April 11, 2022

Addiction is (Most Likely) Not a Disease.


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Nothing I write creates more of a sh*t show than when I write about 12-step recovery.

Every time I bring up something about it that gets under my skin, I get a few people, mad as wet hens, reminding me that not only do they disagree with my opinion, but they’re also pretty sure I’m putting lives at risk by having this opinion.

Some have even come right out and predicted that these articles could be responsible for people dying.

I am fairly certain, unless you are well-versed in the subculture of “fill in the blank” Anonymous, you think I am exaggerating—but this is the literal truth. The theory is that all published accounts of 12-step recovery need to be strictly effusive and positive because an alcoholic or addict may read my less than complimentary article and decide not to attend a meeting. And subsequently die.

According to a lot of the fellowship, I may as well have pushed them into an electric fence.

The more I read and the more I reflect on my own history, the more I believe that calling addiction a “disease” is tantamount to trying to push a square peg in a round hole.

As a matter of fact, I’m mad as hell that I was convinced of this theory and went around telling anyone who would listen that I was afflicted with this “disease.” For 11 years, addiction was my identity. Ironic, because those were the same 11 years I didn’t put so much as NYQUIL in my body.

The first thing “fellow shippers” do when they hear someone assert that addiction is not really a disease is to state that the DSM-5 says it is. The DSM-5 is the diagnostic and statistical manual for mental health—fifth edition. Unfortunately, the DSM-5 has become an all-inclusive label maker for every human experience that exists. Children who throw temper tantrums are not just being a pain in the ass. They are suffering from Disruptive Mood Dysregulation Disorder.

I suppose that having a child with Disruptive Mood Dysregulation Disorder isn’t any worse than having a child with Disinhibited Social Engagement Disorder. The symptoms of DSED, of course, are chattiness and excitement around strangers. Back when people didn’t know any better, they used to refer to this as “precocious.”

Anyway, you might see where I am going with all of this. The DSM-5 means nothing to me because its primary purpose is to take normal human idiosyncrasies and pathologize them. It goes so far as to give people two months to grieve after the death of a loved one. Shed a tear on day 61 and—I hate to break it to you—but you are probably afflicted with Major Depressive Disorder.

Dad jokes aside, now that we have exposed the DSM-5 for what it is, let’s put this thing in perspective. The medical community’s heart was in the right place when it began to trumpet the disease model of addiction. The thought was to get society to stop stigmatizing the addict and accept the fact that their plight is not a moral failing but an ailment; furthermore, the addict will be more likely to seek medical intervention for a “medical problem.” Less altruistic reasons have to do with the ease with which funding can be obtained by the federal government. They have always been more apt to throw money at research for medical problems, as opposed to, say social or psychological issues.

But like many great bureaucratic ideas, this did not work. For the most part, the average person still sees addiction as a moral failing, law enforcement is still focused primarily on punitive measures, and the “recovery industry” in the United States—despite being a $42 billion a year business—isn’t doing too much to help anyone besides the opportunistic entrepreneurs who’ve managed to get their share of the loot. Overdose deaths have increased exponentially over the past few years.

One of the biggest issues I see with the disease model of addiction is that it perpetuates the myth that a person cannot change. Like cancer, the best case is a precarious remission. At any time, you can be overtaken by this malady and all the progress you’ve made from the decades of abstinence is gone.

As a matter of fact, one could make a point that A.A. doesn’t see long periods of abstinence as “progress” at all. It’s merely a reprieve, and even after 20 years, “your disease is out in the parking lot doing push-ups,” meaning addiction is a demon that gets stronger by the hour just waiting for you to slip up and let it back in the door. A steady diet of fear and PTSD is really the best course of action.

If PTSD sounds like an exaggeration, take a moment and think about it. PTSD, for the most part, is a debilitating condition, but it is also the body’s way of protecting itself from future trauma. One might develop it after an assault, for example, and forever be changed and on guard for a second attack. It’s also a static state, which is why it’s so unhealthy. Executive functions are no longer spontaneous, they are fixed to be on the defensive at all times. This is not a great option for many people.

I have spent years hearing these statements being thrown around ad nauseum:

>> Man, my disease is kicking my ass today.
>> My disease wants me dead.
>> My disease talks to me with my own voice.

When we remove the part about addiction being a disease, we can then open the door to the possibility that it is life that kicks our ass every day, personal responsibility always stands between us and the possibility of death, and we are the only ones talking to ourselves in our own voice.

I get the temptation to get sucked into these beliefs. Who doesn’t appreciate a little magic every so often? However, one should not choose magic to govern their decisions. There is unheard of value in the freedom of choice. In fact, people have died trying to protect that right.


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