A Christian View: Is addiction a moral failure?
Introduction: a secular person’s response to his brother’s death by overdose.
When a good friend of mine lost his older brother to an opioid overdose, he confessed to me that he sensed in himself a note of anger amid the concert of grief and sadness.
Where did the anger come from?
He felt robbed of an older brother. He was upset about the series of choices the brother had made—including choices not to get sober and not to take suboxone or methadone. (Both of these medications help remove the physical symptoms of opioid withdrawal and help prevent death by overdose, even when a person relapses while taking the medications).
My friend is not a fundamentalist. Not even a moralist, really. He was raised by hippies and only tangentially identifies with his Jewish heritage. He also oversees a very science-y department at a drug treatment program. So he is not someone you would expect to hold regressive views about addiction. Surely, he, of all people, would be beyond the kind of antique beliefs that would hold a person responsible for their behavior while addicted!
Yet, the anger at the older brother was real—and, I think, understandable.
Why is the moral failure model of addiction out of fashion?
Among the educated, rejection of the moral failure model of addiction has become a universal cultural certainty on par with the rejection of bloodletting as a medical treatment. A JSTOR article by Livia Gershon gives a brief and excellent overview of the shift away from the moral failure model.
This quote from Canadian Physician and trauma guru, Gabor Mate’ captures the tone with which most professionals reject the moral failure model of addiction.
Addiction is not a choice that anybody makes. It’s not a moral failure. It’s not an ethical lapse. It’s not a weakness of character. It is not a failure of will—which is how our society depicts addiction. — Dr. Gabor Mate’
Like many today, Gabor Mate’ advocates for a more lenient drug policy because he rejects the moral failure model.
But what do addicts themselves think about addiction and morality?
When I ask addicts about their experiences, they hold themselves at least partially responsible for their addiction—and for the wrong things they did during their addiction. These are things I hear weekly from people in recovery.
I was a liar
I stole
I was selfish
I knew what I was doing was wrong
I idolized a certain crowd—I wanted to fit in with them
I wasted time. I should have gotten sober a long time ago
Is there any value in rejecting the moral failure model?
I agree with those who oppose the moral failure model of addiction on two points.
One, moral failure is not a complete description of addiction. It would take something with the scope of a Russian novel to describe addiction in all its facets. So, defining addiction as a moral failure is at the very least an oversimplification that leaves out too much.
Two, society injures addicts by heaping shame on them. It’s no one’s right or obligation to shame another person for their moral failure. [“Get the log out of your own eye,” said a wise first-century rabbi]. And drunk-shaming will backfire, causing people to reject the very help that might save them.
Keeping in mind the two caveats above, I’d like to provide 6 reasons the moral failure model is worth keeping around.
6 reasons the moral failing model of addiction is worth holding on to.
The moral failure model maintains human dignity.
We don’t improve a person’s dignity by saying they have a disease and can’t be held accountable for their actions. Instead, such a stance implies that a person has become a drug-seeking zombie—a shell of a human that only acts instinctually. We offer far more dignity to a person by holding them accountable for their actions and by believing in their ability to change.
The moral failure model validates the feelings of many addicts.
Addicts can feel tremendous shame, embarrassment, and guilt about themselves. Rather than brush those sensations under the rug of “the disease model,” we can help addicts face the consequences of their addiction and find forgiveness, peace, and a spiritual unburdening.
Neurobiological and sociological explanations haven’t resulted in definitive treatments.
In the US, we’ve eradicated malaria, smallpox, and polio in the U.S. We haven’t even made a dent in addiction. Even with medications to manage the symptoms of withdrawal, relapse remains as common as ever. I recently watched helplessly as a friend who was taking Naltrexone ran away from his treatment center, became homeless, and almost died of alcohol-induced pancreatitis. I wish it was an isolated story.
And while sociological solutions are worth pursuing, no approach can override the basic fact contained in the old saying, “you can lead a horse to water, but you can’t make him drink.” In the case of addiction, you can literally jail the horse, fire it, take away its children, offer it incentives and various educational programs, or threaten it with divorce, but you can’t make it quit drinking.
Taking responsibility for one’s moral failures can ignite growth.
