They’re screaming it from the rooftops: “addiction is a disease, and you can’t stop it without medical treatment”! But why are they screaming it so loud, why are they browbeating us about it, why is it always mentioned with a qualifier? You don’t hear people constantly referring to cancer as “the disease of cancer” – it’s just “cancer”, because it’s obvious that cancer is a disease, it’s been conclusively proven that the symptoms of cancer can’t be directly stopped with mere choices – therefore no qualifier is needed. On the other hand, addiction to drugs and alcohol is not obviously a disease, and to call it such we must either overlook the major gaps in the disease argument, or we must completely redefine the term “disease”.
Real Diseases versus The Disease Concept or Theory of Drug Addiction
In a true disease, some part of the body is in a state of abnormal physiological functioning, and this causes the undesirable symptoms. In the case of cancer, it would be mutated cells which we point to as evidence of a physiological abnormality, in diabetes we can point to low insulin production or cells which fail to use insulin properly as the physiological abnormality which create the harmful symptoms. If a person has either of these diseases, they cannot directly choose to stop their symptoms or directly choose to stop the abnormal physiological functioning which creates the symptoms. They can only choose to stop the physiological abnormality indirectly, by the application of medical treatment, and in the case of diabetes, dietetic measures may also indirectly halt the symptoms as well (but such measures are not a cure so much as a lifestyle adjustment necessitated by permanent physiological malfunction).
In addiction, there is no such physiological malfunction. The best physical evidence put forward by the disease proponents falls totally flat on the measure of representing a physiological malfunction. This evidence is the much touted brain scan. The organization responsible for putting forth these brain scans, the National Institute on Drug Abuse and Addiction (NIDA), defines addiction in this way:
Addiction is defined as a chronic relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain – they change it’s structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs.
They are stating outright that the reason addiction is considered a disease is because of the brain changes evidenced by the brain scans they show us, and that these changes cause the behavior known as addiction, which they characterize as “compulsive drug seeking and use”. There are two ways in which this case for the disease model falls apart:
- the changes in the brain which they show us are not abnormal at all
- there is no evidence that the behavior of addicts is compulsive (compulsive means involuntary)
This all applies equally to “alcoholism” as well. If you’re looking for information on alcoholism, the same theories and logic discussed here are applicable; wherever you see the term addiction used on this site, it includes alcoholism.
Brain Changes In Addicts Are Not Abnormal, and Do Not Prove The Brain Disease Theory
On the first count – the changes in the brain we see in the brain scans of substance abusers are not an abnormal functioning of the brain. They are quite normal, as research into neuroplasticity has shown us. Whenever we practice doing or thinking anything enough, the brain changes – different regions and neuronal pathways are grown or strengthened, and new connections are made; various areas of the brain become more or less active depending upon how much you use them, and this becomes the norm in your brain, but changes again as you adjust how much you use those brain regions depending on what you choose to think and do. This is a process which continues throughout life, there is nothing abnormal about it. But don’t take my word for it, listen to Sharon Begley, science writer for the Wall Street Journal, who has spent years investigating it and writing both newspaper columns and books on neuroplasticity
The term refers to the brain’s recently discovered ability to change its structure and function, in particular by expanding or strengthening circuits that are used and by shrinking or weakening those that are rarely engaged. In its short history, the science of neuroplasticity has mostly documented brain changes that reflect physical experience and input from the outside world.
So, when the NIDA’s Nora Volkow and others show us changes in the brain of a substance user as compared to a non-substance user, this difference is not as novel as they make it out to be. They are showing us routine neuroplastic changes which every healthily functioning person’s brain goes through naturally. The phenomenon of brain changes isn’t isolated to “addicts” or anyone else with a so-called brain disease – non-addicted and non-depressed and non-[insert brain disease of the week here] people experience brain changes too. One poignant example was found in the brains of London taxi drivers, as Begley and neuroscientist Jeffrey Schwartz pointed out in The Mind and The Brain. 
Is Being A Good Taxi Driver A Disease?
A specific area of the brain’s hippocampus is associated with creating directional memories and a mental map of the environment. A team of researchers scanned the brains of London taxi drivers and compared their brains to non-taxi drivers. There was a very noticeable difference, not only between the drivers and non-drivers, but also between the more experienced and less experienced drivers:
There it was: the more years a man had been a taxi driver, the smaller the front of his hippocampus and the larger the posterior. “Length of time spent as a taxi driver correlated positively with volume in…the right posterior hippocampus,” found the scientists. Acquiring navigational skills causes a “redistribution of gray matter in the hippocampus” as a driver’s mental map of London grows larger and more detailed with experience.
