Is Addiction really a disease?
If not what is it, and how do you recover?
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There are so many different opinions about how to treat addiction, while some of them have a qualitative & quantitative research backing, the truth can only be, arguing about the process of treatment for addiction, takes us away from the purpose of it, love, connection, recovery and freedom from the chains of active addiction. This article aims to dispel the myths, provide some thought provoking points about how the human mind really works, and what is beyond our psychology – for everyone regardless of mental health diagnosis.
On writing this article I came across a quote by Thomas R Insel MD who is an American neuroscientist and psychiatrist who led the National Institute of Mental Health from 2002 until November 2015. Prior to becoming Director of NIMH, he was the founding Director of the Center for Behavioural Neuroscience at Emory University in Atlanta, Georgia.
“We are so embedded in this structure. We have spent so much time diagnosing mental disorders that we actually believe they are real. But there’s no reality. These are just constructs. There’s no reality to schizophrenia or depression. We might have to stop using terms like depression and schizophrenia, because they are getting in our way, confusing things.”
Mental health professionals “at the top” agree that diagnosis and terms used are no longer fit for purpose, because they are not eradicating or finding a scalable solution to mental illness.
What is also becoming more widely accepted is the idea that our reality is entirely subjective. Mental illness cannot be diagnosed through a set of character traits out of the DSM manual because there is only ever a subjective diagnosis of the symptoms presented. Often with no understanding that mental well-being is way beyond symptomatic behaviour and thought processes.
I recently interviewed Dr William Pettit MD – a Psychiatrist with almost 50 years of experience working in the mental health field, specifically with addictions for many of those. Twice Board certified by the American Society of Addiction Medicine as well as teaching at the University of West Virginia Dr Pettit highlights the difference between the mind, and the brain and how we innocently try to cope with chronic mental stress by medicating our emotions to escape our experience of life when we struggle, and why abstinence always looks like a good idea, while we are using substances or processes to feel better. Dr Pettit looks towards mental well-being as the solution to mental illness.
To be clear, the model of disease is a concept, if you cut someone open struggling with addiction, you wouldn’t find any disease to remove. It’s a diagnosis of a set of symptoms whether medical diagnosis or self-diagnosis, it’s often unexplainable by doctors or the person suffering when you dig deeper into the phenomena of being unable to stop destructive processes or substance dependence, even when they are causing complete chaos in someone’s life.
The American Society of Addiction Medicine gives the following short definition of addiction “Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviours.”
13:08 – Into the interview I discuss the idea of disease “I think there were two motivations to make it a disease”
- To stop having people being seen as morally bad people
- To try to get some insurance coverage in the United States where you have to have a disease to get treatment
It appears to have originally started as a way to try to offset the shame of the misunderstanding and help people not to be so judged in society. Also like most other things in modern day medicine where there is potential of big pharma and money-making opportunity for treatment, it became about money. I am not suggesting either of these were a bad thing, the fact that it became possible to get treatment on insurance, probably saved 1000s of lives.
The DSM V states “that an individual who continues using a substance despite significant substance related problems”
18:25 – into the interview Dr Pettit claims “Until a new person finds a new way to deal with life, they’re going to do what gives them the best – relief, even though it has adverse side effects”
19:23 – What happens in the chronic state of mental stress, if you hook people up to PET scanners or MRI’s that measure the physiology in the brain, and you take volunteers, people who have not been abused or have a history of trauma or been in combat, then ask them for 3 minutes to think upsetting thoughts – about something that happened in their life – every one of them created a measurable biochemical dysregulation in their brain circuitry.
The above sheds light on ASAM’s short definition about brain circuitry, and makes sense that if you were in a chronic state of mental stress, which most people suffering with addiction are, why it would seem obvious to use substances, and way beyond any rational understanding of not wanting to but not being able to stop, and despite any consequences.
Bill Wilson the founder of Alcoholics Anonymous explained why AA had refrained from using the term ‘disease’ as he addressed the annual meeting of the National Catholic Clergy Conference on Alcoholism in 1961
“We have never called alcoholism a disease because, technically speaking, it is not a disease entity. For example, there is no such thing as heart disease. Instead there are many separate heart ailments, or combinations of them. It is something like that with alcoholism. Therefore, we did not wish to get in wrong with the medical profession by pronouncing alcoholism a disease entity. Therefore, we always called it an illness, or a malady — a far safer term for us to use.”
