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.” Here we will analyze a few key points and show that what we call addiction doesn’t pass muster as a real 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).

Volkow NIDA Brain ScanIn 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[1].  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.

The NIDA is 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 three major 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
  • people change their behavior IN SPITE OF the fact that their brain has changed in response to repeated substance use
  • there is no evidence that the behavior of addicts is compulsive (compulsive meaning involuntary) (point two addresses this, as well as some other research that will be presented)

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 evidenced by brain scans of heavy substance users (“addicts”) do not represent a malfunctioning 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 it 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[2]

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. [4]

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.

An abridged earlier version of this article appears in the 2014 edition of reference/textbook "Addiction: Opposing Viewpoints" from Cengage Learning/Greenhaven Press
An abridged earlier version of this article appears in the 2014 edition of reference/textbook “Addiction: Opposing Viewpoints” from Cengage Learning/Greenhaven Press

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[2]:

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 we look again to the work of Dr Jeffrey Schwartz[3], 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’d 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 choosing to think.  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.

People change their addictive behavior in spite of the fact that their brain is changed – and they do so without medication or surgery (added 4/18/14)

In the discussion above, we looked at some analogous cases of brain changes to see just how routine and normal (i.e. not a physiological malfunction) such changes are. Now we’re going to look directly at the most popular neuroscientific research which purports to prove that these brain changes actually cause “uncontrolled” substance use (“addiction”).

This supposedly explains why drug use becomes compulsive.
This supposedly explains why drug use becomes compulsive.

The most popular research is Nora Volkow’s brain scans of “meth addicts” presented by the NIDA. The logic is simple. We’re presented with the brain scan of a meth addict alongside the brain scan of a non-user, and we’re told that the decreased activity in the brain of the meth user (the lack of red in the “Drug Abuser” brain scan presented) is the cause of their “compulsive” methamphetamine use. Here’s how the National Institute on Drug Abuse (NIDA) explains the significance of these images in their booklet – Drugs, Brains, and Behavior: The Science of Addiction :

Just as we turn down the volume on a radio that is too loud, the brain adjusts to the overwhelming surges in dopamine (and other neurotransmitters) by producing less dopamine or by reducing the number of receptors that can receive signals. As a result, dopamine’s impact on the reward circuit of a drug abuser’s brain can become abnormally low, and the ability to experience any pleasure is reduced. This is why the abuser eventually feels flat, lifeless, and depressed, and is unable to enjoy things that previously brought them pleasure. Now, they need to take drugs just to try and bring their dopamine function back up to normal.

[emphasis added]

They go on that these same sorts of brain changes:

..may also lead to addiction, which can drive an abuser to seek out and take drugs compulsively. Drug addiction erodes a person’s self-control and ability to make sound decisions, while sending intense impulses to take drugs.

[emphasis added]

That image is shown when NIDA is vaguely explaining how brain changes are responsible for “addiction.” But later on, when they try to make a case for treating addiction as a brain disease, they show the following image, which tells a far different story if you understand more of the context than they choose to mention:

brain scan prolonged abstinence

Again, this graphic is used to support the idea that we should treat addiction as a brain disease. However, the authors mistakenly let a big cat out of the bag with this one – because the brain wasn’t treated at all. Notice how the third image shows a brain in which the red level of activity has returned almost to normal after 14 months of abstinence. That’s wonderful – but it also means that the NIDA’s assertions that “Addiction means being unable to quit, even in the face of negative consequences”(LINK) and “It is considered a brain disease because drugs change the brain… These brain changes… can lead to the harmful behaviors seen in people who abuse drugs” are dead wrong.

When these studies were done, nobody was directly treating the brain of methamphetamine addicts. They were not giving them medication for it (there is no equivalent of methadone for speed users), and they weren’t sticking scalpels into the brains of these meth addicts, nor were they giving them shock treatment. So what did they do?

These methamphetamine addicts were court ordered into a treatment program (whose methodology wasn’t disclosed in the research) which likely consisted of a general mixture of group and individual counseling with 12-step meeting attendance. I can’t stress the significance of this enough: their brains were not medically treated. They talked to counselors. They faced a choice between jail and abstinence. They CHOSE abstinence (for at least 14 months!) – even while their brains had been changed in a way that we’re told robs them of the ability to choose to quit “even in the face of negative consequences.” [5]

Even with changed brains, people are capable of choosing to change their substance use habits. They choose to stop using drugs, and as the brain scans above demonstrate – their brain activity follows this choice. If the brain changes caused the substance using behavior, i.e. if it was the other way around, then a true medical intervention should have been needed – the brain would’ve needed to have changed first via external force (medicine or surgery) before abstinence was initiated. They literally wouldn’t have been able to stop for 14 months without a real physical/biological medical intervention. But they did…

Substance Use Is Not Compulsive, It Is A Choice

The brain disease model of addiction is a bogeyman. "Here Comes the Bogey-Man" by Goya, circa 1799
The brain disease model of addiction is a bogeyman.
“Here Comes the Bogey-Man” by Goya, circa 1799

There doesn’t seem to be any evidence that substance use is involuntary. In fact, the evidence, such as that presented above, shows the opposite. Nevertheless, 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 sight 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. Gene Heyman covered this in his landmark book, Addiction: A Disorder of Choice[3].  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 options 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.

But wait… there’s more! (Added 4/21/14) Contrary to the claims that alcoholics and drug addicts literally lose control of their substance use, a great number of experiments have found that they are really in full control of themselves. Priming dose experiments have found that alcoholics are not triggered into uncontrollable craving after taking a drink. Here’s a link to the evidence and a deeper discussion of these findings: Alcoholics Do Not Lose Control. Priming dose experiments of cocaine, crack, and methamphetamine users found that after being given a hit of their drug of choice (primed with a dose) they are capable of choosing a delayed reward rather than another hit of the drug. Here’s a link to a discussion of these findings: Drug addicts don’t lose control of their drug use.

Three 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.
  • The very evidence used to demonstrate that addicts’ behavior is caused by brain changes also demonstrates that they change their behavior while their brain is changed, without a real medical intervention such as medication targeting the brain or surgical intervention in the brain – and that their brain changes back to normal AFTER they VOLITIONALLY change their behavior for a prolonged period of time
  • 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. This has huge implications for anyone struggling with a substance use habit.

References:

  • 1) NIDA, Drugs Brains and Behavior: The Science of Addiction, sciofaddiction.pdf
  • 2) 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
  • 3) Gene Heyman, Addiction: A Disorder of Choice, Harvard University Press, 2009
  • 4) Sharon Begley and Jeffrey Schwartz, The Mind And The Brain, Harper Collins, 2002
  • 5) Links to the 2 methamphetamine abuser studies by Nora Volkow:

    http://www.jneurosci.org/cgi/content/full/21/23/9414

    http://ajp.psychiatryonline.org/cgi/reprint/158/3/377

Important Notes from the author to readers and especially commenters:On “badness” or immorality: please do not attribute to me the idea that heavy substance users must be “bad” or “immoral” if they are in fact in control of and choosing their behavior. I do not think this. I think that at the time they’re using, it is what they prefer, given what life options they believe are available to them – and I don’t think it’s my job to decide what other people should prefer for themselves, and then declare them bad if they don’t live up to my vision of a “good” life. That’s what the disease recovery culture does, de facto, when they present the false dichotomy of ‘diseased or bad’. To say that addiction is chosen behavior is simply to make a statement about whether the behavior is within the control of the individual – it is not a judgment of the morality of the behavior or the individual choosing it.On willpower: please do not attribute to me the suggestion to “use willpower.” I have not said that people should use willpower, nor do I think it’s a coherent or relevant concept in any way, nor do I think “addicts lack willpower” or that those who recover have more willpower, nor, and this is important, do I believe that a choice model of addiction necessarily implies willpower as the solution.

“Addicts” do not need extra willpower, strength, or support, to change their heavy substance use habits if that is what they want to do. They need to change their preference for heavy substance use, rather than trying to fight that preference with supposed “willpower.”

On compassion: please don’t accuse me of not having compassion for people who have substance use problems. You do not know that, and if you attack my motives in this way it just shows your own intellectual impotence and sleaze. I have a great deal of compassion for people with these problems – I was once one such person. I am trying to get at the truth of the nature of addiction, so that the most people can be helped in the most effective way possible. I don’t doubt the compassion of those who believe addiction is a disease, and I hope you’ll give me the same benefit of the doubt. I assure you I care and want the best for people – and I don’t need to see them as diseased to do so. When you see someone who’s gotten themselves into a mess, don’t you want to help, even if it’s of their own making? Why should we need to believe they have a disease to help them if the mess is substance use related? I don’t get that requirement.

Some Agreement I’ve Found From Addiction Researchers (added 6/10/14)

I began working out my understanding of the brain disease model back in 2005 as I started working on a book about addiction; published this article in 2010; and was happy to find in 2011 when I went back to work with Baldwin Research that they had arrived at a similar conclusion. The way they stated it amounted to “either everything is addiction, or nothing is” – referring to the fact that the brain changes presented as proof of addiction being a brain disease are so routine as to indicate that all behavior must be classified as addiction if we follow the logic.

I was also gratified to have found a neuroscientist who arrived at the same conclusions. I think Marc Lewis PhD and I may disagree on a few things, but it seems we may see eye to eye on the logic I presented above about such brain changes being routine, and thus not indicative of disease. Check what he wrote in 2012 for the PLOS Blog, Mind The Brain:

every experience that has potent emotional content changes the NAC and its uptake of dopamine. Yet we wouldn’t want to call the excitement you get from the love of your life, or your fifth visit to Paris, a disease. The NAC is highly plastic. It has to be, so that we can pursue different rewards as we develop, right through childhood to the rest of the lifespan. In fact, each highly rewarding experience builds its own network of synapses in and around the NAC, and that network sends a signal to the midbrain: I’m anticipating x, so send up some dopamine, right now! That’s the case with romantic love, Paris, and heroin. During and after each of these experiences, that network of synapses gets strengthened: so the “specialization” of dopamine uptake is further increased. London just doesn’t do it for you anymore. It’s got to be Paris. Pot, wine, music…they don’t turn your crank so much; but cocaine sure does. Physical changes in the brain are its only way to learn, to remember, and to develop. But we wouldn’t want to call learning a disease.

….

In my view, addiction (whether to drugs, food, gambling, or whatever) doesn’t fit a specific physiological category. Rather, I see addiction as an extreme form of normality, if one can say such a thing. Perhaps more precisely: an extreme form of learning. No doubt addiction is a frightening, often horrible, state to endure, whether in oneself or in one’s loved ones. But that doesn’t make it a disease.

I think that quote is very important, because it highlights neuronal changes that occur in the same region implicated in addiction (whereas the examples I presented earlier in the article represented some other regions).

In a brilliant paper titled “The naked empress: Modern neuro science and the concept of addiction”, Peter Cohen of The Centre for Drug Research at University of Amsterdam, states that:

The notions of addiction transformed into the language of neurology as performed by authors like Volkov, Berridge, Gessa or De Vries are completely tautological.

He essentially argues that Volkow et al take for granted that heavy drug and alcohol use is uncontrolled, identify neural correlates, and present them as evidence of uncontrollability. Yet they don’t do so with other behaviors, and he provides plenty of examples. He notes that they start with assumptions that certain patterns of behavior (e.g. heavy drug use) are uncontrolled, and others are controlled – based purely on cultural prejudices. He accurately identifies addiction as a learned behavior, or as routine bonding to a thing, and then expresses something very close to my thesis presented above (that all learned/intensely repeated behaviors result in “brain changes”).

The problem of course is that probably all learning produces temporary or lasting ‘change in neural systems’. Also, continuation of learned behavior may be functional in the eyes and experience of the person but less so in the eyes of the outsider. Who is right? We know of people remaining married in spite of-in the eyes of a beholder- a very bad marriage. Who speaks of lasting ‘neural change’ as the basis of the continued marriage? But, even when a person herself sees some behavior as counter functional, it is not necessarily seen as addiction. It may be seen as impotence, ingrained habit or unhappy adaptation. It all depends on which behavior we discuss, not on the brain.

The great points contained in this article would be done an injustice if I tried to sum them up here, so check it out for yourself at The Center for Drug Research University of Amsterdam. As with Marc Lewis, I suspect that Peter Cohen and I might have some substantial disagreements about the full nature of addiction and human behavior in general, but I think we at least agree that the changes in the brain of an “addict” do not necessarily represent disease, and more likely represent a routine process.

Writing in 2013 for the journal Frontiers In Psychiatry, esteemed behavioral and addiction researcher Gene Heyman pointed out something so painfully obvious that we don’t even take notice – no causal link has ever been found between the neural adaptations caused by excessive substance use and continued heavy use. That is, correlation is not causation:

With the exception of alcohol, addictive drugs produce their biological and psychological changes by binding to specific receptor sites throughout the body. As self-administered drug doses greatly exceed the circulating levels of their natural analogs, persistent heavy drug use leads to structural and functional changes in the nervous system. It is widely – if not universally – assumed that these neural adaptations play a causal role in addiction. In support of this interpretation brain imaging studies often reveal differences between the brains of addicts and comparison groups (e.g., Volkow et al., 1997; Martin-Soelch et al., 2001) However, these studies are cross-sectional and the results are correlations. There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug.

Did you get that? Let me repeat the words of this experienced researcher, PhD, and lecturer/professor from Boston College and Harvard who, in addition to publishing scores of papers in peer reviewed medical journals has also had an entire book debunking the disease model of addiction by Harvard University press (I say all of this about his credentials so that I can hopefully STOP getting commenters who say “but you’re not a doctor, and what are your credentials wah, wah, wah,……” here’s a “credentialed” expert who essentially agrees with most of what I’ve written in this article – so please, for the love of god, save your fallacious ad hominems and appeals to authority for another day!)- he (Gene Heyman PhD) said this, as of 2013:

There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug.

And this was in a recently published paper in a section headed “But Drugs Change the Brain”, in which he continued to debunk the “brain changes cause addiction” argument by saying:

There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug. For example, in a frequently referred to animal study, Robinson et al. (2001) found dendritic changes in the striatum and the prefrontal cortex of rats who had self-administered cocaine. They concluded that this was a “recipe for addiction.” However, they did not evaluate whether their findings with rodents applied to humans, nor did they even test if the dendritic modifications had anything to do with changes in preference for cocaine in their rats. In principle then it is possible that the drug-induced neural changes play little or no role in the persistence of drug use. This is a testable hypothesis.

First, most addicts quit. Thus, drug-induced neural plasticity does not prevent quitting. Second, in follow-up studies, which tested Robinson et al.’s claims, there were no increases in preference for cocaine. For instance in a preference test that provided both cocaine and saccharin, rats preferred saccharin (Lenoir et al., 2007) even after they had consumed about three to four times more cocaine than the rats in the Robinson et al study, and even though the cocaine had induced motoric changes which have been interpreted as signs of the neural underpinnings of addiction (e.g., Robinson and Berridge, 2003). Third [an analysis of epidemiological studies] shows that the likelihood of remission was constant over time since the onset of dependence. Although this is a surprising result, it is not without precedent. In a longitudinal study of heroin addicts, Vaillant (1973) reports that the likelihood of going off drugs neither increased nor decreased over time (1973), and in a study with rats, Serge Ahmed and his colleagues (Cantin et al., 2010) report that the probability of switching from cocaine to saccharin (which was about 0.85) was independent of past cocaine consumption. Since drugs change the brain, these results suggest that the changes do not prevent quitting, and the slope of [an analysis of epidemiological studies] implies that drug-induced neural changes do not even decrease the likelihood of quitting drugs once dependence is in place.

Read the full paper here – it’s an amazingly concise summary of the truths about addiction that contradict many of the accepted opinions pushed by the recovery culture –  Heyman, G. M. (2013). Addiction and Choice: Theory and New Data. Frontiers in Psychiatry, 4. doi:10.3389/fpsyt.2013.00031

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.

There are many different ways to argue against the brain disease model of addiction. I have only presented 3 basic arguments here. But beyond just addiction, many modern claims of “brain disease” are fatally flawed, in that they are founded on the logically impossible philosophical stance of psychological determinism. From this standpoint, any evidence of any brain activity is immediately interpreted as a “cause” of a particular mind state or behavior – with no regard for free will/the ability to choose one’s thoughts and thus behaviors. If you understand the impossibility of psychological determinism (or “epiphenomenalism”) then you’ll take all such claims with a grain of salt. For a detailed examination of this issue, see the following article: The Philosophical Problem with the Brain Disease Model of Addiction: Epiphenomenalism

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.

 

Comments

  1. says

    This makes perfect sense.
    How can You even think about stopping your personal addiction if you believe You are “living with a disease”?

    I was taught in AA that i have a disease for the rest of my life!, so I continued to drink,and drug , using my “disease” as an excuse.
    Oh I might as well give up my sobriety, because ill never be disease free….

    Well thats the exact opposite of what I really needed to hear.

    After learning about my addiction being a “Learned behavior” ,and NOT a disease, only then was I able to understand how to control myself,and my addiction, without any excuses.

    Thanks for writing this up , it makes total sense, and i hope it will help someone else out there as well.

      • margaret Weeks says

        i have been an alcoholic and opiate addict. and i believe that of course, use is a choice. but, when an addict is the throes of withdrawing, especially physical withdrawal from alcohol or opiates, your ability to choose has been usurped by cravings. cravings can literally drive a person insane, consequently leaving them with still–a choice–but the brain cannot recognize that choice while under the influence. your brain at that moment has been taken over and you honestly albeit mistakenly believe you must continue on using. it’s a trick the drugs do on the brain, convincing the compromised brain that it must take the substance.

        when i was smoking crack years back, this drug was so obscenely addictive, the compulsion so overwhelming, that i erroneously believed at that moment, i could not stop. i’ve been in situations where the cravings were so immense, i felt completely at their mercy. but then again, as stated before, this was while i was using or withdrawing. if one can be put in a place, like lockdown rehab or jail, where they cannot get a hold of their drug, you are right: the brain adapts to the idea it won’t be getting it’s drug, and begins to concentrate on other things than taking drugs. but this can only occur after cravings have been attenuated, which takes time: anywhere between a month to six months generally. but please, do not tell me that people that have been smoking crack during the night can just simply stop on choice alone in the midst of being highly intoxicated. the brain goes through a major change while smoking crack. and your brain’s condition does take away choice. try and stop suddenly after using heroin for a couple of months straight. it can be done, but the cravings will undoubtedly, take a person back to the drug. choice or the ability to make a choice to stop has to happen when the individual is an environment where there drug is not available. .

    • Parker Nettle says

      You might not be a drug addict, you’re just one of those idiots who did a little research and thinks he knows some science so you make this article like you think you’re some Dr. If you were a drug addict, you would know for a “FACT” that drug addiction is a disease of choice, and not a moral issue you fucking retard. Im tired of being hated on by people who think I’m just making bad decisions. It’s only a moral decision once the drugs have left your body and you have that free agency to choose again… Usually it takes at least 3 days, before then every minute 4 signals get sent to the brain because it shifts from the frontal cortex to the mid cortex and changes the order of importance from 1. kill .2 eat. protect too.. 1. drugs.. 2. kill. 3. eat

      Man you should have wrote an article on something that you actually are, like an article on being a dumb ass. Sorry if I offended anybody but I am very offended.
      http://alcoholism.about.com/od/sa/a/blnida041129.htm

      • Parker Nettle says

        You’re arguments sound like they hold cloud like the taxi cab argument, but that just changes random shit in your brain. Drugs target the area that is responsible for making “CHOICES” what a concept… Which makes it a disease because without intervention or it psychically being impossible me as a drug addict will go to any lengths to get it until I have had at least 3 days of it out of my system where I am finally set free to say NO, or YES to drugs. Ive read so many books on drugs and been to so many rehabs and have been a drug addict for over a century.. I know what I’m talking about, cause im talking about myself. Sometimes when you really wanna know something, it’s best to go straight to the source. In this case, The drug addict.

          • anon says

            Speaking from a the stand point of a person who has both been a drug addict and who has extensively studied addiction and neuroscience academically I can tell you that this article omits key data that suggests that drug addiction is BOTH a choice and brain based disease CAUSED by substances that DIRECTLY effect physiological processes in areas of the brain responsible for motivated behaviors. And if you have not read any neuroscience research in last like 100 years, I am going to let you in on a little secret. The brain is the organ that is responsible for producing all BEHAVIOR!! Another point I would like to make is that it is NOT generally disputed within the literature that addiction IS a brain based DISEASE. In fact it is quite well accepted that it IS. And we actually DO understand quite well what happens to the the brain in response to substance abuse (effects vary from substance to substance) What we do not understand is why some people are able to do a line of coke on Friday night and not develop an addiction. But some people do it once and spend the rest of their lives engaging in drug seeking behavior which has devastating consequences to their lives, and the lives of their loved ones. What is worse is we do not understand very well how to help someone with an addition.

            If you can claim that addiction is not a brain based disease then you would also have to claim that any other disease of thought or behavior is also not a disease. Its like saying schizophrenia is not a disease that bi-polar affective disorder, or autism is not a disease. How ridiculous is that?

            I will tell you one thing right now. TELLING AN ADDICT THAT THEIR STRUGGLE IS A SIMPLE CHOICE IS BULL$H!T

            it is a choice but it is FAR from simple.

            Whoever the f@$k wrote this article cherry picked neuroscience research and contorted it in a way to make it seem like they were making a case for their argument by using buzz words like neuroplasticity and functional magnetic resonance imaging. When they were not at all. In fact much of what we understand about neuroplacticity and the targets of drugs of abuse tells us that substance abuse is very much a brain based disease. Comparing the neuroplacticity that occurs in taxi drivers to the plastic changes in the brain of a user is like comparing apples to oranges. The networks within the brain that were examined in that example have NOTHING to do with motivated behavior. The mechanisms of drugs like cocaine methamphetamine heroine etc. DO!!

            All drugs of abuse have specific targets on parts of the brain that are responsible for motivated behaviors (i.e. choices). They are the same areas of the brain that motivate you to engage in essential survival behaviors like eating drinking water and having sex. The part of the brain that is most intricately involved in this process of reinforcement is the nucleus accumbens (NAcc) and the ventral tegmental area. The NAcc is rich with dopaminergic neurons. When a behavior like eating occurs, dopamine is released which activates this “pleasure center” in the brain. Each time this occurs the behavior that caused it is reinforced (i.e the likelihood of it happening again increases). ALL major drugs of abuse have direct mechanisms which potentiate the release of dopamine.

            First, a very vague and simplistic explanation of how neurons communicate in the brain

            When a neuron is activated it sends an electrical signal (action potential) down its axon, at the end of this axon are terminal boutons which contain chemicals called neurotransmitters (i.e. dopamine). when the action potential reaches the terminal bouton it is signaled to release its neurotransmitter into the synaptic cleft (the space between the axon and dendrite of 2 neurons). When the neurotransmitter is released into the synaptic cleft it stimulates receptors on the dendrite of the adjacent neuron. If a large enough stimulation is produced (i.e. enough neurotransmitters bump into these receptors) an action potential is propagated down the second neuron and so on.

            depending on the type of neurotransmitter, it can have different effects and different targets in the brain. The pleasure centers in the brain are rich in dopaminergic neurons. Dopamine is involved in many other processes like voluntary/involuntary movements, memory, cognition emotion etc. Are any of these affected by substance abuse?

            One of the “jobs” of dopamine is to stimulate the pleasure centers of the brain that tell us “That was a good behavior, doing what you just did will keep you alive!!” Activation of these key centers has allowed us to stay alive and reproduce (If this system was not developed in our brain we would not exist, we would not eat, drink or have sex, and our species would not exist). For any of the neuroscience savvy people out there I am aware that the hypothalamus plays a key role in many of these behaviors, for simplicity sake I am merely reiterating the core concepts in the biological mechanisms of addiction in relation to the reward system, I have no intention to delve very deep into the entire motivation system. I’m not even going to touch very much on the effect of drugs on structures that affect top down control of behavior in relation to addiction. Which BTW there is a TON of literature on.

            I am going to use the example of methamphetamine to demonstrate how the mechanisms of this drug stimulate those pleasure centers (drugs like cocaine and heroine have similar outcomes metabolically speaking but not in exactly the same way). Mehtamphetamine (meth) is a drug that is chemically very similar to dopamine. once in the blood stream and across the blood brain barrier and inside a dopaminergic neuron it has a triple effect on the release of dopamine. It not only stops the pre-synaptic neuron from reabsorbing dopamine out of the synaptic cleft but it injects MORE dopamine into the synaptic cleft by the part of the neuron that is suppose to pull it out (Dopamine Transporter). it inhibits the action of the enzymes that break down dopamine . All of this translates to a flood of dopamine across all dopaminergic systems in the brain.

            At this point i would like to state that drugs of abuse affect more neurotransmitters than just dopamine and effect more parts of the the brain than just the NAcc, but it is historically the most relevant system to addiction that is effected by drugs (by the way whoever wrote this article made NO mention of this system when talking about the brain mechanisms of addiction. And this stuff is “Addition and the Brain 101″ go back to the drawing board HACK. )

            Remember from the explanation of how neurons communicate? If dopamine does not leave the cleft somehow it will continue to stimulate the post synaptic neuron. All of this translates to an activation of the pleasure centers that are WELL in excess of anything you could do naturally. This is why drugs feel good. Besides making us feel good these “pleasure centers” are responsible for making it more likely that we will engage in the behaviors that caused it. This is all screaming “Do that again, it will keep you alive”

            This is a good thing in the case of eating drinking and having sex. (there are mechanisms that produce a sense of satisfaction which terminate these behaviors, which by the way are absent in aforementioned example). So all your brain is hearing is again again agian

            We can see in brain stimulation experiments with rats how powerful of a effect stimulation of NAcc can have on behaviour. Electrodes were placed into the NAcc of rats. These electrodes were controlled by levers in the rats cage. When allowed to self stimulate they would not eat or drink or engage in sex, but rather press the bar until they died from exhaustion!!

            That TOO was a choice the rat made!!

            If any of you out there are reading this and say that a study on rats is not relevant to humans, I am going to let you in on another little secret!! We have all the brain parts that rats do!! Just more built on top. Its called the neocortex. One BIG part of what our new brain lets us do is inhibit motivational drives in order to achieve a long term goal. Like not eating all day when you have a busy day at the office so that you don’t get fired, otherwise you cannot buy food and you will die. (Slightly exaggerated, but you get the point).

            The point that I am making is that these substances hijack the part of the brain that motivate us engage in behaviors essential for survival. Which in turn tells the brain that engaging in substance use was essential for survival. I understand the concept that you may be able to easily cognitively dismiss that statement, but believe it or not motivated behaviors are automatic!! But our frontal lobe allows us to make a choice about what we are going to do about the motivation signal. If you don’t believe me, next time you have a busy day at the office, you miss breakfast lunch and dinner at 8:00 pm tell yourself that you are not hungry. You will still be hungry. But you do have a choice in whether you do something about that hunger or not. In this case the smart thing to do is eat, which is what your brain is screaming at you to do. Same thing applies to an addict, but the brain is screaming much louder, and the smart thing to do is not “eat”. Best analogy for the experience that I have.

            In response to Steven Slate’s comment. Why addicts relapse following the initial withdrawal symptoms pass, is because the withdrawal symptoms are only a small part of the puzzle. What causes the symptoms of withdrawal is complicated and have varying causes depending on the substance. So I will not get into that right now. Generally what you need to know is that withdrawal has a tendency to increase the drive to use drugs because it negatively reinforces the act of using a substance by ameliorating the painful effects of withdraw. If you don’t know what negative reinforcement is (or don’t understand anything else I have mentioned). GOOGLE THAT $H!T !!

            So the drive to engage in a behavior is not principally caused by withdrawal symptoms. But have more to do with plastic changes in the motivational system that tells the brain that doing drugs is essential for survival. Again that is why the taxi cab driver experiment is completely irrelevant to the topic!! It has nothing to do with the motivation system.

            So, is the act of using a drug a choice? Yes it is. You can choose to do it or not do it. The issue that I have with this article is that it completely downplays how difficult of a decision that really can be. And there ARE physiological explanations for why people will steal from their mother and buy drugs instead of food for their child. Actions that completely defy logic and the survival instinct. The explanation can be found in how they effect some parts of the brain involved in survival behaviors.

            Again speaking from that standpoint of an addict and an academic. Learning about the mechanisms of addiction does not come anywhere near explaining the subjective experience.

            Also to anyone out there reading this and struggling with addiction. You CAN stop. You CAN have a life free from drugs. Remember that it is your brain telling you that you need to use to stay alive. But I assure you the opposite is true!! Take it one day at a time, no matter what anyone else says, it IS tough. If you slip don’t sweat it.

            • Tim E says

              Great response to the author of this ridiculous article. I am a recovering person of 16 years and if it was as simple as the author states it addiction would not be a problem, we could all just make better choices LOL.

            • says

              Most of what you have said here rests on the impossible theory of psychological determinism. You are the one trying to impress by talking about neurotransmitters, nucleus accumbens, etc. As an analogy for my readers, imagine if someone tried to explain your trip to the beach by discussing the pistons in the engine of the car you drove to get there. Wouldn’t that be somewhat irrelevant? Would it explain why you chose to pack your stuff, start up the car, and get on the road to a beach? Would it explain why you chose the particular beach? No, it wouldn’t.

              Yes, the physical activity of the brain is involved in everything we think and do – but claiming such activity to be the cause of what we do is a leap. Correlation is not causation. I have addressed psychological determinism/epiphenomenalism at this LINK. I’m not here to deny the technical facts of the neural correlates of “addiction”, but I am here to to get at understanding exactly what they mean. I’m afraid most of the psychological world has been in great error over this issue, and I’m DEFINITELY not the first or only on to think so: see Beyond determinism and materialism, or isn’t it time we took consciousness seriously? by Edwin A. Locke

              There’s another thing we need to know. Despite all of the horrific brain changes, people do choose to cease their “addictions” all the time without a scalpel to the brain or even taking a medication. How is that so, if the brain changes CAUSE the heavy substance use and/or craving??? How is it possible, that later, after they choose to stay abstinent, the brain changes again to look more like the brain of someone who hasn’t had a heavy substance use habit???

              I’ll tell you how – because people are still free to make their choices, and the brain reflects habitual choices. There’s no reason to assume that brain changes cause substance use. That’s a leap in logic based on a bad foundational philosophy of epiphenomenalism.

            • missw says

              Dear author,
              You are wrong. Be thankful you do not understand alcoholism and addiction. You are very blessed.

            • JJ says

              I am not smart enough to get into the scientific debate here …. But I thought the article was just saying “disease” might not be the right word given it’s actual definition. I do not think addiction is a disease but I also agree that it influences your choice and is extremely difficult to stop.

          • Scott says

            What’s that, you idiot. Oh, go to detox for three days and you’re good? You’re so full of shit I can smell you over the internet. You have no qualifications to speak on this subject, you have nothing but an idea that you ‘prove’ through evidence that only supports your claim. This is by no means a scholarly review and you shouldn’t present it as fact because your theory is flat wrong. I noticed you don’t deal with Heroin much, no doubt since all your theories go totally out the window when it comes to Heroin. It’s not just three days, jackass. The symptoms last for months, not days or weeks. After using Heroin for a while you’re brain won’t return to normal functioning for up to a year. This is proven science and what you’re doing is wrong. I hope you feel good about yourself. Does spreading lies out of some grudge make you a big man? You’re flat out wrong headed my friend and an obviously inferior intellect if you’re unable to grasp how your own argument about brain changes belies your very argument. My advice is this, go get a hobby, worry about your own self and get a life, Leave the big moves and big thoughts to the professionals and keep your vindictive, simple mind and mouth closed.

            • says

              The symptoms don’t last for months, they last for days. As Dr Carl Hart, neuroscientist and researcher at Columbia University with 24 years of studying the effects of drugs put it “Heroin withdrawal is like the flu. If you’ve had the flu, you’ve had heroin withdrawal.” What he means is that it’s not as bad as we make it out to be, and it’s very temporary. Having detoxed from heroin too many times to remember myself, and having spent years in methadone programs, I agree. While you may continue to want heroin for months after detoxing, the actual detoxification/withdrawal period doesn’t last for months – it lasts for mere days. Your wanting of heroin is not withdrawal – it is desire based on your belief in the benefits of heroin.

              I also think that a large portion of what people experience in heroin withdrawal is brought on by expectancy. In “Drug, Set, And Setting”, researcher Norman Zinberg layed out his work studying heroin users and found that detoxification becomes worse when heroin users are socialized into groups of other hardened users. The reason is that they learn that it’s going to be unbearable. This I also agree with. My detoxes became exponentially worse after I got into the recovery culture.

              You might be talking about the supposed “Post Acute Withdrawal Syndrome” (or PAWS). I don’t know what there is to that – I’m still studying the issue. But for one, if it is a physical reality rather than run-of-the-mill craving (which is caused by one’s emotional investment in heroin as a cure-all/”only way to feel comfortable in my skin”), it’s not typical of heroin addiction – it’s extremely rarely reported even in the research literature I’ve read in which the authors take it very seriously. Second – an acquaintance who is a quite conscientious, caring, and medically innovative detox doctor scoffed at PAWS and said it’s nonsense.

              Your claim that heroin withdrawal lasts for months flies in the face of not just my claims (and others on my side of the debate) – it also flies in the face of what mainstream addiction theorists who believe in addiction as a disease, loss-of-control, etc, believe and state about heroin withdrawal.

              • Recovering addict says

                being a recovering heroin addict I can tell you that withdrawals feel nothing like the flu so how about you go out buy a bag and get addicted and tell me what it’s like and having been clean for 3 months and still not being back to normal I can tell you it takes way longer than days to recover the physical symptoms last days but the damage It does to your brain lasts much longer you ignorant prick until you know what it’s like don’t claim to be an expert, you people are the reason that this society is fucked up. Listen to the song what it’s like by everlasting, that’ll give you a good idea about not preaching what you don’t know so when you become a heroin addict for years then somehow beat it with simple choice and have a normal brain within days then come back and tell me your opinion is the same

                • says

                  How about you do the most basic ounce of investigation before you spout off like that. I am the author of this article and this entire website, and you can find in many places that I once had a very bad problem with heroin use. I’m the one who’s ignorant??? I’m the one preaching what I don’t know??? You’re here saying I don’t know what heroin “addiction” is like, and you can’t even bother to find out what I’ve been through first.

