is a manual that doctors use to diagnose mental illnesses. You won’t find in the DSM-5 diseases such as liver disease, heart disease, leukemia, etc in this manual, those are true diseases, but you will find addiction in it.
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 if the A/C goes out and is not working. Did 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 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 functions 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, feelings etc. It’s DOES NOT 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 deal with the true causes of their behavior. Go seek professional help, not people in AA 12 step meetings who think addiction is a disease.
Stop with the name calling and cussing, it’s a sign of weak vocabulary. I am curious why you looked up addiction is not a disease, which lead you to this article in the first place? If you truly believe it’s a disease then you never would of looked it up. Maybe it’s because deep down you don’t think it’s a disease. Sorry to tell you, but you suffer from a mental illness, which is not your fault. It will be your fault now that you know, if you use again. You stealing your uncle’s money when you were 4 years old is not a disease, it’s a mental health behavior issue called kleptomania. Which just proves your behavior is all related to mental illness not a disease.
Jackie
Absolutely AWESOME assessment and explanation.
Thanks
Papamick
You’re more than welcome Papamick!
Some times you have to dumb down the explanation to the simplest example for people to understand. I tried to make it as easy as possible, and not get too technical which I could have.
Wow Steve Slade is a fucking idiot. Have you considered that over 90% of addicts have childhood trauma? And there are physiological changes in the addicted mind
I think you mean brain rather than mind, and if you didn’t notice (maybe you didn’t actually read the article you’re commenting on?), this page addresses the significance of those physiological changes in the brain – that’s kind of THE MAIN FOCUS of what I wrote here.
Third, prolonged, repeated misuse of any of these substances can
produce changes to the brain that can lead to a substance use disorder,
an independent illness that significantly impairs health and function
and may require specialty treatment. Disorders can range from
mild to severe. Severe and chronic substance use disorders
are commonly referred to as addictions.
Also, regarding trauma – First I don’t know that your 90% figure is correct. Do you have a source on that? I’ve heard much lower figures.
Second, as Stanton Peele pointed out, 16% of people with high trauma scores have alcohol problems in the most famous study out there. That means 84% of people with high trauma scores don’t have drinking problems. If trauma is to be portrayed as the cause of addictions, how do we square that with these numbers?
Check out the link I posted and you removed Steven Lol!
I haven’t removed anything you posted. You have in fact provoked so much argument here that the 3 comments in which you relentlessly posted the same link have already been pushed down to the next page of comments. If you click “older comments” at the bottom of this page of comments, you’ll find them there, along with one by another commenter who posted the same link.
Howard, once again in your own words you proven that addiction is a mental health issue. “over 90% of addicts have childhood trauma? And there are psychological changes addicted mind” That is what you wrote “psychological changes.” Psychological changes in an addicts brain is not a disease, but it is a mental illness.
Steven,
Judging from his incoherent rants- which include multiple contradictions and uncontrollably hysterical replies- I am convinced that Howard is emotionally unbalanced or perhaps mentally ill. He claims repeatedly [even proudly] he is “sick and diseased” so now he has convinced me that he is sick and diseased. For him, like so many others, it’s a self-fulfilling prophecy and his NA indoctrination has exacerbated his problems rather than mitigating them. That is CLEAR from his illiterate and uneducated replies. Discussing anything with him beyond elementary school levels of simplicity is pointless. It’s like trying to convince an equatorial native of the existence of snow. It’s just not in their range of knowledge because they’ve never experienced it in the course of their lives. If Howard wasn’t such a mean spirited 12 stepping provocateur I might even feel some sympathy for him but I cannot abide such arrogant ignorance. I greatly admire your patience with him and with that Gary Jordan fellow. Keep up the great work!!
Papamick
Ex-Alcoholic/ Ex-Addict
Adoring Grandpa, Triathlete & Animal Love
VIRTUS TENTAMINE GAUDET — STRENGTH REJOICES IN THE CHALLENGE
Yesah ok. I have spoke my peace. ou people are right I am wrong. Good luck with all the help you provide people in your work environment. You people know more than the surgeon general and all his staff, yet have never disclosed any credentials to back yourself. Good luck with changing the world with moral judgement.