Bill W was a normal man who struggled with a lifetime of alcohol abuse, who one day had a spiritual enlightenment experience and never drank again. He was in no way qualified give understanding to alcoholism, but did his best to pass on his life changing experience through the literature of AA and the 12 steps, as a process to enlightenment. Although spiritual awakening is not effectively a process, its experiential and can happen in a moment. He did the best he could with the understanding he had to point people to the spiritual nature of life, and a great job he did of that too, as many people around the world have stopped drinking, changed their lives.
You can find a great paper on the growth and understanding of the disease concept in AA by Ernest Kurtz, Ph.D here.
In 1953 Jimmy Kinnon founded Narcotics Anonymous, in searching back even the very first NA literature from 1956 mentions the disease of addiction.
“We suffer from a disease, just like alcoholism, diabetes, tuberculosis, heart trouble or cancer. There is no known cure for these diseases and neither is there for drug addiction. But by following a pattern derived from Alcoholics Anonymous and its teachings, we have become arrested cases.”
The programme of NA follows strongly the belief that there is a disease, that is fatal and incurable, unless you follow the 12-step programme of NA, in which case it can be arrested, and recovery is then possible. It seems both fellowships have somewhat opposing views on the concept of disease as it related to addiction / alcoholism.
So, what happened…
With significant organisational backing from the likes of The World Health Organisation, American Society for Addiction Medicine, National Institute for Mental Health and many more around the world, coupled with the growing numbers of 12-step groups appearing around the world – all repeating the same ‘truth’ – it is this which has helped to cement this ‘concept’ into ‘fact’.
Conditioning has also played a part. People out there, attending groups, are too afraid to speak out to question whether or not addiction is a disease. Over time, the idea of it being ‘fact’ grew, as like many urban myths and legends have. I am in no way trying to take away or undermine the value of this belief; it has saved millions of lives within the 12-step recovery world.
While everyone has been preoccupied with the politics of it all, sitting in offices debating and discussing, people have been dying on the front lines of addiction treatment world. More often than not, it has become more about money and medication (big pharma) than actually trying to help the people suffering.
Below we take a deeper dive into psychology, covering some of the below points: Click on any of the icons below to learn more.
Is it useful to look to the past for answers?
The Brain (Hardware) Vs The Mind (Firmware)
Why do people state behavioural change as useful but hard?
Tools and Techniques vs Understanding how the mind works
Are we really powerless over alcohol / drugs?
Is abstinence a goal for recovery from addiction
What is meant by spiritual awakening?
Is the opposite to addiction really connection?
What does it mean to be at peace?
The disease concept, and its various prescriptive solutions suggest that there are answers in the past to creating a more fulfilling present and future.
58:40 – The answer is not in the past – the answer is in the present in learning how to live in a peaceful state now, it’s not about analysis of the past, it’s about gaining a new understanding to go forward.
Every moment of my life, I have a second chance…
In basic terms, it’s like walking down the street looking behind you, you are bound to run into something, whereas if you are looking forward with a clear mind, more likely that you will be able to manoeuvre the obstacles that life presents to you.
In The 12 Steps, it suggests taking inventory of the past and ‘righting’ our wrongs allows us to move forward with less shame and guilt about how we behaved during our addiction, with no need to hold onto shame about our past behaviours.
In psychotherapy training, we learn how historical relationships impact our present day, we delve into the creation of our experience through the lens of learned psychology, our coping mechanisms, through the theory of one of many brilliant thinkers from the past, whether its Carl Rogers, Eric Berne, Sigmund Freud or Carl Jung we apply a whole load of theory to people’s present-day manifestation of struggles.
While there is definitely a strong emphasis on “the relationship” being the most important part of any modality of working, what is often overlooked is that, all these iterations of psychotherapy are made up, they are someone’s opinion, they are not fact. There is no parent, adult, child, no ID or Super Ego, the ego isn’t a thing, it’s a manifestation of thought, a made-up concept.
These are all useful concepts, the 12 steps have saved millions of lives, although there is something more to see, way beyond our presenting behaviours, that is factually true for all human beings, that is scientific and underpins all of psychology.
Our understanding of the human mind is evolving, even if you look back at William James writing back in the 1890’s it looks like the past 100 years we have often took a detour away from where he was pointing back then in understanding mental illness. We have delved into problems, diagnosis and labels, rather than looking towards the innate health of all human beings. We have turned labels and diagnosis into a thing, and mental illnesses are growing by the week. We are caught up in analysis, forgetting it has no relevance to the present or future.
As stated by Thomas Insel at the start of this article there is no reality. What he is pointing to, is that every single person has their own subjective thought created experience of being alive, from the moment they are born till they die.