                  Do I deny in this article that changes to the brain are long-lasting? No, I don’t – and in fact I included a brain scan from the NIDA showing changes at one month, and then 14 months later coming back to normal. I don’t deny the existence of the brain changes. Most of this article is about understanding the significance of those brain changes.

                  They claim the brain changes rob us of free will, “hijack” our brain – basically, that we cannot choose because of the brain changes. Yet, people quit substances in the midst of having a changed brain….. they CHOOSE TO NOT USE. Using or not is a choice. Even with a changed brain. And yes the changes persist for some time – but they change back over time too – and if they weren’t causing you to use before, they won’t be able to cause you to use now. They are mostly irrelevant.

                  -Steven Slate

            • Kevin B says

              Scott,

              Why the explosion if you’re so steadfast in you’re belief in the disease/12 step model, and comfortable with the way you’re living? In one article on this site, it points out that real diseases don’t require a core of zealous minions to go around trying to convert people to the belief that they are, in fact, diseases. For example, you don’t hear people trying to push the fact that cancer is a disease on the general public because anyone above the age of two with most of their mental capacities functioning considers this obvious. Again, I’m just going to hope you were drunk and snorting cocaine while composing this post, because, if you were dead sober, god help the people that have to deal with you on a daily basis. I, personally, would rather throw in the towel and go back to drugs before I trudged through life “one day at a time” completely insecure and miserable. The defensiveness of the vast majority of the disease model fanatics is rather telling. Whatever you’re doing, you’re obviously “restless, irritable and discontent”. Im embarrassed for you…like naked in a dream embarrassed. Peace, god bless bro.

        • William Rosetti says

          The disease is that your weak, and your excuse is covering it up with a mask called addiction. Every 3 days it’s a choice to either say Yes or No, and when you say yes it becomes a disease again. Dude, the the coach says, get in the game or sit on the bench, but make a choice, stop using excuses…A disease is when you have a choice to say Yes or No to the fact that the doctor just diagnosed you with cancer, and neither one changes the condition…Everything outside of a real disease is a choice–bottom line… If disease starts with a “YES”, then all habits that started from that point should be categorized as one, from jogging to juggling–get it…

          • Dr. K.Gradson says

            remember people who are associated with a clean slate
            Must not understandthe difference between the factual basis of science and opinion based on theory.the American Medical Association acknowledges addiction and alcoholism not as a moral deficiency rather a pre genetic disposition..if you think someone would choose to be an addict or alcoholic, or for that matter choose To suffer the Consequences , dejection, prejudice, ridicule and the list goes onfrom just being an addict or alcoholicthat kinda seems insane.I see some of you spoke of the diseases of cancer, hypertension, hyperthyroidism, hypercholesteremia, and a few others even diabetes mellitus. From a medical professional let me explainwhere you are sadly mistaken.
            1)diabetes mellitus is a disease proven by the scientific and medical community .this disease can be put at bay, and symptomatically one will not suffer at certain degree If Some behavioral components are followed.for instance diet, exercise, obesity,insulin regularity and consistency by use of injectableinsulin it backwhat you affects what’s your fa.here’s the point you have the disease and diabetes yet behavioral components can play major factors n the progression of such. So as it is with addiction and alcoholism,if you have the disease of addiction and alcoholism and you do not do the necessary things to keep it at bay, you have what they call a relapse. So from a medical standpoint using cancer and diabetes is actually a good analogy and can be proven below. Rats don’t have opinions, scientific studies are facts and do not lie. Do you think a rat would choose alcohol over water if he knew he would die? Please prove to mewhere there is choice in that study.
            Addiction
            THIQ and The Disease Concept of Alcoholism

            T.H.I.Q. –Biochemical Culprit

            T.H.I.Q. was discovered in brains of alcoholics in Houston, Texas by a scientist named Virginia Davis who was doing cancer research. For her study she needed fresh human brains and used bodies of homeless winos who had died.

            She discovered in the brains of those chronic alcoholics a substance that is closely related to Heroin. This substance, known to scientists, is called Tetrahydrolsoqulnoline or THIQ. When a person shoots heroin into their body, some of it breaks down and turns into THIQ.

            The Alcoholics studied had not been using heroin so how did the THIQ get there? When the normal adult drinker takes in alcohol, it is very rapidly eliminated at the rate of about one drink per hour. The body first converts the alcohol into something called Acetaldehyde. This chemical is VERY TOXIC and if it were to build up inside us, we would get VIOLENTLY SICK AND COULD DIE. But Mother Nature helps us to rid the body of acetaldehyde very quickly. She efficiently changes it a couple of more times – into carbon dioxide and water – which is eliminated through kidneys and lungs. That’s what happens to “normal drinkers.” It also happens with alcoholic drinkers, but with alcoholic drinkers something additional happens.

            What Virginia discovered in Houston has been extensively confirmed since. In alcoholic drinkers, a very small amount of poisonous acetaldehyde is not eliminated; Instead it goes to the brain. Through a very complicated biochemical process, it winds up as THIQ. Research has found the following:

            THIQ is manufactured in the brain and only occurs in the brain of the alcoholic drinker. It is not manufactured in the brain of the normal social drinker of alcohol.
            THIQ has been found to be highly addictive. It was tried in experimental use with animals during the Second World War when we were looking for a painkiller less addicting than morphine. THIQ was a pretty good pain-killer but it couldn’t be used on humans. It turned out to be much more addicting than morphine.
            Experiments have shown that certain kinds of rats cannot be made to drink alcohol. Put in a cage with very weak solution of vodka and water, these rats refuse to touch it. They will literally die of thirst before they agree to drink alcohol. However, if you take the same kind of rat and put a minute quantity of THIQ into the rat’s brain — one quick injection – the animal will immediately develop a preference for alcohol over water.
            Studies done with monkeys, our close animal relative in medical terms, show the following:
            Once the THIQ is injected into a monkey’s brain, it stays there.
            You can keep the monkey dry, off alcohol, for 7 years. Brain studies show that THIQ remains in place in the brain.
            The alcoholic’s body, like normal drinkers, changes the alcohol into acetaldehyde and then it changes most of it into carbon dioxide and water, which in the end kicks out through the kidneys and lungs. However, the alcoholic’s bodies won’t kick all these chemicals out. The Alcoholic’s brain holds a few bits back and transforms them into THIQ. As THIQ is accumulated in the brain of an alcoholic, at some point, maybe sooner, maybe later, the alcoholic will cross over a shadowy line into a whole new way of living.

            It is not known by medical science, where this line is or how much THIQ an individual brain will pile up before one crosses this line. Some predisposed people cross the line while they’re teenagers, or earlier. Others cross in their 30′s or 40′s and others after retirement. But once this happens the alcoholic will be as hooked on alcohol, as he would have been hooked on heroin if he’d been shooting that instead.

            With the loss of control, the complex symptoms have become chronic. All aspects of physiology have become progressive and incurable. Now it is clearly a disease.

            GOOD NEWS:

            Alcoholism is a disease.
            Alcoholism is not the alcoholic’s fault.
            Alcoholics can get proper treatment for the disease, which begins with learning the facts about remission.
            The alcoholic can be relieved of guilt.
            The alcoholic can take on responsibility for arresting their disease.
            The alcoholic can refuse to put more THIQ in their brains and refuse to activate the THIQ that is already there.
            Alcoholics can and do recover

            • Rob gam says

              If what you are saying about thiq is true then they can make a pill to dissolve this chemical to be passed out of the body ? If your saying the ” disease” can be cure with remission steps? Then how can it be a truly chemical disease or genetic it comes down to choice. Going through the program to achieve freedom of the alcoholism. Cancer is a disease you can’t take a remission course to cure this ailment , you need medicines , chemo, etc. other disorders like bipolar , autisum, schizophrenia would be a “psychological disorder” , a person can’t think away or choice to take a class to make huallutions go away or into remission. So where’s the THIQ drug, that will turn the disease brain that doesn’t break down the the alcohol to achdelthyde? If I have high blood pressure I take Crestor , if an infection anti-biotics . Alcoholism has many outside factors also , that might make you more compelled to drink . You can’t catch this by some sneezing on you, genetics might play a part , but how much ? 50%? So it’s 50/50 yes or no. Make the right choice

            • Kevin B says

              Dr. K,
              I am interested in your theories, but I’m actually finding it difficult to read your post due to its utter lack of grammar, sentence structure, word spacing, punctuation, and capitalization. Were you tripping on acid when you wrote this, or did you have a chimpanzee serve as your ghost writer? I realize that forums like these are flexible on spelling and grammar, but you’re post is so poorly written that no one in their right mind could justify paying attention to the content. Have some respect for yourself, and present your arguments in a manner that wouldn’t be insulting to a three year old…if you want to be taken seriously that is.

          • Tim E says

            I guess a person with schizophrenia, depression, bi-polar, or PTSD can just make the decision too. Find the facts before you run your mouth on a subject you no doubt no nothing about.

            • Kevin B says

              Tim,

              Unlike addiction, the diseases you referenced were not brought about by years of poor choices made consciously by those who suffer from them. In other words, you’re comparing apples to oranges, and wasting our time as you simultaneously embarrass yourself.

              Thanks

        • anonymous says

          all you really did was prove the guys point.” i cant get clean because, yada,yada,yada.” no wonder your an addict. i used opiates and alcohol all day everyday for years. i quit cold turkey and have been clean for almost 8 years now. why? because i chose to. i made the decision and stuck to it.

      • d jones says

        Nobody is “hating on you”. I submit that you possibly do have an organic brain disease, and possibly need some treatment. A tendency toward paranoia, feeling targeted, could be a symptom of something that can be helped by therapy and drug treatment. I say this because I DO have an organic brain disease, first and foremost. Using/abusing illicit drugs help mask the symptoms.

        • Sonny B says

          Sure, there’s no animosity at all towards addicts. <—-sarcasm, for those aware of Poe's law.
          While I agree that AA is a scam, anyone claiming that addiction isn't really a disease is a scammer as well, and intentionally ignoring or misrepresenting the best medical and scientific evidence available. The taxi driver/movie ticket arguments above are frankly laughable and completely intellectually dishonest, and anyone partaking in an honest investigation of the subject would learn why in very short order. There's a strong component of narcissism and condescension in the 'alcoholism isn't a disease' argument that suggests that those advocating this viewpoint are simply doing so to address some need of their own to raise themselves through lowering others, which is a short step away from the sociopathic creation of an inferior 'them' which must be dismissed, reviled and ultimately hated for 'their' inferiority. It's fair to question why anyone would expend so much effort to prove that a disease that they do not have does not exist, and to assume that there must be some personal benefit secreted within their agenda.

      • Tim says

        You obviously have no understanding of what a “disease” is, so you are saying, that you would call a gambling addiction a disease? How about an addiction to cigarettes? Nicotine is a drug, it’s addictive, not have I ever EVER heard one person say smoking cigarettes a disease, because it’s not. So you’re saying, BECAUSE YOU CHOSE to use drugs/alcohol in the first place, and you are now addicted, that it is a disease? Your lack of intelligence of what a disease actually is baffles me. By the way, using the profound words in your comment just adds to your lack of intelligence.

        • Scott says

          How stupid are you, dude? You’re arguments are the ultimate straw man. You’re comparing apples to oranges. Tobacco addiction isn’t the same as a heroin addiction. If you need experimentation to prove that to you then no amount of science will prove anything to you, you prove only what you already think is true and you skew the evidence to support your claims. This is not science, it’s pseudo-science. Where’s your experimental results? Stop presenting your arguments as science because science has already proven you to be false and a liar to boot. Tobacco isn’t a psychotropic drug you dumbass. IT doesn’t apply. Sheesh. You are a real intellectual giant aren’t ya….

        • Ryan says

          Bro…what we are saying….is that prolonged use eventually develops into the disease of addiction. We are not saying that a few times using or even a few years perhaps…”now you have a disease”. What we are saying is that prolonged use….does physiological damage, changes brain chemistry, causes uncontrollable cravings etc. Once this stage has set in…you now have a “disease” that almost always requires medical and psychological “TREATMENT” in order to heal. The definition of a what constitutes a “disease” can be subjective….. but any “condition” that requires treatment can be considered a disease. Ryan

          • Kevin B says

            Sooooo, what you’re saying is that the process is rooted in choice? I really don’t care if the result of prolonged use is labeled a disease or chemical dependency, though I favor the latter. My beef is with those who claim that they never chose to become an addict or never chose to hurt their families. Like they were just minding their own business and a nasty disease came along that forced them to put a needle in their arm?!?! While we likely didn’t intend to end up helpless, dysfunctional people who pissed on our loved ones, the choices we made put us at risk of ending up in a sorry state where we were capable of doing things we would have never dreamed of. Unless you were raised on Mars, we all deep down knew the risk of our choices, especially if you’re talking about coke, crack, meth, or heroin but we chose to roll the dice anyways. At a certain point, when I was starting to do coke almost every weekend, I knew that it would be wise to stop, but I chose not to because I was having fun and I told myself it will never happen to me. By the end, I was going on solo three day benders with alcohol and cocaine, and I landed in treatment. After all my rambling, my point is that I made the choice to try the substance, the choice to begin to use the substance more regularly, and the choice not to quit when I could have. Therefore, even if addiction is a disease, we are all responsible for the damage we caused, and to conveniently dodge that fact by placing the blame on a disease that took away our ability to chose is irrational, and, more importantly, cowardly. We made our own beds with our choices, bottom line.

      • Alex L. says

        100% agreed dude….its not like we can just say “im just not going to do this anymore”, it LITERALLY becomes the number one survival instinct we have. And by the way there is more to the disease aspect than this guy realizes, all drug addicts also have whats referred to as “decreased hedonic tone” to where genetically we are predispositioned to produce less dopamine than the average person, therefore we do not feel as much “pleasure” out of normal daily activites as average people do, which in turn makes it so when we do that first drug we get a signifigantly larger response than average people so it makes it harder for us to say no in the first place. From there is where the diaease takes hold…

        • TampaBayJane says

          I have been sober over 21½ years in AA and I agree that alcoholism is NOT a disease! In all the years I have attended meetings, I have NEVER bought into the “disease” theory or that ALL of the answers are in the Big Book. It explained A LOT about my OBSESSION with alcohol and the way to STOP alcohol addiction is very simple. STOP drinking! Despite what most AA’s might “think” they DO NOT have all of the answers. What they have is a lot of regurgitated drunkalogues that make them feel better about their miserable lives being stuck to meetings, meetings, meetings. Thank God I was able to realize that it is OK to “take what you need and leave the rest!” Once I realized that it was OK for me to take responsibility for my obsession with alcohol I could recover from alcoholism. I’m not stuck with the Buchmanite cult religion running my every thought or decision in MY life. I can get on with life with NO FEAR of being doomed to jails, institutions or death. If I go to a meeting it is because I choose to go NOT because I will drink and/or die if I don’t. I now have the freedom of a happy life instead of the bondage of an alcoholic obsession!

      • nancydrewa32 says

        …I’m sorry to tell you this, but the article you linked doesn’t offer conclusive proof..and it is from About.com, which isn’t exactly a major medical journal-I’ve been paid to write articles like this,for sites like that- and I promise you the barest of work is done. Notice some key words “this control is MARKEDLY DISRUPTED.( not destroyed, or nonexistent.) Imaging studies have shown specific abnormalities in the brains of SOME, but not all, addicted individuals. ” So not every addict is “infected”? Why did no one have sympathy for my smoking addiction?

        Results weren’t conclusive, and needed much more work-like your reasoning and critical reading skills We haven’t even touched confirmation bias, or the fact that a disease is something an addict can suffer from, and get attention-not a selfish choice. There are many treatment options, but self-efficacy and agency are very important success factors.

      • Michael says

        If its a ‘ disease of choice ‘ then its your own bloody fault for making that choice in the first place isn’t it ? I believe the author is absolutely correct even if he ain’t had the hard experience himself.

        I was a gambling addict for many years but i didn’t try to blame anybody or anything else for my self-induced problems. I never attended any GA meetings or submitted myself to the ‘ higher power ‘ and all that shit.

        I just stopped doing it.

      • Andre Montoya says

        woooaa hostility there bro no need to get butt hurt because the “little research” the guy has done has shot down your weak mentality. Addiction is not a disease whatsoever; all addiction really is, is a mix up of priorities, combined with laziness, and neglect of responsibilities in your life. By claiming a disease all your doing is solidifying the victimized point of view, and ducking responsibility for your own actions. Shit you could call me an addict if you want, but despite the drugs I do habitually, I have never failed to accept responsibility for my own decision making. That is the biggest cop out in the world, you and others alike are the reason users are labeled with such judgmental discrediting perceptions from the rest of the public. Man up, accept control of your life, and quit allowing yourself to get manhandled by the existence of a NON-LIVING SUBSTANCE. You are a human freaking being for crying out loud! The notion of that is not only illogical, but completely retarded to determine one to be held captive by a drug. You hold yourself captive, and these AA NA and other rehab treatment facilities of course enable this fallacy of yours i.e. being a victim, for they are the ones capitalizing off your very own self pity! Of course you will say I am not an addict, but on the contrary addiction, falsified to the max, is defined as enslavement to a habit, practice, or substance to the point cessation causes severe trauma. Well lets see I have been a daily user for most of the past 6 years or so, numerous drugs. You could assume that I cannot go without. But amazingly in despite of such events, I still manage to maintain a 3.00 gpa while in school full time, and never allowed my habits to interfere with my job; these are possible for not only the fact I hold success above all else, top priority, and also I never let a drug decide its going to tell me what I can and can not do. A want is all it will ever be, never a need. By telling yourself you need this to get by, is an error, and the 1st destructive domino. In fact unlike you I have this thing called pride and respect for myself, along with of course a focused mind. I do not consider myself a drug addict in terms of how you picture it, or any one else for that matter. I choose to get high everyday, but no matter how long I stay consistent the fact is I am capable of going without, yeah breaking the monotony would create some discomfort, but it would not stop my heart from beating or my lungs from breathing.
        The only people who can classify as an “addict” to some degree would be abusers of heroin, benzos, methadone, and other pharmaceuticals due to the fact they actually cause dope sickness. But if you use your rational mind Mr or Mrs. Victim you could clearly determine that even those users by utilizing every second of their life to do nothing but get high, to such an extreme degree, and neglecting all together the value of hard work as the pathway to success would be the sole cause of their own demise. In other words, they chose to use to such an extreme they tricked their body into believing it needed those chemicals to sustain homeostasis. A self inflicted wound entirely; had the user not got high just to get high as an “escape” grew up and took responsibility for what happens in their lives their story would be told much different. If Addiction, as you believe so strongly to hold true, takes control of you what automatically instills the notion of destruction following? Would you blame the user or the drug itself for the reckless behavior of some people? Your mentality I would assume would link responsibility to the drug; however, the drug doesn’t force anything, not even consumption. The user decides to consume, determines the value of its effects mentally, and then ultimately develops a certain thought process following use. The user then chooses what actions need be put forth. Drivers influenced by alcohol that crash and kill people are responsible for their actions; even if alcohol held some sort of devilish motives to destroy the lives of people, the user chose to get behind the wheel and drive. My point is the mental state, reasons for using, dosage levels, and all around mental evaluation of what it means/feels to get high, is the creator of your slave state disposition. In essence you are the one who holds the power as the slave owner, over your own body & mind. Furthermore, in my mind if i happened to ever become so gone to such an extreme I would utilize my addiction as motivation to work harder to support my own habit. Turn a negative into a strength, and still be successful. Getting high is mitigation, a get away to alleviate temporarily the negativity one may feel. It is by no means an essential substitute for reality, and if so happens to be used in such way the user depicts the outcome based on their actions. Going from casual use to chronic, and allowing your body to deteriorate, taking ones life with it, is by no means instant. All of that is one step-by-step process, and the user failed to notice or intentionally turned a blind eye to such destruction. That user well aware of the consequences but chose to enable such a detriment is by no means a victim, but simply a careless fool. They mentally, hold the value of their life at so little, imagine themselves pathetic and hopeless to such a degree, that living in torment, by escaping emotional judgement of their own egos holds the essence of life to them all together. Naive prospective, and easily turned around with a new process of taking advantage of the remarkable abilities of the human mind. One such remarkable strength of the mind is adaptability, capable of adapting to any said change in life, be it negative or positive. The mind will adapt and sustain, or possibly create a new level, of homeostasis. All in all Mind over matter, and the mind you possess is the battlefield of life, every thought, action, observation, prediction etc etc must first be processed by the mind before anything else. So therefore by failing to interpret in a positive way, you doomed yourself.

        If you do not believe this persons article why don’t you read 2 of these articles I find quite interesting.
        London General Practitioner by the name of Michael Fitzpatrick, well respected, views addiction as misleading. I cant post link because it wont allow me to share, not even on facebook.

        Also Carl Hart, professor and psycho-pharmacologist from Columbia University ran a study challenging common beliefs of crack and meth addiction and found the original (government run studies) had purposely misconstrued data to hype public opinion. here is the link. check it out.
        http://healthland.time.com/2011/11/21/why-the-myth-of-the-meth-damaged-brain-may-hinder-recovery/

        • Kevin B says

          Andre, I absolutely love your post, but I think it’s important to clarify that alcohol and benzos are the only drugs that can kill you in the withdrawal process. This may not be news to everyone, but I’ll risk losing addiction blog street credit for posting obvious information if it saves someone’s life. Obviously, you can overdose on heroin, opiates, and all forms of cocaine, but withdrawal from anything other than alcohol and/or benzos, while miserable, cannot possibly kill you. If you’re heavy into either of these and want to quit, do not do this cold turkey. Detox under supervision then go from there.

      • Hates worthless junkies says

        You were on drugs when you wrote this. So your irrational. If your irrational your not capable of rational thought or behaviors. Typical to doped up junkies. If you read the whole article, dumbass, you would have read the part where this individual states that the only treatment the author can “ethically” (google that, addicts seem to have no understanding of the word) recommend was detoxification treatments. You’re claiming you have a life long disease that only lasts 3 days to post using? And your offended because this individual isn’t making sense? Instead of writing a response to something you haven’t read, hence “know nothing about”, try writing a response to something you have intimate knowledge of. Like, “why I’m a short sighted illeterate asshole.” With in your oh so very thought out response, quite obviously with out realizing, you actually tipped the scale from the point you wanted to make, to the direction the author was actually trying to prove. Of course there is going to be some MINOR and TEMPORARY changes in the brain, your pumping vast amounts of poison into it genius. And based on the extensive research you’ve already done for us, that lasts how long? 3 days? So your permanently useless because of a 3 day slight brain malfunction brought on by the CHOICE to poison yourself. The amount of time between using is less than 3 days you say? Hmm, well once again the author suggested DETOXIFICATION TREATMENT.

        Youre angry weak minded rant was clearly a direct reaction of your poor “choices”. Stop making these poor “decisions” and perhaps people with stop hating on you. But, if you’re going to continue to blast intellectuals with your doped up irrationalities than I would perhaps invest ear plugs instead.

        Note: I’m personally offend by this guys stupidity.

        • anonymous says

          i went to the methadone clinic for years. why, because i liked it. i got tired of it and quit cold turkey. had bad withdrawls for a long time. but i stayed clean because thats what i wanted to do. this is what i tell the acquaintances i know who still use and act like they dont have a choice, “quit being such a pussy.”

        • Richard Conley says

          “You were on drugs when you wrote this.”

          Prove that Steven was on drugs or admit that you’re a liar with no honor, whose words aren’t to be trusted.

          “Note: I’m personally offend by this guys stupidity.”

          I’m offended that you’re evidently constitutionally incapable of honesty.

        • Dr. Causey says

          The disease concept is exactly that- a concept- albeit useful for some people struggling with stopping chemical abuse; it’s a necessary illusion for people early in recovery that errs on the side of caution. The disease concept is a transitional object to help people develop- to move on to another place in their (psychological) development, which is not unlike a child and pacifier. A child’s pacifier brings comfort, helping a child calm down in discomfort & uncertain situations. Now the pacifier becomes a autistic object when it no longer promotes development or growth i.e. a 12 year old sucking on (needing) a pacifier. Some people due to the extent of their drug use- the long term consequences on the brain- compounded by personality organization, psychopathology, and pronounced difficulties to form healthy co-regulating attachments (failure to attach) seem to be the constitutionally incapable few to which the disease concepts must be reified dropping the concept portion and only considered a disease- as if their life depended on doing so. For others it is a necessary illusion that can help change their relationship with chemicals and promote psychological and even spiritual growth; at some point the notion of addiction as a disease can become dogmatic i.e. less about growth and more about excusing oneself, especially past motivations. Motivation is often complex and knowing without any room for doubt or uncertainty is autistic in that that type of knowing no longer promotes learning about oneself; when one Knows (in a static way) one stops the process of knowing i.e knowing means acKNOWledging oneself or others or any object in the immediacy- this pertinent to people recovering because they often relegate themselves to how they were. So knowing oneself is a continual process of reassessing and evaluating, especially if you acknowledge that our perceptions and interpretations are always partial, which 12 step programs offer (ample perspectives).

          The disease concepts garners value depending on how one utilizes it. A lot of the people who responded to article, the extremely defensive responders, sound like they might always need a pacifier and I would rather them err on the side of caution. For those the necessary illusion commanded much benefit -at some-point but no longer does rather it keeps them in an insidious cycle highlights the biggest danger of the concept: a confirmation bias, a self-fulfilling prophecy . I heard a lot of Sally cry pants resentful about the article differing with their perspective, not wanting to dialogue but attack, which is reflective of addictive thinking, & deficits in self-regulation, which is usually underpinned by a dogmatic reactionary shame.

          • 18+ says

            Thank you for your informed opinion. Worded like you have I can understand and respect the opinion that you offer. As a “Retired Addict” I can appreciate all that you have said and I know that you don’t have to remain an addict for the rest of your life as 12 Step Programs state. Thank you for an intelligent response.

        • 18+ says

          The first thing that I would like to say to you is that you have no clue. Don’t try to judge a man until you have walked in his shoes. Next, you need to try the thing that they call spell check. Finally, if you’re going to speak on someone being worthless and ignorant speak intelligently, you don’t have to use profanity.
          I don’t profess to being an addict for the rest of my life, I am a retired addict with 18+ years without drugs. When I was out there I didn’t have a choice. I had to learn how to stop the cycle. NA & AA helped, but I had to grow past that. I learned over time how to walk on my own. No thanks to USELESS, IGNORANT people (I use the term lightly) like you. You should be offended by your own Stupidity.

      • Larry says

        I’ve been in NA for 2 years and 3 months 1 year in Na was spent still doing drugs. I didn’t need a study to know I was still doing drugs because I had a choice to or not to do the drug. I studed how drugs effected my thought process and came to the conclusion that it wasn’t a disease like the Na book said. Addiction is a choice I listened to people with a lot of clean time and heard the same thing over and over again, same stories, the same life troubles in their life even without drugs. Na and the people within the group of Na stay stuck on the phase I’m an addict for the rest of their life. If you keep saying the same thing over and over again you will be what you say you are. If you say what it’s a lousy day over and over again you are going to have a lousy day. That is what I hear in Na every meeting I go to the same problems different day. Na has turned into alot of members social group and it says in their own books that you need to associate with different types of people that don’t use drugs. I’m at that point in my recovery that I’m ready to have a normal life away from the daily pitty party and the foul language. The success rate of members are increditably low (fact) and that tells me volumes. It doesn’t work very well. My life will be sucessfull because I’ll do the work to make it sucessfull my choice. My be in 10 years I’ll go back and I’ll see the same people talking about the same things. Still saying I’m an addict after all that time and my life will be just fine away from all the stinken thinking.

      • Edward Webster says

        Well said. Thank God everyone in 12-step programs doesn’t buy into this article. Surely it would kill us all.

      • Allen says

        I understand your fustration. If I bought into hopelessness too, then I would be totally pissed off if someone kicked my crutch rightout from under me. I started using drugs and alcohol at age 11 and turned away from a several hundered dollar a day habit and lucrative participation in a distribution scheme at age 23. I fully understand the grip of addiction, and of having something so overbearing that I ended up on the streets for two years and lived hand to mouth. I get it. I taught myself how to read at an adult level at age 20 and eventually put myself through lawschool and now I’m entering a PhD program. I am not a doctor, but I can read and I have personal knowledge of the addicted life and a post addictive reality. We choose our destiny, inanimate objects don’t choose it for us. The use of vulgar language and foul speech is simply a limbic response to your fear that the status quo of a “victim culture” that has permeated our society will no longer be available to you as a shield against the concept of a post-addicted state. BTW the 12 steps are great guidelines, but not moral absolutes, like the Big Bookers want to lean on, sincer their higher power is often of personal design so as to not offend or demand real change.

      • Kevin B says

        “I know what I’m talking about because I’m talking about myself”. So, Parker, you feel comfortable suggesting that your individual experience is irrefutably representative of anyone dealing with substance abuse? That’s like me saying, “I know pepperoni pizza is the best because I’ve tasted all of them and I like this one the most! I don’t care what you say, pepperoni is unquestionably the best kind of pizza” I mean, a century’s worth of experience is noteworthy, but basic statistics would argue that one iteration does not constitute a trend. Oh and some friendly advice…referencing the fact that you’ve been to numerous treatments doesn’t help your argument, in fact, it shows that you’ve put yourself through unnecessary hell by blindly devoting yourself to the disease model myth. A sheep comes to mind…

    • Parker Nettle says

      and I can still live a life beyond my wildest dreams as long as I put my drug into remission. So I’m sorry that you felt that the disease was an excuse to keep drinkin and all that shit, you should’ve just had someone take you to rehab dawg.

    • Kasey says

      I accidentally posted a reply on another person’s thread (February responses) but I meant it for your post. I agree. After living a lifetime in a family with enablers and addicts a person gets tired of all the excuses and being used and abused when they suggest that the person quit and change their behavior. It can be tough to change it, but the people who help need their own lives too. They can’t constantly drop their lives for the addict and arrange everything around the addicts needs and wants. That’s not fair either.

      • ChildhoodSurvivor of alcoholic parents says

        To Kasey (11/18/13): My heart goes out to you. I got fed up with trying to put up with the irrational abusive behavior of both alcoholic parents and accidentally stumbled into Al-An0n Family Groups in my late twenties. They are the ‘sister group’ of those in AA and study an adjusted version of the same 12 Steps. Free, anonymous, found all over the world.
        I learned about how I added to the enabling of their behavior by getting ‘addicted’ to their drinking behaviors…trying to force solutions, walking on eggshells, people pleasing, yadda, yadda. That clearly did not work. In Al-Anon, which I attended weekly (and more often) for 15 years, I learned so much about looking at and changing my OWN behavior. This slowly healed much hurt and resentment towards my parents and I had much less lingering anger when they passed, unlike most of my six siblings. I got my life back and became much more self-honest. I left when I had learned enough. I carry some of the principles with me, still. My trust in God sky-rocketed…leading, quite directly, to an awesome long term happy marriage. It’s not for everyone, but you might find some comfort there. Just like reading these comments: take what you like and leave the rest.
        I am enjoying reading all of this page with discernment. What you are meant to know will come to you without any effort on your part. This is the promise that trust in a power greater than yourself can offer. Staying within the sly crafty ego mind will lead to many dead-ends. Choose again and listen within your own mind for the Right-Minded Voice. It is an individual path, you walk it by yourself but never alone.

    • sean says

      You have no idea what you are talking about. AA saves peoples lives everyday. It saved mine. I have been fighting addiction for almost 10 years now. I went to rehab when I was 20 for an addiction to heroin, got clean and sober and stopped using everything for about a year and a half. Then I started drinking again but I was only a moderate drinker. Fast forward 5 years and I came across some Oxy’s at a buddies house and within 3 months I was just as bad I was when I was 18-19 yrs old. Tried to quit by myself time and time again but I never could. Thought the solution was to get off the oxys and go to a methadone clinic… BIG MISTAKE!!!!! Now im getting off that finally but I had started drinking viciously. Now I have almost 30 days sober from drinking and have been going to AA. The problem is not the drugs or alcohol it is our thinking. The way I think is fucked and I have to change that and my solution to do that is through AA and through GOD. AA doesn’t just teach you how to stop using, it teaches you how to live. How to be a better person. How to stop being a selfish, self-absorbed asshole who doesn’t care about anyone or anything unless im high. Im sorry for my rant here but you guys need to stop with this shit. There is but one solution and that is establishing a spiritual connection with your higher power and working the steps. Thru that true happiness can be achieved and you don’t ever have to worry about how am I gonna get my dope today so I can go to work, how can I catch a buzz before I meet my friends so I can be “normal”. This is the only way that I have found and I have tried them all.

      • TampaBayJane says

        Let me state that I have been sober 21½ years in AA. For the last few years I started seeing and hearing the same old same old differently. I began to wonder if going to meetings all of the time was any different than “doing the same thing over and over again …”

        Check this Web site out and see what you think after you read about the “REAL” Bill Wilson and the Oxford Group (both cult religions that use mind control) …
        It opened my eyes, that’s for sure! http://orange-papers.org

        I agree with what you wrote about AA (because I lived it) but there is also a very DARK side to AA, as well. I have witnessed it and I eventually had to face the truth about it if I wanted to continue to stay sober and sane!