I believe that alcoholism is not a disease but yes it is a contributing factor to other diseases. It exacerbates heart failures, liver disease, pancreatic malfunction, and other listed diseases and disorders like Wirkiney- Korsonoff ( I may have spelt that wrong). I have dealt with many close immediate family members who are currently dependent on alcohol, and who have overcome alcoholism. It is a choice. When the individual perceives it as a disease I feel that they are more likely to use this poor information as an excuse to continue drinking because they believe thier body now needs alcohol, like a person with diabetes needs insulin.
If we were to change the concept and educate more people that alcohol and drugs can cause diseases, instead of being a disease more people would perceive alcoholism and drug addiction as a self inflicted choice. There would be a higher outcome of recovery due to the knowledge gained that the effects of alcohol/drugs can be prevented or reversed, if damage has not become permanent due to prolonged use.
By defining alcoholism as a disease we have given individuals a crutch, a feeling of no choice. Which is not true. Just like fatty foods can cause bad cholesterol and lead to heart attacks, we need to educate people that alcohol can lead to various diseases. Alcohol is a contributing foriegn factor of the body that we choose to ingest. Yes addiction is real, but it is a choice. And by educating others that the obsession to overcome the craving can be changed by thier choice and change in habits, we impower the individual to want the choice of sober living. By giving an alcoholic the notion they were born with this and that they will always have it, only makes the individual feel hopeless.
I also feel that by telling alcoholics that thier prolonged choice of drinking has caused permanent damage to thier organs. They now have to proactively be held accountable to that choice.
I do strongly believe that addiction is a choice. The damages caused by alcohol and drugs are self inflicted. Alcoholism is not a disease but it causes other diseases and disorders. We need to start acknowledging that it is a cause of disease, not a disease. It is a choice, and bad choices have negative consequences. In the case of addiction the negative consequence is disease and death. Alcoholism is not a consequence, the effects of the drug is the consequence. You can choose to quit and lead a healthy lifestyle, even with some of the damaging effects already caused by the choice. Or you can continue to ingest the original cause of your own self destruction, which will lead to a consequence of a slow agonizing irreversible death. I’ve seen this time and time again in the hospital. Those that believe it’s a disease and not a choice are the ones that 90 percent of the time I watch die slowly and painfully due to irreversible liver disease. Those that believe it’s a choice I usually don’t see again in the hospital.
Our power of choice is very important in health and recovery. When we know we can choose we usually choose to make the better decision.
This is my strong opinion, you may disagree. We all have the right to disagree. 🙂
Well said Rochelle!
Agreed!
Rochelle
Thank you for adding a voice of logic and a dose of reality. Especially this: “I’ve seen this time and time again in the hospital. Those that believe it’s a disease and not a choice are the ones that 90 percent of the time I watch die slowly and painfully due to irreversible liver disease. Those that believe it’s a choice I usually don’t see again in the hospital.”
Indeed, Addiction is a voluntary behavior that persists against your own better judgment. Thus, addiction cannot be “diagnosed” or attributed to you by others, including physicians. It’s not a “disease” and you are not “powerless” over it. Addiction is a compulsive psychological behavior and is a symptom: no more, no less. It is solely up to you to decide if your drinking/drugging threatens or harms others and yourself. You must decide now whether continuing your addictive pleasures is worth the destruction that will likely result. In other words, you are free to choose between drinking and not drinking — between the high life and family life and between right and wrong.
Papamick
Adoring Grandpa, Triathlete, Animal Lover
#livestrong #celebratelife
VIRTUS TENTAMINE GAUDET — STRENGTH REJOICES IN THE CHALLENGE
I would just like to say that this article was extremely well written and cited, I agree wholeheartedly with the entire concept (and proof) that addiction is NOT a disease. I’ve also read some of the compelling comments from Papamick, Rochelle, Jackie, and the author himself, Steven. Thank you ALL so much for everything provided here, it brings to the forefront and puts into words exactly what/how my mind and heart feel.
Thank You for those kind words, autismprism !
