Is addiction a disease? Or is it a bad habit?
Do people catch alcoholism or drug addiction in the same way they catch the flu? Or do they acquire the habit by a succession of bad choices?
Do some people have a genetic predisposition to become alcoholics? Or can anyone, anywhere, under the right circumstances, become an alcoholic?
These are some of the questions posed by Dr. Marc Lewis, himself an addict and a neuroscientist, in a new book called The Biology of Desire.
His opinion counterpoints the current theory that addiction is a disease, just like the tuberculosis and cholera. We should always be sufficiently open-minded to entertain alternative theories about problems that psychiatry has always had great difficulty treating.
Kyle Smith has written an extensive article about Dr. Lewis for the New York Post. He begins:
We all know addiction is a disease. It has been so classified by all the authoritative sources. The American Medical Association labeled alcoholism an “illness” back in 1967.
The Centers for Disease Control, the Diagnostic and Statistical Manual of Mental Disorders and Alcoholics Anonymous urge us to think of alcohol and drug addiction as diseases.
Great minds such as Oprah Winfrey, Russell Brand and Joe Biden agree: the then-senator even introduced a bill in 2007 called the “Recognizing Addiction as a Disease Act.” (It never came up for a vote.)
The disease theory is comforting. It absolves the addict of responsibility for his addiction. It tells him that he cannot, without medical intervention, treat his addiction.
Even though the recovery movement-- that is AA-- tends also to treat alcoholism as a disease, it is based on evangelical Christianity, which is not a medical treatment.
Why consider addiction a disease?
Perhaps most important, it has a comforting thought behind it. Hey, it could happen to anyone. You’re not a morally flawed individual if you catch the flu, are you? We don’t think of people with autism, “They could beat it if they tried.”
Addiction-as-disease is in some ways a thoroughly American idea. It ties together how we approach medicine (with a precisely defined target and a definitive program to fight it) and our proudly tolerant spirit in which being judgmental is seen as a kind of vice. Plus it opens up profit opportunities from sea to shining sea.
Moreover, if we tell the alcoholic or the addict that nothing he did caused him to become addicted, we are also suggesting that he can do nothing to overcome it.
We ought to keep in mind that AA, which begins by saying that the alcoholic, on his own, and using his own mental resources, is powerless to overcome his addiction, does add that God can help and that one can overcome alcoholism by giving oneself to God.
Which is not quite the same as thinking that you should take a pill.
To counterbalance the idea of addiction as a disease, Smith reports some of Dr. Lewis’s reasoning:
If addiction is a disease, though, why do most addictions end spontaneously, without treatment? Why did some 75% of heroin-addicted Vietnam vets kick the drug when they returned home?
It’s hard to picture a brain disease such as schizophrenia simply going away because someone decided not be schizophrenic anymore.
This sounds true enough, but we ought to be careful. If some people are predisposed to become addicts, then we could easily explain why some heroin-addicted vets overcome their problem while others do not.
And, no one has ever really suggested that the alternative to the disease theory is your deciding not to be an addict anymore.
Lewis then explains that addiction is a nasty habit. When he continues to say that the disease theory goes back to Aristotle, he fails to note that the habit theory goes back to Aristotle also.
The disease theory originated a century ago:
In 1913, during an era of heavy use of opiates, a book on narcotics urged doctors not to use the word “habit” because “habit implies something that can be corrected by exercise of the will…This is not true of narcotic disease, therefore it is not a mere habit and should not be spoken of as such.
“The man who is addicted to a narcotic drug is as truly a diseased man as one who has typhoid fever or pneumonia.”
One must mention that when a physician says that someone is diseased or sick, the term does not have the same meaning that it has when you say that your neighbor’s behavior is sick.
Lewis theorizes that being socially disempowered incites the bad habit of addiction. He recommends a solution that involves empowering the individual. This might have some value for some people, but one must notice that it is rather sloppy theorizing.
He adds that people with excellent reasons to feel generally powerless in life, including minorities, women, the poor and those with especially dismal family histories, are the ones most in need of reconceiving themselves as empowered individuals.
When Lewis condemns AA for suggesting that people are powerless to control their addiction he ought, in fairness, to mention that AA advises seeking the assistance of a higher power. AA does not see people as weak; it sees their strength lying outside of their will.
Lewis might know it, or he might not, but his is a Nietzschean view of power, one that precludes any access to a higher power. When he talks about will, we recognize that he is referring to the notion of the will-to-power… which is not science, but philosophy. It is a highly individualized force, one that detaches the addict from most support systems and most help networks.