        This is a trailer to a 90-minute documentary being produced RE: The 13th Step … http://www.youtube.com/watch?v=Z-jZ3NWI8uk

      • Hates worthless junkies says

        I don’t think anyone is doubting whether or not AA saves lives. Sure it does, and sure it messes just as many people up in the process. This article is about taking responsibility for your actions and dealing with it, which it sounds like your trying to do. Everyone’s different, there’s no textbook way to beat addiction (that and rational person will or could understand), I think this thread of rants proves that. But labeling something a disease, that has little characteristics of a disease is asinine, and clouds the already clouded judgment of people who are seeking help for their problem. I think it’s fair to call it a “problem”, I doubt anyone will argue that point. Calling addiction a disease simply gives the addict exactly what they want, a loop hole. An excuse to devert any and all responsibility of their own actions. There’s always that voice in the back of your head saying it’s not my fault i do this, or steal that, the disease is making me do it. The people who have labeled it a disease are making money off of it being called a disease. They’re not interested in you getting and staying clean. The more stints you do in rehab and the more scripts they write for methadone and all the other drugs keep they’re pockets full. Take these drugs so you can stop taking drugs?! Does no one else see that’s f-ing retarded?!? Stop go along with what the big wigs want you to do and start thinking for yourself.

        • Edward Webster says

          Walk a mile in a junkie’s shoes and then tell me about control and choices. as the old saying goes, “It takes one to know one.” Also I might add, it takes one to help one. I’ve been in recovery from the DIS-ease of addiction for almost 10 years now and am very thankful for the 12-step recovery process which labels it as a disease. Unless we know what it is, we can’t treat it.

          • TonyB says

            No one is saying it’s easy to make the choice to stop, just like it would not be easy to sit down and read a reasoned political essay from someone of the opposite political persuasion, and even harder to imagine that this person might be right about some of their points.

            When you believe that IMMEDIATE RELIEF trumps DELAYED GRATIFICATION, and when you’ve tried drugs and your system seems to really respond pleasantly to them, indeed it’ll be hard to start considering that “maybe the normies have some good points too. It has led me to live on a razor’s edge-thin world seen only through blinders. My health is poor, my friends are all just as self involved… maybe I was wrong about drugs being the be all end all.”

            Sure, sometimes you’re going to feel as if you need that drug. As time passes, you see how life is livable and enjoyable without believing the worst about it and without believing you need drugs to get thru it. Convictions run deep and you might run back to it. Keep working on it, a DAY AT A TIME, or once and for all if you can.

      • Kevin B says

        Sean,

        Like your buddy Parker, you are suggesting that you’re own success in 12 step (all of 30 days at the time of the post) should automatically apply to everyone, and, even worse, if someone happens to disagree or has had a different experience in the rooms, you’re quick to imply that they just don’t get it. Because AA worked for you, when you couldn’t otherwise stop and you tried rehab and methadone clinics and you this and you that, this allows you to conclude that, and I quote:

        “There is but one solution and that is establishing a spiritual connection with your higher power and working the steps.”

        You can’t possible believe that the only way to get sober is by going to AA because it worked for you. While I actually admire you’re passion for working the steps and fundamentally agree with much of the logic behind the program, you have to recognize how dangerous it is to claim there is one way to heal from substance abuse. This is what all treatment centers preach, and it creates a huge dilemma. What if you go to enough meetings to get the gist, get a sponsor, and legitimately give it a shot, but can’t fundamentally give yourself to the program for whatever reason? If it’s the only way, I guess those of us who it doesn’t appeal to are forced to conclude that our situation is now truly hopeless? I suggest we all meet in the middle and say AA is a highly available option that has worked for many people, but other options exist as well and it’s highly unproductive for any methodology to claim lordship over all matters pertaining to sobriety. While addicts can relate on many topics, each human is unique and the nuances in our personalities, values, world views, life experiences, and history of substance abuse make the thought of forcing all of us into the same treatment program absurd, lazy and irresponsible. If it works for you, I’m honestly happy for you and genuinely wish you the best, but allow people to seek other options that may be better suited for them without being so defensive…please.

    • robin galvano says

      you hit on and are correct on some key issues. in “addiction and grace” by gerald may MD, he concurs insomuch that it is not an addictive personality but an addicted personality. to be alive IS to be addicted. you stated that flippantly but anything from crack to bubble gum can become an idol to someone. ANYTHING that supercedes a persons innate desire for God. attachments becomes desires becomes addictions become slavery.
      the 12 step programs are NOT to get someone to stop the addiction. they are to choose a behavior change. to seek a Higher Power. this provides choice…and freedom.
      while i agree that it is a choice, i disagree with your premise that man can rely on his own mind or will to accomplish that.
      Adam willfully ate the apple. addiction is yet another by-product.

    • Brent says

      It might help someone like you, but it could do serious damage to someone who is drug addicted. I am not saying that you will have the disease for the rest of your life (theory of NA & AA), but it is a disease. For someone like me, it was not only a psychological addiction, but a physical one as well. It wasn’t a matter of just saying no, it was a matter of healing myself with the help of doctors and therapists. You spout this stuff with no expert opinion, just the word of journalists who paraphrase what they have read. I would challenge you to obtain the direct opinion of doctors and scientist worldwide to dispute the findings of the National Institute on Drug Abuse, The National Institutes of Health and The World Health Organization. I would further challenge you to prove that it is a matter of choice by experimenting with one of the addictive drugs, say crack cocaine, for a month and then just quitting, if you can. I am sure after that experience they would dispute the argument that addiction is not a disease it’s a choice. If you can, then maybe I would listen to you.

      • says

        There are plenty of bonafide MDs and PhDs out there who disagree with the NIDA’s position that addiction is a brain disease. The program I work for, which is based on the position that addiction is not a disease, gets plenty of referrals from doctors. I have had several doctors as students. There are doctors such as Tom Horvath PhD who heads up SMART Recovery, and Sally Satel who strongly disagree with NIDA. There are plenty of PhDs like Stanton Peele, Gene Heyman from Harvard, Jeffrey Schaler, Peter Cohen from the drug research center in Amsterdam, etc who disagree with the NIDA et al’s position that addiction is a brain disease. They’re out there, and they’re making strong cases – I am not alone in this.

        If Nora Volkow would have me, she can bring me up to Brookhaven laboratory, scan my brain, get me “addicted” to heroin, and watch me quit on my own, then scan my brain again. I’d gladly volunteer to show that it can be done. However, we don’t really need to do this, since there is tons of epidemiological evidence which shows that the vast majority of people quit these problems without professional assistance.

        Also, you think I’m just quoting journalists? I directly analyzed the NIDA’s presentations, and the research papers published by Volkow on the meth addict brains she scanned that form the core “evidence” for NIDA’s claims. I’ve directly studied the research paper on the taxicab drivers mentioned above – even though I reference Jeffrey Schwartz PhD’s discussion of it (he’s a research psychologist – not a journalist). I’ve read the research papers on contingency management, even though I mention Gene Heyman PhD’s discussion of them (again, he’s a research psychologist, not a journalist). Etc, etc etc. The only journalist I quote here is Sharon Begley. Read more carefully before you take a ridiculously baseless potshot.

      • says

        Gene Heyman, PhD, in a recent journal paper published in Frontiers in Psychiatry:

        “It is time to think about addiction in terms of what the research shows, particularly the more recent epidemiological studies, and it is time to abandon the medical model of addiction. It does not fit the facts. The matching law, melioration, and hyperbolic discounting predict that drugs and similar commodities will become the focus of destructive, suboptimal patterns of behavior. These same choice models also predict that individuals caught in a destructive pattern of behavior retain the capacity to improve their lot and that they will do so as a function of changes in their options and/or how they frame their choices. This viewpoint fits the facts of addiction and provides a practical guide to measures that will actually help addicts change for the better.”

        Here’s a link to the full paper – Addiction and Choice: Theory and New Data

  2. Holly says

    I am utterly committed to not using the 12 step fellowships as a tool for recovery. I am not impressed at all with the limited disease model and the limited recovery on offer in any of them. I am 25 years clean and left them all after 8 years. I had done NA, CODA and SLAA. I never believed I had a disease. I did like CODA and SLAA for shining a light on deeper emotional problems and providing some tools to enhance my self worth. At 10 years I had a complete emotional breakdown/breakthrough when my emotional history that I had buried from my childhood came flooding out like a burst dam. But not before some seriously self-destructive behaviour (although I did not drink or take drugs) had tried to protect me from all that buried pain.

    I would say that my desire to truly recover precipitated this holocaust in my soul, as once my fractured self came out and grief was my only option, I very quickly unfroze and lost much of my compulsive and self destructive nature. In between these huge wells of grief and I won’t sugar coat it, they were intense and long and many years of work, I started to really feel connected to myself and happy and at peace in a way I never had before.

    I just wonder where this fits in with all the cognitive models. I like cognitive therapy and there is definitely a place for it in my life, but I am also a trauma survivor and my experience of this burst dam, which was quite the surprise to me, indicates that the psyche buries much that needs to be released in the emotional sphere. I have known many people who were sexually abused, coming from abusive, loveless and neglectful family homes whose self hatred and self destructive behaviour escalates the closer they get to the place where the trauma resides.

    What are your thoughts and feelings about this? I am loving all these alternatives on the net and researching everything in an attempt to figure out what I would do when faced with trying to help an addict now that I would not send them to AA, NA, SLAA,etc…
    Thank you very much.
    Holly

    • Ashley says

      Hi Holly,
      There are a plethora of resources available to people with addictions. Just because some people struggle with the disease model does not mean 12 step programs are ineffective. This type of support has been around longer than I have and it has saved countless lives. I am glad that you found ways to beat your addiction, but I would not be so quick to throw out other alternatives for others with the same issues. It is a cookie cutter way of thinking and everyone is different.
      There is one good thing about the disease model, and that is taking away some of the shame that many addicts feel and allowing them to finally open up about their burdens. Not to mention the court systems providing more treatment to addicts rather than punishment.
      I wish you the best in your recovery and hope you fine the best that life has to offer.
      Sincerely,
      Ashley

  3. Trish says

    At the time Dr Benjamin Rush first proposed that alcoholism was a disease rather than a character flaw, people also believed that a slave’s desire to escape enslavement was a disease, “drapetomania”. At that time, “fever” was considered to be a single disease. At that time, doctors didn’t even wash their hands before touching patients. At that time, the idea that invisible organisms with their own interests might consider human bodies to be a source of food, shelter & reproductive resources would have seemed ridiculous.

    It might have been forgivable, with the state of medical science at the time, to assume that liver failure in people known to drink copious amounts might be a disease that developed slowly over a long period of time. But we now know that it’s possible that overuse of alcohol might make the liver more susceptible to hepatitis, but that hepatitis doesn’t happen to everyone who overdrinks. We also know that people who never had a drop can catch hepatitis. It’s the infection, not the drinking – or desire to drink – that is the disease.

    But, today, over a century after germ theory, disease can be defined as a physical form of dysfunction caused by:
    infectious agents: bacteria, viruses, prions
    poisons: mainly heavy metals like arsenic & lead
    chromosome malformations, defective genes, malfunctions in epigenetic switches
    organ malformation or malfunction
    hormone levels over or below optimum
    malnutrition, especially insufficinet nutrients like iodine or vitamins [& I mean diseases like pellagra & rickets, not feeling a bit tired & gobbling vitamins]
    noninherited birth defects: low levels of poison or infections during pregnancy, malnutrition of mother, accidents during gestation, malformations of fetal organs of causes that can’t always be determined after the fact

    The thing is, in all the above cases, it is possible to use physical measures to divide the population into two groups, those suffering disease X & those who don’t

    And yet, even though the AMA originally panned The Big Book, doctors, especially American doctors, are heavily involved in promoting the disease concept of addiction/alcoholism. It could be that some aren’t versed enough in science to understand the weakness of the arguments in favor of alcoholism/addiction-as-disease as created/promoted by a failed stock swindler, some see the disease model as a useful way to scare people into better behavior, & some are making money running clinics that promote a theory that sets people up to be repeat customers. And, nowadays, the concept is so popular that some doctors who know full well that addiction/alcoholism is a bunch of hogwash have been intimidated by their employers to go along with the disease “theory”.

    But what makes disease theory such an incredibly ridiculous proposition is that it’s now claimed that pretty much anything anyone wants to do more than once is an “addiction.” I’ve seen FBI profilers on TV saying that serial killers are addicted to killing.

    • Matt says

      I used to be a firm believer in the disease theory, but I’m kinda on the fence now. Your points are based on physical. What about mental illness and gentic disposition?

      • Trish says

        Why would you stop believing in germ theory? Has there been new evidence to demonstrate that bacteria are just adjacent to infections, not causing them?

        Some “mental” illnesses involve actual physically measurable phenomena – schizophrenic brains show differences in size, and shape, that reliably change over time (the areas smaller than normal people get smaller over time). Most of what we now label as “mental illnesses” are about behavior & self-reporting of internal states. I’m not saying the people identified as “mentally ill” aren’t suffering, but suffering and disease, while they may overlap in a venn diagram, are not the same thing.

        • Hates worthless junkies says

          Do you know anyone who made a choice to become a schizophrenic? Do they have the ability to ditch their stymptoms after a few short days? Choices. That’s what the difference between addiction and disease are. I think we can all agree something drives people to habitually use hard drugs, but dressing it up and calling it something it’s not gets us no closer to understanding it than ignoring it all together will.

          • anonymous says

            i personally believe that most addicts that cant seem to stop have a learning disability, they dont learn lessons like normal people. that may be the real disease.

      • Andre Montoya says

        I agree and basically said the same exact things stated here i.e. not a disease, but ones own decision along with reflect interest for positive gain theory behind addiction clinics, as a possibility. I feel its more then that though, or a mix of all your notions. My post was the ^^^^ giant paragraph above, though well written I still forgot to break it up a bit. However, I make some valid points, and I agree with you here. Something needs to change in this world, doctors and other people with creditable power are capitalizing, manipulating public views

    • d jones says

      “Specialists” can call things an addiction, as long as they recognize that addictions can be broken. Moral responsibility is still a part of the solution. NA allows for moral responsibility more than AA in my neck of the woods. I often go to AA and NA meetings to challenge some of the long held beliefs. I watch people go in to these meetings, stay awhile, then leave, come back, or never show up again. Something’s not working. My “sponsor” (he’s more of a friend, really, as we don’t officially work the “steps” and never pressures me to do so) always tells me “take what works and leave the rest”.

      Also, I am learning that people are at different stages in their lives. Maybe they need the structure…for now. But even my therapist who is a die hard 12 stepper, tells me that I need to seek out a plethora of social support orgs.

      Creating new synaptic connections takes time!! It is hard work too!!

      • Trish says

        But the “specialists” claim “addiction” is a lifelong, unbreakable condition that can be managed but not cured.

        Of course it can be difficult to change behavior and habits, but that doesn’t mean the behaviors & habits one wants to change are a disease.

    • mar116 says

      I believe Trish comment on disease theory that “some are making money running clinics” . I have a heroin addicted 21 yr.old daughter that has been to 3 rehabs, outpatient etc…Insurance covered most, but I had a lot of co-pays, medicine bills etc… They all taught my daughter that she had a “disease” and was “powerless” over it! After the insurance was up, and I wasnt waving a check in their face, none of them could have cared less about her, and thats the truth. After going through countless therepist, doctors, all advised after rehab stints, I’m convinced this is all about the money. If she truly has a disease, why doe’s this “disease ”
      disapear when you are entertaining her?. Seems when she is entertained 24/7 , and your spending money on her ( taken shopping, lunches, parks, beach, etc..)
      shes fine, happy and drug free. But once the money for entertainment runs out, she is suddenly back on drugs and has the “I have a disease” cry again.
      I love my daughter more than anything in the world, but my view on this is the return to drug abuse is there when plain old boredom sets in. What happened to the tough love good old days where they just told people “get your &**^&## together? nowadays drug rehabs will have you running your loved one to every counselor in town for the rest of their life.
      Disease? or Money racket
      Maybe I just have a spoiled brat?

  4. Eddie says

    Disease can refer to a condition that causes pain, dysfunction, distress, social problems, and/or death to the person afflicted. Drug or alcohol addiction can be viewed as a mental disease that was brought on by choices in the beginning, paving the way for harmful abnormal behaviors during its reign(20 weeks to 20 years), and by choices end the cycle. Overt stress can have a negative effect on our psyche. We may choose to salve our feelings in many healthy ways: exercising, reading a book, communing with nature, cooking, having a glass of wine, etc. We may also choose to salve our feelings in unhealthy damaging ways: having five glasses of wine, smoking a joint or a pack of cigarettes per day, indulging in cocaine, meth, hard liquor, heroine, etc. Addiction is a disease curable by the level of determination behind the choices to turn the downward spiral around. The physical evidence proves it’s a brain disease, the cure proves that it is not.

    • Expose them says

      Alcoholics Anonymous and other such Anonymous groups do nothing but preach you were born addict and try to act like it’s a disability. When you put a chemical in your body- that’s a choice not a disability. A disability is in everyway involuntary – there’s nothing free will about it. You drink alcohol or ingest a drug in any other way- that’s a choice. Doctors will say a so called addict’s brain is different from everyone elses just so they the doctors can get money to fund such pseudoscience studies and/or collect money from insurance carriers or Medicare, or maybe it’s to hide their own abuse. Statistics prove that those who abuse alcohol or other drugs (past or present), are at their core self-centered liars. Alcohol and drug abuse is a telltale sign of that and nothing more. But thanks to groups like Alcoholics Anonymous they’ll keep on cheating, lying, stealing, and using because these groups support that kind of behavior as long as the abuser comes to their meetings. As long as they aren’t inebriated at the meetings and recite the twelve steps along with the Serenity Prayer they can still lie, cheat, and steal and remain anonymous. Don’t let these abusers be anonymous anymore. Instead expose them publicly in every way for what they truly are – self-centered liars. Do not donate time or money to any organization that supports so called addiction recovery or abusers in any way. Remember these abusers are far from powerless or helpless because they CHOOSE to lie to, cheat, and steal from anyone to continue their selfish ways.

      • Wow says

        You are very uneducated and ignorant. how pathetic and sad. Just wait until someone close to you goes through a disease like this. WOW

        • Stephen says

          This guy who wrote this knows nothing about AA. I am an addict and am not a bad person. I have suffered terribly from addiction. I have always felt different, separate, and apart from the rest of humanity. I am a college graduate and achieved great successes in my life. I am now sober and it is very very hard. I thank God everyday I’m sober and hope and pray I can continue on in my journey of sobriety. This individual is very ignorant and I would love to have you walk in my shoes and deal with the thoughts I deal with on a daily basis. You wouldn’t last. So rude and disrespectful.

          • says

            But I would. Be rude and disrespectful. You have a big stake in being a victim, I’M HERE TO TELL YOU THAT IT ISN’T WORTH IT. I always felt different, separate, and apart from the rest of humanity. BUT SO WHAT? You mean you’re telling me that you feel anxious? Maybe you should check into psych meds. In AA they will tell you to use your higher power. That’s why you are suffering now, because you listen to laymen at AA. Being an alky doesn’t make you an expert on addiction. They are lucky to have any valid insights into their own condition. AA will make you slip sooner or later. You’re suffering because you are listening to the wrong message. You do not have a cunning, baffling, incurable disease. I’m not blaming you for the choices you made but it is time to take responsibility. LIfe is difficult and sometimes brings pain. Just take it.

          • on the other side says

            For everyone who wants to criticize some for calling addicts selfish think back to the many things you did to your loved ones. You are self-centered thieves that lie so much that it seems to become a “disease” of its own. As you may be able to tell I ha e dealt with an addict in my life for a long time and he made stealing medication from me a habit vrom the time became disabled and started receiving prescription narcotics. He would steal from me and I didn’t die or have any compulsion to go and steal from anyone else. Since other family that’s we lived with told me I would be unwelcome in our home if I turned him in I was held hostage for three years and two failed attempts at traditional its everyone else’s fault rehab. My family even blamed me for him stealing my narc. He always had family protecting him giving him the freedom to do whatever he wanted. Happy to report my family after over three years and a refusal to change have allowed me to turn him in and he has been charged. For everyone that says walk in the poor helpless addicts shoes try walking in mine.

          • Ken says

            Yes there are other ways to be sober but I saw a guy take his 43 years a couple weeks ago and he hasn’t slipped like you said people would.

      • says

        Nice work Expose. In addition to all you say, there are predators and child sexual offenders mandated to these meetings. The meetings were started from a con man, narcissistic, womanizing liar and they were made for the same. Stay away people.

      • Parker Nettle says

        Anyone who thinks disease is a choice and not a disease is an idiot and obviously not a true addict. I would have never done the things i’ve done had I had a CHOICE.. THE ONLY CHOICE I HAD WAS CHOOSING TO DO THAT FIRST DRUG AT TWELVE YEARS OLD THAT SHIFTED MY BRAIN TO THE FRONTAL CORTEX TO THE MID WHICH MADE ME A DRUG ADDICT.

        • Xdruggie says

          To say you don’t have a choice is just not true. I know. People need to face the fact that they DO have a choice . No one forced me to take that first drink/ drug- I knew in my heart I could have said no. I knew that the alcohol and drugs had addictive properties but I did it anyhow. That was my choice. When I finally stopped listening to people telling me that I didn’t have a choice- that’s when I was empowered enough to get clean. Telling someone they don’t have a choice because they have a ” disease” only helps to keep them addicted. Great article! Bravo! We need to tell the truth and stop hiding behind excuses. That’s what I did and now, finally, I’m free.

    • Trish says

      No, you don’t get to decide what is or is not a disease, just because you want to get the kind of sympathy that society rightly offers to people who actually suffer physical conditions that are no fault of their own & make life painful, difficult or shorter.

  5. lexie says

    you think when i was a little girl i thought ” im going to be an alcoholic addict t\when i grow up” no. you have no idea what your talking about. addiction is a disease called chemical dependency. for all you people who think that alcoholics and addicts are just low life people and use it as an excuse not to quit, you better dig deeper.

    • says

      Hi Lexie,

      Of course I don’t think that you decided as a life goal to be an alcoholic. But I do happen to think that you’re making a choice every time you consume a drink. Drinking and drugging are purpose driven behaviors – the purpose being personal happiness (or relief from unhappiness, which is still a form of pursuing happiness). I make no judgment about drinking or drugging (or even “excessive” drinking and drugging) in and of itself as a behavior for lowlifes.

      While some people may deliberately use the disease theory as an excuse when explaining their behavior to others, I’m more concerned that many more will sincerely believe and embrace the disease rhetoric, and learn to be helpless as a result – becoming a self-fulfilling prophecy, living up to the lifelong disease view (as I did, once upon a time).

      The disease theory has mainly gained acceptance because it allows our loved ones to explain behavior which they otherwise cannot understand – they see what we do, and the only thing that makes sense to them is that we must be sick, insane, out of control – diseased. The truth – that from our perspective, we believe that the feeling provided by drugs and alcohol is the most happiness available to us – is too simple, too obvious, and at the same time too incomprehensible for them to even realize. Likewise, it’s apparently too simple for counselors and other so-called addiction experts to realize.

      When you realize that it’s simply a choice made in the pursuit of happiness, and yet you also get a glimmer that it might not be worth the price, or that there might be greater levels of happiness available to you – then you can change the behavior. From there, it’s all about exploring your options and making bold new decisions.

      Best Regards,

      Steven Slate
      Author, The Clean Slate Addiction Site

      • Jen says

        Addicts might have the choice to pick up their first drink or drug, or return to it, but in the cycle of using after months or years of being physically and mentally addicted, there is no choice. No matter how much you want to stop, you are going to use if you are in that cycle. Maybe you swear you will not, lock yourself in a room to abstain- but once that craving hits, you will do everything possible to get out and use regardless of your prior promises.
        Other than that i agree that addiction is not a disease. I currently struggle with using after months sober.

        • kelly says

          I agree it’s very difficult to change a habit, and to see that there is a choice. I really believe I just couldn’t see my choices, or I was afraid to change. I didn’t have the courage to do something different. That’s why education about choices/habits in school is so important, and we should teach that instead of scaring kids about drugs.

          It was important for me to look at why I used drugs. Why I wanted them. What was I avoiding? Every thought of drug use comes down to avoiding/escaping something, I think. But I’m no psychiatrist, just a gal who has reflected a lot on why I did it. It took me almost one year to be completely emotionally back to where I was before I started the addiction. I think it was just my brain normalizing, forming new habits, gaining more strength from my activities, getting used to facing situations without substances. What kept me going was “don’t pick up no matter what’, and “take the next indicated step”. That kept me focused on what I had to do to move forward, instead of glamorizing the past.

          • PJ says

            I’m just grateful to both of you for sharing what you have learned, and are continuing to learn about the journey. It helps us all develop in our belief that the change we hope about ourselves is not only possible, but likely. Little by little…It’s process that takes as long as it takes.

            Stay forward focused, Jen. You’re getting there:0) And, Kelly…Thanks for the inspiration you give above. I shared the link to your comments above with someone I know and care about. It resonated in them deeply. Both of these comments did.

            “This” is the kind of stuff that we oughta’ make sure we are all doing in forums like this. It’s such a friggin’ awesome opportunity to share information regarding substance use disorder/addiction…but, as importantly to serve hope, health and well being in a compassionate spirit of humanity. That’s ‘evolution’, baby!

        • Xdruggie says

          But you still DO have a choice. I know- I was addicted and I made the choice to do whatever it took to get clean!

    • Courtney says

      lexi, I too never thought that when I grew up I wanted to become a drug addict but I did. Like my two brothers before me I fell into addiction. My brother just died two months ago, OD. I saw what it did to them but still CHOOSE to do it. No one made me no one forced me. We all have a choice in life, to pick up, not to pick up, to call our drug dealer or not call our drug dealer. Its not a disease its a choice, we may be chemically dependent on drugs because we chose to do them time after time, day after day after day, no one forced us. Us as addicts say we have a disease so we can blame the disease for us being addicts and not out choices to pick up the drug.

      • Sean says

        No, you made the choice. No one denies that you make the choice, but there is also an element of chemical dependency, which is called addiction. I think this site is confusing people about the two. You yourself, said it. “Us as addicts, say we have a disease so we can blame the disease for us being addicts and not our choices to pick up the drug.” Well, no. You should be blaming yourself. You made the choice to start doing drugs and you made the choice to become chemically dependent on them. HOWEVER, no one can sit there and seriously tell me that there is nothing addictive about crack or heroin or even cocaine. This site shows pictures of brain scans and tries to confuse people that this is the same as people who drive taxis. Great, but driving a taxi won’t make you lose your family or rob a store. Playing the piano won’t lead you to prostitution. Just because your brain changes doesn’t mean that the change is good or bad. It depends on how the change occurred. If your change is from drug use, that’s probably bad. What this site is telling us is that everyone just lacks willpower. That could account for a lot of people, but statistically speaking, that could not possibly account for every single addict in the world. It’s just impossible. The statistics involved would literally be impossible. The whole world would be lacking in willpower. The most recent study said there were over 6 million children living with one parent who was a drug addict at least. So, that’s six million weak-willed parents, minimum. Not counting single people. Also, in 2009, the United Nations Office on Drug and Crime released their report on drugs, which said over 1.3% of the world’s population was addicted to amphetamines. Last time I checked, the current population of the world was 7 billion people. That means 91 million people are weak-willed, just from amphetamines? That is not statistically possible. That sounds more like addiction.

        Yes, I agree with everyone that putting the blame on a disease is bull. Everyone needs to take their own share of the blame. Classifying addiction as a disease does not mean that the addicted person is a helpless victim who is innocent. On the contrary, is is their choice. Even 12-step programs teach responsibility first. When you hear them get up there and they say “Oh, I don’t have a problem”. You’re thinking it’s BS. Everyone else is thinking the same thing, but AT LEAST HE GOT UP THERE. Making the decision to step in the meeting is a huge step for some people. At least they got off the bar stool or out of the shooting gallery. I think your comments are all a little naive. My wife struggled with addiction for a while and she needed help to get clean. Myself, I did drugs and when I got bored, I quit. Two different people from two different backgrounds. She has lots of emotional issues and extensive trauma in her childhood. I understand why she did drugs. I don’t excuse it. Neither does she. She constantly admits it’s her fault. Those who put the blame on the disease aren’t fooling anyone. I have to say this site is kind of insulting, to be quite honest. What if an addict were looking for help and this was the first thing they found? They would think they were just too weak and just keep drinking. If hitting bottom and coming back up was a choice, then explain all the homeless people who are out there who have hit rock bottom and still stay there because they are addicted to alcohol or drugs? They have definitely hit rock bottom. I have heard it from hundreds of them that they would choose to pull themselves out if they could. When given the chance, they reverted to their old ways. That’s not a chance, that’s an addiction.

    • says

      “chemical dependency”…..as long as the drug is in your body. Once it is out of your body, you need to rely and apply scientific principles as outlined in neuroplasticity to ensure you never use again, or at least, greatly increase the chances that you won’t.

      I refuse to say…”and I am an addict/alcoholic” at 12 step meetings. I will not reinforce a self fulfilling prophecy by repeating these words. I am a human being, with the propensity to do destructive things to myself and others.

  6. Karen says

    To some extent, I agree with you that addictions should not be classified as a disease like cancer, meningitis or other diseases over which a person has no control. Where I disagree with you, however, is in your argument that addictions cannot be addressed through the medical model used to treat disease. Many clusters of behavioral symptoms that the medical and psychological fields classify as mental disorders vary in their cause and are usually attributed to a combination of physiological, psychological and environmental conditions. In fact, for many (or maybe most) of them, science has not been able to identify a cause. Lack of an identifiable cause for any specific disorder, however, does not prevent the disorder from responding to medical and psychological treatment. Thus, things like depression or addiction can respond to medical interventions that target symptoms both physiologically and psychologically. So, for example, the treatment for someone with an addiction might involve both medicine (although I think that’s often given to address comorbid psychiatric disorders) and therapy to help the person manage and reduce symptomatic thinking and behavior.

    I disagree that classifying addiction as disease necessarily implies that the addicted person is helpless. This simply isn’t true. And it isn’t true even in some other conditions in which science has identified a physiological cause, like diabetes. The reality is that there are many diseases and disorders for which behavioral change is the key treatment (like addiction) or a major component of treatment (like diabetes or heart disease). Simply classifying a cluster of symptoms as a disease doesn’t remove responsibility for management of the disorder from the affected person. Even within the confines of medical disease (and especially chronic disease), people are required to make choices, every day, with regard to how they are going to manage their condition. For some, the only choice is whether to take their medicine. For others, it involves many more behavioral choices that determine whether their disease becomes better, gets worse, or simply remains manageable. Addictions are disorders that fall in this latter category.

    Finally, I also disagree with you that 12-step programs teach helplessness. Which 12-step programs do encompass the concept of powerlessness, it does not involve an absence of choice. The third step talks specifically about making a decision to turn your life over to the care of God. The remaining steps also encompass many concepts of choice and require taking action – in making an inventory, making amends, etc.

    Where you are right, is in refusing to let people with addictions get a free pass on their behavior. People with addictions have a definite choice regarding whether they will make the behavioral changes needed to manage and improve their disorders.

    • Clayton Moretton says

      I do not speak from a scientific standpoint at all. I speak from experience. I am ambivalent to the idea that addiction is not a brain disease. There is one component of addiction that I want to comment on. That would be compulsive behavior. You say that compulsion is voluntary It is my experience that it is not. I was compelled, without relief or any forethought that I had a choice whether to seek out or use drugs. I could not stop. My brain was telling me not to stop until I had procurred drugs. I had to hit bottom before I found the courage to stop……I have been sober 2 years now. I still have cravings, but I know now I do have a choice. Before, I did not. And almost every addict is in the same boat.

      • says

        I’m a bit confused Clayton. Do you think that at one time, you literally were incapable of choosing to stop, and that at a later time you became capable of choice?

        Or – is it that you were capable of choosing differently all along, but you simply didn’t believe (or know) it before?

        • Clayton Moretton says

          I did not make myself clear. I believe that I did not have a choice to stop. I think addiction is more mental then physical, although the physical need was overwhelming. It never became clear to me that I could live another way until a medical intervention from my physician and friends took place. Willpower plays a small role here, but it too cannot work if one has a malfunctioning brain. I speak for myself here……I could not stop. Period. Now, I have stopped. Not just because of the intervention, but because I have turned my life and my will over the God of my understanding. That is something 12 step programs have taught me.

          • AM says

            I believe that you believed that. I also believe that you believed you had the right to treat yourself however you saw fit, even if that included seriously self destructive behavior. You may have believed it so strongly that no one else had the right to tell you otherwise, and you then had the right to lie, cheat, steal, conceal, whatever it took because no one could take that most basic right to destroy yourself away.

            Perhaps a belief in a higher power helped you realize how not alright it was to abuse yourself. Perhaps for some it is deciding they have enough self worth that it is no longer acceptable to abuse themselves any longer. Perhaps removing that choice to choose addictive behavior is the critical difference which allowed to choose something different, and made the real change happen.

            Repeatedly I hear addicts must ‘hit bottom’ and then change happens. Hitting bottom seems to mean that the addict decides the addiction is no longer acceptable. Something about the addiction hits them hard and they have to face the real consequences. They no longer believe it is OK to treat themselves, others, or whatever, with that kind of abuse. That is a choice.

            I think the entier premise of ‘hitting bottom’ shows just how much of a choice and allowing themselves to abuse whatever they abuse demonstrates this completely. If that suddenly puts someone in a position to choose to not use/abuse, then it shows the choice was there all along, but they believed in their core that doing that abuse was Ok for them.

            A choice.

        • Ziggy says

          Compulsion to use and abuse IS voluntary… it’s your “beast” that gains control of your body. It’s that voice that keeps telling you, “come on, it’s ok this time” – the beast is a heartless faithless lover that will always suck you in and do it again and again until you decide (choice) to say NO to it. and NO you won’t die>you also will not hurt anyone else physically, mentally or spiritually by using one more time. I had a real recent experience “letting down” a friend by my stinking thinking that I could have a couple of beers. WRONG. No real harm tho’, apology accepted and back on track. Thanks for listening.