VIRTUS TENTAMINE GAUDET — STRENGTH REJOICES IN THE CHALLENGE
I agree w/this article..I am a chronic physical pain humanbeing due to several medical errors,the limitation in medical testing,and frankly because I am women,,and MOST of the doctors I saw over 23 years were male doctors,,whom maintain the status quo,,all women must have panic attacks,,thus their over exzagerate the physical pain,,,I was forced to endure 23 years of pancreatitis, lower lung collaspe,a gallbladder once a surgeon finally look’d ,was sooo packed w/gallstones,they could not get it out from the laparoscopic hole they cut into my skin,,both organs calcified,gallbladder to the point is was poisoning my system along w/scarring on my pancreas for life.For 23 years I was told,,it in your head,,your a women,,endure chest tube shoved in my left lung that was sooo swollen w/edema the tube itself was actually being shoved into good lung tissue,,ever had a tube shoved into a good lung tissue,,and was called a wimp by the nurses/doctors doing it,,”stop whinning,it doesn’t hurt that bad,unquote,”Or doctors at Mayo clinic,,soo many e.r.s,,,telling me to sees a shrink,,nothing wrong w/your body,,,but NEVER EVER doing anything but normal blood works,never actually doing any testing to see if it was a pancreas issue,,I survive now,,w/permanent scarring on my lung,my lower left ventricle,my pancreas,my spine,,and I will never ever trust a shrink,a doctor ever again,,Soo those of you who claim chronic pain is in our heads,,,let me be your example,physical pain has a physical reason for it,,I bring chronic pain into this mix because ,”addicts,who do not take responsibility for their own disease or whatever,bottum line,,your body,,your responsibility,but addicts who do not take responsibilty for thier bodies,,thus blame my medicines,my pain doctors have cause 10,000 to suffer in physical pain,,because 50 % of doctors have now stop prescribing medicine to lessen physical pain in fear of the dea,losing their lifes work ,their liscence,,,alllll to ,”save thee addict. Now taking away my ability to get a doctor or MEDICINE to lessen my physical pain,,,my insides are scarred for life,,and it physically hurts,,there WAS ONCE medicines AVAILBLE TO ALL CHRONIC PAIN HUMANBEINGS,,BUT now a days w/all this ,,”save thee addict,”’,”reefer madess,when opiate medicine is concern,thus propaganda,,,,,chronic pain medicines are but gone,,,,Medicine to lessen physical pain from broken limb,cancer,arthitis,lupus,lyme desese…all gone,,,,all in the plight of ,”safe thee addict,”’.Our elderly,,who’s bodies are just soo old and broken are forced to live their little remaining years in agony,,to save thee addicts,,,,THAT IS WRONG…WHEN PEOPLE THRU NO FAULT OF THEIR OWN,,HAVE PHYSICALLY PAINFUL MEDICAL CONDITION,,ARE NOW BEING FORCED TO ENDURE PHYSICALPAIN,,,WHEN THERE ARE MEDICINES AVAILABLE TO LESSEN THAT PHYSICAL PAIN ,,IS DEFINED AS TORTURE,,,AND WHEN THESE INNOCENT SOULS CAN NO LONGER ENDURE THEIR PHYSICAL PAIN,,ARE FORCED TO CHOOSE DEATH TO STOP THAT PHYSICAL PAIN,,,THAT IS CALLED GENOCIDE,,,,,BOTH TORTURE AND GENOCIDE ARE INHUMANE,,,AND THE UNITED STATES GOVERNMENT,YOUR CDC,,YOUR SURGEOUN GERNERAL,,,THE DEA,,,ARE GUILTY OF TORTURE AND GENOCIDE ONTO THE MEDICALLY ILL!!!!!! in the efforts to save thee adult addict,,,or for thee REVENGE,, of a parent ,politician, who has lost a adult loved one to a o.d. or addiction…..but that ok rite????as long as we save a addict,,,,,,,,WRONG,,,, in my book,,,maryw
I have been addicted to heroin in the past and struggled with stopping for long periods for years. Is it a disease? I don’t really care. I do know that every time I used it was a choice. It was just hard to chose not too. Your subconscious makes the decision to use, which makes it hard to chose not to consciously. I can choose not to eat for a few days but that too would be hard as fuck. Addicts can stop on their own, but they most likely will not. They need support to increase their chances. Going to jail makes things worse for me personally. The fear of not using when you are strung out is not as intense as the fear of going to jail. Rehab worked better for me, but for some jail might be what gets them to stop. I also met people in rehab that have been through rehab 10+ times. You can stop on your own, but get as much help as you can. For some AA is the best option. It might be bullshit and brainwashing but it works well for some. I think its because of the social aspect of it. Its better to have a bunch of people getting mad in forums convinced addiction is a disease than them out robbing people. For me It makes me happy to think that I do have power to stop. Some people can only forgive themselves for the shitty things they did to use by telling themselves they were powerless. Do and say to yourself whatever it takes to stop using and stop hurting those you care about.
I would say that the closest thing to addiction is OCD which is a disorder and not a disease. It almost seems like addiction is a special type of OCD.
