To say that addiction is a choice rather than a disease is not to say that people don’t really suffer. Nor is it to say their behavior comes from some inherent “badness” within them.
It is to say that their suffering is indeed real, and that it emanates from a set of beliefs about substances, self, and the boogieman of addiction, rather than from a biological defect or disease – and that the individual alone holds the power to choose to change these beliefs and their resultant behavior.
Many of the beliefs that fuel the behavior referred to as addiction are propagated by those who purport to help “addicts.”
Each one of us is constantly making what we see as our best possible, personally feasible, choices aimed at living out a happy existence. To the degree that our beliefs say we are incapable, our potential choices become limited. The treatment industry demands that you believe yourself to be incapable of self-control (i.e. that you are powerless, in need of a “higher power”, formal “support”, etc). While we’re mired in those depressing beliefs, we’re not even exploring whether we might have happier lifestyles available to us. Finding a new perspective (set of beliefs) on substances, self, and “addiction” is key to changing, and it may be a unique journey for each individual, but the core principle is the same: when you come to believe that you’re capable of living out a happier existence than that provided by heavy substance use, then you will leave heavy substance use behind – period.
Hi Stephen. I enjoy your writings. I am a SMARTRecovery meeting facilitator. I frequently use your comments and statements in my meetings and activities. I agree with the view that when we visualize and come to believe that a life without alcohol and drugs being our best choice and chance for happiness, or a life with out engaging in harmful behaviors is possible and we can have a great and reasonably happy life, we are most likely to not wreck ourselves with substances.
I stopped drinking and taking pain pills when I accepted myself as being worthy of a happy, healthy life, and that drinking and using were NOT my best options for the life I wanted and now have. And SMART helped me a lot, but it was my decision-choice to change my behavior that was and is the foundation of my not drinking or using.
A common fear about quitting drinking or drugging completely is that life will suck. Just as fearing not being able to stay abstinent is normal, so is the fear that becoming sober.clean will be a terrible thing. Most of us find that we can in fact get and stay sober, and that our fears don’t come true. Sobriety is freedom, not punishment. Life is great without altering ourselves.
The debate over is addiction choice or a disease rages on, but here’s what I know:
Even if an unquestionable source(s) determined that it is not my fault that I’m prone to addiction and drank and took drugs because it is a disease, that only faith can help me, that it is hereditary, that I have a character flaw and moral failings, that it’s my mom and dad’s fault, my childhood, my ex-wife, my wife and kids, my job, the city I live in, life overall, and that I’m 100% guilty of maladaptive behavior and irrational and everything else actually MADE me drink…. So what! I don’t drink anymore because I have no desire to and when a rare urge comes around, I choose not to. That’s all that really matters to me. And, I’ve never been happier in my adult life since I quit drinking.
I believe there are many different ways to stop hurting ourselves. While SMARTRecovery works for me, it may not work for everybody, and same with other programs. We know most people recover or stop harming themselves without professional or group therapy. We know you don’t have to hit rock bottom or stay in recovery forever. Some people even return to reasonable use. Addiction treatment will continue to evolve. I know I’m happy and healthy and sober. Finally.
Mike Massey
I have been doing a research project on alcohol addiction for my English Composition II class. My paper talks about alcoholism being a disease and not a choice. I used and cited information from your site to show the opposing view. It is nice to see someone that is not a doctor putting so much effort into such a big problem. I have a lot more research to do, but I do have one small argument towards the disease model to share: Type 2 diabetes is a disease that changes how the body reacts to things and it can sometimes be caused or controlled by diet and diet is also a choice. Definitely not saying that they are the same kind of disease, but it’s an example of a disease that can be caused by and fixed by a choice as well.
Hi Emily,
Thanks for your interest. I am very familiar with the diabetes analogy, and I’ll be glad to respond to it (I responded somewhere else on this site before, but I don’t know where that detailed response is off the top of my head) – but first let me say this: I do not endorse any argument which amounts to “you made the choices that got you addicted, so addiction isn’t a disease.”
I do not think anyone “gets addicted” as in, getting into a state where they are not in control of their substance use and unable to stop. That simply never happens, and yet it is the linchpin of the disease model of addiction – getting into a state where you’re uncontrollably driven to use substances. The “you made the choices that got you addicted, so addiction isn’t a disease” argument is absurd as an anti-disease-concept argument because it concedes that in fact the disease exists as a state of uncontrolled substance use resulting from previous freely chosen exposure to drugs. This would be like saying that some STD is not really a disease because you freely chose the risky sexual behavior that lead to you contracting the condition. This is absurd. These conditions can’t be willed away, they involve real malfunction of the physical cells of the body – they are real medical conditions that must be battled on a cellular level with medications and the workings of the immune system – they are not matters changed by new cognitions.
