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, 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 Ilse Thompson, Recover! Stop Thinking Like an Addict, a national survey of 35,000 Americans, with the abbreviated name NESARC, proves this assertion, both with alcohol and drugs. As we point out in Recover!, NESARC discovered 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.”
This is, after all, good news, don’t you think? As Ilse and I say, “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 80 years. And the first neuroscientific discoveries that were claimed would cure addiction (concerning the endorphins) occurred 40 years ago.
Well, the NESARC study compared the incidence of alcohol-related disorders in the decade from 2001-2002 to 2012-2013. Do you feel serious drinking problems have decreased in this time period, given the ubiquity of AA and 12-step rehabs? NESARC actually found that serious alcohol disorders had increased by 50% over the decade, occurring for 14 percent of contemporary Americans in the last NESARC survey compared with 8.5 percent who encountered such problems a decade ago.
Meanwhile, the CDC reports, “between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled.”
So, current approaches seem to be of limited effectiveness, to say the least. Why is that? A new organization formed by psychologist Tom Horvath (disclosure, Dr. Horvath, who is president of the non-12-step SMART Recovery support group, served on the board of my treatment center, based on my Life Process Program), has formed an association of those favoring “self-empowering” recovery, called SEATA.
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 with self-empowering therapies that 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 (including by the NIDA). It is termed “motivational enhancement,” and relies on values clarification exercises to push forward in people’s own minds their primary reasons for leaving an addiction behind.
By the way, Miller and other researchers discovered that one of two primary factors predicting people’s relapsing following treatment for alcohol and addictive problems was their belief in the powerlessness of the disease theory of addiction. You know, the theory pushed on people when they attend AA or enter 12-step focused rehab programs.
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 cure for addiction and most people can overcome addiction on their own.