Beau,
Addiction is not a disease, it is a mental health disorder called substance Abuse Disorder which can be found in the DSM-5. I think you are correct that it falls inline with OCD. We know that addiction is a compulsive behavior. People who are addicted to drug and alcohol are obsess with getting their drugs and alcohol, they will go to great lengths to get their drug of choice. Obsess with getting their drugs, plus it’s a compulsive behavior equals a Obsessive Compulsive Disorder.
So if someone makes the “choice” to smoke cigarettes and develops cancer it was that persons choice to get cancer and they should be treated as such. They do not have a disease. They made a choice to get the disease. Lung Cancer from smoking is NOT a disease it is a CHOICE by your argument. So if someone comes into the hospital with chest pain and spitting up blood and are diagnosed with cancer from smoking they should be told to make better decisions in life and be sent home.
That’s not the argument I’ve made here, and I don’t believe this argument, and I’ve even written specifically against it on my FAQs page.
Smoking is a choice, cancer can be a disease that develops as a consequence of that choice, but the smoker isn’t choosing cancer any more than a skiier is choosing a broken leg. The smoker is choosing smoking, and accepting some risks with it, those risks are not what I am addressing in this article. I am specifically addressing addiction, which is said to be a disease that causes involuntary substance use. I am saying that the smoker is fully free to choose to stop smoking.
I find it kind of heartless that you would send someone home from the hospital because their health problems were of their own making. What kind of a psychotic are you? Please don’t ever work in a hospital, because if I burn myself cooking, or hurt myself playing a sport, I would like to get treatment for those injuries.
Wow you really are missing the point…..the point is choices….people get lung cancer without smoking. Cancer is a immune system malfunction…..if you believe big pharmacy and the AMA….it’s a bunch of bs…..I agree with this article….tons of money made on pharmacy and addiction….. better choices for better habits. …. I may not be saying this exactly right….so don’t chew my head off…my son is an addict and I am glad that SOMEONE has a cognitive reasonable researched different point of view….it makes it more hopeful. I will buy the book!
Here’s a question. If addiction is not a “brain disease” why doesn’t everyone who drinks alcohol become an addicted to it? What about the phenomenon of craving? There is a chemical change in an a persons body when certain substances enter it. Everyone reacts differently to drugs like alcohol. A chemical change in the brain happens to an alcoholic that tells the person he has NO CHOICE but to have more. Reason and CHOICE go out the window. This is not normal. So then why does an alcoholic keep drinking if this happens? Coping skills? Trauma? Abuse? Running away from problems? These all sound like issues that are centered in the BRAIN don’t they?
Why don’t people that become addicted to opioids as prescribed by a doctor for physical pain make the choice to just stop using them? Because their brain is telling them that they are in pain and need the opiates to survive and if they don’t get them they will die. The craving is stronger than anything you can possibly imagine. The only thing I can compare it to that a “normy” would understand is the feeling someone gets when they are in love with someone. When someone falls in love with someone it’s all they think about and they will do just about anything to be with that person. Very similar to addiction. There is a chemical change in the brain. A rewiring of the brain that tells you that you need to be with that person. Ever try to tell someone to just stop loving someone when they are deeply in love? It’s just a choice right?
Pullatude,
You brought up chemicals change in the brain, but you clearly have no clue or understanding of structure and functions of the brain. Because you have not read any of the comments, I will repost my original comment to educate you on the brains structure and functions. By the way, a chemical charge in the brain has to do with the how the brain works(function). A person who is depressed does not have a disease, they have a chemical imbalance(function).
My original comment.
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) please look it up. Substance Abuse Disorder is in the DSM-5 which is a manual that doctors use to diagnose mental illnesses. You won’t find in the DSM-5 diseases such as liver disease, heart disease, leukemia, etc in this manual, those are true diseases, but you will find addiction in it.
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 functions of a house are the working parts inside the house, electrical, plumbing, A/C and heating. So if the A/C goes out and is not working. Did 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, there is also 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, feelings etc. It’s DOES NOT 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 deal with the true causes of their behavior. Go seek professional help, not people in AA 12 step meetings who think addiction is a disease.