Keep in mind AA programs involve a series of activities and exercises that allow the addict to gain some measure of control over his life. It is not about disempowering anyone.
One can question the value of these programs while noting that leaving the addict alone with his bottle and his will to power does not feel like a formula for success. If willpower—yes, I know, it’s not quite the same thing as the will to power—worked, addiction would be much easier to treat and to cure.
Also, if it becomes a question of willpower, those who remain addicted are presumed to have weaker willpower. So, the concept leads to the notion that addicts should be competing against each other, with those who remain addicted receiving a different kind of moral judgment.
If that is sufficient to cure addiction, it would be one thing. I suspect that it is not.
If Lewis had read Aristotle on habits he would know that the philosopher recommended replacing bad habits with good ones. It is not quite the same thing as making it all a mental exercise, a test for your willpower… one that you will most likely lose.
AA does offer a series of good habits to replace bad ones. Among them and most obviously, it recommends repairing to an AA meeting instead of repairing to a bar.
Obviously, this is not the same as resisting or saying No to the addiction.
Lewis might provoke controversy by saying that addiction is more about desire than it is about enjoyment. In his eyes it is more about the temptation, the anticipation than about getting high or drunk.
When we crave something, our brains are awash in dopamine, which brings pleasure in itself. Addiction is less about enjoyment than it is about anticipation, about desire. But resisting temptation requires a lot of brain energy. At some point fatigue sets in and it becomes too exhausting not to give in.
How then does it happen that our cravings bring pleasure but also push us toward actions that do not provide satisfaction of those cravings? The theorization is simply inadequate here. If cravings did not bring some serious discomfort no one would ever try to satisfy them.
Lewis prescribes self-mastery:
Achieving mastery over yourself requires instead a shift of perspective and a reinterpretation of your emotional state. “Instead of tying yourself to the mast in order to resist the Sirens’ song, you must recognize the Sirens as harbingers of death and reframe their songs as background noise,” Lewis says.
If Lewis knew the Odyssey, he would know that Odysseus does not tie himself to the mast. He tells his men to tie him to it. At that point, of course, he does not resist the Siren’s songs, because he cannot do otherwise than to stay tied to the mast. A moment’s reflection will tell you that if he had tied himself to the mast, he would have been better able to untie himself. If his men tie him, he will be far less capable of untying himself.
Lewis is suggesting that you can resist the Sirens once you learn how to reinterpret them. Again, this is a trendy philosophical notion. It is largely nonsense, as witnessed by the fact that the basis for the scene in the Odyssey is that Siren songs cannot be resisted by using mere willpower. What makes you think that you can do what Odysseus could not?
In case studies he presents in the book, he explains how honest personal reflection, reconnecting how past behavior led to current predicaments and imagining a different and better future were instrumental to successful outcomes for addicts.
Addiction isn’t a direct result of a stress-filled childhood, but there is close correlation between the two, and a survey that explored high youth suicide rates in some Native American areas of Western Canada found that in such communities young people were “incapable of talking about their lives in any coherent, organized way,” Lewis says. “They had no clear sense of their past, their childhood, and the generations preceding them. And their attempts to outlines possible futures were empty of form and meaning. They simply could not consider their lives as narratives, or stories.”
It is well enough known that Native Americans, in Canada and the United States suffer serious psychosocial problems. Whatever the cause, one should show sufficient respect for the difficulties they face by not pretending that they can solve their psychosocial problems by perfecting the art of storytelling.
If you had to choose between a treatment that taught them how to function in the world and a treatment that advised them to get lost in their minds by learning how to tell stories, very few of us would opt for the latter. Moreover, learning how to function in the world does not just happen because you have improved your state of mind or exercised your willpower.
And yet, Lewis believes that you can cure addiction by learning to tell stories.
In his words:
“Humans need to be able to see their own lives progressing, moving from a meaningful past to a viable future. They need to see themselves as going somewhere, as characters in a narrative.”
Life’s a book; write the next chapter yourself.
In fact, life is not a book. Writing the story of your life will not in itself tell you what to do when you are walking by the bar on the way home. It might tell you that you are strong enough to resist temptation, but it might tell you that you are so strong that you can go inside and not be carried out in a stupor.
It is generally a better idea to avoid the street and the bar where all your old friends are hanging out and to head straight to the AA meeting. There you will find moral support, fellowship and community. It beats stories.