02 Jul No One Chooses to Become an Addict
Just how does the general public understand addiction? The disease model—the understanding that addiction is a medical condition not unlike diabetes or heart disease—has been around for decades. The competing theory—that addiction is a choice or a “bad behavior”—flies in the face of medical research. The idea that addiction is somehow a moral failing, a result of laziness, or just plain evil has been disproved thoroughly enough that you’d think this notion would have died a natural death long ago. Yet it lives on. Why won’t this idea go away?
The Disease Model – What It Is and What It Isn’t
To call addiction a disease requires some explanation. Taking that first drink or smoking marijuana for the first time is clearly a choice. Developing an addiction (and hence “catching” this disease) is thus linked with choices or behaviors. Teasing apart the choice from the disease seems a little tricky at first glance.
Let’s start with a basic assumption: no one wants this disease. Addiction is never a choice, in that no one ever thinks or believes that their first drink or drug will lead to addiction. Every addict or alcoholic thought “it won’t happen to me – I’ll be careful, I’ll be smart about it, I’ll stop before that happens.” Addiction is never a choice, a lifestyle, a decision or an “option.”
Addiction does not always involve physical dependence upon the drug, but when it does, there is no question about choices, laziness, or other reasons someone is drinking or using drugs: he or she is doing so because stopping is physically painful or sometimes even dangerous. Alcohol, certain pills (bezodiazepines), and opiates can be so difficult or painful to stop using that detoxification from these substances is considered a medical emergency.
The disease model doesn’t take away responsibility, but it should reduce blame. Consider how many people, as teens, try their first drink or drug. Within any large group of friends, many will try drinking (for example) during high school, and perhaps drink too many beers at parties a few times. Many of those teens will go on to drink responsibly as adults and never develop alcoholism. Some will develop the disease. Why it happens to some and not others should help ease blame: most likely those who developed the disease had a host of risk factors—genetic, familial, psychological and/or emotional. They were no more lazy or wicked than the other teens—just unlucky. The fact that some “got away” with experimentation and some developed the disease of addiction is a matter of risk factors and luck—not personal fortitude or morals.
But What About Responsibility?
Here is where things get interesting. Have you ever had a friend or relative who has diabetes, but doesn’t follow their doctor’s advice? Perhaps they don’t yet have to use insulin, and are expected to “control” their disease with diet. Do they always follow the diet closely? Or do they “cheat” from time to time? What about a family member with heart disease who has been told to exercise regularly and lose weight? Does your loved one comply with those orders? Let’s take this one step further into a truly difficult realm: what if a loved one, through being the victim of a crime, ends up with a sexually transmitted disease? Having a disease, no matter how you “caught” it, is a difficult, unpleasant, and now potentially life threatening problem to manage. Getting treatment and stepping up to the task of managing it is a heavy but necessary responsibility.
Because of what the disease of addiction does to the people who are connected to the addict or alcoholic, it is natural to feel strong emotions about calling addiction a disease. Family members experience tremendous collateral damage from addiction—financial, emotional, social, sometimes-physical damage that can lead to strong feelings of anger, resentment, hurt, and betrayal. Often the addict or alcoholic is terribly angry about having this disease as well. It may feel deeply unfair and confusing when looking back over his or her drinking history and seeing that “everyone else” could keep drinking safely but his or her own drinking escalated to becoming a problem.
All this anger fuels a sense of wanting to see addicts “pay” or be punished for all the harm they have caused. In society, we see this in harsh and punitive laws against drug possession or trafficking, and politicians who often want to appear “tough” in the face of crime.
But one critical difference that separates addiction from all the other diseases mentioned above is the impact addiction has upon the brain. Addiction impairs judgment while under the influence of the substance, but also changes thinking and emotional centers in the brain when the person is not high or drunk. One of these impacts is the reliance upon denial as a defense mechanism. Now tie that in with notions of responsibility and you can see how insidious and challenging this disease really is: a key symptom of the disease is the belief you don’t have it. It takes time and a lot of evidence in the form of harm, negative consequences, and loss before many addicts will be able to admit that addiction is what is happening. And if you can’t admit it, you can’t take responsibility for it. In this way, addicts infuriate and confound their families and communities, and feed the incorrect notions about morals and choices.
The Bottom Line?
Addiction is a disease, one that impacts your body, your mind, your family, and your entire community. Getting help means helping yourself and everyone around you. You don’t have to buy this explanation lock, stock, and barrel in order to start addressing your addiction. Just try to keep an open mind and learn as you go.
Find relief in recovery. Life gets better with addiction treatment.
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