If we really care about addicts, we will want to see them put addiction aside and begin to flourish. This cannot happen as long as we explain away a person’s behavior as symptoms of a disease. It is only when a person faces the consequences of their behavior that they can begin to grow. One woman I know credits a devastatingly honest conversation with her ex-husband for helping her seek treatment. The words stung but they were a call to responsibility and they helped her get sober. There is solid truth in this verse: “Wounds from a friend can be trusted, but an enemy multiplies kisses.” Proverbs27:6
When we reject the moral failure model, we do a disservice to the addict’s loved ones.
This is especially true in the case of children who are ignored, neglected, abandoned, or abused by an addicted parent. These children are often hurt, angry, or confused. It is inhumane to ask that child to dismiss their parent’s failures as a disease. Rather, parents should seek to make amends, not convince children that “a disease made me do it”.
Nearly all forms of treatment and recovery eventually ask addicts for accountability.
I don’t know of a single form of valid treatment that doesn’t require the “patient” to make choices and decisions. Whereas bypass heart surgery is performed ON a patient. Treatments for addiction always involve patient behavior change efforts. Thus, every available treatment asks the addict to take moral actions and avoid immoral ones.
Motivational Interviewing asks addicts to consider the pros and cons of using in order to spark a decision to change. This approach assumes that individuals are capable of making decisions, and thus, are accountable for their actions to some degree.
12-step programs ask addicts to consider character flaws and recommend that addicts make amends whenever possible.
CBT treatments require that addicts make a decision to change their thinking, avoid triggers, and not give in to cravings.
Relapse prevention programs counsel addicts to change their surroundings, keep busy, and develop coping skills to avoid emotional triggers to drink and use drugs.
Contingency management programs implicitly accept that addicts make choices, which can be influenced by small rewards and consequences. The rewards and consequences are so small, in fact, that it becomes clear the addict is making healthy choices rather than being enticed by huge incentives.
Medication-assisted treatments (MATs) are the programs with the strongest affiliation with the disease model of addiction. Yet even these programs require that clients be responsible for participating in their own care by attending appointments and collaborating with the treatment team to discuss tapering off.
My experience with accepting my moral failings
As I consider the lives of people I know, I have to admit that morality plays a role in addiction and recovery. In my own case, the process of getting very honest about my moral failing was an integral part of my recovery. Getting honest is a process that I cherish. It was empowering to take responsibility. It helped me feel human again.
But most importantly, getting honest about my moral failing improved my relationship with God. There is nothing quite like the experience of telling the Creator of the Universe your worst and most embarrassing moments. But, what happened after being honest is what truly cemented our bond.
After getting honest, I began to believe that I was forgiven. It was difficult to believe, at first. But, over time the message of the gospel was imprinted on my heart. My faith and confidence in God’s love and mercy were strengthened.
The experience of confession and forgiveness became a spiritual engine driving changes in my attitude and habits. I became less anxious, less resentful, and more compassionate to others.
Conclusion
As I think about my friend’s anger over the loss of his brother to an opioid overdose, I can’t help but think that scientists and addiction experts may want to reconsider the moral failure model of addiction. For decades they have trumpeted the disease model and sniggered contemptuously at the moral failure model. In doing so they have ignored the voices and beliefs of addicts and their loved ones. Instead of listening without judgment, they have selectively listened to and distorted the stories they have heard.
They’ve operated under the belief that judgment and morality are always offensive—and that compassion and grace are the only keys on the piano that are worth playing.
Perhaps it is time they admit that the disease model is incomplete—that science itself lacks the descriptive power to name and organize the experience of addiction.
Perhaps, the clients and research subjects were right all along. Only something as ancient and powerful as religion can take on an opponent like Addiction.
To be fair, Jesus refers to sin as a disease and himself as a doctor. So, the medical model is on to something when it describes addiction as a disease. But, Jesus offers a more complex and nuanced vocabulary. Although he uses the metaphor of a disease, it is not the only metaphor he uses.
The complexity and accuracy of the metaphor matter because the metaphor directs attention towards solutions that fit within the metaphor. Whereas medicine and treatment are the only tools for recovery in the metaphor of disease, Jesus offers a stunningly complex and thematically rich pathway to restoration.
Biblical metaphors of idolatry, lost sheep, bondage, captivity, and slavery to sin offer a helpful array of ways to describe and make sense of addiction.
Check out the song below for an emotional example of the complexity of Christianity. The song begins with a description of sin and shame yet those feelings are soon transformed into gratitude and joy.