Living in the now is the only experience of true contentment and peace of mind, as suggested by Dr Pettit, finding a new way to move forward, and experience life, allows us to live at a different level of consciousness, where using drugs or processes to medicate our emotional state no longer looks like a good idea.
22:23 – Dr Pettit – first of all we have neuroplasticity, which is showing now that if people do get back to a peaceful state of mind, that there is an incredible amount of restructuring that can happen in the brain, that 25 years ago we didn’t think was possible.
He goes on to explain the difference between the mind and the brain, and that peace of mind is spiritual and formless, it’s like the firmware, the brain is only a computer, the information that is in there is what’s installed, and even with someone who’s brain is not in perfect condition, they can still have peace of mind, the firmware is always intact.
“Dr George Pransky said “the mind” in the field of psychology, was often seen as synonymous with the brain, limited to the brain’s analytical and memory bank capabilities. Sydney Banks contributed to the field of psychology by stating that mind is spiritual in nature rather than biological and that mind is the source of all life and the fundamental intelligence behind all life.”
Although people can be permanently affected by their substance abuse, they can still experience peace of mind and live a life full of contentment. In the field of psychology, where most use a diagnosis that fits with ‘brain disease’, this doesn’t consider the mind and brain being two completely different things.
In most treatment programmes and modalities of change for addiction there is a requirement to change behaviour in order to help perpetuate the experience of psychological change.
32:35 – I asked about the statement – “Substance use disorder, like the treatment of all chronic disease, involves behavioural change, and behavioural change is hard.”
34:15 – Dr Pettit says “Behaviour is the last step” Using the metaphor of a train, it’s like trying to make the carriages go in a different direction to the engine, it’s never going to happen.
Trying to change your behaviour by trying to change your behaviour is hard, that’s correct, because behaviour is the result of your current state of mind.
Everyone is doing the best they can, given the thinking they have that looks real to them. So, living in a different feeling state is the solution to behavioural change.
When we are struggling with addiction we are always living in a distressed feeling state, and then trying to find oblivion or escape from that feeling state, after time, taking drugs becomes the way to feel normal rather than get high, the highs just stop happening.
34:59 – With whatever thoughts we are giving attention to, there’s also a physiological effect, so we often feel it in our body, we feel a tension in our stomach, in our head.
21:55 – Research will show very clearly, that the primary problem, has been the chronic state of mental stress, that has created the internal experience of dis-ease that the people have responded to by using a substance.
There is a common misunderstanding that experience is created by other people and events from the outside in, but it just doesn’t work this way.
The realisation and SEEING of how experience is created is the key to freedom from medicating your emotional state. It is the key to living in the now and experiencing the peace of mind and freedom that helps free us from the diagnosis or belief that there is a disease.
43:43 – What’s the difference between giving people tools and techniques vs arming them with the understanding that they have all the answers.
There is a huge emphasis, and whole industry built around psychological process change, there are modalities of change that are based on optimising the behaviour or thinking of a person in order to change their experience of life.
In 12 Step meetings people often suggest to bring your body and your mind will follow, in CBT people become more aware of their negative thought patterns, and it becomes a thought management process, yes they are looking in the right direction, that thought creates experience, but it’s still a strategy for managing our experience.
44:40 – Dr Pettit says – In science even if a paradigm is failing, it will not be replaced until its successor answers the questions that it could not answer. Even if its failing, it will stay there until it has an adequate replacement.
Managing something implies that it can go into chaos at any time, it’s a balancing act, like spinning plates, you keep them spinning they don’t fall over. So, while someone is struggling with their state of mind, the creation of their emotional experience, tools and techniques may give some respite, but there’s always going to be something to manage that could fall over at any point.
Giving someone tools and techniques to manage their experience is the difference between teaching someone to fish vs giving them a fish. Once you teach them how to fish, you no longer have to keep feeding them.
When people understand how the mind works, that experience is created from within, they no longer need to keep repeating a pattern of behaviour in order to be ok. There is a realisation that they are innately ok, and are just creating the illusion that something is wrong that needs fixing. They get to live in a new feeling state.
Apparently, Einstein Said: The answers to problems will never be found, at the same level of thinking that they were created.
47:38 – I am seeing a trend emerging, while people have got uncomfortable feelings, or a difficult state of mind, they are going to want to medicate it regardless. Unless they really understand the nature of experience, where it comes from, they are going to continue to use drugs, alcohol, food, gambling, sex or tools and techniques to manage their state.
