Addiction is (not) a disease.
In a previous blog post, I shared the process of developing a lesson for a recovery group.
When developing a lesson, I am aware of the central conflict in all addiction programs. The conflict can be summarized in two equally true—but paradoxical—statements:
Addiction cannot be cured when judgment or confrontation are used.
Addiction cannot be cured unless an addict makes changes in their life.
Statement one is often associated with the medical model of addiction. What is the medical model of addiction? In short, that addiction is not a moral failing, but a chronic, relapsing disease. A friend of mine posted something on Facebook recently that was very much in line with the medical model. The post was long by social media standards. It detailed how difficult it is to break free from addiction because of the compulsive nature of the cravings. It received a lot of FaceBook applause and likes.
But, I felt conflicted. After working with literally hundreds of addicts and working my way out of a significant drinking and anxiety problem, I agree and disagree with the post. On the one hand, I get it. Shame and confrontation don’t fix addiction. And there are certainly medical consequences of addiction that need medical treatment.
At the same time, there is a role for personal responsibility and choice-making. After all, no one has gotten sober solely through the efforts of a doctor.
An addict has to take action in order to fix their addiction. They need to separate from every person, place, and thing that could lead them back to using drugs and alcohol. They need to find new friends, new activities and learn new coping mechanisms. No doctor or caseworker can do this for the patient.
If addiction is a disease, it is more like type II diabetes than, say, a congenital heart defect. By that, I mean that generally speaking patient behavior leads to the development of both type II diabetes and addiction. And treatment for both “diseases” requires that the “patient” make new lifestyle choices. A child born with a disease like a faulty heart valve doesn’t make lifestyle choices. In fact, the child does very little to contribute to the treatment of the disease. The child is probably completely immobile—anesthetized upon an operating table—during the most curative portion of the treatment: surgery. Not so for addiction. The addict often takes accountability and does “work” to get better.
This is the paradox surrounding addiction. Blame, shame, and confrontation are not only unhelpful, they make situations worse. Yet, recovery is impossible without changes in lifestyle choices. Thus addiction appears to compromise free will and blame is unhelpful. At the same time, accountability and personal responsibility are essential for recovery.
I am reminded of these two statements.
“and this [salvation] not from yourselves; it is the gift of God, not by works, so that no one can boast.”
“faith without works is dead”
Anyone who wants to work in this field should be ready to live with mystery and cultivate a sort of comfort with confusion because addiction is hard to define.
Because addiction is hard to define, it is hard to determine when to provide compassion or when to demand accountability. Both play a role in recovery.
The proper resolution to the problem of addiction is outside the grasp of the human mind. Looked at honestly, addiction inspires fear and trembling.