      • says

        but you can change your brain’s tendency to be OCD. I think the science of neuroplasticity is very exciting. I always felt like the moral component of addiction was the prevalent one that needed to be addressed. Why would the emphasis be so much on relying on a higher power? Who helps a person to adjust their moral behavior, historically? A higher power. So, whether you acknowledge it or not, the 12 step programs are using “moral methods” to change a person. Predominately, so, I would say. How about step 4: moral housecleaning. Making right (moral) choices is replete throughout the 12 step literature.

    • says

      Thanks for the input Karen, but I have serious problems with the diabetes comparison:

      I disagree that classifying addiction as disease necessarily implies that the addicted person is helpless. This simply isn’t true. And it isn’t true even in some other conditions in which science has identified a physiological cause, like diabetes. The reality is that there are many diseases and disorders for which behavioral change is the key treatment (like addiction) or a major component of treatment (like diabetes or heart disease).

      A cellular malfunction is the root problem in diabetes. The symptoms are all caused by the cellular malfunction. The behavioral changes are all about regulating the amount of sugar intake so that those cells don’t get more work than they can handle (and thus symptoms are minimized).

      Substance use is a behavior. If behavioral change is the treatment – then doesn’t that mean that you just choose to stop using the substance? It’s very direct, whereas the diabetes thing is indirect, and wholly different.

      You can’t choose, as a behavior, for your body to handle sugar and insulin differently. You can only choose to use medicines which make up for the deficit, or choose to regulate your sugar intake so there won’t be so much malfunction. From there, symptoms may subside as a result. The cause is cellular malfunction. But in addiction, symptom and cause are one in the same – the symptom is using to much – and if the treatment is to change your behavior, then the cause of the behavior is chosen behavior. Do you see the circle you’ve sent me in?

      Now, I know you didn’t say this, but your diabetes example makes me feel the same way I do when hear people say that “abstinence is the best treatment for addiction.” Huh? How is it a treatment? If addiction is using substances, and abstinence is not using substances – how is anything being treated? How is a disease or medical treatment involved? It’s just do it, or don’t do it.

      I didn’t eat lunch yet today. I guess the best “treatment” for that is to eat lunch. I’m gonna go treat myself behaviorally now.

      • Ziggy says

        I know that certain ethnic groups are more susceptible to diabetes and alcoholism…does it really matter if you have destroyed your pancreas and liver by overindulging in your favorite substances that are pre disposed genetically to cause poor health? I know plenty of borderline (not on insulin yet) diabetics that will eat themselves into their graves because apparently they have NO voluntary control of what they put in their mouths and swallow. RIGHT!. Does anyone see my point?
        It really does not matter if you are fighting for your physical survival. Maintaining your social status and personal relationships is ENTIRELY choice. Expecting others to make excuses for your PTSD or childhood trauma (oh you have to love me no matter what – NOT) is NOT acceptable. If you are driving impaired, I have serious issues with that. Sorry, that’s my morality. If you want to be miserable and punish yourself for the rest of your life, please don’t take me out with you. I am HAPPY!

      • Don says

        Steven and Karen-

        I would like to offer the following to help explain the differences and relationships between disease, addiction, symptoms, behaviors and causes.

        The nutritional and psychological literature that I have consulted seems to be pretty much in agreement that addiction is a biological state in which our body has become acclimated to, or adapts to, the presence of a noxious or toxic agent (alcohol, drugs, unhealthy food) such that the toxin no longer has the same effect; this is known as tolerance.

        Addiction is not, as Steven states, “using substances”; using substances is a behavior. A symptom and a cause are also not, as Steven states “one in the same – the symptom is using to much”. Again, using too much is a behavior. The behavior is imbibing the toxic agent in quantities and frequencies sufficient to create the biological state defined above as addiction. I think it’s important to distinguish between chosen behaviors(using substances, abstinence) that we are trying to change, the biological state caused by those behaviors(addiction), and finally the chronic diseases that may result from maintaining this toxic biological state at a cellular level(liver disease, diabetes, respiratory disease, etc). I believe that making these distinctions actually supports the model that addiction is not a disease and that the root-cause of the whole thing is changeable behaviors.

        While addiction has it’s own symptoms(physical dependence, tolerance, withdrawal) and can be extremely difficult to eliminate, it isn’t necessarily a disease, which also has symptoms. The word “cause” could be used in many areas. Our behaviors may cause a change in our biological state, which may then cause certain chronic diseases, which may then cause certain symptoms. We might even say then that our chosen behavior is the root-cause of our liver disease.

        Finally, I would say that this same model could be applied to a disease such as type-II diabetes. Our eating habits(behaviors) may contribute to a biological state(addiction), which may lead to diabetes(disease).

        I hope this is helpful and I welcome your thoughts and any feedback.

        -Don

        • says

          Hi Don,

          I appreciate your contribution to the conversation. But I must note that tolerance and withdrawal are not the same as what is known today as addiction. Specifically, the NIDA says that they are not one in the same, and that “addiction” as they define it needn’t include tolerance or withdrawal. When addressing the difference they state that addiction, or “compulsive drug use despite harmful consequences—is characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and, sometimes (depending on the drug), tolerance and withdrawal.”

          Since this has come up several times in comments, I have decided to put up a page dedicated to this issue. It doesn’t necessarily address every point of your post, but you will find it relevant. It covers some of the problems I see most often when the issue of physical dependence is raised. You can see the page here: http://www.thecleanslate.org/dont-you-know-about-physical-tolerance-and-withdrawal-aka-physical-addiction/

          To your points about causes and symptoms, I maintain that in many of the definitions and diagnostic criteria they are one in the same. The use of drugs is considered both a symptom and a cause of addiction. I promise you I didn’t create this circular logic, the various organizations who claim to be the authorities on addiction came up with this. Perhaps you misunderstand me – I like to point out the absurdity of it.

          Thanks,

          Steven

    • says

      This is an important claim:

      Thus, things like depression or addiction can respond to medical interventions that target symptoms both physiologically and psychologically.

      It’s wrong. Addiction does not respond to medical interventions. I have tried to find evidence that it does, but I just can’t. Treated addicts don’t do any better than untreated addicts. Epidemiological studies have shown this to be the case again and again. Gene Heyman lays out a whole list of such studies in his book “Addiction: A Disorder Of Choice.” I list one of my favorites here: http://www.thecleanslate.org/self-change/substance-dependence-recovery-rates-with-and-without-treatment/ This is from data collected in 2002, and is a follow up to a study done from data collected in 1992 – and the results are nearly identical! The point is, that when treatment centers claim any success, they’re only taking credit for self-change which would’ve taken place anyways without treatment.

  7. says

    Thank you for this post Steven. I can see the trolls are at it again. Maybe they need something to talk about for the upcoming Christmas alchothon. Nothing new. I wonder if excessively clinging to 12 Step mythology and fellow indoctrinees is a disease too?

  8. Clayton Moretton says

    I found this site while doing research for an English paper. Before I started to access this kind of information, and after I had been going to 12 step meetings for 2 years, I did not really have a belief either way as to whether addiction is a brain disease or not. Never really gave it much thought, even though it is described as a disease by AA and the like. I read the text in this site pertaining to this subject, and was enlightened to say the least. I was compelled to write something about my experience in recovery. What I have expressed here is just that, my experience….nobody else. Now while medical intervention and 12 step programs don’t work for some, it has helped countless millions over the years. I am not a scientist, nor am I well versed on addiction. I am however, an addict who has had the obsession to use arrested. What has worked for me is mine, and I own that. I just wanted to share experience where I thought maybe someone would appreciate it. Chastising someone for putting themselves out there is unkind and inappropriate. As is with the name calling (trolls? really?) I stopped that behavior when I stopped using. I respect your right to express your opinion, have some respect for me as well.

  9. says

    Sanctimonious lately? I do find it fascinating that Steppers comment on blantly contradictory approaches to addiction as if their input hasn’t been heard 7 million times before. I respect that you had an experience in “recovery.” Some people, such as myself, who have left AA are angry. Sites like this provide many with validation who cannot find it elsewhere. And here you come along to bless the world with your “spiritual awakening” that, to put it frankly, many are sick and tired of hearing about. You don’t have a disease. You choose to believe that a supernatural entity removed your “obsession” just as you chose to retort to a post I made that didn’t care for what you had to contribute. I do think however that since you did find this site, some doubt must be lurking somewhere in your mind. Just remember: “your best thinking got you here.” Have a nice day :)

    • Clayton Moretton says

      Not once did I say I had a disease. I did say that that was what AA suggests to its members. I am not convinced either way that addiction is a disease or not. So yes, I guess that means I have doubt. I think addiction should aptly be called a disorder, not a disease. I was not being righteous at all. I don’t think that just because I found help through 12 step programs that I am better than anyone else. But it worked for me, and that is all I really was trying to say here. I suppose that does make me a little biased, my bad.
      I am not a religious person all, but finding some solace in a “supernatural entity”, as you call it, is for me, my God. I in no way believe in God as Christian religions believe. It’s just something for me to believe in, a “false God” of sorts. Look, I in no way meant to point fingers, or put myself up on a pedestal. I just know what has worked for me. That is my belief and opinion. And we all know what they say about opinions. Let’s just agree to disagree. I’m done.

  10. says

    Though I admire your more liberal stance as an AA member (and I am assuming you are), I loathe it at the same time. I think it’s really what pulls a lot of people in the Program, including myself. I knew a lot of people in AA like that. Traveling around to different meetings, telling jokes, going to baseball games, “fellowshiping,” etc… I was part of it too. Say one thing contrary to AA dogma and you instantly become the elephant in the room. The comportment of these “friends” changes faster than you can say the serenity prayer. I think it was this that bothered me the most. Of course, there are the obviously “crazies” in AA like the Big Book “thumpers.” But I think the real danger exists in exactly the more milder “we’ll love you until you can love yourself” cunning niceness that ever so slightly hardens at the faintest indication of dissention. It’s cruelty at its finest simply because it’s practically invisible to non-members. The loneliest feeling in the world. It’s infuriating just detecting this tone in your writing (oozing with sanctimony and Step-speak by the way).

    • Joe says

      Ryan, you sound like a jerk. I think AA has a flawed approach, but to to downplay someone’s good experience just because you had a bad one is simply being a jerk. It is okay for some people to make changes in a way that doesn’t work for you. And it is also okay to share that on a forum like this. Drug addiction is a problem whether you subscribe to the philosophy on this website or to the disease rhetoric – and people making positive changes is really what is important. If you don’t agree with AA, that is fine, and obviously many people would agree with you. But there is no common sense in being a jerk and trivializing someone else’s success, even it it came via a path you find wrong. Being a jerk doesn’t do you or your viewpoint any favors.

      • ZSL says

        Joe, you’ve completely defeated your own argument by calling Ryan a jerk. His anger is as valid as your need to scold him.

    • HAHAHA says

      Hey Ryan, I agree with you I just left AA after almost 5 years when I realized how harmful it was to my psychological health and then realized it was a cult, and I was one of those people who would talk about praying to goddess or telling people you don’t need to believe in god at all, and basically was able to retain some sort of my own identity, but I still mixed it with telling people its a fatal incurable progressive disease and I wholeheartedly believed the stories that if I stopped going to meetings I would go crazy and die. since I stopped going to meetings I feel better than in my whole life, much safer, I got sober when I was 21 and didn’t believe it was a disease at all until I went to meeting after and meeting while I was in a desperate and vulnerable state and believed the bullshit message which I then carried for years. I feel better in some ways but now I am dealing with the fallout of realizing I was in a cult for years and feeling somewhat guilty of participating in it and roping others into it. but in the end I was vulnerable, I was sucked in and either people will leave or stay and it doesn’t really matter, as long as I have my self back and know who I am. I guess the last thing I want to say is AA really really really badly hurt me in a number of ways and that’s just as valid as AA helping another person. It deeply hurt me and terrorized me for years with stories of how if I left I would go crazy drink and die, but had no answer for the fact that meetings are full of predators. I was always told try different meetings. I tried so hard to make it work, but the healthier I got over the years the more horrible and pointless and depressing AA seemed to me, but now I am not chained to it and I don’t have to believe I have a disease.

  11. John S. says

    I came across this site quite by accident, while doing research on Neurological diseases. I have had several memebers of my family afflicted with Neurological diseases. Specifically Parkinson’s and Alzheimer’s. Neither of these diseases is completely understood and neither is curable. I do not believe alcohol is a disease per se. It is still a baffling and strange affliction that isdifficult to vercome. I do believe I am powerless over alcohol. I am an alcoholic and have had success in straightening my life up with AA. I am also pragmatic about the program. It is not for everyone. It is certainly not the ticket for the many 17 year old alcholics and crackheads trying to stay out of jail that the court system has dumped on AA. Likewise, there are certainly a large number of folks in AA that have problems greater than alcohol. A good number choose to use it as a substitute for professional counceling. Alcohol merely exacerbates these problems But, there are also plenty of sincere and kind people that are willing to help a newcomer. AA has helped me.

    • Ryan says

      @John S.

      I am glad you find AA helpful and have remained abstinent for so long. I have to pick away at a couple aspects of your post however because I think it is very crucial. You say: “there are also plenty of sincere and kind people that are willing to help a newcomer. AA has helped me.”

      Your last sentence clearly states that you were helped by AA. Correct? Before it however, you say that there are people willing to help ‘newcomers’ after stating that “AA is not for everyone.” My question is, what are the criteria for determining whether a ‘newcomer’ can be ‘helped’ by AA? If not met, would you ‘help’ the ‘newcomer’ find an appropriate alternative? What if the ‘newcomer’ expresses disdain for AA? Is he in ‘denial’ or on a ‘slippery slope?’ Is he told to ‘go to different meetings,’ thus undermining his own judgement? These are very important points for me as someone who has left.

      You also expressed some disdain for ’17 year old’ ‘crackheads’/’alcoholics’ and their presense in AA, which, if I remember correctly, is a violation of AA’s fifth tradition (Each group has but one primary purpose—to carry its message to the alcoholic who still suffers). It also seems like a 4th Step may be forthcoming: see Chapter 5 of ‘Alcoholics Anonymous,’ page 417 might be great supplemental material.

      Another question for you personally: As a person who, I imagine, ‘helps’ people with potential ‘diseases,’ I am curious as to what your credentials would be for involving yourself with the ‘treatment’ of a ‘disease,’ if they were?

      You also say that some AA members have ‘problems more than alcohol.’ Are these particular AA members drinking alcohol as they attend AA meetings, so that it could be postulated that they may have other problems as well?

      I think questions like these are very, very important. A lot of blanket, unclear statements, I find, are made in the promotion of AA. Hope I didn’t pick away at your comment too much.

      • Joe says

        Let me sum up what John said for you:

        – AA isn’t for everyone.
        – Alcohol addiction is a conundrum, but is different than other traditional diseases
        – Alcohol addiction is difficult to overcome
        – John bought into the idea that he is powerless over it
        – AA may not be the right program for multiple issues beyond alcohol abuse, though it can clearly help some people (including himself)
        – AA should not be used as a substitute for professional counseling, as there might be deeper issues that alcohol only magnifies
        – People in AA are not villains – just because they subscribe to a questionable method of treatment does not make them evildoers. There are good people who put in the time to help those with addiction. Qualified or not, volunteers and “recovering” alcoholics are probably just trying to help.

        My own point might be – clearly AA was not the right thing for you, and I agree that it is not the “right thing” in general. But it has/does help some people make better CHOICES, even if it is through that poor method. For those people, it has done good. Maybe they are brainwashed. But it is not your job to try to trump their happiness with your own feelings of contempt for AA.

        Hope this helps clear things up.

        • Ryan says

          It is challenging not to dip into passive-agression when responding to AA members. It is doubtful a comment here would change the beliefs of one. Critisicim of AA is very tricky to engage in. Your accusation of me ‘being a jerk’ and not a simple acknowledgement of ‘behaving passive-agressively’ is, in itself, quite irritiating. Whether AA ‘helps’ someone is not my concern. I expressed frustration with ‘blanket, unclear’ statements being made in its promotion that I believe are harmfully misleading.

          One of your responses, for instance, I take issue with: ‘Alcohol addiction is a conundrum, but is different than other traditional diseases.’ I don’t believe it was deliberately calculated this way, but you first (perhaps having noticed that I don’t believe in the ‘disease’ concept) equate ‘alcohol addiction’ with being a ‘conundrum’ (a relationship I might find more palatable) then, at the end of your sentence, you re-introduce, now a bit buffered, the conept that ‘addiction’ IS a ‘disease,’ before generalizing and softening the equation by making reference to ‘other traditional diseases.’

          I think this maneuver is, though not deliberately, unnecessarily mendacious and indicative of ‘disease’ proponents’ awareness that no one is REALLY going to believe that ‘addiction’ is a ‘disease,’ so it is tempting to obscure their contention in hopes that it will be accepted, at last.

          As far as sites that promote AA doctrine, there are millions and millions. A comment on one of the far fewer quantity of more critical sites is doubtless going to deter any attendees from attending to make ‘good choices.’ Moreover, I have never, nor ever will, visit an AA sympathetic site to introduce ‘my views.’

          I am all too pessimistically aware that AA ideology is truly beyond criticism and I think that is sad.

          One last thing: your contention that ‘alcohol addiction is difficult to overcome’ is, in my opinion, a belief that ought to be challenged, as the moderater of this site has, I believe, quite admirably done. I can imagine people who are drinking ‘alcoholically’ already have that belief ingrained in them to varying degrees. I don’t think further proselytation of it is helpful to such people in the long run.

          • Ryan says

            One last thing Joe, after having reviewed some of your other comments. You say, ‘i hate junkies and i hate how they are carefully babied and enabled by people with no balls,’ and recieved no response or charge of ‘being a jerk.’ While I do not wish to finger-point, I find it quite fascinating the double-standards that pervade addiction debates, mostly leaving criticism of ‘treatment’ virtually impossible (with ad hominem attacks), and far more vulgar admonishments of ‘addicts’ as seemingly welcomed and permissible.

          • Joe says

            Obviously responses and forums like this allow feathers to be ruffled, but I appreciate interesting dialogue. And I can admit my too-quick reaction in saying “jerk” – I honestly do apoligize. (The veil of the internet can cloud my judgement to be insulting.) My point is simply that helping people make better choices, overcome an addiction, be productive members of society, etc. etc. (however you define it) should be the end goal. Changing the worldview on addiction can and should be a part of that, but not the only consideration. If someone actually did have success with AA, and found it beneficial, it is their right to feel that way, to be proud of overcoming an obstacle. The way I view an AA success story is not that a person is in remission/recovery from a disease, but that AA did likely influence that person to make different choices – which is not all bad. Even if their philosophy is flawed, this is a success (to that person). And if that person lives in fear of that “one drink that could send them spiraling,” then that fear is continuing to simply affect their choices, and the stance of this website is still intact as to why that person has changed. (Even if that person thinks they are powerless, you and I and others know differently.)

            You and I seem to agree that this site’s message is generally correct, and that the “disease” idea is incorrect. I was paraphrasing John by calling it a conundrum – but if it was so simple, there wouldn’t be this site and countless others with varying ideas on how to find soultions to what is clearly a problem for many people. The topic is confusing, and though the answer may seem incredibly simple (choose different), it is difficult for many to not only accept, but to put into action that answer. Further, I was again paraphrasing for John by saying that “alcoholism is difficult to overcome.” Keep in mind, that whole post was in response to yours claiming that his statements were unclear. (And, if I misinterpereted John, I apologize – though he seemed clear enough to me for a web blog reply.) But how can you say it is not difficult to overcome? That, I am unclear on. If the belief is that it is all choice as this site suggests, then it is alarming to think that you, the site moderator, or anyone else believes that some choices are not more difficult than others. Addiction may not be a disease, but habits and lifestyles are simply that – habits and lifestyles. Lifestyle change is difficult, be it someone trying to diet, drink less, study more, take care of a baby, balance a busy work schedule, etc. Just because you make the “right” decision to do something (ie: stop drinking excessively) doesn’t mean that it is easy. To convince someone that making huge changes in their lifestyle choices is easy would be doing them a disservice.

          • Joe says

            Looking at your other post, that may have been another “Joe.” I just found this site yesterday, and never posted about hating junkies, etc. So, please strike that from the record!

          • Ryan says

            Very good Joe, and I certainly can agree with you that forums like this allow feathers to be ruffled. I will not delve into my personal reasons for having so much contempt for AA, but will try to answer some of your questions:

            ‘But how can you say it [addiction] is not difficult to overcome?’

            ‘To convince someone that making huge changes in their lifestyle choices is easy would be doing them a disservice.’

            I base my opinion on my conviction that alcohol and other chemicals contain no inherent ‘addictive’ properties and that it is mostly the belief that they do that can make the process excruciatingly difficult. Also, I have a bias towards Stanton Peele, and his general approach that addiction (to whatever) serves a very important part of an ‘addict’s’ life and is, in many ways, a function of mostly psychological and environmental factors. He has, for instance, brought attention to the fact that many US soldiers used heroin ‘addictively’ in Vietnam, for instance, but not upon return to the US. Sure not using heroin might have been a healthier and more moral lifestyle for them at the time, but ignoring the atrocious environment and its devastating psychological imprint and encouraging or coercing abstinence, would, in my mind, have been doing them a disservice. I find the general practice of disregarding these and less extreme factors, and mandating or pursuading permanent abstinence to be too reductionistic and due mainly to the predominant temperate and stringently moral climate of this country that has, perhaps, paradoxically led to higher addiction rates.

            I have my own ideas about why addiction is so prevelant today and especially in this country, and so perhaps differ in some of my views. However, I do sense you have quite a bit more empathy for such individuals and insight into the phenomenon than the other Joe, for instance (my apologies), and so appreciate your consideration of my comments.

          • Joe says

            Ryan – At some point individual opinions prevail, and for all I know mine are hogwash. I cannot say that I have personally had a substance abuse or otherwise addiction problem. I have never been to AA. And, to that end, I credit my choices and actions for avoiding such things. I however and very interested in this topic. I have family members who have abused both drugs and calories, detrimental to their lives in various ways. I have been to fundraising events that openly use the words “disease” and “predisposed,” which simply rubbed me the wrong way. I have a level of empathy because some people are not educated enough to make better choices. Or, they make one bad choice and quickly fall into a negative pattern because they lack the will or succumb to external pressures (still, through their own choices). I feel sorry for them, and agree that if they “feel powerless,” their chances of making changes do not increase. I also have a level of disdain because, doesn’t everyone know “drugs are bad”? (Obesity is bad, too much alcohol is bad, etc.) So, part of me resents them for wasting the life they have as well as money, resources, charitable programs, etc. In short, my opinion wavers.

            But no matter my level of empathy, I am a firm believer that will power can conquer it all, but I guess I just have a hard time believing that it is easy. Whether it is a choice, a chemical addiction, a lifestyle, a means to escape, or anything else, people sure seem to struggle with it. Maybe they struggle because society and the “disease rhetoric” tell them to struggle. Nonetheless, it seems that for many it is easier to continue using, and more difficult to stop. Whatever that reason for being more difficult, to me it stands to reason that it is in fact difficult.

          • Ryan says

            Understood and well said. For myself, having drank heavily in college and experimented with drugs, catupulted into the ‘treatment’ culture (family coercion) and then getting demonstrably worse, was a horrible experience. It was like I never got to learn that drinking excessively doesn’t make me all that happy anyways and I won’t do it anymore. Instead it was psychiatriy, 12 Step Groups, a life-long battle, yadayadayada. All of which, I have had to ‘deprogram’ myself from and reconsider now. Hence all the independent research I have been doing (including this site). Since leaving, I’ve gotten a lot less judgemental on people who use drugs, behave irresponsibly, immorally, etc… I have come to understand that there are probably reasons for such self-destructive behavior that I am not the one to deduce or comment on (no more than Bill Wilson). For that reason Harm Reduction seems like the most ethical approach, but if anyone, like me, was interested in abstinece alternatives to AA, I would point them to this site or the works of Stanton Peele.

            I will mention I was stuck for awhile in AA because I always felt the compulsive need to ‘help’ such people. Now that I understand that a lot of it is strong, culturally re-inforced beliefs and emotional difficulties beyond my control, I no longer feel that compulsion. The only thing I am vocal about (if only on forums, and then again only occasionally) are the publically hidden inadequacies and indecencies that I have witnessed occur in AA, behind all the ‘serenity’ talk. While, of course, I have met many pleasant people in AA, it wasn’t them that was driving me nuts, but the inextricable aspects of powerlessness, self-condemnation, and deceptive religiosity that drove me to leave, which, unfortunately cannot be divorced from the organization, despite any presense of ‘kind’ or ‘caring’ people. Moreover, I have witnessed too many people collect Time and grow even more insufferable to be around, into ‘spiritual’ parrots, or into ticking time bombs. I’ve seen more than a couple smart, creative, empathetic individuals lose those very precious qualities in ‘service to the Program.’

  12. richard weedin says

    Thanks for this excellent site. Some years ago I was scared straight after waking up in ER strapped to a gurney convinced I had been kidnapped by a religious cult. I even asked the doctor to call the police so I could affirm otherwise, elliciting chuckles all around. I topped the leader board that morning, attaining a .35. So horrific (and expensive) was it that I had no problem fooling around with choice or not: My life at that time had been plainly revealed. I had got myself knee deep in hell and was not going that way again. I still smoked my pack a day, however, and had no thought about quitting. Until a friend of mine contracted viral pneumonia and spent a week in hospital. “I haven’t smoked in a week and I don’t even miss it.” I was happy for him. I thought this was the start of something new for him, and I considered my own situation in that light. But–only a few days back home, breathing from an oxygen bottle, reporting weekly to a lung specialist to whom he lied about quitting–he was back again on the usual smokes. That did something to me. A window opened and I stepped through it. I let go of the smokes. There might have been a couple days of discomfort, don’t remember for sure; but whatever discomfort may have been was not enough to drive me back into the fold. I reiterate: I just let them go.
    Suffice it to say, I am again back in the fold. With yet significant behavioural and salutory differences. Not all has been lost from that morning in ER. One thing for sure: I keep it at home. (My buddy, Kerouac: “Try never get drunk outside your own house.”)
    The point I’m trying to make is: it is not the substance used. It is the person using it.
    We addicts are not just zombies. We are human beings. Just like the restive you.

  13. kelly says

    I had an interesting conversation with a friend who has struggled with a food addiction. She weighed 250 lbs. She lost 80 lbs. She said addiction is not a choice. It is a disease. She said she has to really watch her sugar intake or it sets off uncontrollable cravings. She says she is in recovery now so her weight is normal. I ave watched a close relative struggle with this same sugar issue over many years. He has to work out relentlessly and is on an Atkins diet to stay fit. Whenever he ingests any sugar (which is even in bread), he just gets these extreme cravings that he says he cannot control, and every few months he will go on a binge, until he again decides to go back on the diet. Without that diet he would be a blimp. I have seen it. Is there any evidence to show these people have just not realized their power of choosing healthier habits/values instead?

  14. kyle says

    Uh…. clinical studies have proven addiction to be a disease, the brain functions differently. It’s a disposition. As a recovering addict, who has been one year clean after ten years of abuse, I believe that in order to get clean, you have to treat the disease as a disease. Anyone who believes it’s a choice will eventually make the wrong decision. I’m insulted by this article. If addiction is a choice, then so is being gay or falling out of love with someone. Good luck with anyone who fails to admit powerlessness because if you can’t do that, there’s no way in hell you can get past the first step of recovery. If you think you can beat it and fail to respect how tricky the sickness is, then you’re bound to relapse.

    • says

      To my knowledge, no research has ever proven addiction to be a disease. If you would read Steven’s article a little more carefully you might better understand what he’s so well explained (not only here, but all throughout this site) – – that there is nothing abnormal about the biological adaptation of the brain to drug use; it’s nothing more than the brain’s process of learning. The presence of a neurobiological correlate to a particular behavior does not mean one is powerless to control that behavior – unless you believe that free will is an illusion and humans are essentially robots, predestined to act out the dictates of their brain’s wayward neurochemistry. There is nothing abnormal about the pathology underlying “addiction” – the process is conceptually identical to any other form of learning.

      To classify problematic drug use as an illness is to disregard the major distinction between drug-associated biological changes and the deliberate act of seeking, obtaining, and using substances. If I may quote Jeffrey Schaler – “drinking is a behavior, while cirrhosis of the liver is a disease; smoking is a behavior, while lung cancer is a disease. Drinking is not cirrhosis and smoking is not lung cancer”

      When people reprogram themselves to understand that drug or alcohol use is a choice, they’ll become empowered to make their own decisions, rather than living down to the expectations of the recovery culture. Admitting powerlessness, and passively surrendering one’s will to an external source to fix one’s life, it all leads nowhere.

      • Kelly says

        I thought addiction is always a choice, until I spent a couple hours this weekend with a friend who was an overeater for decades. She said it is harmful for me to tell people addiction is a choice, not a disease because it could make someone relapse. She does not go to meetings anymore, but she says she has, after 20 years, only now reached a point where she can eat a candy bar and be satisfied. She used to steal food and eat out of trash cans, hide food, etc. So my question is: To what then do you attribute the cravings that some get to alcohol or sugar, once they start eating, these uncontrollable cravings that don’t go away even after years,and that remain a lifetime struggle. Thoughts?

        • Trish says

          I think claiming to have an “addiction” to food is a totally different thing – mostly because a person can’t decide to not eat food any more.

          But if we’re talking about people engaging in behaviors that they claim are not a choice, I have to ask – if someone has no control over their use of, say, an illegal drug, why do they do their using in secret – why does their “out of control” behavior not include, say, sparking up a joint at their desk in view of the boss? Obviously, they know there would be negative repercussions. So if they can control behavior enough to try to not get fired or arrested, they can control over their behavior.

          As for this person who used to eat out of garbage cans and can now eat a single candy bar & feel satisfied – how could that be possible if that person has no choice in behavior? How did the ability to control the behavior in question come about if being more in control isn’t possible?

          As for sugar, all primates find sugars very attractive. We are hard-wired to prefer foods that are concentrated forms of energy, so sugar, fats, honey, fruit are more attractive than lettuce leaves or celery or tubers that require a series of steps to process out dangerous compounds. Since in the wild food is not always reliable, creatures that could quickly identify and strongly prefer concentrated sources of energy would have an advantage that would be passed to the next generation.

          I also don’t understand why, if a person who believes that s/he has an addiction and that this belief helps him/her to have enough self-control to not engage in behaviors that s/he doesn’t want to do, hearing someone saying, “I disagree” would be enough to make this person chuck a belief & behavior that works for him/her & go on a bender.

          • Kelly says

            All good points, thank you for your response. For some, disease theory is easier to live with than taking responsibility, which is probably why she felt so defensive.

            I still struggle to understand whether these people who cannot refrain from eating the entire gallon of ice cream are really overtaken by extremely strong cravings, or if they ate that first bowl of ice cream with the expectation that it would be okay to finish the entire gallon. But then again, who am I to judge what they are experiencing and if they want to label themselves as different from other people?

      • Question... says

        Wait. Is the use of drugs and alcohol a choice? Or is the abuse of drugs and alcohol a choice? It seems to me that if it were a choice, “alcoholics” should be able to control their alcohol consumption, even when drinking. Is that what’s being proposed here?

        • says

          Yes, that is exactly what is being proposed here. People are in control of their substance use consumption at all times, even when we call them “addicted”, and even while they’re already intoxicated. They can always choose. I understand this sounds radical, but the science backs it up.

          Here’s a link to an article on this site which gives references to several studies that show alcoholics don’t lose control of their drinking even after having ingested alcohol: Do Alcoholics Lose Control? The Results of priming dose experiments say no

          Here’s a link to a recent article in the New York Times about Dr Carl Hart of Columbia University, who has shown the same to be true with several drugs such as methamphetamine and crack cocaine: The Rational Choices of Crack Addicts

    • says

      Are you saying you were born an addict? Born addicted? I don’t think you were. If it weren’t a choice, then NO ONE would EVER be able to get CLEAN. You would ALWAYS use. If you were once addicted, and now you are sober, what made your disease ‘go away’? It just vanished? Into thin air? No…you stopped using. You made a choice to stop. We are not talking about tourette’s syndrome here…swallowing a pill or booze is not involuntary. It may be harder for some people to muster up the will power, and I think the more you use the harder it is, but it is not impossible. Don’t let these 12 step programs tell you that you’re an addict for life. It’s BS. You’re an addict when you’re an addict. When you’re clean, you used to be an addict. Don’t buy into the crutch and get labeled and set up to fail again and again. It started with one pill. One drink. Somewhere between THERE and ADDICTION you made millions of choices. You are not robots. You’re people. Use your beautiful minds and make good choices to be beautiful people. I think it’s incredibly awesome that anyone who was once addicted is now sober. INCREDIBLY AWESOME. I can’t say enough how incredibly awesome it is….Now go and be even more awesome by refusing to wear an ‘addicted for life’ label and refusing to be labeled ‘diseased’. Go on…do it…you know you want too ;) Peace and love…

      • Gabriel says

        Amen, i particularly enjoyed the Tourettes reference as I have Tourettes, and what i find irony in is the fact that i can control my tourettes 90% and it is a REAL neurological disorder I don’t choose to “tic” but i can choose not to, it has taken years and a lot of will power but i can control and overcome it for the most part.

        That being said it infuriates me when addicts claim they have a disease that they have no control over while i genuinely “suffer” from something that truly is involuntary, if i can overcome my tourettes they sure as hell can choose to NOT pour a drink or eat a pill.

        Be strong people, most everything in life is a CHOICE, happiness is a choice as well, and i believe most “addiction” stems from not choosing to be happy.
        If you do not choose to be happy with what you have right now, you will never be happy in the future.

        There is more to life than drugs, and you TRULY CAN Experience a greater happiness and high than drugs provide, you just cannot be too afraid to be willing to try and experience it!