So, the longer you drive a cab in London (that is, the longer you exert the mental and physical effort to quickly find your way around one of the world’s toughest to navigate cities), the more your brain physically changes. And the longer you use drugs, the more your brain changes. And indeed, the longer and more intensely you apply yourself to any skill, thought, or activity – the more it will change your brain, and the more visible will be the differences between your brain and that of someone who hasn’t been focused on that particular skill. So, if we follow the logic of the NIDA, then London’s taxi drivers have a disease, which we’ll call taxi-ism. But the new diseases wouldn’t stop there.
Learning to play the piano well will change your brain – and if you were to compare brain scans of a piano player to a non-piano player, you would find significant differences. Does this mean that piano playing is a disease called Pianoism? Learning a new language changes your brain, are bilingual people diseased? Athletes’ brains will change as a result of intensive practice – is playing tennis a disease? Are soccer players unable to walk into a sporting goods store without kicking every ball in sight? We could go on and on with examples, but the point is this – when you practice something, you get better at doing it, because your brain changes physiologically – and this is a normal process. If someone dedicated a large portion of their life to seeking and using drugs, and their brain didn’t change – then that would be a true abnormality. Something would be seriously wrong with their brain.
Its not just physical activity that changes our brains, thoughts alone can have a huge effect. What’s more, whether the brain changes or not, there is much research which shows that the brain is slave to the mind. As Begley points out elsewhere, thoughts alone can create the same brain activity that would come about by doing things:
Using the brain scan called functional magnetic resonance imaging, the scientists pinpointed regions that were active during compassion meditation. In almost every case, the enhanced activity was greater in the monks’ brains than the novices’. Activity in the left prefrontal cortex (the seat of positive emotions such as happiness) swamped activity in the right prefrontal (site of negative emotions and anxiety), something never before seen from purely mental activity. A sprawling circuit that switches on at the sight of suffering also showed greater activity in the monks. So did regions responsible for planned movement, as if the monks’ brains were itching to go to the aid of those in distress.
So by simply practicing thinking about compassion, these monks made lasting changes in their brain activity. Purely mental activity can change the brain in physiologically significant ways. And to back up this fact, Dr Gene Heyman brings up the case of Dr Jeffrey Schwartz, who has taught OCD patients techniques to think their way out of obsessive thoughts. After exercising these thought practices, research showed that the brains of OCD patients looked no different than the brains of those who never had OCD. If you change your thoughts, you change your brain physically – and this is voluntary. This is outside the realm of disease, this shows a brain which changes as a matter of normality, and can change again, depending on what we practice. There is nothing abnormal about a changing brain, and the type of changes we’re discussing aren’t necessarily permanent, as they are characterized to be in the brain disease model of addiction.
These brain change don’t need to be brought on by exposure to chemicals. Thoughts alone, are enough to rewire the very circuits of the human brain responsible for reward and other positive emotions that substance use and other supposedly “addictive” behaviors (“process addictions” such as sex, gambling, and shopping, etc.) are connected with.
The Stolen Concept of Neuroplasticity in the Brain Disease Model of Addiction
Those who claim that addiction is a brain disease readily admit that the brain changes in evidence are arrived at through repeated choices to use substances and focus on using substances. In this way, they are saying the disease is a product of routine neuroplastic processes. Then they go on to claim that such brain changes either can’t be remedied, or can only be remedied by outside means (medical treatment). When we break this down and look at it step by step, we see that the brain disease model rests on an argument similar to the “stolen concept”. A stolen concept argument is one in which the argument denies a fact on which it simultaneously rests. For example, the philosophical assertion that “reality is unknowable” rests on, or presumes that the speaker could know a fact of reality, it presumes that one could know that reality is unknowable – which of course one couldn’t, if reality truly was unknowable – so the statement “reality is unknowable” invalidates itself. Likewise, the brain disease proponents are essentially saying “neuroplastic processes create a state called addiction which cannot be changed by thoughts and choices” – this however is to some degree self-invalidating, because it depends on neuroplasticity while seeking to invalidate it. If neuroplasticity is involved, and is a valid explanation for how to become addicted, then we can’t act is if the same process doesn’t exist when it’s time to focus on getting un-addicted. That is, if the brain can be changed into the addicted state by thoughts and choices, then it can be further changed or changed back by thoughts and choices. Conditions which can be remedied by freely chosen thoughts and behaviors, don’t fit into the general understanding of disease. Ultimately, if addiction is a disease, then it’s a disease so fundamentally different than any other that it should probably have a completely different name that doesn’t imply all the things contained in the term “disease” – such as the idea that the “will” of the afflicted is irrelevant to whether the condition continues.