Using tools and techniques is always going to be a management of symptoms, not dealing with the underlying misunderstanding, and therefore while it has its merits and benefits, is not a long-term solution to free people from suffering.
The first step in Narcotics Anonymous states “We admitted that we were powerless” not only over drugs, but over our addiction. It suggests we need to admit this fact in order to recover, it is often a huge relief for people who are unable to stop. Looking at that differently, all it is really saying is what Einstein said above, I can’t recover from the problems I’ve created with the current level of knowledge, and that when I surrender, I am able to take on board new ideas. The grain of truth is, an open mind is paramount to recovery.
It suggests that there is nothing deeper than the addiction, that it is chronic, and permanent.
1:09:40 – What’s true is “at my level of understanding, I am powerless over my thinking”
Dr Pettit clears up that without new information, then it will always look like we are powerless, that when we start we can’t stop, because we are always using alcohol or drugs to supplement, avoid or improve our experience of life, and he also states that:
1:10:50 – Being out of control of the alcohol is secondary, it’s not primary alcohol is what gives me relief from the experience I have created.
What is clear is, there is a direct relationship between peoples feeling of well-being and their using of drugs and alcohol.
While the concept of powerlessness has been helpful to so many people, there is a level deeper, powerlessness is referencing the manifestation, the experience, as the cause of the problem, whereas in fact it is the result of the misunderstanding, it is the symptom.
While in a lower state of mind, using alcohol will always create a reaction, a relief of the physiological and mental state that we have created within.
Physiological components are also another reason why people, who struggle with addiction, they often report relief from their withdrawal symptoms after deciding to use. They say this long before having any substances in their body..
1:06:04 – I asked Is total abstinence a goal for recovery, does it mean pass or fail?
It has become apparent that, in some recovery circles, and many modalities of treatment, abstinence is the overall goal. So much so that many consider relapse to mean failure. While not likely to be intentional, when relapse is perceived to be a failure, it, unfortunately, creates fear and dogma around the subject matter.
It makes perfect sense to suggest abstinence, all treatment modalities aside, it just seems like a sensible thing to do, while alcohol or drugs look like the solution to improve your experience of life, just don’t use them.
The problem is, as discussed earlier in this article, behavioural change, without a change in state of mind is hard. If what you are inclined to do every time you have a difficult experience, is take a mood-altering substance, then eventually you will either use or suffer from being in a state of chronic mental stress. There has to be something beyond that.
1:06:44 – “To me the goal of recovery, is peace of mind”
When you break it down, it starts to become clear that abstinence cannot be the goal, a change in state of mind is the goal, which results in the ability to make more rational choices, abstinence is a result of a change in state of mind.
While it may just sound like technicalities, it is a completely different experience, when you live with an improved state of mind.
Low state of mind
High state of mind
I hate how they do that
I wonder why they do that
That person really has it in for me
Perhaps they see it differently to me
I need do fix this RIGHT NOW
I know this will work itself out
As people get a deeper level of peace, their need for the medication lessens, allowing them to live in a more peaceful state of mind, with no desire to use, no behavioural change is needed.
When you live in that peaceful state, you have clear access to make the right decision for you, whatever that may be.
1:06:05 – Dr Pettit – “To me the word spiritual just means it has no form, no matter”
Spiritual awakening means the awakening of the spirit within. To many people suffering with addiction, it looks like there is nothing beyond their own reality, what they experience on a day to day basis, the behaviours leading up to using, then the using, then the aftermath, living with addiction is very insular and isolated.
12 step fellowships suggest that ‘as a result of’ doing the steps, you have a spiritual awakening. You wake up, out of the world you are living in, into a new more peaceful subjective reality.
What we know is true is that human beings can suddenly change at any point, and as a result they have nicer relationships and a better quality of life, this is an effortless process, where they no longer need to medicate themselves to be ok, they already are ok.
Throughout time people have had spontaneous awakenings that have been life changing.
Bill Wilson of Alcoholics Anonymous Dec 1934
Suddenly the room lit up with a great white light. I was caught up into an ecstasy which there are no words to describe. It seemed to me, in my mind’s eye, that I was on a mountain and that a wind not of air but of spirit was blowing. And then it burst upon me that I was a free man. Slowly the ecstasy subsided. I lay on the bed, but now for a time I was in another world, a new world of consciousness. All about me and through me there was a wonderful feeling of Presence, and I thought to myself, ‘So this is the God of the preachers!’ A great peace stole over me and I thought, ‘No matter how wrong things seem to be, they are still all right. Things are all right with God and His world.’”