So again, I do not endorse the “you made the choices that got you addicted, so addiction isn’t a disease” argument. In fact I hate this argument and cringe every time I hear it. Especially when people who think that we are in agreement utter it. It does a disservice to people who seriously counter the disease model of addiction, and sets up the perfect straw man for the pro-disease-model crowd. Most of all, I can’t stand when it’s attributed to me, because I’ve never expressed it as an argument. My argument is not that you make the choices to “get addiction” – it’s that what we call addiction represents a string of always freely made choices. These choices are the expression of a developed preference that is subject to change by the same freely chosen thought processes that can affect every other personal preference. But that’s getting a little deep now for this discussion.
Now back to the diabetes argument. Diabetes, while it can be brought about by freely chosen exposure to too much sugar or whatever, is ultimately a matter of a malfunction at a cellular level. So it’s much like our STD’s mentioned above. Furthermore, the dietary measures that can be taken to keep diabetes in check do not end the cellular malfunction. The cells still malfunction. You may keep symptoms away, but you don’t get to eat what you want. You have to permanently alter your life to cater to your cellular malfunction. As the Joslin Diabetes Center states:
“Addiction” is not caused by a cellular malfunction. The patterns of substance use that are popularly referred to as addiction are the product of cognitions – thoughts – judgments, preferences, etc. They are patterns of choices people make based on what they freely choose to think, and can freely choose to think differently about. These choices are never caused by cellular malfunction. Never. Please see my more in depth article on the brain disease model of addiction if you think that brain scans prove that “addiction” is caused by a cellular malfunction in the brain.
Plenty of people go through periods of behavior where they feel addicted and meet the criteria for addiction and everyone around them would describe their behavior as “out of control”, and yet they stop it, and they don’t have to permanently alter their life the way a diabetic would. The vast majority of “alcoholics” eventually become non-problem drinkers. Many with drug “addictions” become non-problem substance users as well. The diabetes comparison simply doesn’t work. I hope this answers your question, and I welcome you to poke some holes in what I’ve said here, as that will help me to sharpen my thinking and presentation on this topic.
Thanks,
Steven Slate
What about the long-term effects of alcohol in impulse control?
If i have an impaired area in my frontal cortex, how much i am really in control of my impulses?
There are reductions in white matter pathways even after 5 years of sobriety.
Of course, some of these guys were able to become sober, but there’s something to say here about the fact that it’s not the same freedom of choice as everyone. Some people are rendered almost incapable of coming back and it appears that after your 50’s the brain doesn’t recover anymore from alcohol abuse.
I don’t know what to make of claims of “impaired impulse control.” I don’t really know of credible evidence of “impaired impulse control” and whether any such evidence is even relevant to serious substance use issues. Nora Volkow was co author on a paper a few years ago that found impaired impulse control in cocaine addicts. There were two big problems.
1) As Stanton Peele pointed out, the non-addicted siblings of these cocaine addicts also showed impaired impulse control. So, you could have that impairment, and not have a problem. (link to article by Stanton)
2) The impulse control test she used (which had to do with watching a computer screen for cues to hit the spacebar, and included cues to hit that would sometimes be quickly followed by cues to abort hitting the space bar) doesn’t seem relevant to actual substance use in the real world in a real person’s life. It’s devoid of the real motivation behind substance use. I think those tests are like Libet’s wrist flicking tests that many people believe disprove the existence of free will. Legendary research psychologist Albert Bandura spoke to this issue well, saying:
Bandura, A. (n.d.). Reconstrual of “Free Will” From the Agentic Perspective of Social Cognitive Theory.
I definitely welcome any links to what you consider to be some reliable evidence about impaired impulse control in addiction.
-Steven
It’s not something that is really checked in longitudinal studies because brains can recover from a lot of things. But here is one link i could remember: http://pubs.niaaa.nih.gov/publications/arh284/205-212.htm
Another thing just to clarify if i understand correctly: To stop being an “addict” and live a sober (or almost sober) life one just needs to want to stop more than they want to get high?
If i know that alcohol is just making things worse for me, but every time i reach 10 days without it i end up binge drinking one or two days again this means that i really doesn’t want this to end? I don’t think i can find happiness/fulfillment in other things and for this reason i keep returning to the same patterns?
I know intelectually that my drinking habits are bad for me, but when i try to stop i end up going back because i’m still associating drinking with relief, relaxation, socialization and happiness? Since all my friendships revolves around drinking, this seems to be the case.
It’s just a matter of wanting enough, stopping the illusion about the effects of drinking and work on getting the same effects from reliable and healthier sources/actions?