Also you mentioned “the phenomenon of craving.” You do understand that cravings has to do feelings, and feelings are a frunction of the temporal lobe. Having cravings is not a disease. I love ice cream, and at times I crave it, and I wont be happy until I have it. If it’s 2am and I’m craving ice cream, I’ll find a 24 hour Walgreens and buy it. Once I have that first spoon full of it, the phenomenon of craving kicks in, and I’ve been known to eat half a gallon in one seating. It’s hereditary, my father, mother, and brother also love ice cream as much as I do. Is my family’s love for ice cream a disease? No it is not. If I going to a doctor and tell him/her that I’m addicted to ice cream and that it’s a disease because of the “phenomenon of craving”. The doctor is going to tell me to go to Over Eaters Anonymous, which is Group Therapy, which falls under mental health. By the way, I’m 5’3″ and 120lbs, and very active so I can eat all the ice cream I am an craving. #FEELING,#TEMPORALLOBE,#FUNCTION,#NOTADISEASE
Jackie
Will you marry me? LOL .. I love ice cream too. I don’t think anyone who “craves” ice cream has a chronic progressive brain disease but I do know that if I eat it too quickly, I will get “brain freeze” from taking too big of a spoonful- is practically a rite of summer. LOL
Great comment
Papamick
Papamick,
Sure why not, I’m single. LOL! You crack my up, and I don’t mean drugs! 😉 I’m probably single because of my addiction to ice cream, which I eat a half gallon yesterday and it was freezing outside. It’s good all year round.
I don’t think that drug and/or alcohol is a chronic progressive brain disease because I don’t believe in the brain disease theory. I do believe know it’s a mental illness, which is chronic and gets progressively worse over time. Example: Bipolar Disorder is a chronic progressive mental illness. If Bipolar Disorder goes untreated for years the mood episode get worse over time. So someone first manic episode will be very mild, and will only have one or two symptom of the illness, but go 20 years with out treatment someone will show signs of all the symptoms. Hints why it takes an average of about 15 years to get diagnosed with Bipolar Disorder, because it is truly a chronic progressive illness, just like a Hoarder who’s OCD(mental illness) gets get worse over time. Same goes with an addict, their mental illness gets worse over time.
P.S. It’s funny that I’ve replied too both Howard and most recently Pullatude with my comment of it’s a mental disorder not a disease and Structure/functions of the brain that I never get a reply back. Maybe it’s because they can’t debate with the truth, and that my comment is 100% correct, which it is! lol
Jackie
When they [above mentioned] realize that facts don’t care about their feelings, they usually bow out- and not too graciously. You sound like you are in a position to help a lot of people. Thanks for the awesome clarity.
Papamick
AMEN– right with you…. It is hard to reason with someone who wont listen…. clearly the case… BTW— No one here is judging. My son an addict–He is a great human being when he is not using. He had an accident at work that knocked some front teeth out a year ago— they gave him oxy– for the pain and lots of work being done. It started as an opiate addiction. It is sad cruel…and I blame big pharma/medical for giving this highly addictive stuff out like candy. This problem really escalated in the 1990’s with oxy and has gotten worse with every year. It is a HUGE industry– so is methadone—-treatment etc. $$$$$~~~~ for ever successful sober person— they lose revenue…. greed kills….
I think “disease” is also the incorrect term! But allergy is NOT! I have not put a drink or drug in my body for over 9 years but if I picked one up again my brain would be hi-jacked and with this weird “allergic” reaction that normal people don’t have…. I lose all choice and literally turn into a different person! Now the tougher question. This allergy is cumming, baffling & powerful. Outsiders can spot it before the afflicted can. Denial & resistance is what one will get trying to convince the individual they have one! Once one accepts they have it your correct it’s my choice…. but live with the obsession that’s created once you take stop the substance And alone I’m in hell…. so wait alcohol was just a symptom a numbing process or an escape route? Now we are onto something…. yes! Living from the head up & drinking is much easier than the F word (feeling) or living in an embodied state! to be cont….
Pullatube is just another juvenile imbecile with an inbility to use reason and logic. His childish arguments are full of non sequiturs and glaring fallacies. We often wonder who are the 5 out of 100 people that benefit from 12 step programs? Its people like pullatube whose emotional development was arrested before puberty. Those who remain frozen at 10-12 years of age and the predators who prey on them.
There are good reasons why 12 Step programs work for a small minority of alcohol abusers. The primary one is that they insist that you maintain your alcohol focused life. This allows you to continue drinking, for example, while pleading that you are “powerless” over your “disease.” That’s probably the primary attraction to these programs – you’re excused from either changing or assuming responsibility for your behavior.