  15. kelly says

    “Those who decide they need help to stop smoking tend to lack self-efficacy”, so their results are not indicative of all who quit smoking. 2/3 – 3/4 of smokers quit on their own! LOVE IT!

    http://www.cnn.com/2012/07/11/health/diet-fitness/quitting-smoking-weight-gain/index.html?hpt=hp_bn12

    “The data in the study include only those smokers who volunteered for clinical trials and attended smoking-cessation clinics, a “self-selecting minority of smokers who may differ in important respects from those who quit without professional assistance,” the authors write.

    Those who decide they need help to stop smoking tend to lack self-efficacy. They might have similar problems with the dietary and physical activity behaviors important in weight control. So these results may not be generalizable to all smokers who quit because two-thirds to three-quarters of ex-smokers stop smoking without professional help or interventions.”

    • Kelly says

      If AA and NA really worked, people would heal and 1. never have to go again, and 2. be able to drink normally.

      If you are AFRAID of alcohol, if you think that having one drink will either bring you back to drugs or into a spiral of drunkenness, then you have not moved on from your addiction issues, you are stuck. A program that works will include teaching people to drink normally again. It’s fine if someone LIKES to be a teetotaler, but it’s not fine if they do it out of FEAR.

      Just my 2 cents.

  16. Kelly says

    Steven, I listened to that radio interview and I like what you said to the interviewer about your early rehab experience, when asked why you took the drugs. You said you liked it, and the counselor ridiculed you. When I stopped using drugs, and my husband and counselor asked why I did it, the same thing happened to me. They wouldn’t believe me when I said I liked it. So I had to keep searching about why I did it. Did you have to search about why you did it? Did you think that was necessary for you?

    • says

      I lost my understanding of why I was using drugs for a few years. I began to believe the hype – that substance use, for an “addict” like me, is completely divorced from any sense of purpose, that it’s a mystery, that it’s driven by an elusive disease. As long as I “didn’t know why” I was doing it, my problems became worse. An integral part of change, for me, was getting back to basics, and knowing that I was using simply for the pleasure (and I also needed to make sure to disconnect the usage from any other “underlying issues” – more on that in another post, at another time).

  17. Kelly says

    I have a request for an article called “Why choose addiction”, or “why do they do it?”. I watched “30 on 30: Unguarded”, a documentary about basketball star Chris Herren and his oxy and heroin addiction. It is very good and brought tears to my eyes in places. The movie intersperses his story telling in front of groups of people with footage from his career and home videos. His addiction got even worse after he married (around age 20 I think), and had several children.

    Steven, you often write addicts will stop when they find more meaningful activities, like work, family, etc. . But there is more to it! There are people who choose addiction when they do have a meaningful life already! Like Chris Herren, I had meaningful work and that same perfect family. He had home movie going on outings with the kids while high, I did that too. He had a double life, I had that too. He was good looking, athletic, I had that too. However, I didn’t go into those dark places of deep addiction after I had my kids. My husband watched the movie and he says I wasn’t that much different from Chris, that i’s just a matter of degree.

    So watch the movie and think about it – the question really is, why does someone choose addiction? I’ve come to believe it’s a lack of knowledge of where it can lead. What are some thoughts on this?

  18. Kelly says

    This is good from the Time magazine article
    “Surprisingly little research is conducted on the positive effects sought by drug users and what they actually achieve via their drug consumption; the assumption is that alcohol and other drugs are always bad and their users are irrational.”
    Read more: http://healthland.time.com/2012/08/20/why-college-binge-drinkers-are-happier-have-high-status/#ixzz24JLNzaSH

    I get to think about what I achieved with my drug consumption, and I get to put away the assumption drugs were bad and I was irrational. Wow, a great light went on. It’s true that I did exactly what I wanted and I only beat myself up over “why I did it” because I feel guilty about my husband and kids. For myself, I have no guilt at all, because I did not cause any damage, and the financial stuff I don’t mind because I wanted to do it and I can easily pay if off by working today. What a freedom this gives me.

  19. Ken H says

    Interesting that the writer complains about people not seeing that addiction is a disease, but the writer FAILED to state that sex addicts and likely other addicts also have the addicts disease!! Talk about unfair!

  20. Concerned Guy says

    Wow. What a useful post and comments. I’m torn both as a addict and as a person seeking truth whether from a scientific view or spiritual view. What I do know is in the beginning for me I was “unbalanced” and CHOSE to self medicate. It was a CHOICE not a disease 100%. However, what I know now, is physically I can’t stop. There is NO CHOICE. If I stop I could hurt myself. Sure feels like a disease. We can all chime in with our smart debates but the fact of the matter is I’m a decent person who loves my children and can’t seem to find the way to FIX my life. I can’t WILL my way to getting over a cold nor can I WILL my way to quitting drugs. I could at the beginning had I “looked into my future” but I can’t NOW. So I’ll say it again it sure feels like a DISEASE but it also gets old feeling WRONG all the time. Whether it is or not only the atoms know for sure, right?

    • Joe says

      “Whether you think you can or you can’t, you’re right.” – Henry Ford

      This pretty well sums up why feeling “powerless” is counterproductive. Apply this saying to your drug habit, and you might see that will power and choice are strong enough forces to do many things.

  21. Kerilynn says

    I have been to rehab and can tell youthe disease concept is complete crap. “They”-that is, usually councelors that have not one iota of what it is like to live with an addiction- brainwash you into beleiving this concept. Usually with a VERY high relapse rate. However, while I can tell you first hand that I believe most rehabs are just another business to prey on those who may be able to be swayed to follow the disease concept I truly do believe that it IS a genuiine mental illness and therefore we with this diisorder are ijdeed sick and can benefit from somw sort of therapy whether it be aa/na, spirituality, conventional therapy etc. But a disease? Sorry. No bueno. That is an excuse. I am a good person who has made bad choices. I now choose my family and Jesus Christ over alcohol and pills and as long as I put them first, I will be alright.

  22. Selffulfillingprophecy says

    Thanks,

    I needed to read this today after a tedious and annoying day at the office, being disrespected by a single minded society follower of the disease model. Of course I was told I was the outsider after giving a referral for a non-12 step program, which ultimately helps the individual learn skills, make goals, and achieve accomplishments through changing and implementing new activities. So sorry for wanting to empower an individual! Naughty me! But yey to the pharmaceutical companies who will have another person groomed for a life of addiction in and out of treatment due to relapse (which is part of recovery remember!) – I’m being passive aggressive if you didn’t notice. Oh and the money they get for all those medications that they will end up getting. Whatever happened to ‘get your shit together’ and to taking responsibility for actions. Is smoking cigarettes a disease? No, but it causes diseases, so stop or get lung cancer, your choice. Alright, how about this then…do we send cancer suffers to jail? Oh, well if drug addiction is a disease, why do they all go to jail? Erm…okay, so what about personality disorders. I have been told in treatment clinics that a person should not only have a personality diagnosis because ‘there is no cure’ and that ‘they cannot bill for that diagnosis alone’. However, personality disordered people have significant differences in their brains…so why don’t they have direct treatment ‘cures’–because they are just like addiction–they can be changed with re-wiring like CBT, DBT and can change through personal improvements and hard work, (most cases I imagine). Oh malarky, what a mess this society is in. Bottom line, it’s all about money…if someone has a ‘disease’ they are in treatment, they ‘relapse’ because it’s ‘part of recovery’ and then the pharmaceutical and insurance companies get money up the yinyang for ever. Suprise suprise. And the longer we sit arguing about whether addiction is a disease or not, the longer they get to scoop up peoples lives and money. We all know addiction is not a disease, you are not a disease, you have choices and you can take responsibility for your actions. Yes, it might be hard, you need to re-wire your brain to feel happy about things that might just not feel so good at first, but it takes time and self-empowerment. I know it’s possible – I’ve done it myself.

  23. Brandon says

    Im so sick of hearing addiction is a disease. No its a choice, you did it to yourself. All it is is a cop out, a way to pass the blame and not take responsibility. Its pathetic. I used to be addicted to several things for years. I had the willpower to quit myself, so if I can just choose to quit, how is it a disease? People with real diseases can’t just decide to “cure” themselves. even brain diseases, people can’t cure themselves. When people claim addiction as a disease, it slaps people with a real disease in the face. Its a selfish move, and sickens me. Grow up, take some fucking responsibility, and face it. dont act like a little kid and pass the buck.

  24. Mike C. says

    i too believe addiction is not a disease and I stay away from “voodoo” 12-step cults. I will go so far as to say addiciton is a habit formed as a maladaptive coping-skill. I see addiction as always coming from one or more underlying causes (it is not primary as disease-concept theorists like to say). Read “The Alcoholism and Addiction Cure” by Chris and Pax Prentiss from Passages Malibu.

    • Kelly says

      Passages is very expensive. You can get the same stuff by reading The Forgotten Five Steps and working with a counselor in a few sessions. Underlying issues like depression, anxiety would require other work, I am not sure of what is involved. Or read the stuff on this site. Steven recommends St. Jude’s. How much does that cost? My friend needs rehab, and his family can afford the $18k for one month but don’t want to spend it so he’s going outpatient. I don’t see why changing a habit should cost tens of thousands of dollars. That’s just a scam.

      • Mike C. says

        Yes, very expensive (I know a couple of people who went there). I didn’t mean go to Passages, just get the book. On Amazon, it is less than $11 for the paperback. The book explains the philosophy used at passages so that you can apply the same principles to yourself.

  25. Crystal says

    I am also a strong believer that addiction is not a disease. I grew up with a mother who was a severe alcoholic, currently have a sister who is a prescription medication addict, and another sister who is a heroin addict. I deal with this on a daily basis. I know for a fact that it is their CHOICE. I know this because there was a time in my life where I was also addicted to prescription pain pills for a number of years. And geuss what? When things started to fall apart, and I noticed that everything around me was becoming shit because of my addiction, I chose to stop on my own. I decided I didn’t want this to be my life, locked myself in my apartment, quit my job, and detoxed myself. It sucked and it was hard, but I made a choice and made it happen. The same way I made the choice to start taking polls in the first place. I havent been addicted to pills in 8 years and have no desire to ever be again. Since getting clean, I have had surgerys which required me to tale pain medications afterwards, and I chose to take them as prescribed, and stopped taking them when the script ran out. Addiction is a choice, and I truely believe with all of my heart that these doctors and scientists telling people they have a “disease” is only fueling their addiction more, and giving them an excuse to continue.

  26. Mike says

    I guess Alzheimer’s and dementia aren’t diseases either. Darn old people! Why don’t you play some crossword puzzles and keep your brain in shape so I don’t have to remind you to when to eat and bathe. This article does nothing to convince me of their argument, actually it seems to confirm it more than anything. Fact is, if addiction wasn’t labeled a disease then the help and treatment that’s available now wouldn’t be available. We’d all be hopeless on the street stealing and prostituting ourselves because society has given up on us. We’re good people who get caught up on bad situations. Hopelessness is rampant in the addicted mind. Shame and guilt only help to perpetuate these negative behaviors. Most addicts blame themselves plenty for all their poor choices. Compassion can go a long way.

  27. Mike C. says

    I guess meditation must be a disease too. There are a lot of peer-reviewed studies showing that changes in the brain occur from meditation practice. Yeah, right. Folks, it’s called “brain plasticity” and that term refers to brain changes resulting from expeirence. The brain changes from just about every experience, whether it be meditation, taxi driving, falling love, addiction, etc. Addiction is an experience which in turn causes changes in the brain.

    • Kelly says

      Obviously, the brain changes as a RESULT of an activity, so Nora Volkow confuses the issue by claiming brain changes from drug use are a disease.

      However, many disease proponents point to a genetic predisposition to addiction, but curiously only to alcoholism. While it is possible that some races, like Chinese or American Indians, have difficulty metabolizing alcohol, that still doesn’t mean they have to do it, so it doesn’t prove that wanting to get f*cked up is a disease.

      It seems more likely that this supposed alcoholic disease pattern seen in some families is in fact a learned behavior, just like poverty, lack of education, child abuse, etc. Kids learn from their parents how to drink, and those who don’t think for themselves can just repeat their parent’s mistakes.

      • Mike C. says

        Thanks Kelly. I know there are some studies that show a genetic predisposition to alcoholism (and possilbly drugs and process addictions too). But predispositions are not destiny; there ultimately is a choice involved.

        I know you understand this Kelly, but I just wanted to follow up for other readers.

      • Clay says

        I am a recovering addict who has been clean for over 3 years. I had to have help to get that way. While I am no expert, and don’t subscribe to either side of the theory that addiction is a choice or not, do think this: It is known that chemical changes take place in the brain with addiction. When that chemical change has taken hold, why can’t that chemical change somehow take away one’s ability to make a choice? I mean, there has been a profound chemical imbalance that affects one’s behavior. I’m just asking. Thanks.

        • Mike C. says

          Clay, I understand where you are coming from. I went to a rahab to break my dependence on alcohol. However, the ultimate choice and decision to go to rehab was mine and indicitive of my decision (choice) to stop what I was doing. I see the rehab more as a timeout to break the cycle I was in, not that they “cured” me. It was all my doing, not the rehab, the counselors, the therapists nor some supernatural being. The rehab turned out to be 12-step based (they told me it was not on the phone) so I put my foot down and told them I did not sign up for a 12-step program. My counselor worked with me and found some SMART Recovery meetins for me to go to and excused me from 12-step attendance. I enjoyed them but no longer go since their meetings are not a for-life thing. I also found a Buddhist temple near the rehab and started attending. I believe that helped too. IMO, it is my personal growth that keeps me abstinent and gives me better choices than to drink.

  28. Derek says

    I think at first addiction is a choice. At first smoking is a choice. These are choices made. We often don’t make good choices since we are human and often these choices are done based on peer pressure, etc.. However, after those choices are made for whatever reason I do believe the disease model sets in. When I was a teenager I chose to do drugs. I had no problems with drugs or my chemical processes in my mind prior to that crappy choice. However, ever since that dreadful day addiction had had my card. Smokers don’t smoke with the chance knowing they might get cancer. They smoke for other reasons. However, once they start smoking it is hard to stop and overtime their chances of getting a disease like cancer increases. I know for a fact I had no disease at first. It was a choice. I also know how hard my body has had to fight with opiate abuse. It is a battle I haven’t won yet. Sure feels like a disease to me, at least it does now.

    • Clay says

      I agree Derek. Not to be disrespectful……of all the people here who claim to know all there is about addiction….whether you had an addiction problem or not…..most of your information comes from books. Books that you made a choice to read. Biased books. Not one of you here has the letters PhD, MD or any other professional connotation.

      • Richard says

        I have an MD after my name, and I don’t think addiction is truly a disease. Most of my colleagues feel the same way, although we won’t say it when not behind closed doors. If we said what we really thought, the Steppists would try to get us fired for turning their sacred cow into a cheeseburger.

        • Kelly says

          When I asked my HMO’s chemical dependency program therapists, in a group meeting, whether you need God to be sober, they said “no”. Many of the people in that group did not even go to any 12 step meetings, and the therapists didn’t care. This is a major HMO in the state in which I live.

    • Kasey says

      I wish my family would think like you. There are too many enablers and too many addicts who get upset if you don’t treat them like they have some disease in my family. The addicts never get better and just use the enablers and both get angry at the rest of us who try to tell the addict they have to change their own behavior. The reasonable people are considered the black sheep, because they don’t want to go along with the ruse any longer.

  29. says

    I agree completely. Furthermore, I have attended many AA meetings and never does the speaker claim that their alcohol or drug use is compulsive. Generally it’s just a reaction to stressful events, or they are just trouble makers who like to do drugs. Once they learn to deal with stress (or just finally decide it’s time to grow up) then they stop drinking and drugging. In my opinion, AA is a drinking club designed to look like a group of tee-totallers. They go back to the booze when it’s convenient. For example, if they are stressed at work, instead of getting a new job they drink too much and get to work late. Or if they are angry at their wife for getting old, or if they want to pick a fight at a bar. When someone says, “AA is the only thing that ever worked for me”, it means that they have learned to use alcohol as a tool to manipulate and hurt others, and often have relapsed many times.

    I heard you on BlogTalkRadio today. Thanks for your work and this great resource!

      • Clayton Moretton says

        I found this website about 2 years ago while doing a research paper. Interesting theories abound here, including mine. I don’t subscribe to any theory regarding whether or not addiction is a disease or not. That, I do believe, is the basis for this site. I am a recovering addict, with over 3 years clean. Addiction ruined my life. I was one of those who did not have the willpower to quit on my own. I have used the 12 step rooms, and they have helped me immensely. I did not use them as a crutch, but instead, used them as a source of support and encouragement to get, and stay sober. What I have noticed here in this site, is that many addicts have shared their experiences with their own PERSONAL journeys of recovery. Those who believe that addiction is not a disease belittle, criticize, chastise, and degrade those who have found help in the 12 step rooms of recovery. Saying they (we) have no willpower, are losers. It may or may not be true that addiction is a brain disease, but I do know this: One doesn’t choose to become an addict. Who the hell would want that life? Who the hell are you to tell someone that their truth is a lie? Have you been in their shoes? Is it their life your leading? That is just wrong. Personal life experiences are just that: Personal. That means each experience is unique to that individual. So how can you all generalize your beliefs about what YOU THINK is right (maybe that is right for you), but it does not apply to the person you are criticizing. Opinions are like assholes: Everyone’s got one. So, if a person succeeds in recovery by going to, and believing in, 12 step programs, who’s to say they are wrong? They are now being productive members of society, not a burden on public agencies, and not out pillaging and plundering. It seems to me that nobody respects the other’s opinion here…and that goes for both sides of the coin. So why doesn’t everyone stick to the topic of this site and not tell someone what has worked for them is wrong. It worked. For them. They should know.

        • Richard says

          You seem to have missed a MAJOR point of this website: the numbers show that !2 Step programs AREN’T effective. No amount of presenting argumentum ad populum fallacies will change this.

          • Clayton Moretton says

            The fact that 12 step programs are or are not effective is completely irrelevant. What is relevant is what works for some people, and not others. I am by no means trying to promote 12 step programs as “the” road to recovery. I totally understand the purpose of this site…it is a place for people to present their cases as it pertains to whether addiction is a brain disease or not. While visiting this site from time to time, I do see a lot of discussion on just that. However, I also see a lot of people sharing their own personal experiences of their journey through addiction and into recovery. If someone shares their feelings, and it involves something other than willpower to get sober, say 12 step recovery, they get slammed. People call them names, tell them they are weak, or that they are losers. Yes, I have seen that. People have done that to me here. So what if you got sober on willpower alone. Good for you…..I mean that. But, what if you are without that needed willpower, are weakened emotionally, and you need to seek help outside of yourself? That doesn’t make you any less deserving that someone who is opposite of them. The issue that I have with some people who comment on other’s posts is that they think that if they can do something a certain way, well, why can’t someone else?

            They don’t seem to recognize that like them, every other person’s journey through addiction, and into recovery, is their own personal journey. Nobody owns that except for the person living that experience. If willpower works for some…Great. More power to them. If 12 step programs work for others, why should their power be diminished because of somebody else’s beliefs? Why should it matter how a person got sober? We all don’t travel the same road for a reason…..we are individuals.

            So, to Richard, the MAJOR point of this website is NOT to show that 12 step programs are not effective. Whether or not addiction is a disease of the brain ( the MAJOR point of this website), it should not matter how a person gets sober. The question is a scientific one; disease or not? Not the way you or anyone, me, he, she or them got sober, but to maybe understand how the addiction process works and gain a better understanding so all can make an informed, educated, and individual choice as to how they get, and remain sober. By the way, those fallacies you mentioned, are not fallacies. As long as it works for just ONE person, it can’t, by definition, be a fallacy.

          • Richard says

            In argumentation theory, an argumentum ad populum (Latin for “appeal to the people”) is a fallacious argument that concludes a proposition to be true because many or most people believe it. In other words, the basic idea of the argument is: “If many believe so, it is so.”

            This type of argument is known by several names, including appeal to the masses, appeal to belief, appeal to the majority, appeal to democracy, argument by consensus, consensus fallacy, authority of the many, and bandwagon fallacy, and in Latin as argumentum ad numerum (“appeal to the number”), and consensus gentium (“agreement of the clans”). It is also the basis of a number of social phenomena, including communal reinforcement and the bandwagon effect. The Chinese proverb “three men make a tiger” concerns the same idea.

          • Clayton Moretton says

            No Richard….you missed the point. Not anywhere did I say that 12 step programs were more effective or not effective than whatever. What I have been saying all along is if that someone thinks that 12 step programs are helping them, and they stay sober……why tell them that they are wrong for doing so?? Some people can do it with out any outside help….and others can’t. We are all not the same for christ sake. So if you think that eating with your left hand is evil (the ancient Egyptians thought that the left side of the body was inhabited with evil spirits) and it doesn’t work for you…realize this: It works for others. Same as 12 step programs. Whether the evidence proves otherwise statistically is not important. If people get help in the 12 step programs….that is important.

          • Edward Webster says

            Actually Richard, a 12-step program has been very effective for me the past 10 years I have been clean. Thanks for letting me share :)

  30. Clayton Moretton says

    Richard, thank you for that interesting information. Really, I mean that. My comments could most likely have been taken as aggressive. I apologize if they were. I guess I was just in sync with so many other’s comments when they are challenged with an opinion that is different than theirs. I too, am guilty of that from time to time. Again, thanks.

    • says

      Clayton your comments are truly remarkable and you are a better man than I for taking the high road with these debates. Thanks for speaking for me on issues I was feeling but not communicating well on.

  31. says

    You have to apprehend that all of these individuals that are part of a “caring community” have their own agenda and motives for pushing the notion that street drugs are just a medical problem rather than a moral or ethical problem. I never sold drugs but it wasn’t until a long time after I stopped using them that I realized that I was part of a death industry.
    See, my father, for example, wonders why don’t we just legalize drugs. We may end up there, but he doesn’t see it the way I do because he has never been on a crack binge or strung out on meth or lived nine years in Vegas and understand street life the way I do.
    Some addicts, like heroin users can function and hold a job on a maintenance dosage of smack but how about crackheads? Crack is an inhalant. How are they going to hold jobs? Every 15 minutes they have to go to the crack (break) room and get a tune up? Or herd em together in a giant holding pen on the edge of town and air drop the shit into the compound? Do ordinary working people want to support that kind of “disease?”
    Perhaps there could be developed some kind of replacement drug that would hold the crackheads. I’m talking about cocaine here because that is the only drug that I used that I would use up whatever was there, use all of it and then go out chasing for more. I did better on meth for functioning.
    On the other hand I have been taking medication for 16 years now for bipolar disorder and that stuff saved my life. And yet there are armchair experts in AA who would tell me to use a higher power to cure my mental illness. I spent a little over a year in AA and I have now 9 years and two months and I’m glad I didn’t listen to those people, the same way I don’t listen to opportunistic doctors mewling about love and compassion. You KNOW these guys have an ulterior motive when they talk about disease and they are so deeply dishonest as to never doubt their self serving lies for one instant. Anybody that does not hold people accountable for their mistakes in life, in this world, is robbing people of their dignity and humanity and at the same time being duplicitous and deeply unethical their own selves. Here is the major difficulty here; responsibility is not blame. Telling addicts that they are victims of a disease and by implication that they are not and cannot be held responsible for their actions isn’t just bad medicine it is also means that these people will never get a chance to grow past the infantile state that is addiction.

  32. says

    This is a truly fantastic article by Mr. Slate. What I don’t fully understand is why so many 12-steppers are so hostile. Why do they feel the need to attack Steven with ad hominems? Is it because he brings to light some uncomfortable truths? Maybe they should go for a 12-step walk off an 11-step pier.

    I think some people want to call addiction, especially to less socially approved drugs (opiates, cocaine, amphetamines, ect), a disease because they think people will be less judgemental. However this is not the case, calling addiction a disease INCREASES stigma and discrimination against addicts. Why? Because people perceive those who cannot control their behavior as scary, even if “its not their fault.” If you care about reducing the stigma of addiction stop calling it a disease.

    Aside from Stanton Peele’s books, for another good critique of the “disease” of addiction see Peter Cohen’s The Naked empress: Modern neuro-science and the concept of addiction. (Link at http://www.cedro-uva.org/lib/cohen.empress.html).

      • Dee Smith says

        Steven —

        Thank you for this website and the courage you have demonstrated to expose the myths of addiction. I have been looking for material to assist me in dealing with some personal behavioral issues that I would like to change and the information I have found at your site is most helpful. What I find alarming is that the concept of “addiction” as is continually dramatized in our society indeed takes away from the fact that we humans are free agents and have brains for something else other than to fill the hole in our skulls. Thank you for plain talk on this issue.
        While I AM a follower of Christ and trust in His ability to assist me in my endeavors, you have reminded me through your posts and writings that I am not at the mercy of the world’s perceptions that what we term “addiction” is a disease of body or mind; it’s a choice. I am NOT a victim. And while we may experience discomfort “getting out the poison,” that that is merely a process of giving the body, brain and soul a chance to heal from the poisons we volitionally feed it.
        I agree with you that our perception of “addiction” is skewed by the medical/rehab community, the media and in many ways, the fed. Thank you for reminding me that I am not at the mercy of any of them and I am not at the mercy of anything, except my own choices. Now, I get to do the work to get myself back in line, and I will let God sort out the rest of it. 12-stepping is definitely is not for me.

        Warm regards,
        Dee

  33. says

    I firmly agree.. My name is Paul and I am the director of my local chapter of Reformers Unanimous. To many people listen to the lie of society that addiction is a disease. I myself was an addict. I am no longer. It is not a disease, it is a Spiritual Heart Condition and a choice that with the “RIGHT” treatment can and will be helped. I also do not believe in the once an addict always an addict belief. This is yet another lie society. If you need help and you are tired of trying to find the “RIGHT” help please go to http://www.reformu.com. I thank the individual who wrote this article, I don’t know if you are a Christian but you have the right mindset on this matter. God Bless You.

  34. Claire says

    I was wondering if anyone, who has been classed as an alcoholic at some point in their lives, can actually drink in moderation now? Maybe that could provide some sort of evidence that it is possible?

    I was told I was an alcoholic, I drank 24/7 for the last 3 years of my drinking hell, prior to that I drank a lot – daily, just not 24/7 and I always experienced blackouts and was never happy until I passed out in a drunken stupor. I was hospitalised on numerous occasions, put on a drip, went to an AA rehab, lost my job and my partner. After my last drinking bender in 2010 my life and mind changed. I was out of the alcoholic fog and able to focus on what was going on in my life, in my brain, in my thoughts. With the help of CBT and various other counselling, I managed to sort out my mind to become a happy person – normal again. I was not born an alcoholic and with these new tools I received from therapy, I was now able to have the occasional glass of wine. I no longer have to drink to obliterate all of the demons that were in my mind in the past. I CAN and DO control what alcohol I can consume. I always used to have to drink round the clock, I had the DT’s and now, I wake up the next day and just carry on life normally until another social occasion takes place and I then go out and have what I want to drink which is nowhere near in the region of what I used to have. Three glasses of wine usually.
    Maybe I am in the minority though. I know so many people who have not been able to do this and they have tried but unfortunately the drink seems to have been too overpowering for them.
    But how come I am now able to drink normally after once being classed and lived as a hopeless alcoholic. Has my ‘disease’ now gone?

  35. doobiemaster3000 says

    This article had me at first with the basic premise of drug addiction not being a disease, because anybody who is addicted to drugs CHOSE to take those drugs. Unless you are a teenage girl getting pimped and shot full of drugs by your pimp on the street(which happens in every city in every country in the world, sadly enough), I dont feel a whole lot of sympathy for drug addicts, and I’m an addict of sorts myself, altough heroin and crack arent my DOCs thank god. Im 18 years old and I’ve been addicted to both chew and cigarettes since I was 14. I started smoking pot at age 14, and at 16 it went from a weekend treat to a fullblown lifestyle. Now sometime if Im outta bud its hard to sleep and eat. I know they say weeds not addictive, but that is a lie. Im physically addicted as shit and I dont like it. I keep telling ymslf that I need to just stop and slow down, but I feel like I just love it too much. And im afraid of wat would happen to be honest. Im really high right now on pot, xanax, and methamphetamine that my doc precribes me for my add. Most people getadderall, but for some reason my doc gave me desoxyn (meth), and its got me a little bit hooked and i dont even like it because I have adhd. Sorry this was so fucked and long but im flyinn. If you take aything from it though, ADDICTION IS NOT A DISEASE, ITS A CHOICE, BUT ITS IS EXTREMELY REAL AND IF YOU FUCK WITH DRUGS IN AN IRRESPONSIBLE MANNER, YOU WILL REAP THE CONSEQUENCES. AND TO ANY PARENTS, this is coing from a tenn whos been on adhd meds prescribed since 9th grade. If you give your child adhd meds like adderall or ritalin to help them in school, make sure they dont abuse it, because its a slippery ass slope and soon its stops working. I barely graduated and Im the luckiest guy ever to still be attending a very good college in the fall. But Im worried about y career there and how long ill last. Fuck drugs. dont pop molly and start sweatin its not worth it i did it a lot this year cus i was like im a senior fuck yeah who cares. and now im having memory issues and i feel dumber overall. i got a 1980 on my sat, and a 32 on my act and now i think i wold probably get a 1600-1750 at the most. I have trouvle focuing now even in conversations with friends. sont do molly. its man made devil shit my friend took that and acid one noght and i was there and he thinks hes possesed now and it happened like a month ago. he thinks cps are after him and shit. Im sorry for my rant but I needed to get this out thesre for people to know. from a fuck up, get-high who didnt give a fuck but now really wishes he did. peace out yo reppin the seatown

  36. doobiemaster3000 says

    This article had me at first with the basic premise of drug addiction not being a disease, because anybody who is addicted to drugs CHOSE to take those drugs. Unless you are a teenage girl getting pimped and shot full of drugs by your pimp on the street(which happens in every city in every country in the world, sadly enough), I dont feel a whole lot of sympathy for drug addicts, and I’m an addict of sorts myself, altough heroin and crack arent my DOCs thank god. Im 18 years old and I’ve been addicted to both chew and cigarettes since I was 14. I started smoking pot at age 14, and at 16 it went from a weekend treat to a fullblown lifestyle. Now sometime if Im outta bud its hard to sleep and eat. I know they say weeds not addictive, but that is a lie. Im physically addicted as shit and I dont like it. I keep telling ymslf that I need to just stop and slow down, but I feel like I just love it too much. And im afraid of wat would happen to be honest. Im really high right now on pot, xanax, and methamphetamine that my doc precribes me for my add. Most people getadderall, but for some reason my doc gave me desoxyn (meth), and its got me a little bit hooked and i dont even like it because I have adhd. Sorry this was so fucked and long but im flyinn. If you take aything from it though, ADDICTION IS NOT A DISEASE, ITS A CHOICE, BUT ITS IS EXTREMELY REAL AND IF YOU FUCK WITH DRUGS IN AN IRRESPONSIBLE MANNER, YOU WILL REAP THE CONSEQUENCES. AND TO ANY PARENTS, this is coing from a tenn whos been on adhd meds prescribed since 9th grade. If you give your child adhd meds like adderall or ritalin to help them in school, make sure they dont abuse it, because its a slippery ass slope and soon its stops working. I barely graduated and Im the luckiest guy ever to still be attending a very good college in the fall. But Im worried about y career there and how long ill last. Fuck drugs. dont pop molly and start sweatin its not worth it i did it a lot this year cus i was like im a senior fuck yeah who cares. and now im having memory issues and i feel dumber overall. i got a 1980 on my sat, and a 32 on my act and now i think i wold probably get a 1600-1750 at the most. I have trouvle focuing now even in conversations with friends. sont do molly. its man made devil shit my friend took that and acid one noght and i was there and he thinks hes possesed now and it happened like a month ago. he thinks cps are after him and shit. Im sorry for my rant but I needed to get this out thesre for people to know. from a fuck up, get-high who didnt give a fuck but now really wishes he did. peace out yo reppin the seatown

    • Matt says

      How bout when you when you hurt your back and your doctor gives you 100 mcg of fentanyl and you don’t know what the hell it is? Does that count too?

      Matt

  37. Kelly says

    Food addiction seems to be different from other addictions in two ways. First, people must eat, so the person struggling with food cannot just quit and forget about their chosen substance. Second, they say they are addicted to sugar, and sugar is in almost everything, so the craving is constantly restarted. Third, they deal with cravings all the time. I have several people close to me who get mad when I forward them any addiction as choice articles. They say I don’t understand them, their cravings, the constant struggle. These people are of healthy weight; however,it is a daily struggle for them.

    I am really curious about this, and any input is appreciated!

    • HAHAHA says

      if you eat whole foods and don’t eat wheat or refined sugar then that physical craving for sugar should stop. if the person needs sweet things they can eat fruit. lots of people lie about a lot of things so they can keep doing what they want to do and pretend like its not what they want to do, so you feel sorry for them, so they can control and manipulate you to get whatever it is they want out of you, whether its attention or money or whatever else.

  38. Courtney says

    I never thought that when I grew up I wanted to become a drug addict but I did. Like my two brothers before me I fell into addiction. My brother just died two months ago, OD. I saw what it did to them but still CHOOSE to do it. No one made me no one forced me. We all have a choice in life, to pick up, not to pick up, to call our drug dealer or not call our drug dealer. Its not a disease its a choice, we may be chemically dependent on drugs because we chose to do them time after time, day after day after day, no one forced us. Us as addicts say we have a disease so we can blame the disease for us being addicts and not our choices to pick up the drug.

  39. says

    After 5 years doing the 12 step programs, I am coming to believe how much the disease concept is a cop out. Now, what do I do for support groups? Are there “it’s a choice” support groups?

    Oh, also, hell hath no fury like when a person goes into a 12 step substance abuse program and starts saying “it’s a choice” Especially with the old-timers.

  40. says

    Here’s food for thought: before a drug like crack became so readily available, what did people do to alleviate the “disease”? I spent the first 45 years of my life, not craving any type of cocaine, regardless of its form. No craving whatsoever. But once I was introduced to it…wham….the addiction took hold….the physical addiction, that is. Physical addiction brought on by choosing to continue to use. Sorry, NA, but I break the disease model, just by this exerpt from my life history.

