The most mind-numbing phrase in addiction rhetoric: “out of control”

The addiction treatment and recovery world has created a web of myths and misinformation that leaves troubled people utterly confused. Unfortunately, this confusion also seems to make our substance use problems more extreme and longer lasting.

My ongoing goal is to break through this confusion with the facts and logic (my main work in this area is the book The Freedom Model for Addictions: Escape The Treatment and Recovery Trap). This is easy enough to do when it comes to claims like “you can’t get over an addiction without treatment.” There are decades worth of epidemiological data demonstrating that the vast majority of people do get over their addictions without treatment, and that treated populations fare no better than those who never receive treatment. We have a clear claim, and a clear set of data by which to test it.

What’s much harder though, is to break through the confusion caused by unclear claims and vaguely defined terminology and concepts. Have you ever read a language you don’t speak? You can say the words, but you have no idea what is meant by the sounds coming out of your mouth. Many people who repeat the terms and phrases they’ve been taught to use regarding “addiction” are doing much the same thing. They’re saying words and phrases, but don’t really know what they mean.

The most repeated unclear addiction phrase I encounter is “out of control”:

John’s cocaine use is out of control.

Diane’s pill use is out of control.

My drinking is out of control, I need to regain control.

If you don’t know what you mean by this phrase, yet you use it to describe your own substance use, how can you ever hope to have any clarity on the subject? You can’t. That’s why I say this is a mind-numbing phrase. You can’t really think in terms you don’t understand. Granted, you may say the words in your mind, but you aren’t really thinking, you’re just repeating a script.

Let’s take binge drinkers as our example. These aren’t the type of drinkers who drink morning to night every day. A binge drinker doesn’t drink every day, but they drink to extreme levels every time they do it. What can a binge drinker possibly mean when they say that their drinking is “out of control”? Do they mean it is just happening, and that they aren’t choosing to do it? Is the alcohol pouring itself down their throat? Of course, we know that Alcoholics Anonymous teaches that there is something like an allergy to alcohol that quite literally causes “alcoholics” to keep drinking against their will after the first drink. The broader recovery movement has continued this theory in other ways, even though it’s been disproven. Many people believe it though, and so some who say their drinking is “out of control” do mean this. “Once I start I can’t stop” they say.

I encounter many people who don’t believe the allergy model, yet nonetheless continue to refer to their binge drinking as “out of control.” What do they mean by this phrase? When I ask, they often look dumbfounded and eventually admit that they don’t really know what they mean. Many of them say they believe their drinking is fully a choice, but they still continue to refer to it as “out of control.” This is a massive contradiction. It’s no wonder they struggle to make any sense of their behavior.

My job is to present people with ideas and information that challenge their most deeply held beliefs about addiction. So I often push further on this issue. If I can get an answer from a binge drinker as to what they mean by “out of control” it’s usually a list of reasons that their drinking is bad. They drink too much and behave in ways they regret. This includes behaviors such as swearing and being verbally aggressive; sending belligerent text messages, emails, or online comments; cheating on a monogamous relationship or doing other sexual things they regret; physical violence; drunk driving and other risky choices; cancelling out on other plans and responsibilities in order to keep drinking; and any other sort of embarrassing behavior. They also list other costs/consequences such as spending too much money, getting arrested, becoming hung over, blacking out, hurting themselves in falls, or making themselves sick.

If I press someone who’s calling a loved one “out of control” they eventually come out with the same sort of list of bad things as above. Some think their loved one is literally “out of control” i.e. not actively choosing their drinking but somehow being compelled to drink. But again, that’s only some – others don’t subscribe to the idea that this behavior is truly involuntary. Despite this fact, they use language that portrays the behavior as involuntary, both in describing the problem (so and so’s drinking is “out of control”), and in describing the hoped for solution (they need to “get their drinking under control” or “regain control”).

This behavior we call addiction is not involuntary. As I noted above, the allergy model of “loss of control” in addiction is at odds with the scientific evidence. Further, the brain disease model has never provided credible evidence that substance use becomes involuntary. Over 90% of alcoholics” and over 96% of “addicts” quit or reduce their substance use while their brains are changed to a degree that is supposed to make them unable to do so – and they usually do this with either no treatment, or treatment that consists only of talking with others in a therapeutic setting. We don’t do brain surgery on them, and there is no evidence that the medications used on a tiny minority are associated with better results than going without treatment.

So if we’re using language that portrays problematic substance use as involuntary, we are mischaracterizing the situation. All of this troubling substance use is voluntary.

The funny thing is, we all seem to recognize this with young people. When a 20 year old sorority girl binge drinks, becoming falling-down-drunk at parties every weekend, we laugh at it. It’s basically a rite of passage in our society. We collectively disapprove of this behavior to some degree, but we also accept it. It’s just college kids doing what college kids do, and college is basically the culturally agreed upon time to do that. We are usually loathe to portray this behavior as involuntary. We think labeling them as alcoholics would be silly. It’s just partying. We recognize that college kids want to drink recklessly. That they like it. That it’s a badge of honor for them. Many older people have cherished memories of engaging in the same behavior at the same age, even though they eventually stopped engaging in it, and found new ways to enjoy themselves.