Most so-called alcohol support groups are, in fact, merely a bucket of crabs that will keep dragging you back down to their level. Try and escape and you’ll be warned that it’s too dangerous to get a life, or to mingle with “normies,” or grow up. It’s too dangerous to stop building your life around alcohol.
So you stay in the alcohol bucket, drinking or not, or complaining about your spouse, or parents, or children, or……
And what’s the point of all of this?
Obviously the point is to avoid actually making any real change. That’s what groups like AA and Alanon and Alateen do best, they help you maintain the “security of familiar miseries” –– instead of fixing your life.
Wow papamick or papadick is it? It’s amazing how ignorant you are. AA or any support group is about making a total change in your life and how to cope with things. I have no idea what idiot fed you that stupidity that vomited out of your head about AA but they must have been really really fucked up. You have obviously never picked up a book in your life. Your comments are like you said juvenile and you are obviously an imbecile. You should take a long hard look in the mirror and figure out where your deep seeded anger for people trying to get help comes from. Get your head out of your ass.
“The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge. ” Pullatube’s innane comments, logically flawed conclusions, and tortured syntax prove the truth of this aphorism. I’m not sure if Pullatube was born ignorant but he sure does work hard at being stupid.
Arguing with stupid people such as pullatube is like playing chess with a pigeon. No matter how good you are at chess, the pigeon will just knock the pieces over, shit on the board, and strut around like it’s victorious.
The people that have made this site and help to maintain this abomination are fucking wastes. You should be ashamed of yourselves to be backed by religion. All you are doing is pushing away people and for the people that fall into your trap you are trying to say it is a choice and that god can save you from it. You should go back to Salem where you and your “church” murdered people for being different. This is not Gods will, you are backed by a smiteing organization and this should not be published nor seen. What a disgrace.
This comment is baffling. Maybe cunning too.
Where am I saying god is the answer? I’m pretty sure that’s the 12 step model. Although I’m sure a god would absolutely be able to stop a person from using substances (god can do anything, right?), it’s not the claim I’m making because I don’t think there is a god. I am an atheist. So, I’m really confused by your entire comment.
Jim
You were obviously on LSD or some other psychedelic drug when you wrote this. You need a one way ticket back to reality.
Being condescending and mean is a choice too papa. Insulting people is not constructive and is alienating. If that is what you think will persuade people to your point of view then go for it.
So addiction is not a disease. It is a mental disorder. I personally feel that there is choice involved and addicts are not completely powerless. But just because something is a mental disorder and not a disease does not make the issue of free will so black and white. A good example to point out is schizophrenia. This too is classified as a mental disorder. I have also seen on the internet people call it a brain disease. They can suffer from delusions, illusions, et cetera. Sometimes it makes them violent. Was the act of violence a choice? Just something to think about. I don’t think the whole choice thing is so black and white.
Yes we always choose what we do…but a large part of why and how we make those choices is out of our conscious control. Schizophrenia is an extreme example. You could say their conscious is far more impaired than the addict and I would have to agree. But the addict brain is also impaired to some extent compared to a non drug affected brain.
Of course it is a choice…..that is why some people quit.
What I am saying is that I believe it is a choice, but less of a choice for some people than others. I think our understanding of choice at this point in time is too simple to grasp the full concept.
Beau wrote: “it is a choice, but less of a choice for some people than others”
It’s either a choice or it’s not a choice. There are no “degrees of choice” – no sliding scale for some but not others. Example: for addict one, using was 98% choice. For addict two, it was only 3% choice, for addict three, it was 27% choice. This is nonsense.
Beau wrote: “our understanding of choice at this point in time is too simple to grasp the full concept.”
What are you talking about, Beau? Perhaps you were a bit sleep deprived when you wrote that. Choice is an act or instance of choosing-nothing more, nothing less. It’s NOT a “concept.” …. sheesh. Your statement is incoherent and unintelligible. I’ve never heard of anything being “too simple” to grasp or too simple to understand. You have muddled the discussion by overcomplicating the simple definition of ‘choice” and by attempting to assign a convoluted sliding scale to it with regard to substance abuse.
The “disease theory” of addiction contradicts empirical evidence and rational thought and you are not thinking logically.
Papa why do you have to throw in insults? You talk about maturity in other posts. Your unnecessary insults show a lack maturity.
Beau
I do NOT have a brain disease and I sure as hell am not POWERLESS. I had to “man-up” and make a mature, informed decision about the direction of my life. I had to choose between bedlam and chaos and a normal balanced existence. I chose the latter.