  41. says

    Relevant to some of these threads: when people say at the 12 step meetings…..”I tried everything, and nothing else works.” That’s misleading and possibly dangerous. Why? Because the majority of what is said in 12 step programs is designed to help the newcomer. In a way, this is limiting newcomers to the erroneous concept, that they might as well save themselves the wasted effort of searching for other sources to become addiction free. For example, I see medical doctors (psychaiatrists) to address other issues, which, by the way, could be helped by neuroplasticity concepts I am seeing. Many of these newbie 12 steppers have organic mental illnesses as well and HAVE to be treated first for any hope of succcessfully getting substance abuse free.

    I’ve been bucking alot of the stuff said in 12 step programs. They have yet told me to leave (as the principles won’t let them :) ) Now, I go to try to confirm to myself that the disease model is the wrong approach, I have yet been disappointed.

  42. Clay says

    Greetings All! I have made several comments over the last couple of years. I respect people’s idea that addiction is not a disease of the brain. There is plenty of evidence to support that. I also respect, and believe that it is a disease of the brain. What has become a center of discussion here is what works for different people. Not necessarily addiction per se. Now, if someone can put down a drug/alcohol, and never turn back, my hat is off to them. Some people can do that. Some people can’t For anyone to say that just because they can do something is reason good enough for someone else to do the same has absolutely no understanding of human psychology. It would be like because I can bat a ball out of the ballpark, why by god, you should too. It just doesn’t work that way. People who use the rooms of 12 step recovery have found a way to put down that drug/alcohol. It doesn’t matter if you found another way. Who cares what works as long as it works? I think the people reading posts on this site would be better served if there was no bashing or downplaying anyone’s course of sobriety. Each person’s journey is their own. Have some respect for them as you would expect it for yourself.

    • says

      Hi Clay,

      There’s something wrong with your formulation.

      Batting “a ball out of the ballpark” is doing something. It is an act based on skills gained through practice, strength training, etc.

      To not use drugs or alcohol is ‘NOT doing something.’ You can’t compare a behavior to the absence of a behavior. It takes no skill to not do something.

      This is where the disease concept has truly destroyed rationality. We’re so convinced that there is a thing called addiction with a life of it’s own that takes skill and strength to battle, that we take it for granted and don’t even realize when we’re comparing a behavior to an absence of behavior.

      We use phrases like battling addiction; overcoming addiction; triumph over addiction; fight addiction; succumb to addiction; etc, so much that we forget that the term “addiction” really just describes an active pattern of behavior – a series of active choices – and that its opposite is literally the absence of such choices. It is not an entity to be battled or to succumb to. It is not a disease. Nobody lacks the ability to NOT carry out a complex behavior such as finding, acquiring, and using intoxicating substances. What we call addiction is not like a sneeze, a blink, a reflex, or a twitch – it’s a complex behavior carried out over time. To continue “addiction” takes ability and strength – to discontinue it requires no such thing.

      -Steven

      • Clay says

        Yeah. Ok. You got me on that. The point being is that everyone does not have the same capabilities as the other. Some people can put down that drug, with willpower alone. Some cannot. This site has lost it’s direction. You’ve made your arguments about whether addiction is brain disease. Some agree. Some do not. The point that is being missed here is, does it really matter how and why and what someone does to get and stay sober? Stop bashing those who need, or even think they need help. Good on those who do not. Stop degrading those who do. I’m unsubscribing from this site primarily you belittle the human spirit.

        • says

          “Stop bashing those who need, or even think they need help. Good on those who do not. Stop degrading those who do. I’m unsubscribing from this site primarily you belittle the human spirit.”

          That statement is like one of those loaded questions – such as “When did you stop beating your wife?”

          How can you throw something like that out there in good conscience Clay?

          I do not bash troubled people. I’d love to see the examples of where you think I’ve done such a thing. And I certainly DO NOT belittle the human spirit. On the contrary, I have great respect for the human spirit. I think people have free-will – the power to choose their thoughts and behaviors. I do not think they are powerless over their own choices. When do I bash people and belittle the human spirit? Is it when I say that people can make different choices and change and improve their lives? Is that when I belittle the human spirit and bash people? Is it when I warn them to stay away from people who would teach them self-defeating scientifically unfounded beliefs that run counter to what we know about human psychology?

          Did I belittle you when I congratulated you on your personal successes? Because that’s what I did. You were expressing some very self-contradictory things that I probed slightly, but I decided to just wish you well after you reiterated them, instead of pursuing an argument. http://www.thecleanslate.org/myths/addiction-is-not-a-brain-disease-it-is-a-choice/#comment-6498
          I didn’t tell you to leave AA, or that you were weak for attending AA, or that you should get sober in some other way – or any of the other things I get accused of here.

          It should be noted though, this isn’t a support group. This isn’t an AA chearleading forum. This site is about the nature of what we call addiction, and what we should do to help people with it. There is active debate about these concepts here, and if debate or disagreement about these concepts is considered to be bashing and belittling, then I don’t know what to say in response to that sentiment.

          It matters what gets pushed as the truth about addiction. I’m sick of people telling me I’m not allowed to have an opinion about it.

          Also, just to reiterate for other readers – my point in the last comment had nothing to do with baseball. Let’s not get stuck on that, as I now see that’s a possibility from Clay’s reaction.

          The idea that:

          Some people can put down that drug, with willpower alone. Some cannot.

          misses the point. It continues to view addiction as being an entity with a life of its own – it views addiction as a force that people need an ability to stop. I’m not saying some people have the ability. I am saying that it is not an issue of ability, because “addiction” is activity – it is a series of choices. Its opposite takes no ability, no “will-power”, no effort. Its opposite is the lack of the choice to use substances (or less choices to use substances, in the case of “moderation”). Viewing it this way, there is no such thing as those who can stop it or those who can’t stop it. It is not a bear attacking you in the woods. It is not a boulder rolling down a hill.

          It is not a thing to be stopped, or “put down.” There is the choice to use substances, and when people make that choice at high frequency/quantity despite high costs, we call it addiction. To do the thing we call addiction, takes effort and is an active choice/set of choices. To not do it, is to simply not do it – that requires no effort, no special skill or ability.

          • Clay says

            Look, I have made some bad analogies here. I have ranted and even whined a bit. And yes, Steven, you did congratulate me on my success. And I thank you for that. It’s not you in particular that I aim my, for lack of a better word, distraught-ness at. Way too many times I have seen people share their vulnerabilities with this site, and too many times have been “beaten down” by those who do not agree with them, in the way that they got or stay sober. Nobody is created equal….in the mental and emotional arena. I applaud those who have the mental capability to make a conscience decision to stop using drugs. Some do not. I just want for those people who think that because willpower works for them, give some validity to those that lack the willpower or mental strength to do so. I just wish that everyone could give credit where credit is due, and not lessen the experience of those less fortunate than themselves. I did make a conscience decision to stop using, through the help of 12 Step Programs. For me, I needed that emotional and supportive boost. After 4 + years of being sober, I find myself questioning whether I need to keep my “membership” in those groups. To be honest, I don’t think I could have gotten where I am without them. Which brings me to this summation. If I needed some help at the beginning to “motivate” me, and say, for instance you did not, but, we both remained sober…what’s the difference? The outcome is the same. I do respect the opinion of all who contribute here, even though I may not show it. It would be really very cool if everybody respected everyone’s opinion. Good night everyone.

          • Jeff says

            To say that not using drugs is the absence of doing something and therefore takes no willpower is so inexplicably absurd I don’t even know where to start. It is clear that you have not experienced, nor have you worked with anyone who suffers from an addiction or compulsion. Abstaining from drugs is ABSOLUTELY “doing” something. You are using willpower to resist an intrusive and incredibly powerful urge to do something that stimulates the reward pathways in your brain. This argument proves beyond a shadow of a doubt to me that you have no understanding of what addiction really is.

            Use your logic for a change. If an alcoholic or addict could simply “stop” participating in a behavior, why would they resort to the — according to your beliefs — infinitely more difficult task of going to 12-step meetings, engaging in treatment, attending therapy, etc? If people could just not do it, it wouldn’t be a problem.

            Let’s do another thought experiment using your logic: According to you, not using drugs should be just as easy as not murdering puppies since they are both an absence of behavior. If both are equally “easy,” why is there an addiction epidemic and not a puppy-murdering epidemic?

      • Matt says

        Steve,

        It is not better than you comparing addicts to soldiers, or skiers, or a woman that saved Jews in WWII. That was the dumbest article I’ve ever seen.Your a damn hypocrite!

        Have a wonderful day,

        Matt

      • says

        Hi Steven,

        I’m a fan of the site and agree with a lot of what you say here, but I do disagree with your statement that is takes no ability/effort to not do something. Even if addictions are “merely” deeply ingrained habits, they can still be very difficult to break. Take cigarette smoking for example, even people who have given up the habit for years sometimes crave a smoke during periods of intense stress. The craving can be intense and can feel like a battle.

        Similarly people with OCD who spend half their day washing their hands (or whatever) may find the anxiety over germs overwhelming. It can require a significant effort to resist the desire to do something, especially when that activity reduces anxiety and produces pleasure (at least in the short term, even if it causes greater anxiety and distress in the long term).

        While I personally do not consider addiction a disease, there are certainly aspects of addiction that are disease-like. I suppose to some degree the debate over whether addiction is or is not a disease is partly semantics and arguing over the definition of disease.

        My view of addiction is that people, for reasons that are poorly understood, sometimes develop strong emotional attachments to certain activities, using drugs being just one of these (others potentially addictive activities include eating, gambling, religion, nationalism to name a few). Breaking these bonds can be a traumatic and difficult process, and when the person refuses to break this attachment despite significant negative consequences we call it addiction. This does not mean that the addict lacks free will (as the NIDA brain-disease model implies).

    • ZSL says

      When you say he has no idea what he is talking about, do you mean he doesn’t cite the research well? Because I thought he pointed out the evidence pretty clearly. If you want addiction to be classified as a disease, don’t get all huffy when the research doesn’t support your worldview.

  43. hu.. says

    when the CDC takes it out of the book, ill believe this article… until then… rant all you want…ps what credentials do you have besides being well spoken

    • says

      I am not a doctor, if that’s what you’re asking, although I could cite several MD’s and PHD’s who agree with my stance. I don’t expect any of my readers to accept my arguments on authority, or the opposition’s arguments/assertions on authority. I hope my readers will exercise their own judgment on the validity of the disease model. I hope I’ve raised points that help you to think it through and find the correct answer.

      -Steven Slate

  44. Outside-Looking-In says

    I am an opiate addict and I thought your article was inspiring, it gives me hope that one day I will be free from all of this. I made a mistake, and it is very discouraging to think that I will never be the way I used to be before drug addiction, or that I’m destined to be an addict for the rest of my life.

  45. Sean O'Neill says

    Most the comments lead a lot to be desired addiction does respond to medication. To compare addiction to a taxi driver as the article does, major loosing of association. A majority of drug addicts and alcoholics want to be diapered and told there.
    Science has proved it is a brain disease it is genetic, so you people keep argue right to your dirt nap. The choice you have is to seek treatment or not.

  46. Jeremy says

    My father has been an alcoholic for as long as I’ve been living, 22 years. He has consistently flung himself at alcohol repeatedly throughout this time. Despite this I can honestly say that it’s not a disease from my own observations. Everytime he drinks there is a motivator to drink that is not the alcohol itself. For him its women. He is the kind of person that needs companionship, which in itself is not a bad thing. However, in his case, being in a romantic relationship is as vital as breathing. My dad is truly obsessed with “having a woman” as he’s described it several times to me. I’ve checked his computer a few times and have seen search histories for at least a dozen dating sites, and in the recent past he’d go out on dates with a new girl every other day. My reason for saying this is that every time he meets a “nice woman” he ultimately ends up drinking with them. When he is “happy” drunk he has a tendency to dote on his partner too much and after a while they end up dumping him. Its at this point he enters his destructive phase, both externally and internally destructive. He flies into drunken rages about how each woman is psychotic and started treating him like crap when the truthis he is the one that goes nuts and starts treating everyone horribly.

    Its because of these facts that partially convince me it’s not a disease. Sure the alcohol changes how he thinks and what actions he takes, but when he’s not drinking? There are no chemicals influencing his obsession over women are there? The alcohol can’t send his brain messages when it isn’t in his body right? Are there severe physical changes to his brain that specifically cause him to grab his wallet, climb into his car, drive 3 miles down the road to walgreens, and buy the booze?
    Saying alcohol directly causes a disease in the brain that generates these actions is proposterous. My father is fully aware of himself when he seeks out relationships because it is a learned behavior for him. He makes the choice to consume alcohol when he meets with his girlfriends, not because the “bottle calls to him” but because he made the choice and accepted the drink with a perfectly clear head (aside from romantic urges). My entire family has met with him on several occasions, and even set up meetings with former alcoholics and AA groups. He’d go a few times and then say “I don’t have the time. Too busy.” He has enough time to go on all of these dates though right? So he obviously made the choice to date instead of help himself.
    Alcoholism isn’t a disease. Saying it is a disease is just a mask and a cop-out so alcoholics don’t have to confront the real issues behind the alcohol.

  47. a few studies to consider says

    If type 2 diabetes is a disease then Addiction is a disease.. as people with type two diabetes are choosing not to loose weight and make other life style changes that could “cure” them.. I really dont see what choice has to do with a disease. People choose to get diseases all the time and people choose to fail to address and even promote diseases all the time. After all the person who continues to eat poorly, not take medications, and not exercise is choosing to promote their heart disease.

    • Michael says

      ” I really dont see what choice has to do with a disease. People choose to get diseases all the time…….” LOL.

      Is that glaringly self-contradictory or is it ME thats dyslexic ?

      • a few studies to consider says

        If a person chooses to overeat, not exercise, not address their obesity then IMO they are choosing to get and keep type 2 diabetes. If a person chooses to have tons of unprotected sex with untested partners then IMO they are choosing to get STD’s.

  48. a few studies to consider says

    sorry and I think the mainstream recovery community and the fellowships are so stuck in the dark ages its sick.. it is well beyond time that they pull their head out of the mysticism and move forward with real science.. we once thought the world was flat, but we know batter now. That being said addiction is definitely a disease.

  49. says

    Dear Steven,

    Thank you for your website. Although I do not agree with all of your opinions, I believe you have created an important forum for the discussion of addiction.

    Behavior is a function of the brain. Abnormal function of the brain can always be linked with abnormal structure. A neurological correlate can be identified with every psychiatric pathology. Abnormal structure leads to abnormal function. The brain is an organ like any other in the body. When specifically talking about addiction, this has been shown on more than just imaging studies. This has been shown at a molecular level amongst various neurotransmitters, receptors, and electrophysiological properties of specific neural networks. There are to many peer reviewed scientific articles describing this to even point to a particular citation. This points toward the disease model of addiction. In addition, metanalysis of monozygotic twin studies show a high correlate of addiction to particular substances; suggesting a genetic basis (The Genetics of Addictions: Uncovering the Genes. http://focus.psychiatryonline.org/article.aspx?articleID=50718). Indeed this can be seen in families where alcohol and drug abuse are rampant. This could perhaps be dismissed by saying it’s more because of nuture rather than nature. An individual became susceptible because of high exposure. This is becoming dangerously close to sounding like it’s contagious, although not in the traditional sense. We are again straying back toward the disease model.

    I do agree with your opinions on choice. Following through with an addiction is a choice. However, unlike any other organ in the body, we can change the structure of our brain – as you clearly pointed out in the Maguire et al. paper on taxi drivers. We can alter neurological structure via psychological function. If it can be done through AA, NA, St. Jude, St. Joseph, St. Thomas, the Bible, the Bhagavad Gita, or standing on your head while singing show tunes then it’s all good. But why do addicts do it in the first place? Why is there that lack of control? Why would someone choose that in the face of adversity? I know you mentioned earlier that in your active addiction you continued to use because you liked it. But why did you like it more than the next person? When things were going so wrong right before you went to rehab why did you keep on using? Why could you not make the right choice? Moral deficit?

    When rats learn to self administer cocaine, they love it. Can’t get enough of it. They’ll do it to point of seizures if possible. However, if you pair those self administrations with a nasty foot shock, most stop. But some (around a third) don’t.. Some keep on going. Why? Moral deficit? Are they just dumb? If you rescue the hypoactivity in the prefrontal cortex via optogenetic stimulation then they stop seeking the cocaine when it’s paired with foot shock. With a minor change in structure they stop exhibiting the pathological behavior of compulsively seeking cocaine in the midst of negative consequences. They become like the others. The brains of those rats vary from the average rat, and so does their behavior (Rescuing cocaine-induced prefrontal cortex hypoactivity prevents compulsive cocaine seeking. http://www.nature.com/nature/journal/v496/n7445/full/nature12024.html). The brain of an addict varies from an average persons. This is merely one neurophysiological pathway abnormality that can be found in an addict. Other abnormalities have been described, and I’m very sure that more will be discovered.

    Addiction is not merely about choice. People (or animals) want to choose the best thing. It is very similar to schizophrenia or depression in that addiction is about distorted thinking. Addicts think they are making the right choice. I need to get my act together. I need to quit. But, in order to take the first steps in getting my act together I need to get high. I need to get high right now.

    I don’t look at the disease model of addiction as a means to absolve an addict from blame, but a means to better understand the neurobiological basis of behavior. I believe treatment of the active addict or those in recovery is important. But the study of addiction as a disease allows us to understand how all people tick. Preventative medicine is the best medicine. Your father’s family died to alcohol related incidences for five generations. Who cares if it’s genetic or up bringing? An early diagnosis may prevent a further tragedy. There’s a saying that says the sins of the father will be visited upon for seven generations. That may be true, unless you actively decide to be the seventh generation.

    It’s good that you’re making a collection of literature that supports your hypothesis. Be forewarned, do not be married to your hypothesis. Read what other people are saying on the other side of the issue. I hope I’ve provided some insight.

    Kind regards,

    Tharanee

  50. Clay M. says

    I have been reading and receiving comments here on this forum for about 3 years. Most of the information and experiences I find here are informative and enlightening. What first caught my attention to this website was the name in the title: Addiction is NOT a brain disease, it’s a choice. At the time, I was writing a paper on the subject. While there are both proponents, and opponents of this theory, there are just as many if not more opinions. While it is controversial, there is scientific evidence on both sides of the story that each “theory” is correct. What cannot be determined as correct or incorrect are people’s own individual experiences. I have been free of drugs and alcohol for over four years. At first, I thought AA and the like were the only answer. I have mixed feelings as to whether addiction is in fact a disease or not. I have found through AA that support from others can be invaluable. I have used AA over the years as such, and also a social network to be around other sober people. One thing that troubles me with some of the posts here is common when one is strongly opinionated, and that can be on both sides of the table. I believe it is important that we each recognize that, contrary to common belief, we are all not created equal. Some people have a greater potential for being more intelligent than others. Some have a propensity to being physically stronger than their counterparts. Others are, for a lack of a better term, and certainly not meant to be derogatory, “weak minded”. That, in most medical circles, can be considered as mentally challenging. The willpower that someone possesses to quit cold turkey is certainly an envious trait, and, one to be admired by some. The lack of willpower does not make anyone a loser, pussy or any of the other negative names placed upon people not like others. An experience of being able to put down a substance without any outside help is just that, an experience, that is owned by that person. On the other hand, someone who is at some sort of disadvantage not to do so, has an experience that is just as valid as anyone else. On both sides of the fence are people who get on their “soap box” and preach that their way of thinking is the only way. Each side needs to think about the individual, and their own personal experiences. I don’t have all the answers, and I don’t claim to be all knowing. What I do know is that it is wrong to demean or put down someone when you have never walked in that person’s shoes. I think that if everybody here, no matter what your experience has been, sticks to information and opinions that are motivating and positive, may actually be able to help someone in need instead of inhibiting one from wanting to get better.

    • robin says

      I like what Clay M had to say. We are all individuals. I am 50 something and have seen people who have literally lost everything and still use drugs. Tell me why a person would want to live a life full of heartache, homelessness, incarcerations, loss of physical health, loss of mental health, hospitalizations, stigma, all just to get high? I believe it is a disease just because I have seen it in my own family. A wonderful kind, giving, handsome, intelligent person lost in drugs. Sorry, I just do not believe they would do this by choice. Like someone else said, if you had a family member or someone you cared about who was addicted you might change your mind on the disease thing. Just saying………

      • says

        Hi Robin,

        I’m the author of this article and everything on this site. Thanks for reading. I personally engaged in a freely chosen pattern of behavior that most would call “addiction.” I was definitely losing it all. I understand your point, I’m sure people that I must’ve been totally “out of control” of myself – and I even felt that way at certain points. But when I finally decided to stop the madness, it was when I realized that:

        A) there had to be a happier way of life than I was living
        B) I was CAPABLE of living that happier lifestyle

        Part of how I changed my behavior after 5 painful years in and out of treatment programs who were teaching me to feel powerless and out of control, was that at the end of it, someone taught me that I was in full control, and that I was pursuing what I thought was my best feasible option for happiness (staying high on intravenously injected heroin and cocaine as much as possible, or on alcohol or other drugs when those weren’t available) at the time. The word “feasible” is important. Part of why I believed shooting coke and heroin all the time was my best option for happiness was the fact that I didn’t really believe I had better options available, or that I would be capable of successfully pursuing those other life options.

        Does this mean I was diseased or mentally ill? Well, even though I was diagnosed with several anxiety and mood disorders including bipolar, I don’t think I was really mentally ill. What I suffered from was a limited perspective, low self-esteem, and a belief that I was incapable of change and growth. When I changed that perspective, I was able to stick to the decision to abandon heavy substance use, and pursue a better life for myself. I was never physically unable to change, nor was I out of control and compelled – I was choosing behavior that I believed was my best feasible option for some level of happiness in my life. The reason I personally know this is the case is because it was sort of my original belief before I got into the recovery culture, and because when I looked back at my previous cycles between abstinence and extreme substance use, the abstinence always felt like a miserable torture – like being deprived of any reason to live. The insanity of heavy use, with all of it’s easily predictable painful consequences, was far more satisfying than abstinence at that point in my life, from the perspective I held at the time.

        I have now stopped that behavior for 12 years, and have been drinking at extremely low levels and frequency, problem-free, for almost 8 of those years. I don’t “manage my disease”, I don’t go to meetings, I don’t avoid “triggers”, and I feel no pull to resume my former behavior at all. I do not think of myself as a “recovering addict”, “addict”, or even “recovered addict” – because part of my change was changing my belief system, to know that I was in control of my own behavior the entire time, and in the future. Yes, I suffered horrible withdrawal symptoms whenever I would stop using heroin back then, but I was in control of my behavior nonetheless. I was never an “addict” because addicts – defined as people who can’t control their drug and alcohol consumption (or other such behaviors) don’t technically exist. Addiction is just a construct of the recovery culture – a construct created with the best of intentions to explain puzzling behavior and attempt to help people – but a faulty construct nonetheless.

        You said:

        Tell me why a person would want to live a life full of heartache, homelessness, incarcerations, loss of physical health, loss of mental health, hospitalizations, stigma, all just to get high?…… Sorry, I just do not believe they would do this by choice.

        I’m glad you asked in this way, and I understand the thinking. It seems to make sense. However, it rests on a premise that you may not realize. I have an article that explicitly address this at the following link: http://www.thecleanslate.org/addicts-choose-negative-consequences/

        The solution for our loved ones, is to help them broaden their perspective on what potential lifestyles they might be capable of living. And in the meantime, we should also respect that their lives are their own, they always work hard to pursue exactly what they believe is their best feasible option for happiness, and that even if that is heavy substance use, it doesn’t make them bad people. It’s their life, they get to choose how to live it. This isn’t to say we should tolerate people stealing from us and using us and otherwise violating other people’s rights, but those behaviors are separate from substance use itself.

        Thanks again for visiting the site,

        Steven Slate

        • says

          Steven,

          You mention that you had to stop the madness, yet you disagree with a personal diagnosis of mental illness. Madness is synonymous with insanity, and by it’s very definition a mental illness. Any diagnosis made during active addiction is immaterial, because it is masked by the drug use. I’ve heard it said that addiction is but a symptom of underlying causes. The fact that you suffered from limited perspective, low self-esteem, a belief that you were incapable of change or growth, and seeking drug use as the best feasible option for happiness sounds very much like straight forward depression. I believe relieving your depression helped you break out of the destructive cycle of drug use, which most (definitely not you) call addiction.

          There is no definition that can be found anywhere that addiction does not fill every aspect of. You cling to the opinion that imaging studies of addicts vs. normal individuals are irrelevant. However, these are the only studies we can do in humans. We are not ethically allowed to damage portions of peoples brains and see if we can make them into an addict, no matter how much I would like to. But it’s been done time and time again in animals (Neurocircuitry of Addiction.http://www.nature.com/npp/journal/v35/n1/full/npp2009110a.html). What needs to be done is to redefine disease so that it excludes addiction. Let me do it to Webster’s. Disease: A condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms, except addiction. There! Done!

          You state that addiction is just a construct of the recovery culture, but addiction was on the lips of clinicians in 1914 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2301059/pdf/brmedj07197-0028.pdf) well before the recovery culture was even a glimmer. Indeed, at this time most doctors would have agreed with your opinions. However, times change and science pushes our knowledge further. The Dalai Lama once stated, “If science proves some belief of Buddhism wrong, then Buddhism will have to change. In my view, science and Buddhism share a search for the truth and for understanding reality. By learning from science about aspects of reality where its understanding may be more advanced, I believe that Buddhism enriches its own worldview.”

          You state that you are not an addict, because you can control your drug consumption. You mention your 8 years of drinking as proof. But you mention before that alcohol was only usually an option when your drugs of choice were not available. I’m not sure your brain is wired specifically for alcohol like some alcoholics. Perhaps some field research is in order. Buy a month supply of heroine and cocaine for extremely low level daily consumption. Opioids and stimulants are commonly used in low levels as medicine. Most people, who aren’t addicts, have no trouble stopping. You of course, not being an addict, should have no difficulty with this.

          I hope I’m not coming off as to aggressive. It’s just that I’m very passionate about neuroscience and this topic in particular. I really enjoy your website. You help bring these topics to the forefront.

          Kind regards,
          Tharanee

          P.S. Please don’t buy a month supply of cocaine & heroine. I would rather see you live a fulfilling life in (what I believe to be a little ignorant) bliss, than return to the desolation of your past.

  51. John says

    He uses the conclusions of a newspaper sciene writer over VOLUMES of research by doctors and other medical professionals as the basis for his conclusions. This is not science – it’s simply using some other writing to support HIS OPINION that it’s a matter of choice.

    I’ve seen too many people affected by this DISEASE – and it’s backed up by all the major medical associations – to know that it is NOT a matter of choice. It’s hopeless idiots like you who keep people down in the gutter by stigmatizing them as simply being too weak to change. What a crock of BS.

  52. a few studies to consider says

    I recently witnessed something that finally put this to rest in my mind. I am a person who has suffered from addiction.. I am well versed in the neurochemistry, neuroanatomy, symptoms, and causes of addition. But when a very good friend, someone I love, someone who was sober for almost five years and then has gone back to totally reasonable use of drugs, even those in that she was “addicted” to.. oh and before anyone claims she wasn’t addicted, she was called edward scissorhands but the loser screws int the joint because the effects were so bad from injecting speed balls she couldn’t move her hands.. but she has been able to do all this on will power.. so yeah its a choice, but the thing is that I thought she was mentally ill because of her behavior.. her behavior is unmistakably a mirror image of the horin=bly named “king baby” syndrome out of hazelton. I am an addict.. I work with addicts everyday as staff on bluelight.org.. This hit home like a ton of bricks.. drugs are just a failed solution at a much deeper issue.. call it what you want … disease, destructive thought pattern.. but I no longer have any doubt in my mind that the drugs aren’t the problem.. http://www.democracynow.org/2014/1/6/drugs_arent_the_problem_neuroscientist_carl

    I know these do not represent unfathomable scientific proof.. but after plodding through over 30,000 pages of data.. these are some of the best things I have seen written on the subject.. is it a choice, yeah it is, but the underlying illness is what makes the choice so hard not to make.

    http://www.spectator.co.uk/features/8857821/fixing-a-hole/?fb_action_ids=10201789177466318&fb_action_types=og.likes&fb_source=other_multiline&action_object_map=%5B151100521716844%5D&action_type_map=%5B%22og.likes%22%5D&action_ref_map=%5B%5D

    http://debiehive.blogspot.com/2014/02/addiction-mental-health-and-society.html

    I was fooled for so long and understand the illusion.. but when I see someone do the impossible.. sober up and then return to non addictive use.. but still has the symptoms of an unaddressed addiction.. someone whose strength absolutely blows me away.. and pain absolutely kills me.. its crystal clear. i I went from one of its biggest doubters to a person with not a shred of doubt.

  53. Clay M says

    Check out a blog…..debbiebayerblog.com and read the article on Phillip Seymour Hoffman. I think you’ll find it quite interesting.

  54. Sal Pitello says

    Does the Center For Disease & Prevention (CDC) consider addiction a disease?

    I haven’t been able to find anything on their site about it. Of course, the CDC talks a whole lot about diseases caused by certain addictions, but doesn’t seem to think addiction is, in itself, a disease.

    If they consider addiction a disease, you’d think they’d be talking a lot about it over there.

    Maybe they know better. Or, maybe they just didn’t get the memo.

    Anybodfy know their position?

    Regards,

    Sal Pitello

  55. Tori says

    Positive changes of the brain, like tennis, driving or piano skills, do not, in any way relate to something that brings on the consequences of cancer or addiction. That is a poorly thought out point and I immediately stopped reading due to your reasoning skills being disqualified by that sheer ignorance. Most diseases can be avoided if you don’t partake in something negative.. Like poor diet, not exercising, smoking… And yes, drinking and using drugs. The area of the brain that brings on addiction is what your entire personality and view of the world is built on. If the activity of the dopamine, seriotonin ansd whatnot is only brought to that of the average person by using drugs or drinking, I’d say it is comparible to low or high blood sugar and its corresponding diseases(s). Yeah, you have to take that first drink or drug to mess with your system but due to a bad childhood, a bad pregnancy, or any other contributing factor, your brain could already be off and all that first drink would do is show you a more ‘simple’ way to control the way you feel. If your body has an uncontrolled growth of cells and you have cancer and need to do something to put a stop to that, I could relate the same idea to addiction. Though it isn’t as devastating as most with cancer, addiction could be called an uncontrolled sense of self. You don’t feel right, you can’t fix your depression or your crippling anxiety (or anything else related) because your body is not producing enough serotonin and such to bring you to the level of the average person. After treating your uncontrolled symptoms, you start to feel better., just like with a lot of diseases. Yes, cancer can kill someone if the uncontrolled factors are not helped by treatment but if no amount of treatment or drug can aid in the addiction, the person will surely overdose and die, kill themselves or wind up hating themselves from behind bars. The amount of positivity and hope and determination you have with every disease also plays a huge factor in how well the treatment goes, whether you believe that or not. This includes cancer and addiction. I have seen outcomes from both sides on both issues. Thankfully, the use of therapy and psychological medicine can have a stronger impact on addiction than other diseases but there are always still those resistant to treatment I could go on forever but yeah, addiction is more than a choice and though it may not coincide with your own personal definition of disease, there are far too many factors for anyone to be able to say that it is just a battle with self-will.

    • says

      Hi Tori,

      Thanks for questioning my “reasoning skills” – now, do you have a coherent refutation of my points?

      If not, then I would say your own admission that you didn’t read the article fully disqualifies you from criticizing the content.

      Your comments are incoherent at best.

      -Steven

      • D Smith says

        Mr. Slate you’re twisting the results of studies to bolster your opinions. You’re also name dropping and offering your personal experience to refute studies based on empirical evidence.

        The London cab driver study was among the 1st to show that our brains continue to grow and develop throughout our life time; the study is an example of healthy brain development. The study demonstrates that our experiences over time can directly shape the structure of our brains. The brain changes of cab drivers aren’t a disease because they improve functioning. Changes present in the brains of addicts are maladaptive. They impair judgement, decision making and change priorities: the addiction comes first at all costs.

        Unlike you, most addicts don’t choose to stop even though their health declines, relationships degrade or disappear, they lose their job, home etc.. Their brains are telling them that their addiction is what’s most important. Most addicts don’t make good choices even when sober, because of what’s happening in their brains. Maladaptive changes in the brains of addicts fit the AMA’s definition disease well.

        When discussing the study that presented the brain scans, you give no value to the treatment participants received during their 14 months of sobriety. They simply didn’t choose to abstain by themselves, they did so with treatment, which obviously helped them. There is nothing in either study that supports the “addiction isn’t a disease” model.

        12 step programs and traditional in-patient programs didn’t work for you, but they do work, especially in combination with each other. Your website reads like a well written forum rage post, which is sad considering google lists your site in the top of the “addiction not a disease” sites. I wouldn’t want people visiting your site to think that seeking treatment is pointless, but that’s basically what you’re telling people and that’s extremely unfortunate and misguided.

        I would strongly suggest visiting treat programs to get a better idea of what good treatment looks like. Visit out-patient counselors too. Perhaps you’ll then be less hostile to “treatment” in general. If maintaining this website keeps you sober I wish you the best of luck!

        • says

          D,

          I appreciate your good-faith reply to my article, disagreements and all.

          However you say that:

          When discussing the study that presented the brain scans, you give no value to the treatment participants received during their 14 months of sobriety. They simply didn’t choose to abstain by themselves, they did so with treatment, which obviously helped them. There is nothing in either study that supports the “addiction isn’t a disease” model.