Substance Use Is Not Compulsive, It Is A Choice
On the second count, is there any evidence that substance use is involuntary? When the case for the disease is presented, the idea that drug use is involuntary is taken for granted as true. No evidence is ever actually presented to support this premise, so there isn’t much to be knocked down here, except to make the point I made above – is a piano player fundamentally incapable of resisting playing the piano? They may love to play the piano, and want to do it often, they may even be obsessive about it, but it would be hard to say that at the site of a piano they are involuntarily driven by their brain to push aside whatever else they need to do in order to play that piano.
There is another approach to the second claim though. We can look at the people who have subjectively claimed that their substance use is involuntary, and see if the offer of incentives results in changed behavior. Heyman covered this in his latest book, Addiction: A Disorder of Choice. He recounts studies in which cocaine abusers were given traditional addiction counseling, and also offered vouchers which they could trade in for modest rewards such as movie tickets or sports equipment – if they proved through urine tests that they were abstaining from drug use. In the early stages of the study, 70% of those in the voucher program remained abstinent, while only 20% stayed abstinent in the control group which didn’t receive the incentive of the vouchers. This demonstrates that substance use is not in fact compulsive or involuntary, but that it is a matter of choice, because these “addicts” when presented with a clear and immediately rewarding alternative to substance use and incentive not to use, chose it. Furthermore, follow up studies showed that this led to long term changes. A full year after the program, the voucher group had double the success rate of those who received only counseling (80% to 40%, respectively). This ties back in to our first point that what you practice, you become good at. The cocaine abusers in the voucher group practiced replacing substance use with other activities, such as using the sports equipment or movie passes they gained as a direct consequence of abstaining from drug use – thus they made it a habit to find other ways of amusing themselves, this probably led to brain changes, and the new habits became the norm.
Long story short, there is no evidence presented to prove that substance use is compulsive. The only thing ever offered is subjective reports from drug users themselves that they “can’t stop”, and proclamations from treatment professionals that the behavior is compulsive due to brain changes. But if the promise of a ticket to the movies is enough to double the success rate of conventional addiction counseling, then it’s hard to say that substance users can’t control themselves. The reality is that they can control themselves, but they just happen to see substance use as the best option for happiness available to them at the times when they’re abusing substances. When they can see other options for happiness as more attractive (i.e. as promising a greater reward than substance use), attainable to them, and as taking an amount of effort they’re willing to expend – then they will absolutely choose those option instead of substance use, and will not struggle to “stay sober”, prevent relapse, practice self-control or self-regulation, or any other colloquialism for making a different choice. They will simply choose differently.,
Two Most Relevant Reasons Addiction Is Not A Disease
So to sum up, there are at least two significant reasons why the current brain disease theory of addiction is false.
- A disease involves physiological malfunction, the “proof” of brain changes shows no malfunction of the brain. These changes are indeed a normal part of how the brain works – not only in substance use, but in anything that we practice doing or thinking intensively. Brain changes occur as a matter of everyday life; the brain can be changed by the choice to think or behave differently; and the type of changes we’re talking about are not permanent.
- Drug use in “addicts” is not compulsive. If it was truly compulsive, then offering a drug user tickets to the movies would not make a difference in whether they use or not – because this is an offer of a choice. Research shows that the offer of this choice leads to cessation of substance abuse. Furthermore, to clarify the point, if you offered a cancer patient movie tickets as a reward for ceasing to have a tumor – it would make no difference, it would not change his probability of recovery.
Addiction is NOT a disease, and it matters, as we’ll learn on the next page that this has huge implications for anyone struggling with a substance use habit.
- NIDA, Drugs Brains and Behavior: The Science of Addiction, sciofaddiction.pdf
- Sharon Begley, Scans of Monks’ Brains Show Meditation Alters Structure, Functioning, Wall Street Journal, November 5, 2004; Page B1, http://psyphz.psych.wisc.edu/web/News/Meditation_Alters_Brain_WSJ_11-04.htm
- Gene Heyman, Addiction: A Disorder of Choice, Harvard University Press, 2009
- Sharon Begley and Jeffrey Schwartz, The Mind And The Brain, Harper Collins, 2002
Why Does It Matter Whether or Not Addiction Is A Brain Disease?