Yet, if a 40 year old mother of two begins to engage in the same behavior, we instantly call her an alcoholic. Friends and family intervene, and implore her to seek treatment for addiction. We will call the mother of two “out of control,” and send her to people who tell her she is literally “out of control.” They will tell her that she has a neurological disease that forces her to drink and behave this way. They will tell her she cannot “stop on her own.” They will tell her that she binges because she literally “loses control” of her drinking after a single sip of alcohol.

Do we think the sorority girl literally “loses control” and drinks involuntarily after the first sip of a beer? We usually don’t believe that, for the reasons listed above, because we recognize that college kids want to act wildly, and that drinking provides them a way to do that. Why do we think this is out of the realm of possibility for a 40 year old? You may respond that it isn’t normal for the 40 year old mother of two to want to do such things, and I’d agree. But that leads right to my point – which is that the only real difference between these two women are the cultural norms that they’re expected to live by.

Now, we might use the phrase “out of control” to describe both these women’s behavior. However, we seem to mean different things by it in each case. “Those girls at the sorority are out of control” just means they are acting pretty wild and causing some trouble. We don’t mean that the sorority girls are somehow possessed and behaving in ways that they do not choose of their own free will – yet this is exactly what seems to be meant when applied to the 40 year old mother of two. There’s a degree of acceptance with the sorority girl’s behavior, while the 40 year old’s behavior is seen as so unacceptable that she couldn’t possibly choose it of her own free will.

This vague shifting use of language ensures that we never face what’s really going on. The 40 year old wants to drink recklessly. She wants to party. It’s unusual, but that doesn’t make it involuntary. There are simple explanations for it that don’t require a vague concept of disease or possession. Maybe she had her first child at a young age, and is now taking her chance to get the experiences she feels she missed out on while she was dedicated to work and parenting, and her peers were partying. Maybe the kids are growing up and moving out, now she has leisure time available, and she doesn’t know what to do with it other than get drunk. Maybe there are other explanations, but the point is that there’s no reason for us to assume she doesn’t want to do what she’s doing. She’s not literally “out of control.” She’s “out of control” only in the colloquial sense of behaving in socially disapproved ways.

An intervention doesn’t have to occur for us to enter into this land of confusion. Even if nobody intervenes, she may begin to think of herself with the phrase “out of control” and be just as confused about what she’s doing and why. The reason for this is that the norms are well known. She knows that a person like her is not supposed to behave this way. She knows that in our culture, she’s not supposed to like getting drunk, she’s not supposed to want to act wildly, she’s not supposed to want to become uninhibited through drinking, she’s not supposed to want to throw caution to the wind like this. She begins to indict herself, saying to herself that “a mother shouldn’t act this way.” This is what my colleague Mark Scheeren calls a shame script. It’s when you know your behavior is disapproved, outside of norms, and you begin to identify with it – “I am a bad mother. I am an alcoholic.” It hurts, and the most instantly comforting way to deal with that pain is to tell yourself that you aren’t responsible for it, and don’t really choose to do it, that you are “out of control.” She repeats these things often, but the shame scripts don’t seem to change her behavior, they just make her feel worse about it.

On some level we know this phrase is nonsense, even though everyone uses it. Yet we repeat the script because it offers an excuse. To believe yourself to be literally “out of control” gives you a way to dodge some responsibility for your behavior. To portray yourself this way to others gives them an excuse to lay off a bit on their expressions of disapproval. But the end result is that you feel powerless to change. And even if you don’t want to change, it still leaves you feeling horrible about behavior that you obviously find some value in right now. It puts you in a horrible internal conflict.

The greater cultural reason we all engage in this charade of portraying some disapproved behavior as involuntary is simple. It helps to preserve our norms, to enforce a common moral code. I’m not religious, or even a believer in God, but I recognize that religions traditionally led the way in moral codes. As they fell out of favor, we started enforcing behavioral norms by pathologizing unapproved behavior, calling it a disease, and using the guise of medicine to enforce the norms (some would say the religions only fell out of favor because psychiatry claimed dominion over morality. I’m inclined to agree). So now we don’t tell each other “you’re acting like a jerk – stop it!”, or “what you’re doing is a sin.” Thank god for that. But our current alternative is no better. Instead we say “you have to admit you have a disease, and accept the gift of treatment.” In this age, real science has been co-opted as scientism: things that look and sound scientific. We dress up the disease of addiction as scientific by presenting a brain scan of an “addicted brain” that has very little to do with the conclusions it’s attached to. Our moral authorities are no longer the church leaders – they are anyone who can spew enough nonsense jargon and numbers to tell us some behavior is pathological.