Steven, I like your site and the work you are doing. I think you are on the forefront of a generational change in attitudes which is long overdue.
I flip-flopped in and out of the effects coerced treatment and behavior mod for a long time, until my competencies got to the point where no amount of self-doubt and fear could keep me buying into nonsense, and that was an exciting time..And I wrote..a whole lot. Questioned everything, because that’s what we need to do. I think anyone indoctrinated does that as part of a process of returning to objectivity.
However, then I began questioning neuroscience and, yup, they don’t have all the answers either, nor are most well-represented in the media, nor do I have a pHd, but I just kept deconstructing everything. I’ve had to ultimately stop playing full time skeptic and decide whether I want to go back to school and catch up with wherever a current discipline is at then do my little mart in moving it forward. Debunking AA or any scientifically unsupported treatment for whatever you want to call drug use is child’s play, but so is making impassioned simplistic semantics-driven arguments about whether addiction is a disease or a choice..What you are really debunking is the limits of the English Language and the limits of the disease-model of medicine, not addiction. But again, so what…go study the humanities, or pick a hard science, and either collect data or try your hand at creating some useful predictive clinical models which correlate well around the disease..I mean behavior….I mean frame-based cognitive quanta – I mean….Shit, we still don’t have GUT, are we building up from the standard model or down from gravity?
It’s easy to debunk models. They all break down sooner or later whether the subjective meets the objective: our minds. Choice is a physical process, and can be changed, but by what, more choice? You are simply nitpicking semantics, and among what non-arbitrary distinctions there are in the present state of medicine and imaging, you miss the one obvious one in all your behavioral addiction vs. substance addiction, and that is the fact that behavior addictions can be rewarding, but not self-reinforcing. That single feedback loop is no less a disease pathology than the known genetic preconditions for diabetes. There isn’t a right or wrong position on this semantic argument. The answer is it’s both, it’s none, it’s time for a nap. I like disorder personally, but labels are meaningless unless used constructively to treat in any case. You seem pretty motivated, so why not go study medicine and come up with an improved descriptor or schema? Or smoke dope all day and prove over and over that linguistics is analog and Godel proves that nothing equals anything anyways. The your war on “disease not choice” has two primary fallacies: one, the definition for disease you are using (and I generally agree with) is not clearly accepted (you appear to be limiting all disease to that of epigenetic factors) and in any case not quite as black or white as you think: diabetes and substance abuse can worsen permanently with continued behavioral choices. Stimulant abuse has been shown to damage the dna in neurons which will permanently change the re-expression of dopamine receptors and have cascading effects.
I’ve no idea where I am going here, other than to say: hey, you are smart and motivated, and so let’s call the slate clean: go find a way to help some people somehow with all that remaining energy!
Why would I study medicine when my opinion is that this behavior is not in the province of medicine? Seriously? That makes no sense. And I’m sorry, but I believe there is an objective reality to be understood out there. Just throwing my hands up and saying that addiction is and isn’t everything and anything doesn’t work for me. That is the exact opposite of identification and definition which is at the core of understanding objective reality so that you can deal with its demands. If we’re going to aim to solve addiction we need to know what it is. If the fact that there are physical correlates to a human action make it a disease or medical condition – then literally everything we do is a disease or medical condition. Everything. And then, we have defined and come to understand nothing. Because to define something is to find it’s essential attributes that distinguish it from other things. What distinguishes heavy substance use from a disease? Oh I don’t know – the fact that it is a choice! The fact that it isn’t caused by a physiological malfunction of some sort. The fact that it is directly changed by will alone.
And as far as telling me to go put my energy into a solution – thanks for telling me the same thing that thousands of other people have ignorantly said to me here over the years. Where do you get off assuming that I’m wasting my energy and being destructive? Where do you get off knowing nothing about me and telling me what to do with my time? FYI I am co-author of the 13th edition of The Saint Jude Program, an educational approach to substance use problems taught at the Saint Jude Retreats, so thanks for your concern and advice, but I’m already plenty busy creating solutions. But again, if you want to solve a problem, you have to understand it first. You can’t just agree to see a thing as a disease because it sounds like a nice thing to say or because you have such a ridiculously wide definition of disease as to make the term completely meaningless. And if you proceed to treat something as a disease when in fact it is not, then you will at the very best be COMPLETELY ineffective, but more likely cause extra harm along the way, as the rehab industry of “treatment” for a non-disease has done.
Thanks but no thanks for the advice and input. You contradicted yourself along the way, repeatedly advocating medicine and clinical approaches after starting out by saying it isn’t a disease. I can’t go nowhere with that.
-steven