When we accept the unproven view that addiction and alcoholism are brain diseases, then it will lead us down a long, painful, costly, and pointless road of cycling in and out of ineffective treatment programs and 12 step meetings. You will waste a lot of time without finding a permanent solution. When we examine the evidence, throw out the false disease concepts, and think rationally about the problem we can see that addiction is really just a matter of choice. Knowing this, we can bypass the rehabs, and find the true solution within ourselves. You can choose to end your addiction. You can choose to improv your life. You can choose to stop the endless cycle of “recovery” and start living. You don’t need to be a victim of the self-fulfilling prophecy that is the brain disease model of addiction. There are alternative views and methods of change which I hope you’ll take the time to learn about on The Clean Slate Addiction Site.
How To End Addiction, Substance Dependence, Substance Abuse, Alcoholism, and General Drug and Alcohol Problems (updated 1/31/2014)
Due to the fact that most conventional rehab and addiction treatment programs follow the false belief that addiction is a disease, they are generally not effective at dealing with these problems – so I really can’t ethically recommend any “treatment” programs other than a run of the mill detoxification procedure if you feel you may be experiencing physical withdrawal symptoms – you can find that through your local hospital or emergency room; by asking your primary care doctor; or by calling 911 if you feel your life is in danger due to withdrawal (beware that withdrawal from alcohol and some prescription drugs such as the class known as benzodiazepines can lead to fatal seizures). But what comes after detoxification is simply personal choices, and treatment programs actually discourage productive personal choices by attempting to control people and feeding them nonsense such as the disease theory and idea of powerlessness.
If you want to end or alter your own substance use habits you need to make different choices, and commit to those new choices for a long enough time that they become habitual, or your new norm. How do you orient yourself towards this and get in the proper mindstate? It all starts at the level of thought. You have to believe it is possible for you to change, and believe that there are more enjoyable lifestyles available to you. It’s not easy, and I don’t mean to downplay anyone’s struggles by saying this behavior is a choice. Any habit can feel terrifying to change, but that doesn’t mean it’s impossible.
For extreme users, there are two main stages to quitting:
1 – The early period where you stop using even though you crave it strongly.
This is the part that feels the hardest. It can sometimes last a few days, weeks, or months. People do it all the time though, most on their own without formal help – and a smaller percentage do it while attending a 28 day program, or a 90 meetings in 90 days regimen of 12-step meetings. The funny thing about the 12-step route is that the main advice given is “don’t drink, and go to meetings.” So, while they’re denying your ability to choose, they tell you to choose not to drink or drug – “one day at a time.” In the 28 day rehab route, the same thing is happening – while your power of choice is being denied, you are choosing to stay sober at a rehab rather than to leave and get high or drunk. In every case people are choosing to change their substance use habits. It seems the only exception to this would be jail, or some other type of coercion.
The part that makes the early stage so tough is that from your current perspective (which has been created by repeated choices to use substances), drugs or alcohol are the things that you know you can do that will probably make you feel better than anything else. So it feels as if you’re denying yourself the best possible thing available to you; it feels as if an incredible force is involved (and it is, but we’ll get to what exactly that force is in a minute). It’s a huge conflict, but you hold on, because you want to end the pain that often accompanies the pleasure of heavy substance use.
For people to make a different choice, they need to make a change in the way they see their options. That is, they need to judge their potential choices differently. This is what happens when people say, as they do in AA, “I got sick and tired of being sick and tired.” At the very least, they are essentially saying that “my life would be more satisfying if I simply subtracted drug use from it”, and for many people that is enough. They have come to believe that a better lifestyle than their current one is available to them. Such thinking reflects the fact of a change in perspective – they no longer see the substance use as such a valuable choice – and they do envision there life, without much change other than removing substance use from it, as a happier option. Interviews with people who have quit heroin, cocaine, and alcohol without treatment or support groups reveals a “cognitive evaluation” process that is much the same – they say they realized they wanted to grow up, be more responsible, spend more time with their families, finally get their career off the ground, etc.
For many though, all they realize at the beginning is that the substance related problems are too painful – but they don’t necessarily believe there is any doable lifestyle available to them that will make them happier than getting high and drunk. So they are in the middle, in conflict – they love getting high, but they hate its negative consequences. These are the people who feel the most hopeless, helpless, and lost. They have no vision of something better, so stopping substance use, even for a few days feels like an incredible feat of willpower to them. They don’t know what they want.
Going to rehab or to AA gives some people a framework for getting through this early stage. Many just go to detox. But the vast majority get no formal help at all, and still manage to get through the early period of change. I’m all for people doing whatever they feel will help them at this early stage. However, most of the formalized help options seem to fail when it comes to stage 2…
2 – Making your short term changes last.