You DO NOT have a brain disease and you are NOT powerless. You too have to cowboy-up and make a mature informed decision- a choice.
I do agree that it is a choice. Maybe there is not a sliding scale of choice…but some people’s subconscious might be more powerful and influential over the conscious when it comes to drug use. Just a theory buddy. I thought that would be implied with the way I was talking.
I can see what I worte is confusing. What I meant by saying “What I am saying is that I believe it is a choice, but less of a choice for some people than others. I think our understanding of choice at this point in time is too simple to grasp the full concept.” is not our concept of what a choice is or the definition of the word, but the process leading up to and determining that choice. A child can choose not to eat candy, but when they do do you judge them at the same level you would as an adult? They both were faced with the same choice, but the child had a disadvantage. That is all I am getting at.
Ok I’m no phycology major or anything but I am in recovery for drug addiction .. yes drug addiction is a choice but it also a feelings disease.. I choose not to take that first one and I humbly asked God to remove it . I’m in early stages of recovery but time don’t matter cause it’s always easier to do what you have always done… I only had to change one thing and that was everything… Thanks
April,
What in the hell is a “feelings disease”? I’ve never hear of that. Please explain.
A disease is defined by abnormalities of the structure and function of the bodies organs and systems.
Feelings has to do with emotions, and emotions is mental health, and no mental health issues is a disease. They are mental disorders. So to fix the addiction people need to figure out what caused them to use in the first place. Emotional stress, childhood trauma, do they suffer from a mental disorder like Bipolar Disorder, OCD, schizophrenia, etc. most addicts are self medicating to control the symptoms of a mental illness and don’t even realize that is what they are doing, because they don’t know they are mental ill.
An certain addict might have less “control” over making the choice to stop than another addict. What control is in this context is not clear. What is free will? Does it really exist? Or is choice just based on chaos? Is every choice we make dependent on random events and the last choice we made? I am getting very philosophical here I know, but to me it just seems obvious not everyone is on the same playing field when it comes to control over their next choice.
Hi Beau,
I believe free will exists. If it doesn’t, then discussing addiction, or anything really, is pointless. If we can’t choose, then what is the point of trying to inform ourselves? And really, we couldn’t “try” to do anything, since the concept of effort presupposes choice. I put together a piece on the philosophical issue of free will in psychology and how epiphenomenalism rules the field, but doesn’t hold up philosophically: Philosophical Problem with the Brain Disease Model of Addiction.
But I want to bring up another point here: I think we need to get away from talking about the “choice to stop.” (note, I realize I have talked about choosing to stop often). Here’s why – when we look at it as a “choice to stop”, it’s almost like we’re talking about a car pointed down a steep hill, and that it’s a foregone conclusion that the car will just keep rolling down the hill, and that a force is needed to stop the car from moving. That is, the car is destined to move downhill unless stopped. However, the choice to use substances is a positive choice. It isn’t a foregone conclusion that a drug user will just keep using drugs without any effort whatsoever, and that the only effort would be to stop using. What is propelling the drug user? He sees benefits in drug use. It’s not super easy to keep using despite all the people and authority figures in his life trying to stop him from using. He’s choosing to use. Continued heavy use is an effortful uphill battle.
There are many discussions of addicts which literally say that addicts “can’t put the brakes on” regarding their use. The addict is actually putting the gas pedal to the metal though in regard to substance use. Yet we continue to say that addicts “lack self-control.” If we are to believe that the addict lacks this ability, then the implication is that non-addicts “can put on the brakes”, non-addicts have sufficient “self-control” (or impulse control, or willpower). Think about what this really suggests – that non-addicts walk around every day wanting to use substances, feeling the impulse to use extreme amounts of drugs, but that they’re constantly “putting the brakes on”; exercising “self-control” to stop themselves from using; controlling the “impulse” to use substances. Do we really believe this is the case? I don’t. I think that if you asked the question in these terms, most non-addicts would tell you that they simply don’t want to use substances like that – not that they’re stopping themselves from doing so.