          And you have a point – I don’t give much value to the treatment they received – because I don’t view it as “medical” in any way. I discussed this briefly in the article:

          When these studies were done, nobody was directly treating the brain of methamphetamine addicts. They were not giving them medication for it (there is no equivalent of methadone for speed users), and they weren’t sticking scalpels into the brains of these meth addicts, nor were they giving them shock treatment. So what did they do?
          These methamphetamine addicts were court ordered into a treatment program (whose methodology wasn’t disclosed in the research) which likely consisted of a general mixture of group and individual counseling with 12-step meeting attendance. I can’t stress the significance of this enough: their brains were not medically treated. They talked to counselors. They faced a choice between jail and abstinence. They CHOSE abstinence (for at least 14 months!) – even while their brains had been changed in a way that we’re told robs them of the ability to choose to quit “even in the face of negative consequences.”

          At the end of the day, the “treatment” they received was likely just a series of conversations. A conversation can be helpful, but it is not medicine that treats a bonafide brain disease. It is an exchange of ideas, in which one party may develop a new perspective on which they decide to cease using substances – or in which the individual may ignore everything which is said to them, refusing to consider any of it seriously, nodding and otherwise pretending to agree, telling the counselor what he thinks they want to hear, etc. It is up to the individual to voluntarily choose to integrate some advice, insights, or cognitive strategies expressed by the counselor into their own thinking, and if any of that stuff is correct, they will develop a new choice/preference as a result. Hopefully they ignore the stuff that is incorrect though.

          As Jeffrey Schaler said:

          What passes as clinical treatment for addiction is psychotherapy, which essentially consists of various forms of conversation or rhetoric (Szasz, 1988). One person, the therapist, tries to influence another person, the patient, to change their values and behavior. While the conversation called therapy can be helpful, most of the conversation that occurs in therapy based on the disease model is potentially harmful. This is because the therapist misleads the patient into believing something that is simply untrue–that addiction is a disease, and, therefore, addicts cannot control their behavior. Preaching this falsehood to patients may encourage them to abandon any attempt to take responsibility for their actions.

          Addiction Is a Choice | Psychiatric Times. (2002, October 1). Retrieved August 4, 2014, from http://www.psychiatrictimes.com/addiction-choice

          I happen to think that as sometimes happens, these subjects saw a choice between abstinence and jail, and chose abstinence. But perhaps, something about those conversations was helpful. I do not deny this possibility. I don’t know what was said in those sessions. But I do know this: it likely wasn’t a “medical” intervention, because conversations aren’t medicine, and nothing in the article indicated that a medicine or medical procedure was used – only generic “treatment” was mentioned, which likely consisted of what we know it usually consists of…. conversations. And thus, these outcomes actually support the choice model rather than the brain disease model.

          To this point:

          Unlike you, most addicts don’t choose to stop even though their health declines, relationships degrade or disappear, they lose their job, home etc.. Their brains are telling them that their addiction is what’s most important.

          My health declined greatly, I was arrested many times, spent many days in jail, lost many relationships, lost jobs, lost my place to live, etc – and felt like I must continue to use nonetheless, at great continued risk to my life. I went through all of that. I felt powerless. I felt helpless. But at the end of it was a new perspective and a choice to change. It was entirely of the mind – not the brain. I had to think differently about things in order to change my preferences and my actions. All those feelings of powerlessness and compulsion are real pain, and real feelings. But they’re not really the consequence of a physiological disease. They are the product of thoughts. They are the product of a set of beliefs which are a kind of trap, but which people can see their way out of, and it involves choosing to examine and see things differently. This is done in the mind, not the brain.

          AND I would add, that everyone who gets past this problem chooses to do so. Everyone. Whether they’ve received “treatment” or not, whether they’re die-hard steppers or not. If they’re past it, they’re thinking differently about substances (or about their other life options; their chances of successfully changing; etc) than they previously did, and their preference has changed in some way as a result of choosing to think differently. I do not presume to be special and/or presume that those who believe in the conventional recovery culture are somehow lesser then me, and weak, or whatever. They’re just mistaken about the true cause of their change – but they carried it out by choice, just like me.

          Please don’t think I’ve never visited treatment programs, outpatient counselors, meetings etc. I’m quite experienced with them.

          -steven

  56. Lesly says

    This article disturbs me greatly. My son is almost 16, he started doing drugs at 15. He has tried many. Yes, cancer is a disease. Diabetes is as well, mental illness etc. as there is no cure for cancer although great strides are being made, there is not a way to control the symptoms as in diabetes, mental illness and others. Addiction is a mental disorder, as organic as any other. Often it is a symptom of many types of mental illness. As my beautiful, kind son told me as he was crying, I tell myself I won’t, and I do anyway. Many things in his life have gone downhill as a result. An addict has to make the choice to treat symptoms of this devastating illness. But it is never cured. I believe this article is very damaging and condescending. Witnessing a loved one go through it, is heartbreaking. And if not managed will often lead to death. So, is that a choice?

  57. shay corba says

    I am not an adduct so I know I do not have a lot of credit on this subject, but from what I have seen both through research and day to day experience working with and talking to addicts I feel it is a case by case thing whether or not one can just quit. For example many of you on Herr have talked about after your 3 days clean you could stop and not go back or even stop cold turkey but then others of you have said you cannot quit that easily and that no matter what you’ve tried you keep going back. I feel both sides here are correct. For some people quitting is not exactly easy but easier for them then it is for some who no matter how much they try, no matter what they do, it feels as if that addiction is controlling them and they go back. I do not feel that it is their fault though I know many of you disagree with that. If any of you would like to comment or offer feedback in my theory I find it can be helpful to see other sides and hear their counters so I will be happy to read them and respond. I just ask that you would keep it civil. Thanks for taking the time to read my opinion it is appreciated I hope you take it into consideration.

  58. Linda says

    Wow. Just wow. My first problem with this article is the title. You were looking for a fight weren’t ya? That is a very bold claim! Your opinions are not facts and if you want to avoid hate in the future maybe you need to reevaluate your words. Something better would have been, “Is addiction a brain disease after all?” , but then you would have to re-write this whole article. It was a very one sided argument, and as the reader it seemed like you have never had an addiction problem, only that you do not like them!

    Another issue I see with this, is the whole changes in brain statement that were made. Yes our brain changes throughout our lives, however- drugs actually kill brain cells! Why wasn’t this mentioned? Everybody knows this- I guess it would not benefit your argument, so I understand that! And I can’t BELIEVE that you compared drug addiction to playing a piano. I really got the feeling you know nothing about drug addiction! Playing the piano does not give people psychological and physical addictions along with the withdrawals.
    Last, because I’m not wasting anymore of my time on this ridiculous shit anymore, when you brought up the points about the Heyman experiments, I was very offended that you took the work of an amazing project and twisted it around to make it look bad! This experiment was not for people like you to try and prove to the world that “we all have choices” (high-pitched, annoying nasal voice). Their work was for pure educational purposes, to try and come up with a cure for addiction. You may have just turned off thousands of people in the wrong direction.
    Everyone is entitled to their opinion. But when you make them look like true scientific facts you look bad.

    • says

      I’m curious why it is that you consider my claim that “addiction is not a brain disease, it is a choice” to be “a very bold claim”, which indicates that I’m “looking for a fight.”

      It would seem to me that if your evaluation is true, then the claim that “addiction is not a choice, it is a brain disease” would be at least equally bold and “looking for a fight.”

      Just so you know, they said it first. I responded.

      I’ll leave it up to my readers to wade through the rest of your nonsense on their own. A 2nd grader could see through it.

  59. Michael says

    Mr. Slate:

    Thanks for putting it out there.

    These discussions can get quite incendiary. In my experience, debates about whether or not addiction is a disease are rarely debates about whether or not addiction is a disease—they are usually not-so-thinly veiled attempts to either assign or duck responsibility for behavior. The last time I discussed this issue with anyone was with a young man from AA in his late twenties, who had armed himself with as much of the latest research as he could, much of it already mentioned on this and other sites. As a biochemist with a strong understanding of the difference between scientific models and clinical metaphors, pointing out the difficulties in each of his arguments came rather easily. I must admit to a certain immature giddiness on my part until, the last arrow flung and finding no target, he broke down into tears, sobbing “But believing that this is a disease is the only thing that got me to stop drinking.” As I said, that was the last time I discussed this issue with anyone.

    “No man is happy without a delusion of some kind. Delusions are as necessary to our happiness as realities.” Christian Nestell Bovee

  60. dnm says

    HA! All I have to say is this……YOU CHOOSE TO PICK UP THE DRUG! You were not BORN addicted to the drug. SO stop making excuses for your addictions! You shouldn’t have made a DUMB ASS DECISION to TRY a DRUG that you KNEW damn well could lead to being an addiction. HELLO!!!!!!

    • Rob says

      Sooo… babies that are born addicted to crack, or heroin (and other opiates) actually CHOSE to pick up the drug? That makes them a ‘dumb ass’ as you call it. Interesting theory, but fail.

      • Richard Conley says

        What you just described are cocaine/opioid DEPENDENT babies, not ADDICTED babies. Addiction has a psychological component that dependence does not. The two terms aren’t interchangeable, so I guess you failed.

  61. Karen Lynn says

    This is, quite possibly, the worst research paper I think I have ever read. Just complete garbage all the way through. Nothing but exaggerated claims that never actually get connected factually together. Try getting this peer reviewed dude and you’d be exposed for the fraud that you are. The internet brings out all the crazies, gotta say.

    • says

      Try peer reviewing something with unsupported criticisms such as “Just complete garbage all the way through.”

      Do you have any detailed criticisms of specific claims? Or do you just enjoy spouting arbitrary insults?

      • Richard Conley says

        Steppists resort to garbage like this when they don’t have a factual leg to stand on, so to speak.

  62. anna ortiz says

    I am so over joyed to hear that there is actually someone out there that shares the same views as myself, i have never had any addiction , but am a daughter of a mom who has had drug addiction for well over 30 years. the doctors just tested her brain yesterday at interfaith medical center in brooklyn ,n.y. verdict is organic brain syndrome. so looked it up , and same ole same ole… then came across this wonderful article. my theory,, if someone can dig a hole, then they can most certain get themselves out. step by step… it is such a great reward that they can give themselves, if they are willing to do the work… it takes a lot of cunning and energy wasted toward negative things,, they can turn it around and make it positive… no one wants to take personal responsibility … i can say my mom never taught me anything,, but i would be lying ,, she did , she taught me how not to act.. i really did learn by watching her nod out on the couch… we all have choices to make,, let us think on the consequences of a decision ,,before we make one..she is threatening to leave there tomorrow…!

  63. Rosie says

    Addiction is frustrating, non sensical and a never ending cycle of crap. Having spent 10 years with an alcoholic who had hopscotched through life onto various substances he eventually stopped drinking for 5 years. It did not end. The behaviors of this diseased mind continue EVEN WITHOUT THE SUBSTANCES. This was what convinced me it was a deep rotted psychological malfunctioning of the brain. This man in the end was diagnosed with PANCREATIC CANCER, have already developed an addiction to opiates from back issues, that in retrospect I am convinced he was deliberately exasherbating so his supply of drugs would not dry up. He ended up having to have his lower spine fused together. Then like I said he was disgnosed with the “killer” cancer. A year after being treated by one of the most famous, reputable clinics in North America I discover he is “stock piling” his drugs, getting them from his back doctor and this “famous clinic” and not telling either what he was doing. He has Hepatitis C and now has to have his stomach drained of fluids every couple of week, he is clear…would you believe of cancer, he has virtually no mobility due to his back, he is a walking wreck and 99.9% of it is due to the fact that he was and always will be an addict with an extremely diseased brain. Nothing these people do makes any sense, they can actively engage in killing themselves and still be in denial nad telling you that “you” have the problem. It is horrible. Addiction is like being possessed by a devil, a parasite, that feeds off your life, your spirit and that of anyone it can latch on to and it sucks you dry until you are a withered raisin. Every see a heroin addict, exactly what they look like, raisins……sucked dry of life. I hate addiction and it is hard to not want to get away from every addict whose path you cross as they will destroy you as they are being destroyed but the simple fact is, they have an extremely diseased mind that without and amazing program and the help of an excellent team of mental health advisors trained in addiction that can lead that person throught the maze of psychological , behavioral, spiritual, emotional, physical..to name a few, dmages that have been done by substance abuse and almost deprogram and reprogram that person to understand their minds and fight their addiction daily, they will relapse. There but for the grace of something bigger than me go I. Thank God I have the strength, self disciplne, weak stomach, guilty conscience, sense of responsiblity to not need to drown myself in a bottle if my problems get overwhelming, oh I have had biggggg problems to overcome. I wade in the water too deep I know when to turn around and come in, I know when too much wine is too much, wouldnt dream of popping pills to avoid facing something. Think how nice it would be to not have to deal with the problems but just have something in me that has stopped me from ever going too far. Addicts dont have that. Its like a death wish. Its like a walking insanity. I have no medical degrees or research to back it up only experience of living with an addict, forms of comparison and a lifetime of observation…….addiction is a disease alright. God forbid you have an accident or illness and have to be treated long term with pain killers. Always be careful what you say as as much as I believe addicition is hereditary I also believe it can effect anyone and that stuff alters your brain, of course it does. Then come back and say its not a disease when your life is being destoyed by a substance you cannot stop taking becuase it has gained control of your mind. Would not wish it on ayone and would not wish living with them on anyone either.

  64. kenny says

    Substance Use Is Not Compulsive, It Is A Choice
    There doesn’t seem to be any evidence that substance use is involuntary. In fact, the evidence, such as that presented above, shows the opposite. Nevertheless, when the case for the disease is presented, the idea that drug use is involuntary is taken for granted as true

    I DO Not think addiction is a brain disease.. but for me personally i was a cocaine baby, and from 12 fed ritalin i didnt want but at that age i dont consider that a choice.. then like most people in this world they try a drink or a drug.. from then on i was hooked immediately. continued to drink, hard drugs anything… I dont know you mean in this article are you saying addiction is a choice or recovery is a choice.. because for some people i never had the choice to moderate my drinking..i have tryed to believe.. i could and used moderation management still didnt work.. i tried to train my brain to moderate. i didnt work for me..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. … i dont like it when people bash aa program or other programs some one could see this and end up not going to aa when it could be the thing that ends up saving thier life… aa is very effective is you take all the suggestions.. sponser meeting steps service… i see alot of articles saying aa does not work… its because so many people go into aa and dont even do the steps… anyway i do like your article and agree with a lot of it good writing…

    • says

      Hi Kenny,

      You said: “I dont know you mean in this article are you saying addiction is a choice or recovery is a choice”

      I am saying that all of it is a choice – to use or not to use, to use a little or a lot, or to never use again – it is all freely chosen behavior. As well, the thoughts that create your desire for substance use are a choice too – you can choose to stop believing it feels great, or that you need it to self-medicate, or whatever particular benefits you believe you get from substance use. You can choose to stop believing all of that, and as you commit to that belief, your desire will go away. But regardless of whether you have the desire or not, you are never out of control of your substance use.

      The only exceptions are of the type you raised – if someone forces you to use, as you were forced to use ritalin as a child; or as soap opera characters are often kidnapped and forced to take drugs. But this is obviously not what we’re talking about when we talk about addiction. We’re not talking about people taking substances under the coercion of another person. And I should mention that no one can force you to be “addicted”, because being addicted doesn’t exist.

      There is no evidence that AA “works” for anyone. See this review of the research: http://www.ncbi.nlm.nih.gov/pubmed/16856072

      Furthermore, people who attend american treatment programs (of which upwards of 95% of them push the twelve steps and meeting attendance), or 12-step meetings alone, have no better rate of recovery than those who don’t get any help at all. Do you know what that means? It means that those programs ARE NOT EFFECTIVE. See this research: http://www.thecleanslate.org/self-change/substance-dependence-recovery-rates-with-and-without-treatment/

      AND, AA attendance has been shown to increase binge drinking rates, when compared to CBT or no help whatsoever: http://www.thecleanslate.org/alcoholics-anonymous-increases-binge-drinking-brandsma-study/

      So, I am not afraid of people reading this and deciding not to go to AA. They lose nothing by not going, and in fact, they may save themselves a lot of trouble by not going. If you want to go, and you enjoy it, that’s great for you and I have no desire to stop you. But I do want people to have the truth about “addiction.”

          • kenny says

            Hey thanks for the reply steve.. im not sure if your being sarcastic to terry or a agreeing.. I may be a moron though.. what do you mean , because being addicted doesn’t exist… one more thing you said Furthermore, people who attend american treatment programs (of which upwards of 95% of them push the twelve steps and meeting attendance….. in another article you say 95 percent of people leave aa in the first year so some times your stats really dont add up…..so what do you think i should do.. im 10 months sober… i dont believe in the aa thinking… i want to drink normally… so i just believe i can drink normally and choose to and get drunk once in awhile.. because ive tried that way.. can you explain why i havent been able to moderate like you said.. because you said it is very plausible…

            • says

              Kenny,

              That 95% of rehabs use the 12-Steps (in the form of 12-step based counseling methods, promoting meeting attendance and the steps as a necessary “aftercare”, holding meetings in house, or by bringing attendees to meetings) – in no way contradicts or is incompatible with the fact that 95% of new AA attendees drop out of AA within a year. How exactly do these two separate facts not “add up”? One is saying something about methods used in treatment programs, which is true and verifiable by published US government research. The other is saying something about how many people remain in AA for an extended period of time, and is backed up by AA’s own research.

            • says

              Also, yes I was being sarcastic to Terry. He responded to me by calling me a moron. It is clearly not a compelling argument, because it’s not an argument at all – it’s just name-calling. It achieves nothing. It shows that Terry likely has nothing to back up with whatever disagreement he has with me.

              • says

                So, I think your question is “why haven’t I been able to moderate?” Correct me if I’m wrong.

                My answer to that question is that you are 100% capable of using substances at whatever level you wish – high levels and high frequency; high levels and low frequency; low levels and high frequency; low levels and low frequency; or not at all – all options are available to all people. There is literally nothing that proves people cannot control their level/frequency of substance use. Again, there is no research that proves this.

                The research that is available proves that people are in control and can make different choices when they see fit.

                You have been capable, but you either haven’t truly wanted to use moderately, or you’ve changed your mind about it along the way.

                That you made a choice you later regretted (heavy substance use) in no way proves a disability. You only explain it as a disability because you’ve been taught to do so, and it’s convenient to do so. If say, you decided to have only two drinks, and then had several more drinks, then that simply means that you changed your mind along the way, and decided more drinks would make you happier. I can’t tell you the full extent of what’s going on in your mind at such times – maybe you still believe the loss-of-control rhetoric, and this has created an expectancy effect within you that makes you feel as if you must keep drinking. Or maybe you’re having an abstinence violation effect, where you’ve invested so strongly in abstinence and counting your sober days, that you begin to feel loss and regret and say “fuck it, I already ruined my sober time, I might as well go all the way with this.” Or maybe you really just love getting drunk, and you don’t like a mild buzz. I really do not know everything that goes on in your mind, but I do know this: you are freely choosing each drink or hit, because you think it’s your best available choice – even if you regret it after the fact, and then describe it as a loss of control to save face, or make sense to yourself of the fact that you spent your whole paycheck, or pissed off your family, or whatever.

                You are choosing each drink or hit because you prefer it to any potential alternatives. If you change your mind about the value of these highs versus the value of other things, you will change your substance use. But if you retain the same lust for substances, you will act out the same style of using substances again and again.

                Do not take anything I have said here as a recommendation to drink or use substances at all – I do not recommend it. I am simply describing the thought processes and facts surrounding this topic.

                -Steven

  65. Ross Andrews says

    You are a refreshing voice in a sea of negativity. People LOVE to define themselves by what they are AGAINST rather than what they are FOR, and that way of thinking is responsible for creating a huge self-reenforcing feedback loop. When you tell yourself that you are addicted to something, and you change your patterns of living in order to avoid being tempted by “the thing”, you give that thing just as much control over yourself as if you were still abusing the thing. An easy example is dieting. “I’m on a diet so I don’t eat sweets”. Well guess what you’re going to think about and talk about all day long? SWEETS. The fact that you think about it all the time doesn’t prove that you are addicted to them, it proves that YOU decided to give sweets control over you. The answer to pretty much everything is power. When you tell yourself that you are powerless, that something or someone has control over you, you are a slave to it/them. When you make the conscious decision to be the one who is in charge of you, and you work on that every single day… when you take responsibility for everything single thing that happens to you… when you decide that you are no longer a victim…. then you cannot become addicted to anything.

  66. Tyler says

    No one wants an addiction. And to be honest, people are weak, addict or not. To say it’s a choice, to have an addiction, means the individual can just stop.

  67. Lara says

    I completely agree with this. I got into an argument with my ex husbands mother about this topic. She calls her sons drug addiction a disease and says he has no choice. Well he is currently sitting in jail for the next year because he lies and consumes drugs regularly instead of taking care of his children that are wondering where the hell their daddy is . He also stole 15 thousand dollars from his boss and got away with it. Calling drug addiction a disease is a total cop out excuse that gives addicts justification to not take accountability for the poor decisions they have made. we all know that these drugs are addictive and extremely harmful as many of them are illegal for a reason. the fact the people are knowing putting themselves in this position is probably because of some emotional wound or abandonment issues. The thing is, doing drugs wont fix that, making choices to change what you don’t like about your life is a much more effect use of your time. The whole mentality of an addict is that they are victims in a world that is out to get them. Its always one excuse after another to why it is someone else s fault. Anyone who tells the person they care about who is an addict is being an enabler and only making matters worse. what we should say is you put you here you can get you out so get your game face on because what ever you put into it is what you will get out of it. changing your perception to “what the hell am I doing? I am better than this! I want more out of my life, no one is going to give it to me, i need to get it myself”. then the next step is stop thinking so much about your self and start thing about ways you can help others. there are people in the world who have real diseases go help someone in need

  68. Jane says

    I quit drinking the first time at the age of 21. I didn’t even know what AA was to consider going? I decided I wanted to quit because I was abusing alcohol and I made some poor choices. I relied on my own willpower, asked God for some help, and quit. No celebrating a sober date, didn’t remember when it was and didn’t care, got on with life and it was no big deal. Fast forward 30 years-After not drinking for 30 years I drank again and once again abusively. However, this time it was to forget about a failed marriage of 30 years and the death of loved ones within a very short period of time. Decided I didn’t want to live that way after 11 months of drinking heavy and decided to cut down and drink in moderation, only this time I had bad withdrawals . Dr. suggested rehab and not knowing what I was getting myself into, I said yes. 12-Step (AA Based) taught me I had a progressive fatal disease and I was powerless. If I wanted to get well I had to work the steps, get a sponsor, and attend the 90/90 meetings of AA. At first I didn’t buy into it, after all, hadn’t I quit rather easily without all this 30 years ago? After much brainwashing, I temporarily bought into this nonsense of addiction being a disease. I was severely depressed because of my divorce after 30 years and the loss of my father and other loved ones. Rehab did absolutely nothing to address the whole reason I picked up again. Graduated rehab and began my 90/90 days of boring repetitive meetings. Heard the same stories repeated over and over, including all the “How I Hit Rock Bottom and Whoa is Me,” stories. Experienced the controlling sponsor who said my sobriety comes before my family, witnessed the 13th stepping going on around me, was reminded of alcohol constantly being that was all we talked about, and heard all the scare tactics, including “Jails, Institutions, and Death.” In this kind of atmosphere, with my real problems still not addressed, I grew much more depressed. Relapsed big time, tried to kill myself with alcohol and pills, almost ended up dead and nearly arrested, but after a trip to the hospital I ended up in an institution instead. As they say in AA, “It Works if You Work It.” I was working it, the problem is the program wasn’t working for me. Of course when I said something to that degree, I had to be reminded by my fellow AA Zombies that I probably wasn’t working the steps properly, I must not have done a thorough inventory, or “Oh, My Gosh, I must be keeping Secrets!” No, as it turns out, AA was keeping secrets! Decided to do some research as I noticed the cult-like tendencies of this program. Was horrified of what I discovered. Mr. Bill Wilson was the “King of the 13th Step,” AA was formed from the Oxford Group Movement (a cult), he stole the copyright to the Big Book (screwing the 30 some other people who helped write the book out of their money), the men he built his theologies on such as Carl Jung, Frank Buchman, and Emmitt Fox, are accused of being cult leaders and based on what I read, I believe it. The Wilsons had a Spook Room in their home where along with Dr. Bob and his wife they held séances and you can find this information on sites favorable to AA, such as the Wilson family home, Stepping Stones. Then there’s Dr. Jellinek, the father of the Disease Theory, who may not be a doctor after all as he was kicked out of college for skipping class too much and it appears from documents that his credential appeared to have changed. Fraud! The deceit continues today as our court system sends criminals to AA meetings instead of prison as a plea deal at times. As a result we now have rapists, child molesters, and other violent criminals in the rooms and due to the whole anonymity issue, none of us have to know until it’s too late, which has been the case for far too many. After these discoveries, I decided to read the book I should have been reading all along, the Bible. Numerous passages in the Bible indicate that drinking in moderation is not a sin, however, the state of drunkenness most definitely is and is referred to as foolish. Now for something to be both foolish and a sin, it must be based on behavior and choice. The Bible talks plenty about the sin of drunkenness and in no place does it indicate it to be a disease. If your a Christian, do you really think God would judge us for having a disease? Bingo there’s my answer! Said goodbye to those I thought were my friends in the rooms of AA. Quickly learned they were not my friends as they lost my phone number, stopped saying hi in passing, and removed or blocked on FB. I guess your only a friend if you remain a sheep within the herd. On a positive note, I finally got some real help for my depression from a counselor not associated with the 12-Step program and I’m not depressed anymore and as a result I’m avoiding “Jails, Institutions and death.” I’m starting to get over my anger at being lied to by what passes as recovery in this country. By the way, the good ole USA is the only country in the world that accepts the “Disease THEORY of Alcoholism.” Kinda makes you wonder! I’ve given God the credit he deserves for my recovery and I’m enjoying life again. They say AA has saved thousands! Could it be that those who really want to get well remain active in a program that convinces them they have a disease that only AA can cure and their more than happy to take the credit. How many has AA destroyed? How many marriage have been destroyed due to a spouses new addiction to the program or 13th Stepping? How many people have been killed, raped, or had children molested as the result of a program that takes no responsibility for supporting criminals sent to AA? Finally, how many people died through suicide or attempted it like myself because of the failure of 12-Step rehabs to address the real problem or because some Nit-Wit Sponsor who thinks their a doctor tells their Sponsee, no anti-depressants for you, that’s not sobriety? Both AA and The Disease Theory of Alcoholism are based on lies, if you want to find the truth, close the Big Book and open your Bible.

  69. Rob says

    I don’t know if anyone’s said this or not, but aside from all the geek-speak, and neurological/physiological/psychological discussion, there’s one more simple fact that this whole article overlooks. ADDICTION CAN KILL YOU. Using the ‘taxi driver’ example is ridiculous. Any ‘disease’ that can kill, maim, injure, hurt, even just negatively affect you, is simply that. A disease. Using an example that does not lead to death by overdose (you can’t overdose on taxi driving, but you can overdose on water, just to remove the people who might say “just don’t CHOOSE to do it”) is completely and wholly irrelevant. Here’s an idea – stop drinking your coffee, your tea, your ‘health drinks'; stop eating your carbohydrate-riddled foods, stop constantly returning to this page to make sure you get your point across – because if you don’t, you’re choosing to be addicted to them, by your own admission of what you think addiction is.

  70. Heisenberg says

    Thank god for this website!

    I am in a drugs and behavior class in college, and everyone has just accepted the disease model without any second thought. I was getting concerned that I was the only one who felt this way.

  71. guest says

    Used to abuse the shit out of some morphine, however, coke is now what I currently enjoy, mainly due to the fact I have not found a smack dealer. I honestly do not see why I cannot use any type of drug I wish, if I’m free and all. I do not care about consequences, if I die, then shit, I’m dead. I use for the high, the euphoria, the sense of calm. Been in and out of rehab, been through NA, CA, AA, etc., still use. I realize the stigmata, the consequences; they mean absolutely shit to me. Just want to use, to ‘self-medicate’, what, who gives a fuck? (I don’t, for damn sure) Death honestly is the last high I can attain, and it’s natural. So, I say fuck ‘em, I’ll use whatever, whenever, and have zero regrets. If, financially, I cannot afford the hard drugs I like, I’ll go through the motions of PAWS, with the intent to do more when the opportunity arises. Get off my fucking g back, let me grow papaver somniferum, and have what life I’ve freely choosen to live for the short interim it may last (but given my luck, I’ll live for fucking ever). Do not care if addiction is a diseaseof the mind or choice gone wrong, just want what I want and can’t see why it can’t be that way.

    • Richard Conley says

      Megan’s post was obviously created by someone who lacks even the most rudimentary of reading and/or debating skills. Steven’s years of being an addict are a matter of record and are clearly posted on this site. But you knew this already; you just didn’t like his conclusions and like a good little Stepper drone, resorted to ad hominem arguments rather than attempting to refute his point. Because you can’t.

  72. John says

    I was an addict for 17 years and was taught the disease concept from the start of it all. I have been sober for 2.5 years and I no longer believe addiction is a disease. It makes sense that after using drugs repeatedly over a period of time will change our brains chemistry but also after abstaining from drugs for a period of time will change it back. After being clean for 8 months was when I started to notice the desire to use was less powerful. Then after about a year I had no desire to use drugs at all. I also believe that just abstaining and allowing your brain to return to normal may not be enough. Like the article said, if you don’t have something in your life that makes you happy or gives meaning, then getting high might feel like the best option to “fill the hole”. I give all the credit to Jesus for giving my life meaning and happiness as well as the ability to overcome a habit that is both powerful and dangerous. The good news is that addiction is not a disease and that you do not have struggle with it for the rest of your life.

  73. Ryan says

    I truly have a hard time with this article. I am an addict and when I was in my heavy use phases…It did NOT matter how hard I tried to self-talk (or choose) my way out of using. The cravings were simply TOO OVERWHELMINGLY INTENSE. The threat of loosing family and the pain it was causing them, the health risks etc… did not matter. It finally took me blacking out, crashing my truck and landing in jail for six months that finally forced the issue and got the ball rolling. And even when I got out…my brain still wasn’t fully healed and I relapsed a couple times landing myself back in jail for another 6 months. Now however, my brain is more capable of functioning normally, allowing me to make better CHOICES. You have to get healthy first….and that takes time. Recovery is a process….its NOT A SWITCH (CHOICE) YOU FLIP. Plenty of ignorance in this article…I’m afraid!! God Bless!!

  74. Ryan says

    Wikipedia—
    A disease is a particular abnormal, pathological condition that affects part or all of an organism. It is often construed as a medical condition associated with specific symptoms and signs.[1] It may be caused by factors originally from an external source, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune diseases. In humans, “disease” is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases usually affect people not only physically, but also emotionally, as contracting and living with many diseases can alter one’s perspective on life, and one’s personality.

    So addiction IS a true disease because is causes dysfunction. Whether you call it a disease or disorder….it “affects” the normal functioning of the person. Unlike cancer that suddenly attacks the body….it becomes a disease (or disorder) that develops over time with chronic use. And just like cancer……. most of the time, IT REQUIRES TREATMENT!!!!!
    To answer your question, I began taking antidepressants immediately after my last relapse. I sought more intense psychological help when I realized “I COULDN’T DO IT ON MY OWN” like you claim I could have. And “time” along with physiological and psychological treatment is what healed my brain. But dude…if you think severe addiction doesn’t change your brain chemistry or that you develop patterns of behavior that are almost impossible to break with sheer will power…than you are deluded. Furthermore….everyone is different and situations are different. If you are able to just all of the sudden “say no” and quit cold turkey….good for you. But it is not that easy for most. If it was simply as easy as just saying “NO”…..millions and millions and millions would be able to quit after the first trauma, hardship or downfall etc… and there would be no need for “TREATMENT CENTERS”. Most need some sort of intense intervention….and yes in some cases…medication. But time to get right mentally and heal is key. You seem like an arrogant and self-righteous chap as well as very shallow!! I Bet you can’t quit that cold turkey!!! LOL

    • John says

      Hi Ryan, I would like to explain how I see that addiction is not a disease, but a choice. Compare it to cancer for example. If someone has cancer they can’t wake up in the morning and choose to not have it. It takes chemo therapy to get rid of it. With addiction you have the choice everyday whether or not to use or get high. I’m sure you have probably made the choice to not use for days, weeks and months or more consecutively. Now here is the part that I think a lot of people don’t understand. The fact that addicts still have desire and cravings even after months of sobriety probably makes it feel like your going to be that way for the rest of your life, especially when you have doctors and groups like A.A telling you that. According to the article the brain does go through some changes after you have used chemicals for a prolonged period of time. These changes are not abnormal and can even be seen in peoples brains that are not addicts. The good news is that the brain chemistry that has been changed due to use of chemicals will change back after abstinence and replacing your obsession with alcohol or drugs with something you consider to be more important. The problem with the disease model and therapy groups is that they teach you that your stuck with having the cravings. Just having in your mind that addiction is a disease and that you must rely on an A.A group or even a higher power can be a stumbling block in getting your brain’s chemistry or thought process changed to where you eventually won’t have the cravings anymore. If you noticed in my first post that I do give credit to God for my recovery, but not that he performed some miracle and healed a disease. It’s because I believe God created us as intelligent and capable human beings. Anyway I don’t have a perfect interpretation of every aspect of addiction, just thought I would share my opinion.