Once you get out of the woods of the momentum of habit and possibly physical withdrawal symptoms comes the next issue: how to make this change last.
It will last if you change your perspective. If you are focused on a lifestyle you believe will bring you greater happiness, then cementing your short term change into long-term change will feel almost effortless. Do people who do this have more willpower than the ones who can’t seem to do it and keep going back to their old habits? NO – and I can’t say this strongly enough: willpower is not the issue here. The person who lives life for some time believing that being high on drugs or alcohol would be amazing, and then eventually goes back to doing just that – is exercising their will. They are doing what they want to do. They are not weak. They often show great strength – in the act of procuring money for drugs; buying the drugs; and trying to use the drugs while going undetected by family members and others who are policing their activities.
The issue is not one of strength of will – it’s of the will itself. They still judge heavy substance use as their best feasible option for happiness. For them to change their habit in the long-term, they need to come to believe that some other lifestyle is more “worth it” and doable for them than the “addict” lifestyle is.
This is where formal addiction treatment and support groups usually fail these people. They offer them no way to grow past this desire and shift their gaze to more attractive lifestyles. In fact, the things they teach and do at addiction treatment programs actively divert people’s attention away from the task of finding better options. They keep people focused on the wrong things:
- The need for support. This implies inherent weakness, and a need for strength from outside the individual. They are not weak, they are strongly pursuing their will.
- Battling an imaginary disease. The desire for heavy substance use is taken for granted as something the “addict” will always have, because it comes from a genetic or neurological defect / malfunction.
- Hitting bottom, Confronting Denial, etc. They teach people that it needs to get bad enough to deter them from further use – and in fact, many believe they need to keep going to meetings to remind themselves of how bad it could get if they used again. This keeps them in the mode of, again, taking the desire for granted as a constant presence, and battling it. The problem is, most “addicts” already understand and experience many of these costs, and yet they choose to use anyways, because they see substance use as their most attractive feasible option for happiness.
- Avoiding triggers. Objects and images are granted great power because they may trigger memories, and thus are to be avoided “don’t drive past the bar” is the perfect example – the logic being that seeing the bar will trigger you to go in and drink. If you have somewhere you believe better to be at than the bar, then it will “trigger” nothing except perhaps a memory of things you did at the bar – but your actual behavior will be determined by your beliefs about what choices will get you the positive results you desire in life.
- Triggers 2.0: Stress, anxiety, depression, etc. The more modern, supposedly progressive treatments focus on emotional and psychological problems as the “underlying causes” (i.e. more complex triggers) to be avoided, or else the “weak” “addict” will be caused to use drugs and alcohol. Again, people behave in ways they believe are their best path to happiness. Yes, depression may make the quest for happiness even more urgent – but if the person perceives some better feasible route to happiness other than drug and alcohol use, they WILL NOT choose to use drugs or alcohol. Stress, anxiety, and depression, are all very normal parts of life that people deal with in a multitude of ways. The treatment industry instills beliefs that overcomplicate these problems, creating an unnecessary causal connection between them and substance use in the minds of “addicts” in their care. Yes, these problems should be dealt with, but people shouldn’t be taught to neurotically hunt for the slightest hint of negative emotion as evidence of a pending relapse. They should be looking for the choices that can bring them the greatest life satisfaction.
There are more. I could keep going. But the basic point is this: when people truly believe they have better feasible choices available than heavy substance use, then they don’t use substances. Many people get sober initially to reduce painful consequences – to be just ever so slightly happier than they are in the “addicted” state. But that’s not a very happy place. Over time, if they really develop their belief in happier life options, and start pursuing those options, they lose the will to use substance heavily. They replace it with a will to live out whatever their vision of a happier lifestyle is.
Some people will never choose to perceive that anything is better than heavy substance use. It is a choice to think that way. Nobody can force another person to judge things another way. It is a volitional act. What can be done, is that we can give people helpful information, that they can then choose to use to find and develop happier options for themselves. Or you can give them misinformation like the disease model, and useless tasks like avoiding triggers, that will subvert their efforts.
I understand the people in the recovery community and addiction treatment industry mostly mean well, and believe what they preach, but I think they are sadly mistaken. Addiction is not a disease, and therefore not an issue of weakness or external forces causing this behavior – it is behavior people freely choose because they believe it is their best option for happiness. If they come to believe some other course of behavior will be more rewarding and within reach for them, then they will follow that course of action, and their change will last.
The solution then, is to change one’s mindset – but the brain disease model of addiction essentially says this is an irrelevant matter.