Sydney Banks 1973
I was in a conversation with a Psychologist who said to me “You know Syd, the other night you told me you were insecure, and I’ve never heard such nonsense in all my life” and I heard him, and what I heard was there is no such thing as insecurity, there is only thought, and it hit me like a tonne of bricks, that all my insecurity was only my own thoughts and it was like a bomb going off in my head.
Syd goes on to say
It was so enlightening it was unbelievable, and for 3 days and 3 nights I never slept, because there was such beauty coming into my life that I had never experience before.
On that night, there was a disidentification from this unpleasant dream of thinking and the painful emotions. The nightmare became unbearable and that triggered the separation of consciousness from its identification with form. I woke up and suddenly realized myself as the I Am and that was deeply peaceful.
We’re often trying to put words to the unexplainable, explain something that isn’t logical or common, that sounds a bit out there to some people. Regardless of the experience the outcome is life changing, life as they knew it had changed, and moving on from there things were very different, experiencing more peace, more joy and fulfilment in life.
There are many stories of enlightenment including more clarity of the events leading up to and after Bill Wilsons experience here
There is a famous Ted talk with nearly 14 Million views called “Everything you think you know about addiction is wrong” that talks about the opposite of addiction being connection, but still it talks about people suffering as ‘addicts’ as if it’s a permanent state of being that’s unchangeable and chronic. It is still obviously looking at what happens within the psychology, the variable, rather than what creates it, the constant.
People who are connected and present to life don’t often wake up one day in a good mood and say, “think I will go and use heroin today” but there is an awakening between stopping taking drugs, and getting connected.
What is missing is the process between addiction and connection. The reason addiction is a growing problem is because the steps between the 2 experiences of life, looks worlds apart, often impossible, and completely alien to anyone suffering, in the same way that addiction often makes no sense to someone who is connected to life, from a logical perspective it just looks crazy, addiction is anything but logical.
Bill Wilson could not have possibly known what was going to happen to him, nor if you had asked him the day or hour before it did, would he have been able to bring it on, it was not the result of prescriptive treatment for alcoholism.
Connection comes as a result of a spiritual awakening, when we wake up, we naturally are more in our lives and less in our thoughts. We become more present and involved in our current relationships and we build new relationships. We experience more joy, love, peace of mind and fulfilment in our daily lives.
Connection is our natural state when we are not caught up in our thinking about life.
Unfortunately for many, the process of being caught up in thinking, lasts a lifetime.
37:40 – What’s clear on working with alcoholics is that they are beautiful people who just want to find a place of peace
Peace is often mistaken as a circumstantial experience, i.e. when there is no noise or distraction, but what we are talking about here is a level of peace within where you can return ‘home’ at any time. You always know that things are ok on a deeply grounded level, regardless of your thoughts and emotions in the moment.
You see that your feelings of anxiety or insecurity about the world around you are not a measure of your mental health or well-being, that peace of mind comes from a place much deeper, beyond what you currently see if you are struggling.
Naturally as we float in and out of our thinking about life, we experience peace and insecurity at different times, in different places with different people, these are all natural, when your well-being is not attached to this, life is much more peaceful.
To be at peace means to have a different relationship with your experience of life, regardless of the surroundings. Realising the answers you are looking for are always within, and not in any concept.
When people have an insight into how experience is created, their lives change, they have a transformation, see something within, that was already there but they just didn’t realise.
It’s like to going from a caterpillar to a butterfly, we can go through stages of understanding, and as a result, the reality that we live in changes, but we never go back. This is very different to learning concepts.
When you transform, often nothing changes on the outside, but everything looks different, because the perspective you are looking at life with has evolved.
Transformation through insight is permanent, it does not need maintaining, it lasts a life time. Insight can come quickly or slowly, there is no time limit or judgement on how long it takes.
Is addiction really a disease? There is definitely a dis-ease to addiction, but it looks apparent that addiction is the symptom of a misunderstanding of how our reality is created
Regardless of the opinion of organisations, modalities of treatment, fellowships, concepts and ideas about how to treat people, the most important thing is the grounding of the helper, and love compassion, understanding for the person suffering.
We have become so caught up in the process of treatment, we have forgot the purpose of it
Looking towards the health of client rather than the struggles, helps them see that they are not their symptomology, they are innately healthy and can move along the path to recovery.
At UKAT we provide rehab treatment through the 12 Steps and Strengths models of treatment for addiction, and we integrate various holistic treatment modalities into our programmes. Love, compassion & Understanding for people struggling underpins the delivery of all treatment.