So the reality is not that addicts lack an ability to control their desire to use (that they can’t choose to “stop”) – it’s that they have a great desire to use. This might sound like semantics, but I guarantee you it’s not. It is an important issue at the heart of addiction. I meet people every day who are looking for an answer on how to stop. They often try to come up with deterrents. Many have told me they try to deter themselves by going to meetings, and paying attention to tragic stories that they hope will scare them out of using. They try to remember the consequences when they crave substances so that this might stop them from using. This is not unlike the families who use tough love, and try to make people “hit bottom” to stop them from using. It’s also related to the way counselors try to “confront denial” to stop addicts from using. They assume that addicts don’t understand all the risks they’re exposing themselves too, and the costs they’re incurring as a result of their use. Addicts are well aware of the risks and costs. Focusing on these things won’t stop them – they’ve already continued heavy use despite these risks and costs.
The desire is what needs to plucked apart. The question isn’t “how do I stop” – it’s “why should I keep using.” There’s a laundry list of benefits that addicts think they get out of substance use. There’s a laundry list of things that addicts prioritize below whatever it is they think they get out of the experience of intoxication. It is this perspective that creates the addict’s ultra-strong desire/preference for substance use. They keep expending the effort to use substances because they currently think that this is their best available option. For the addict to stop their problematic level of substance use comfortably and permanently, they need to re-assess why they should keep doing it, rather than why they should stop. They need to re-assess the benefits of abstinence and/or moderation too, and see if those options can be seen as more attractive than their problematic level of substance use. This should all be done by re-assessing and comparing benefits rather than costs, because perceived benefits are what motivate them into action. If greater benefit is seen in moderation than heavy use, and less benefit is seen in heavy use, then there is no self-control, impulse control, or willpower needed to change – there is no choice to “put the brakes on” – they will easily cease choosing heavy use when they see less use as more pleasing.
Does this jibe?
-Steven
So the reality is not that addicts lack an ability to control their desire to use (that they can’t choose to “stop”) – it’s that they have a great desire to use.
Yeah I think you clarified what I was getting at with this statement. Addicts have a greater desire to use. A psychopath has a greater desire to kill. A child has a greater desire to eat candy.
I was reading your link and laughed when you said you didn’t want to get into theories of mind because that is what I virtually asked of you. Funny.
Kind of changing direction here, but what do you think of using drugs like Ibogaine coupled with therapy to treat drug addiction?
And before I asked any more questions I will explore the rest of the site. Didn’t really explore it yet and didn’t realize this is your site. I’m popping in and out of this article as I program a video game so I have been kinda lazy.
And I don’t believe in powerlessness. I always thought that was a dumb concept.
Another example would be making the choice to eat. You can choose not to eat at anytime. It is going to be harder to choose not to eat when you are hungry as opposed to when you are not as hungry. Some people might be more “hungry” than others when it comes to drug use.
I say might because I don’t know. No one knows for sure at this point
Some people are afraid of spiders. Others not so much. It would be harder for the person afraid of spiders to choose to catch it as opposed to the person not afraid. Yes it is still a choice. Yes it is possible for the person scared of spiders to in time to get somewhat over their fear. I just want people to be able to empathize more with others. Addiction needs to be looked at in this same light. There are people that need more help than others to quit using drugs. They require more support to get over their greater fears or maybe their reward system is more profoundly affected by drugs.
I want to be clear I am not disagreeing with the conclusions of the article. I think Slate is super logical in his approach. I just no there are people reading this and thinking to themselves “See. I shouldn’t feel bad for addicts. I would choose to stop and they simply just choose not to.” I am just trying to minimize this reaction
Beau
???????? Spiders, eating,feelings, milk, kids candy, psychopaths, killing, subconscious ???? ? Sheesh man .. all of this nonsense has nothing to do with the point of the article. If you’re insulted by criticism of what you write, then give more thought to your comments before you post them.
Facts don’t care about your feelings and neither do I. Grow a set of balls and man-up. It’s time to throw away the security blanket and teddy bear.
I feel like i am watching that movie Grumpy Old Men. It kinda does buddy. It is helping me gain a deeper understanding. Analogies work great for me.
And what do you mean it is time to man up? Im sober, i work full time, i go to college full time, i have sex with my girlfriend every day. I really dont know what else i can do to be a man.
It all makes sense. These old dude is going through manopause. No but seriously if you wanna find the most unnecessary mean people in the world…just look to the people leaving comments on the internet. Im done arguing with Grandpa. The other thing is I try to respect my elders even when they dont respect me. And im starting to fail at that here
And why are you leaving comments about me…are your intentions really to help me…or are your intentions to insult and try and get a rise out of me for your own entertainment. If that is what makes a man you can count me out. I have a different opinion of what makes a man. It is not this old school tough love i am a man and you are not approach