Why Treating Addiction as a Disease Isn’t Helpful
We are taught in contemporary America that addiction is a chronic disease. This pronouncement is given by the NIDA, NIAAA, ASAM, NAADAC and other government and non-profit addiction agencies and is unquestionably accepted. However, the term disease, as it relates to addiction, carries with it a disheartening and harmful connotation.
The idea that addiction is a disease originated with Alcoholics Anonymous in 1935. AA members believed then, and now, that they were saddled with a lifelong inability to control their drinking, for which the only remedy was never to drink again. To deny this truth about themselves meant they would die, go to prison, or end up in a hospital.
And the remedy? To attend meetings of fellow alcoholics in church basements around the United States, where they were imbued with the 12 steps. Yet many people report being offended by the 12-step philosophy, its constant references to God, and the stories repeated at meetings about people’s personal degradation and ultimate salvation through AA.
It is worth reading and thinking about the actual 12 steps, starting with the first three:
- We admitted we were powerless over alcohol—that our lives had become unmanageable.
- Came to believe that a Power greater than ourselves could restore us to sanity.
- Made a decision to turn our will and our lives over to the care of God as we understood Him.
Are you prepared to swear this oath? Because doing so isn’t a matter to be debated at an AA meeting or in rehab. This is the truth as delivered from the mount. And the many people who gag on it are not given many other options for help.
There has always been the question of whether AA, as a spiritual approach (as 12-step supporters label it) is really a resolution for a medical disease. And, so, American medicine has developed a modern disease approach that proposes that addiction is a chronic brain disease. In terms of this meme, your brain is kidnapped by drugs, and you cannot escape from their grip. This is the idea presented by America’s drug research agency, the National Institute on Drug Abuse (NIDA) and its oft-quoted director, Dr. Nora Volkow.
There are a number of objections to this formulation, two of which I’ll mention. First, most people overcome addiction on their own. This is such a controversial assertion that I could write a whole post about it. Fortunately, the government does research to prove it. As I point out in my recent book with Zach Rhoads, Outgrowing Addiction with Common Sense Instead of “Disease” Therapy, a national survey of 35,000 Americans called NESARC found that:
“26 years after first becoming dependent, half the people at some time dependent on nicotine were in remission, a milestone reached for alcohol after 14 years, for cannabis six years, and for cocaine five years. Although there were not enough heroin addicts in this population to analyze, the investigators found that other data showed their remission point likewise to be quicker than for alcohol and cigarettes.”
What a powerful message this is, if only it were broadcast as loudly as is the one that addiction is embedded in our brains and our lives, presumably forever for most people. But such recovery from drug addiction goes unrecognized, as it does with alcoholism, because it usually occurs without treatment.”
Which brings us to the topic of the effectiveness of AA and 12-step rehab. Or, alternately, what cures have brain science and the NIDA come up with? There are no brain cures for addiction, and none expected for decades. But, keep in mind, AA has been in existence for almost 90 years. And the first neuroscientific discoveries that were claimed would cure addiction (concerning the endorphins) occurred 50 years ago.
How are we doing with drug addiction this century?
Of course, we as a nation have been confronting rampant opioid deaths since the start of the 21st Century. In the year 2000, about 17,000 Americans died due to drugs. By the year 2022, the number of deaths had risen to over 110,000. The drug death rate has since dialed back to around 100,000 — still more than five times the level there were in 2000.
There is a great debate about why deaths due to drugs rose so much. The principal belief was that too many opioid painkillers were being prescribed.
But that explanation doesn’t hold water. Primarily because opioid prescriptions were greatly restricted beginning around 2013, so as to be reduced by 60 percent by 2017. Yet drug deaths continued to rise over that period.
Why have they risen, and risen so rapidly in this period? Of course, the primary explanation has been the rampant use of fentanyl in street drug supplies. Still, we should remember, fentanyl is prescribed for medical use. And people do use the drug personally and very often safely when they observe precautions like knowing the source of their drugs and being clear not to mix fentanyl with other drugs, such as cocaine or benzodiazepines.
Finally — and very distressingly — when drug deaths reduced somewhat across the country, they did not do so equally for everyone. In fact, for deprived and marginalized groups they didn’t decline at all and even increased!
Can we reduce drug addiction for individuals and as a society?
At a deeper level, when we label something as a disease, doesn’t that imply that we have some kind of a medical way to handle it? Instead, we’ve seen an epidemic — a quintupling— of drug deaths. This epidemic has continued for the most vulnerable populations. It’s as though calling addiction a disease is not a way to cure it. Instead, it almost seems to be a way for us to explain the mass of drug deaths as being out of our control and almost to wash our hands of them!
Does “self-empowerment” continue to have meaning in a drug deaths epidemic?
Recall that government surveys continually find that most people overcome drug addictions, often within a relatively short time, usually without treatment.
How does that occur and what are its implications? Such research findings indicate that people do retain control of their lives even after being addicted to drugs. This discovery is noteworthy since it tells people that it is within their capability to quit, even when they have unsuccessfully attempted quitting before. The answer lies in people both relying on their personal resources and support systems, and developing new coping skills.
The term “self-empowering” contrasts with the powerlessness approach of AA and the chronic brain disease meme. It says that people have the ability to overcome addiction, which they tend to do on their own over the long-term, but that self-empowering therapies can assist them in achieving in a quicker time frame.
William Miller is the researcher behind one such treatment, generally regarded as the most effective available for addiction and alcoholism. It is termed “motivational enhancement,” and relies on values clarification exercises to help people recognize their primary personal reasons for wishing to quit an addiction.
Miller and other researchers have discovered that one of the primary factors predicting people’s relapsing following treatment for alcohol and addictive problems was their belief that they were powerless — as the disease theory of addiction teaches them. They were far less likely to relapse following treatment when they believed they had control and employed active ways of coping with their lives and substance use.
What to take away from the disease v. self-empowerment models of addiction and recovery
In my experience, treating addiction as a disease is not helpful. This approach can make an addict feel powerless about their addiction and feel like full recovery is impossible. In reality, there are no brain causes or cures for addiction and most people can overcome addiction on their own.
We are instead taught in contemporary America that addiction is a chronic disease. This pronouncement is given out to everyone with a substance use problem. Yet the term “disease” as it relates to addiction is disheartening and impedes the hopefulness people need to recover.
Instead, we in the Life Process Program encourage and support people’s self-empowerment and their regard for themselves. Which is, after all, the only way that people can genuinely improve their lives and leave addiction behind them.
Dr. Stanton Peele, recognized as one of the world's leading addiction experts, developed the Life Process Program after decades of research, writing, and treatment about and for people with addictions. Dr. Peele is the author of 14 books. His work has been published in leading professional journals and popular publications around the globe.
