One More Time: Why Substance Abuse is Not a Disease

Recently, I wrote an article saying that alcoholism and substance abuse are not diseases, but problem behaviors. A disease, I wrote, is something that — regardless of the cause — progresses inside your body, and that only passive submission to medical intervention can stop. A problem behavior, on the other hand, is something that — with or without outside help — will only stop once you commit to stopping.

As usual, this simple, almost obvious idea hit a few nerves. Here’s what one reader wrote:

I find it disturbing that your opinion of addiction is put forth so aggressively when it is in fact so uninformed and narrow minded. Your argument is based on what “a number of emails affirmed” that addicts “buy into political correctness” and they are “waiting for a promised fix that will never happen”? Where are your sources for this profound knowledge you are sharing here? Who do you know that promised a FIX, you? Believe me, they better than anyone know there is no FIX! The idea that addicts “use” the medical, or rather physical component of their disease as an “excuse” to continue abusing is ludicrous.

I never wrote that there’s a “fix.” On the contrary, my article states that the only fix is you, the substance-abusing person, not some external agent. Even when a person goes to AA or NA every single day of the week, that’s only an hour or two out of every day. The person with the problem is still with himself or herself 24/7. I also did not write that all addicts use the medical model of addiction as an excuse. Many therapists or doctors do, but that’s because of their beliefs or ideology, and has nothing whatsoever to do with facts, reason or science.

In fact, I find that the vast majority of addicts do not like this model. This reader describes herself as a psychotherapist (yikes!) with multiple degrees in social work. She offers these degrees as evidence to counter the logic and facts I describe. None of her claims can alter the fact that nobody is putting the substance into the addict’s body but the addict himself. If this is not a choice, then it must be something or somebody else placing the substance into the mouth or the arm or wherever the substance is going.

The reader calls it “narrow minded” to place the addict in charge of his or her own recovery. I call it narrow minded to label alcoholism or addiction a disease. In fact, it’s cruel, as well as inaccurate. When you’re the one standing in your own way, and you finally admit that you’re doing the damage to yourself, then you don’t have to look at yourself as a victim. Once you stop looking at yourself as a victim of your behaviors and ideas, then the world becomes your oyster. When you’re a victim of yourself, and nobody else, there are steps you can take and a whole new attitude you can develop. No, it’s not easy. But anyone who has stopped drinking or drugging has, in fact, been the one to attain (and maintain) any sobriety. Yes, I’m placing the blame for the problem on the person who engages in the self-defeating or self-destructive behavior; but by the same logic, I place the credit on those who save themselves. “You have to do it, and you can do it,” is not a message of narrow mindedness. “Let someone else take care of you,” as the disease model implies, is narrow minded, inhibiting and frankly wrong.

In fact for many in recovery that knowledge of the disease aspect of addiction is where they begin to understand the why of it all. (The disease centers in the brain. The alcoholics brain does not process alcohol the way an average drinker! s does.)

There’s no proof that brain chemistry forces anyone to put anything into one’s body that is excessive or harmful. It’s ludicrous to assert or assume this. The brain sends us signals, and it’s probably true that the brains of some people process alcohol differently from the brains of other people. But the brain cannot force you to drink or use drugs. Where is the proof that it does so? In fact, if this were true, nobody would be able to stop drinking or using drugs, as millions of substance abusers have. The people who stop do so without any pill or external medical intervention. How do you explain that?

How can a disease be cured, or go into total remission, without any medical intervention? Therapy, AA/NA, rehab programs consisting of group therapy — these have helped many, but they are not medical interventions. And many stop drinking or using drugs without any of these non-medical interventions.

Thus they [addicts] can begin a path to recovery. If a person with diabetes does not change their “chosen” lifestyle, against the Doctor’s orders and continue to self-destruct, by drinking, over eating, eating sugar and sweets, not exercising, suffering beyond what medical intervention can accomplish are they no longer medically ill?

Well of course you’re still medically ill if the alcohol or substance abuse has created medical problems. If you’re fortunate, when you stop using drugs or alcohol, the medical problems will go away; sadly, some have paid the price of continuing illness or death even after they stop drinking, using drugs or doing things like smoking or overeating. This therapist lumps together two things — substance abuse and medical problems created by substance abuse — and uses the medical problems caused by substance abuse as proof that substance abuse is, in fact, a medical disease.

It is the same thing my man. I could go on and preferably have a lengthy conversation with you about this subject. But the most important part of what you have put forth in print is not only pure narrow minded opinion but more importantly detrimental to those in the community (which you serve?) looking to understand their addiction and find a way to achieve their recovery that they desperately want.

Do addicts desperately want to be told that they are the victim of diseases over which they have no control other than passive submission to medical intervention? I don’t find that to be the case. And I have talked with thousands over a period of twenty-five years. I receive notes or letters from thousands more. While it’s probably natural to wish that someone could wave a magic wand, or give you a pill, or even provide surgery, to force you to stop wanting a substance, it does not follow that any such pill, surgery or magic wand exists.

Actually, the people who are serious about quitting, in my experience, neither want nor expect someone or something to do it for them. They might want someone to coach or guide them through it, but they understand that it’s up to them to make and keep a commitment not just to stop substances, but to live a self-interested, rational and purposeful life.

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