Don’t read me as endorsing a return to religious enforcement of morality. I’m not. I’m against the whole enterprise of telling each other what to do. In the passages above I’m simply describing what the situation is. I’m definitely not pretending to espouse an original idea by doing so either. See the work of Thomas Szasz or Ivan Illich for deeper thinking on this subject. The reason I bring it up is to answer the natural question of why we’re all suffering this mass delusion about “addiction.” We don’t play the addiction and recovery charade because it accurately explains problematic substance use and helps people who are truly “out of control.” We play the charade because it allows us to intervene and control each other, justifies drug prohibition, and upholds behavioral norms. Otherwise, we’d have to agree to live and let live on behaviors we dislike. We don’t want our children to think these behaviors are legitimate life choices to make, so we think we have to call them diseases and pretend nobody would ever freely choose to engage in them.

So here’s the thing. If you don’t want to understand your own behavior; if you want your own behavior to feel foreign to you; if you want to feel incapable of changing it; if you want to hate it while continuing to do it – then go ahead and repeat the script that you are “out of control.” This will ensure that you remain completely in the dark and stuck in place. But if you want to feel in control, then you need to recognize that you are in control every step of the way. You need to own it. For our binge drinking 40 year old mother of two discussed above, this is very simple. It means recognizing that right now, she likes to be reckless with her drinking; she likes to be uninhibited; she likes to tell people off with drunkenness as her cover; she likes to feel young again; she likes to break the norms; she likes that when she’s drunk she doesn’t have to be responsible for everything; she likes the hi-jinx she gets into while binge drinking; she likes to get drunk.

This doesn’t solve all of her problems. But it sets an honest foundation on which to begin solving her problems. It is the basis of self-understanding. It forms the basis of new choices too. By recognizing this behavior as something she chooses, she can begin to reassess it and see if she has better options she’d rather choose. If she wants to continue the behavior in the foreseeable future, she can just enjoy it, and be straightforward about doing what she wants to do, instead of getting caught in the confusing state of believing it is just happening to her. Then, when she does see fit to change, she can do so on a dime, instead of searching for some magic to help her “regain control.” You can’t regain what was never lost, and so attempting to do so – to try to recover from a fake disease – is a fool’s errand that will only leave further destruction in its wake. It’s better to opt out of that nonsense altogether.

If you have a loved one whose drinking or drug use is causing problems, and you feel it’s proper to intervene, then tell them EXACTLY what your concerns are. Don’t tell them they’re out of control. Tell them your real worries, whether that is that they are endangering themselves, or that they’re pissing you off, or that you think they may be sacrificing their future. Tell them of the better options you think they have available to them. Tell them the truth as you see it, instead of repeating these addiction & recovery scripts. The last thing they need is the recovery charade and its mind-numbing nonsense. It’s better to just give them reality, even if that’s uncomfortable. I understand the impulse to try to just get them to agree that they’re “out of control.” It’s a shortcut. It allows you to turn them over to a professional who you think will deal with the finer details. But I’m here to tell you that addiction professionals usually won’t really deal with the finer details. They’ll just increase the impersonal charade, by trying to convince them of the “disease” and “loss of control” and by using scare tactics to try to manipulate them into abstinence. They will only teach them how to play the recovery charade – to say the things they’re supposed to, like that they don’t want to use substances, when in fact they really do. Your loved one has a much better chance of making their substance use choices less problematic if they start assessing it in real and practical terms. The delusion that they are “out of control” drives them away from real and practical assessment.

Trust me when I tell you that “addicts and alcoholic” really and truly want to take alcohol and drugs. They are in control of themselves and using that control to do what they want to do. I overcame great odds to keep up my own heroin and cocaine habit. I walked 13 miles in a snowstorm once to get those drugs. I took buses and walked to go to a mall to shoplift things, then lots of walking and buses to go to another location to pawn or sell those things, then more walking and busses to finally get to a drug dealer, and then again to find a secure place to take the drugs. I did this day after day, all day long. I did it in neighborhoods and places where the police were looking for me. I did it with all kinds of people trying to stop me and all odds against me. I carried out an amazing number of scams, hussles, and manipulations to keep my “addiction” going for 5 years. What is “control” if not successfully fulfilling your own goals? I displayed an astounding amount of effort, ingenuity, and “control” – as do all “addicts and alcoholics.”

So the issue is not lack of control. The issue is our desires or goals. We will not stop until we really don’t want to use the substances. I like to say that we’re dealing with a preference for heavy substance use, rather than “addiction” because the term addiction implies a lack of control, and because I know that we change preferences often throughout life. I did not increase my level of “control” when I quit heroin and cocaine. I changed my preference. I started to believe I could be happier without taking those drugs all day, and by devoting my time and energy into other things. I used the same “control” which allowed me to keep the drug use going, to then carry out my new preferences. This is not necessarily an easy change of mind when you’re in the thick of it, but to do it, you need to tackle the proper issues. You need to start out with a realistic assessment of the situation, which is that you want to be doing what you’re doing right now (even though you don’t want the negative consequences of it). Then you can figure out what you want going forward. I can’t explain all that here and now, but I did write a 450 page book in which half of the content is dedicated to making this preference change, The Freedom Model for Addictions: Escape the Treatment and Recovery Trap.

We should ALL stop using this phrase “out of control.” It does more harm than good – as every falsehood must.