      • Ryan says

        I respect your honesty. But as with cancer….you need TREATMENT to attempt to cure it correct? So why doesn’t this apply to addiction? And your brain imaging argument doesn’t hold water as” the effects are “experiential” and the physiological “symptoms” cannot be seen on a computer screen. They are felt!!! Like PTSD….there is “disorder” taking place in the brain. I suffered with it as well and I COULD NOT simply choose to stop those symptoms. PERIOD!!! Again I needed treatment to help my brain begin to heal functionally. Now…it is true that one can choose to quit using and persevere through the discomfort and anguish until they are functioning again, But, when you define disease…..you can call it what you will. Intense cravings are caused by a physiological “dysfunction” of the body. Do you consider Diabetes a disease? Well how do most people develop diabetes? You got it…poor eating “HABITS”, Like using habits. There are many things we can choose to abstain from….including drugs and alcohol. But there is “OVERWHELMING” evidence that chronic use “changes” a persons body and in most cases….one needs Treatment of several kinds…medical and psychological. Do you consider Schizophrenia a disease….this person cant wake up in the morning a choose to not have it either…right? We are splitting hairs as to how we define disease. You seem to think it is only limited to those that are organic (other than mental).
        Lastly, you mentioned the Lord. I lean on the Lord as well. But here is a tidbit to consider….We are ALL FALLEN in a Cursed world and if you are familiar in ROMANS 7:15-20 I do not understand what I do. For what I want to do I do not do, but what I hate I do. 16 And if I do what I do not want to do, I agree that the law is good. 17 As it is, it is no longer I myself who do it, but it is sin living in me. 18 For I know that good itself does not dwell in me, that is, in my sinful nature.[c] For I have the desire to do what is good, but I cannot carry it out. 19 For I do not do the good I want to do, but the evil I do not want to do—this I keep on doing. 20 Now if I do what I do not want to do, it is no longer I who do it, but it is sin living in me that does it. What does this say to you? God Bless

        • John says

          Ryan I understand that we are fallen but God does not want us to live in a constant struggle with addiction.

          Romans 8:2 says-because through Christ Jesus the law of the Spirit who gives life has set you free from the law of sin and death.

          The famous words of Jesus in John 8:32 “Then you will know the truth, and the truth will set you free.”

          When I stopped going to 12 step meetings and treatment centers where the disease model is taught is when I noticed that the desire wasn’t there anymore. I believe the truth that set me free is when I started believing what that verse and others really say. Before I just took them for granted. I know it is a struggle in the beginning but if addiction is a learned behavior then it can be forgotten or un-learned. What I mean is that there should be some scientific evidence that shows that the brain returns to the way it was before the substance use started. Can you help us with this Mr. Slate? I apologize if you have already answered this question in a previous post.

    • says

      Definitions, to be of any use, are supposed to narrow things down by identifying the essential characteristics of a thing that differentiates that thing from other things. You have provided a definition of “disease” that is so broad that it could literally include any state of affairs with negative consequences. And I quote:

      “disease” is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories.

      I’ve seen this about a billion times, and frankly, I’m disgusted by it. If you have any level of comprehension, you should understand that this is describing the metaphorical use of the term disease. Thus, you shouldn’t attempt to use this definition when discussing whether or not addiction is a medical disease – i.e., a condition involving malfunction on a cellular level – i.e., the physical parts (tissues/organs/what have you) of a living being not working how they normally should work.

      Under the definition you provided, I could say for example that choosing to be in a relationship with a drug dealer or a mobster is a disease. Would such a relationship lead to “dysfunction” in your life? If you consider having to live a lie; exposing yourself to arrest; being complicit in crime; etc to be “dysfunctional” then bingo – such a relationship is a disease. But even if it’s not a relationship – maybe you were born into a family of criminals – this unchosen circumstance can cause dysfunction; expose you to potential injury; etc – and thus it is a disease.

      Or perhaps you chose a college major in which there is little potential job opportunities or where the potential pay for such jobs is so low as to have you living in poverty. You’re also in debt $200,000.00 – which you will never be able to afford to repay. Is your secondary education a disease? Under the definition you’ve provided, yes it is most definitely a disease.

      Do either of these “conditions” fit what we think of when we hear the word disease? No, they don’t. We wouldn’t think that medication or surgery were the proper solution to either of these conditions. We would think that they were particular choices with particular consequences for which the people involved would have to make new choices to remedy the consequences if that is what they desire. In the case of being born into a family of criminals, we would think the person was dealt a bad hand in life, and that they’re disadvantaged, and will have to make the tough direct decision to distance themselves from their family if they want to cut down their exposure to risk. We wouldn’t think they’d need a medical doctor to solve their problem though.

      Summing up – your definition of disease is so broad as to be useless in the quest to understand the nature of addiction. If you want to say it’s a metaphorical disease, go ahead and do so, and own that – don’t try to have your cake and eat it too by fitting addiction into a metaphorical definition and claiming that it’s proof of a biological reality.

      -Steven

      • Ryan says

        Dude, that is the wykpedia definition!!!!!!!!!!!!!!!!!! We are not talking about the first time someone chooses to try drugs or after several times or even a few years “chooses” to set it down. We are talking about the “condition” that one can develop over long periods of time that create Disease like symptoms and require disease like treatment. That is the “condition” of addiction. Once an addict has gone so far, it becomes a Disease. Tell a 20 year Heroin addict….”hey, you should be able to just say no”!!!! NO……..THEY NEED MEDICAL TREATMENT!!!! And dude…..does being in a relationship with a drug dealer or mobster change your brain chemistry? Does it cause cravings to hang out with more mobsters? NO!!! That is the dumbest example of attempting to prove that my argument is too broad!! Really dude??? Really??? And the college example too? WOW dude….that is the most amazingly stupid line of reasoning I have ever heard. You might as well have said….”because I read a lot of books….I have the disease of readers sclerosis”. WE ARE TALKING ABOUT THE “PHYSIOLOGICAL” CONDITION, PHYSICAL SYMPTOMS, BRAIN DAMAGE, CHEMICAL IMBALANCE ETC……………………..”CAUSED”……………….”AND BECOMES THE RESULT”…………..OF CHRONIC USE!!! IT DOES NOT MATTER HOW SOMEONE “DEVELOPS” A DISEASE………….WHETHER FROM THIS, THAT OR THE OTHER!!! You want to explain to me why you say that it can only be “cellular”. Who made that RULE? CTE…that boxers and football players develop is a Disease that can have “PERMANENT” symptoms. Just like Alzheimer’s disease!!!! Chronic users can have permanent symptoms and damage as well. Besides, Who are you or anyone to say “WHAT” is a Disease or what isn’t. The definition is “BROAD” for a reason. Any condition that changes the normal functioning of the body….and this includes the MIND (or brain) for long periods of time until death or cure could be called a disease. Is the term “disorder” better for ya? NOT ONE HUMAN BODY ON THIS PLANET IS “PERFECT” and void of problems. Therefore….Quite frankly….the list could even be broader!!!Your arguments are weak as hell……as there IS TONS OF SCIENTIFIC EVIDENCE THAT CHRONIC USERS DO DAMAGE TO THE CELLULAR STRUCTURE AND CHEMISTRY OF THE BRAIN and therefore……………THEY “NOW” HAVE A DISEASE!!!!!!!!! And YES, many millions of times over…. they are helped with medication!!! I WAS!!!!! And lastly….To say that a Disease can only be called a Disease if “SURGERY” is required…..is laughable!!! Sorry, But I am a recovering addict of over 20 years and at points in my life …….I WISH I could have simply CHOSEN to quit. But It doesn’t work that way bro!!! I needed help!!! Sorry If I was a little abrasive!!! God Bless……..

  75. Zach says

    No. Just, no. I’m not even going to say anything else about how ridiculous this article is, since so many people have made CORRECT points already on how it is indeed a disease. I will, however, say how appalled I am at the general lack of compassion for other people’s obvious suffering. I’d have to say most of those who are arguing against the facts of the disease have probably not had any level of experience with addiction, or at least not as much as they’d like to believe. I’ve met other addicts in recovery who don’t believe that it’s an addiction and that’s all well and good for them. Hell, if it works for you then great; as long as your healthy and happy. But telling other people they’re wrong about how they feel they should get help is not okay. If I listened to the people spouting this nonsensical “weak will power” BS at me while I was still in active addiction, then why would I have gotten help? It would have been solely my problem to fix since it must be all my own fault. Sure, I MUST have wanted it to ruin my life. There are no pros to living like that. Why would someone choose to continue doing so if it were really up to them? There are definitely more scientific, peer-reviewed, FACTUAL findings on the subject; but others have already presented them (mostly to closed minds and deaf ears), and really it all comes down to the question of why someone would choose to destroy their own lives if it really were a choice. It’s not. Plain and simple. If you want to believe its a choice, that’s fine. But please, PLEASE don’t put other people down who might otherwise seek help for their addiction if you hadn’t made them feel so guilty and helpless about themselves.

    • says

      Hi Zach,

      You said:

      “If I listened to the people spouting this nonsensical “weak will power” BS at me while I was still in active addiction, then why would I have gotten help?”

      I just searched this page for the terms “will power” and “willpower”, and found 29 instances of these terms (your comment containing one). Although I didn’t do an exact count (I skimmed the instances of the terms), it appears that this concept is mentioned a few times by people who quit without treatment; a few times by those who say it takes willpower; and the majority of times it was mentioned appear to be from those who take issue with my article and the view that addiction is a choice.

      Oh yeah, there are also 3 instances of me using the term “willpower” in this article. The first appears in this quote:

      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.

      The other two appear here:

      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.

      I think those two excerpts clearly show my opinion that this is not an issue of willpower or weakness. I’m not sure of why I need to keep being accused of making this a matter of willpower or weakness – except for the fact that other people are projecting their own false dichotomy onto my presentation.

      Onto another issue – you said:

      Sure, I MUST have wanted it to ruin my life. There are no pros to living like that. Why would someone choose to continue doing so if it were really up to them? There are definitely more scientific, peer-reviewed, FACTUAL findings on the subject; but others have already presented them (mostly to closed minds and deaf ears), and really it all comes down to the question of why someone would choose to destroy their own lives if it really were a choice. It’s not. Plain and simple.

      The point of saying “addiction is a choice” is that the behavior is in direct control of the individual at all times, and the belief system that motivates the behavior is also within control of the individual. You can choose different beliefs and you can choose different behaviors. You are autonomous in this respect – nobody can do these things for you. The most someone could do to make your behavioral choices for you is to lock you up in a cell where your choices are limited.

      The fact that a behavior or series of behaviors has high costs or risks involved does not prove in any way that it wasn’t or wouldn’t be freely chosen by someone. This argument you have made is foolish, although I don’t fault you for it, since it is in common use in the addiction-as-a-disease rhetoric. Rather than repeat a lengthy discussion on it, I’ll just say this – there are plenty of behaviors we consider to be freely chosen that also come with high risks and costs (even fatal costs). And I will provide you with a link to my discussion on this topic here: Why would someone choose to be “addicted” when they know it will cause so much pain? I hope you’ll read it.

      -Steven

  76. Ryan says

    Steven….”belief system that motivates behavior is also within control of the individual”………… HAS NOTHING TO DO WITH ADDICTION!!! Again you are flat WRONG!!! My thoughts or my beliefs can motivate me to want to quit all they want…but when brain chemistry and cravings and physiological conditions are involved…. this makes it a “medical issue”….not a “thinking” or “belief” issue. Again….dude…YOU ARE WRONG!!! You are tired annoying…..and should give up your pushing your “beliefs” and “opinions” on the subject and the world….because that is ALL THEY ARE….”OPINIONS”……………..BACKED UP WITH NO SCIENTIFIC EVIDENCE WHATSOEVER!!!!

  77. BiochemistGuy says

    Mr. Slate, I congratulate you on using critical thinking skills and on applying the scientific method to support your position. I agree with your analysis and I have yet to see any scientific evidence that “addiction” is a disease, almost by definition it is NOT. If nicotine addiction is a disease why are clinical interventions so less effective than simply quitting cold-turkey? Since a VAST majority of ex-smokers, millions of them I might add, had no “treatment” whatsoever and “treated” people almost always relapse it strongly supports the contention that it is a choice. I think clearly profit-motive (smoking cessation products are big bu$$ine$) and industry lobbying is the primary driver of the “di$ea$e” classification of this phenomenon. Alcohol and drug “treatment” has been hijacked by religious cult-like dogmatic “step-programs” that insist one give oneself up to a “higher power” to overcome their “disease.” What other disease is treated by prayer? NONE, ZIP, ZERO! In fact, it is illegal to withhold treatment of a child on religious grounds. Why is that? BECAUSE it’s all bunk and we would have dead kids lying around on the streets of America if that was allowed. They want to indoctrinate you into their religion and have no reservations about taking advantage of you in a seemingly defenseless state. If it was really a disease a religious treatment program (step-program) would be the very last choice in treatment. All evidence I’ve seen shows that these religion-based treatment programs are an absolute abject failure and likely do more harm than good to many participants (especially those forced to attend by courts).

    I think this is clearly a complex issue (primarily because of the human toll it takes on individuals and our society) but likely rooted in basic biology. Drugs, such as alcohol or nicotine, provide an altered state of mind and the propensity to seek mind-altering states in the human animal (and other animals as well) has long been documented throughout recorded history and archeological findings show it has always likely been true (ancient Egyptian mummies with drug metabolites in their system for example). Clearly marijuana co-evolved with humans and likely alcohol has been used far into prehistoric times as well. After initial exposure to these “fun” mind-altering chemicals (with “spiritual properties”) they become reinforced (classified as “reward”) in the brain, dopamine and other substances reinforce this reward feedback mechanism in the brain. We thus return to these “drugs” and form a desire to experience their effects again (the “high”). At some point in time, depending on the biological state of the organism, the use of these chemicals become destructive and the individual abuses them – inducing pain – eventually horrific pain in some individuals. However, great pain can be MUCH more tolerable than living without the distraction the drug provides and we don’t want to be left alone to suffer internally, inside one’s own brain, like a horrific prison. This is what we call addiction. The harm from the drug is not enough to overcome the pain of NOT taking the drug. Evidence shows that many, possibly most of us, prefer NOT to be left alone inside our mind. It must be escaped no matter the consequences (to some individuals) and thus this leads to highly destructive addictive behaviors and the (apparent) inability to stop.

    The following research appears to support this hypothesis:
    http://www.sciencedaily.com/releases/2014/07/140703142154.htm

    • Ryan says

      Bio retard guy…. (sorry I shouldn’t have said that)….But I did….LOL

      “Yet to see any scientific evidence” huh? Let me guess….you haven’t looked!!!!!!! Dude…. prolonged drug abuse can change brain structure and function!!!! What the hell do you people not get with this FACT!!

      http://www.sccgov.org/sites/dads/Presentations/Documents/The_Science_of_Addiction.pdf
      http://www.nlm.nih.gov/medlineplus/magazine/issues/spring07/articles/spring07pg14-17.html
      http://www.issues.org/17.3/leshner.htm
      http://www.attcnetwork.org/explore/priorityareas/science/disease/

      “If nicotine addiction is a disease why are clinical interventions so less effective than simply quitting cold-turkey?” BRO…YOU SERIOUSLY JUST PUT NICOTINE ON THE SAME LEVEL AS HEROIN OR METH AMPHETAMINES OR ALCOHOL? I guess that’s why you got the RETARD blast!!! LMFAO…..

      “What other disease is treated by prayer? NONE, ZIP, ZERO!” Oh really wise guy????? Apparently you have never heard of “healings” before. Oh…that’s probably because you don’t believe in God ehh? And that somehow makes you an expert on the power of prayer huh?? Again…. uncontrollably Laughable!!!! Ask any of the billions and billions and billions of believers past and present if the power of prayer hasn’t healed them in one way or another!!! There wouldn’t be such a thing as “prayer” if it wasn’t REAL and GOD wasn’t real!! Furthermore…… the method of “treatment” (anti-depressants, AA, Prayer, detox, psychotherapy etc…) that is employed for the disease of addiction……. does not in any way discredit it being a disease. People can recover from all kinds of other conditions as well with abstinence and prayer and therapy and whatever….like PTSD…… but it is still A DISEASE AS WELL!! However with severe addiction (especially heroin or opiates and severe alcoholism)…..it usually requires “medical” and psychological treatment. A disease bro…. is ANY CONDITION THAT DISRUPTS THE NORMAL FUNCTIONING OF THE BODY!!! This includes the brain (mind).

      “Drugs, such as alcohol or nicotine, provide an altered state of mind and the propensity to seek mind-altering states”…… WHAT????????? Nicotine is a mind altering drug? What like Crack? Since when? Man….Again you compare nicotine to alcohol? Dude….you really are deluded aren’t you!!! They are not even CLOSE to having similar effects on the brain.

      P.S…..could you please site where you got all this rambling nonsense from? Cause you sure as hell didn’t get it from any medical professionals!!

      You seriously sounded like you just “mused” all of what you said!!

      Ryan

      • a few studies to consider says

        Nicotine is one of the most addictive substances on the planet.

        “Tobacco use causes more deaths each year in the United States than
        AIDS, alcohol, cocaine, heroin, homicide, suicide and motor vehicle
        crashes combined”

        Here are a couple jokes around this..

        Why do people quit crack before tobacco, because quitting crack is easier.

        Why do people quit herion before tobacco, because quitting herion is possible.

        Addiction is a psychological drive to use a substance or engage in an activity that have stimulated the mesolimbic reward pathway. Physical dependence is when a person has to take a substance in order to feal “normal” due to neurotransmitter down regulation and its resultant tolerance.

        Here is a great audio book, written by an esteemed medical professional from John Hopkins.
        https://www.youtube.com/watch?v=lVB_tan-gig

  78. jan says

    Wow. I had no idea there was so much hatred between non active addicts. If the disease model scares its believers into not using because they feel that using once will make them active again, how are they wrong? If you believe addiction is a choice and that you are no longer an addict then drink to that and go slam some dope, you can stop whenever you choose. I really don’t understand why addicts in recovery and addicts who no longer choose to be addicts are so creeped out by AA dogma. People can believe in a higher power if it keeps them sober. You all use to believe your own lies. I would rather have someone believe that an imaginary friend protects their sobriety rather then driving drunk? When did you junkies get so opinionated and self righteous? We normies don’t care how you got sober just please stay that way.

    • says

      There is a thing called reality. It exists independent of what any of us a think about it. As human beings, we need to understand reality in order to make decisions that will help us to survive and thrive and continue to create better outcomes for ourselves. For example, if you understand the reality that fire destroys human skin, you’ll be sure to keep your skin away from fire. Make sense? You need to know the facts of reality in order to survive and thrive.

      So, how are people who assert that addiction is a medical disease wrong? It is not, in objective reality, a disease. Bottom line.

      It is not a condition caused by a physiological malfunction of some part of the body – it is not a disease. When we think that it is, we look for the wrong solutions to it. We look so far in the wrong direction that it leads us away from the truth and answers that would help people to deal with this problem in a way that works.

      If you want to argue for scaring people into abstinence, that can be done without lying about the nature of addiction. We have a scare tactic called the war on drugs. Maybe you’ve heard of it?

      I take issue with this part of your comment as well:

      If you believe addiction is a choice and that you are no longer an addict then drink to that and go slam some dope, you can stop whenever you choose.

      It seems you assume that because a choice is available (moderate use), that you should do it. It also seems that you assume the choice part is only about loss-of-control. So then, if you can use without loss of control, then you should use. I would just like to take this opportunity to point out to my readers that this is not logically implied by my assertion of a choice model, and I do not endorse such thinking. You should do what works best for you in your life – this may or may not include some sort of substance use. I can climb a jungle gym, and stop whenever I want – but I haven’t done so in too many years to count – because that activity doesn’t fit with how I prioritize my time and potential activities that will make me have a happy life.

      • Ryan says

        “So, how are people who assert that addiction is a medical disease wrong? It is not, in objective reality, a disease. Bottom line”.

        K smart guy….. then “WHAT” do you call the “condition” or “state” or “REALITY”…………of someone exhibiting these symptoms;
        (by the way….these symptoms can and many times do “PERSIST” for months….even years and in some cases….”NEVER GO AWAY”)

        Decreased coordination
        Difficulty concentrating
        Increased appetite
        Slowed reaction time
        Paranoid thinking
        Drowsiness
        Slurred speech
        Memory problems
        Confusion
        Slowed breathing and decreased blood pressure
        Dizziness
        Depression
        Euphoria
        Decreased appetite
        Rapid speech
        Irritability
        Restlessness
        Nasal congestion and damage to the mucous membrane of the nose in users who snort drugs
        Insomnia
        Weight loss
        Increased heart rate, blood pressure and temperature
        Hallucinations
        Greatly reduced perception of reality, for example, interpreting input from one of your senses as another, such as hearing colors
        Permanent mental changes in perception
        Rapid heart rate
        High blood pressure
        Tremors
        Flashbacks, a re-experience of the hallucinations — even years later
        Withdrawals

        IF A PERSON IS SUFFERING FROM A COMBINATION OF ANY OF THESE SYMPTOMS AND THEY ARE NOT SUFFERING FROM A “DISEASE”………….. THEN WHAT THE HELL ARE THEY SUFFERING FROM MR. SLATE?????? TELL US THERE WISE GUY………… WHAT DO “YOU” CALL IT?????

        YOU ARE A JOKE!!!!

        • says

          Are you that thick? Or is your post a joke?

          If you break your leg skiing, this doesn’t make skiing a disease.

          If you walk among rattlesnakes and get bitten and poisoned, the medical condition isn’t “walking-among-rattlesnakeitis.”

          As John Booth Davies, Professor of Psychology at the University of Strathclyde and Director of the Centre for Applied Social Psychology, said:

          The fact that the short and longer-term disruptions of behaviour which sometimes result from taking drugs can become the occasion for postulating drug taking as a disease manifestation shows a familiar confusion; namely the confusion of intentions with outcomes. For example, during the late 19th and early 20th centuries, missionaries went to Africa where many of them caught malaria and died. The disease was malaria; not the decision to go to Africa. Furthermore, whilst a doctor can in principle treat the malaria, he can only advise people not to go to Africa, on the basis of his own beliefs and opinions about Africa. In a similar way, damage to health caused by drugs does not imply that the decision to take them is pathological, any more than deciding to go to Africa is pathological.

          Davies, John Booth (2013-12-02). Myth of Addiction: Second Edition (Kindle Locations 972-977). Taylor and Francis. Kindle Edition.

          In case you’re unaware, the assertion is that addiction – which is usually described in some way as the act of taking drugs/alcohol past the point where they are causing considerable damage to a person’s life – is said to be a disease itself. The act, is supposedly the disease – the consequences aren’t the disease of addiction – the act of taking drugs/alcohol itself (or the imaginary “compulsion” to do so) is what is referred to as the “disease of addiction”. It is supposedly an unchosen behavior caused by some arrangement of neurons. However in reality it is no such thing.

          As for these other conditions you raise, sure, they are diseases, medical conditions, illnesses, injuries OF THEIR OWN – I have no bone to pick with their status. However, the fact that many of them can be caused by heavy substance use says NOTHING about the habit of using substances itself being a disease. NOTHING, WISEGUY.

          I cannot even believe I just replied to this comment.

          • Ryan says

            Man….you have got to be the biggest F-ing moron ever!!!! Rattlesnakes? Skiing? Again you use the most idiotic, irrelevant, unrelated examples of life activities to somehow prove your ridiculous line of reasoning. As if somehow your analogies of breaking a leg and the act of getting bit by a snake are on the same par as a 20 year addiction to heroin!!! Dude….get your F-ing head out of your butt and at least “TRY” (I know that is hard for you to do) to stay within the realm of REALITY.

            I HAVE NEVER ONCE SAID THAT THE HABIT (OR ACT) OF SMOKING THE CRACK PIPE OR SHOOTING THE METH WITH THE NEEDLE IS THE DISEASE!!!! If I take a hit of pot, or drink a beer, or smoke some meth….obviously I have NOT just contracted a disease. That is common sense. The disease model of addiction However, ….is when I continue smoking the meth or shooting heroin over a long period of time… and I then begin to make wholesale changes to the structure and chemistry of my brain. This is now when the “disease” or “condition” or what ever the hell you want to call it has set in. Because I now have DEVELOPED a host of symptoms that become my “EVERYDAY REALITY” …….. I now have the disease of addiction. WHY? Because now, my body has become dependent on the drug (heroin for example), my thinking patterns have become distorted and habituated to the point that I cannot focus on anything else except how I am going to get high for the day. I NO LONGER HAVE CONTROL of “the CHOICE” making areas of my brain and all I can do is repeat the vicious cycle over and over again day after day.
            Dude, I am not discounting the FACT that many people DO quit using without treatment. But that is not what we are talking about. People have been cured of cancer by prayer for God’s sake!!!! It doesn’t matter the affliction or the cure. What matters is that a human being is suffering from an abnormal set of symptoms. And it doesn’t matter for how long the person suffers. Whether it is someone suffering from cancer for 10 years, diabetes there whole life, schizophrenia for 20 years, M.S….PTSD………………………….. OR SOMEONE REMAINING “ADDICTED” TO HEROIN FOR 10 YEARS….”UNABLE TO STOP USING” because they are now mentally incapable of doing so. NOT because in YOUR DELUDED MIND they should be able to simply use more will power. DUDE SOME PEOPLE SIMPLY “CAN’T” because of how their prolonged use has reinforced their “helpless” state.

            You piss me off Bro honestly!!!

            You seem to not only think you are so powerful and intelligent as to think you KNOW how “EVERYONE” should be “ABLE” to function. But yet obviously don’t know a “F%^&$#@-ing thing about what an addict “ACTUALLY GOES THROUGH”. To me…You appear cold-hearted, arrogant and display ZERO compassion, understanding and empathy. If we as addicts feel we are suffering with a disease and are struggling to quit…. Then give us that right to deal with our afflictions in that context and vein…..and leave people the hell alone bro!! FOR REAL!!! You (and other “choice” proponents) spouting to the world that “everyone” should be able to “just quit”….makes you people look like the most conceited, self-righteous people alive. Tell you what……….Why don’t you do an experiment tough guy and you put on a 20 year meth habit, or drink alcohol heavily for 40 years or shoot heroin for even 1 year and then come back to us and tell us how “easy” it was to just stop. That right there is what is so stupid about your argument.

            Habits like brushing your teeth or other habits that you attempt to portray as the SAME as a drug habit are not in the same realm what so ever.
            Once the disease of addiction is manifest in a persons life……….That is when the behavior and thinking becomes HABITUAL. The act of driving downtown and buying some crack is not a disease in and of itself. It is the “CONDITION” the body and brain are now in that forces the person to experience behave certain ways. It is not an “organic” disease that you claim is the only “KIND” that qualifies to be called a disease. But I don’t give a rats ass what smart asses like you think it should or shouldn’t be termed. It is STILL A PERPETUAL DYSFUNCTION OF THE BODY!!!!!!!!!! And so now in this example……it is nearly impossible to turn the car around and go home. I am driving down town to get my dope whether I like it or not. Trust me Bro….I have been there….where the cravings were so bad…. I HAD to get my dope in me to feel better and function. I could NOT simply say to myself…” yeah I think I’m done, forget it…. I don’t need this shit anymore, I think Ill go play some golf today”. HELL NO!!!!! Bottom line….I was suffering with the disease and I needed a major intervention, medical treatment and therapy. Now I have since been CURED of the Disease. I needed help. Some people can quit cold turkey. But we both…… had the disease. No matter what YOU say Slate!!!

            It is absurd to deny that someone who doesn’t feel normal except when he has an opiate (or whatever) in his bloodstream, or who can’t stop thinking about cigarettes when he tries to quit smoking, has something wrong with him and the problem surely resides in his brain, rather than his pancreas to say that this state cannot be classified as a disease. What’s wrong with calling the condition a “brain disease,”? NOTHING!!!

            That’s what makes this article and your “OPINIONS” useless and meaningless.

            The only thing it accomplishes in my opinion is to expose you as being an arrogant person !!!
            This site shows NO love, compassion as well as provides no HELP to those who SUFFER with addiction.

            Try something else Slate. Really!!!! This article does nothing to help addicts or others understand addiction or provide hope or meaningful encouragement to those who suffer.
            All it does is attempt to shine a light on “yourself”.

            RYAN

          • Matt says

            Do we really have to do the skiing thing again, Steve??? It is absolute bullshit, and you know it! Come on, man…Do we really have to go over that shitty article you wrote aain? It was terrible! And now a rattlesnake…I know you can do better than that!

            • says

              Do we have to go through this thing of you deliberately missing the point again Matt?

              You can be outraged about the comparisons and analogies again, but it doesn’t disprove my point. All it does is make you sound like Crocodile Dundee saying “that’s not a knife!” But it is a knife. It has all of the essential attributes of a knife – it just happens to be small knife. But of course Crocodile Dundee isn’t being serious in that scene, he’s being colorful – he doesn’t really believe the smaller knife is not a knife.

              You, on the other hand, really believe that non-essential attributes make for a different thing altogether. A voluntary behavior is a voluntary behavior – whether it results in negative consequences or positive consequences, or a mixture of both. Its outcome doesn’t determine its status as voluntary or involuntary.

              A commenter presented a list of negative health consequences as some sort of proof that addiction is a disease/involuntary behavior. I presented other behaviors known as voluntary non-disease behaviors (skiing; walking among rattlesnakes; and missionary work) that can also result in negative health consequences, in order to show that a negative health outcome isn’t proof that the behavior that lead to the negative health outcome is itself a disease driven involuntary behavior.

              Do you get how this works? It’s called abstracting and conceptualizing. It’s how human beings classify things and gain knowledge. You can be willfully ignorant about it, but you’re only making yourself look foolish.

            • Ryan says

              He “can’t” do better than that!!!! He compares addiction to EVERYTHING UNDER THE SUN!!! It’s all he has!!! My question though is this. If ALL addicts should be able to make the choice to simply quit and be done with it………. How come Slate….in his testimony he states that he floundered around in different treatment programs for 5 years. Gee….. perhaps because he was in the same “mind frame” of confusion and mental instability (the disease of addiction causes) that most all addicts are in. Hmmmm…. I bet that never occurred to him before ehh? Addiction “hijacks” the brain and mind and prevents most addicts from simply “giving it up” and moving on. That is why most of us must go through the “PROCESS” of rehabilitation. That’s why most addiction experts and medical researchers have concluded that it is indeed A DISEASE!!! For some reason….. “choice proponents” can’t wrap their egotistical minds around the fact that addicts brains and minds have been altered structurally and chemically as well as psychologically (thinking) to a point where simply “choosing” to stop is nearly impossible. This is why people like Slate piss me off so bad. It’s not enough to be in the throws of addiction and suffering….but then we have to listen to people like him tell us “we are weak” and should be able to “just stop”. It’s not that easy for the majority of addicts. Teaching them that they do indeed have a medical condition that can be cured with proper treatment does a lot more toward providing hope and understanding of what they are going through than telling them the are simply….. “poor choice makers”. That just plunges a dagger right at their pride and self esteem….. telling them that there is something wrong with “THEM” personally…… and not that there is something wrong with the drugs themselves and the condition of their body that the drugs have put them in. God bless Ryan

              • says

                Ryan,

                You are exactly correct that my mind frame – i.e. my thoughts, beliefs, ideas related to substance use, my own abilities, etc – was what kept me having problems with substance use for so long.

                However, I’m not sure why you think this implies disease. It would be great if you could explain that. Because, if the thinking that leads a person to a set of choices that ends poorly is indicative of a disease, then all thinking that leads to all unfavorable outcomes is disease. Wouldn’t that be diluting the term “disease” at least a little bit?

                Diseases happen to you, regardless of what you think. You can’t reverse the growth of a tumor, or produce insulin by changing your mindset. But habitual behaviors can be changed by changing your mindset.

                You said that I tell people with substance use problems that they are weak. I’d like to see you produce evidence of this claim, or retract it. I have never said any such thing. I go out of my way many times in my writings and the classes I teach to proclaim that such people are not weak, and are indeed quite strong, as evidenced by the stream of obstacles they clear in order to continue to do what they want to do. I go to great pains to say this is not a matter of strength and weakness of the will/willpower – it is a matter of what exactly you “will.”

                While I have indeed referred to addiction as representing a poor set of choices in the past, I try not to use that language now, because I can’t judge whether substance use is a poor choice for someone else. However, I have never labeled people with substance use problems as “poor choice makers”, and that matters. I don’t believe that people are stuck in a state of being a “poor choice maker” no matter what their record of choices – I believe that people grow and change and learn and are always capable of making more beneficial choices.

                I don’t know about you, but I was not born with all the knowledge needed for successful living. I’ve had to learn throughout life, and I have much more to learn. The fact that I’ve gone down some roads that haven’t worked out so well in the past didn’t mean that I was incapable of finding better roads for myself. I’m ok with learning from those choices, and improving my life. I wish everyone else could be ok with that. You don’t have to be perfect, and I don’t even know what perfect is. But I know that I can learn from my mistakes and try to improve.

                I do not say that people are flawed personally because they’ve made some choices that haven’t worked out, and I don’t believe it. Again, none of us come into this world with the knowledge to make the best possible choice at all times. We have to earn that knowledge. It’s called being human.

              • Joe H says

                Here we go with another fucked up Normy (someone who has never had an addiction and has no clue as to what he is talking about). You can bark, bitch and moan about what you THINK you know so it makes you sound like an utter idiot just like this article. Addiction is a fucking disease just like cancer. Fucking Idiot!!!!

                • says

                  Hi Joe,

                  I’m struggling to understand how calling me a “fucked up Normy” and asserting that “Addiction is a fucking disease just like cancer. Fucking Idiot!!!!” amounts to anything more than barking, bitching, and moaning. I’m also struggling to understand how it could do anything other than make you “sound like an utter idiot.”

                  Have a great life.

                  -Steven

      • allie heisenberg says

        Your telling me people should do what works best for them to stay sober only if it is done in the context of the addiction model you argue for. How did you come to the conclusion that I prefer the disease model over the model you advocate? You could have just as easily concluded that I argue prayer works. But I did not argue in favor of any of them. War on Drugs? Who say’s that anymore? So you assrt that ambiguous campaign slogans don’t scare addicts into being sober? I don’t see how that discredits abstinence only. You won’t stick your hand in a fire because you know it would get burned. That leads me to believe that you would abstain from sticking your hand in the fire.

        • says

          Allie/Jan

          I argued against your subjectivism. Your comment (as Jan) basically amounted to everyone is correct it’s a disease, it’s a choice, it’s anything, why argue over it???

          This is just insulting silliness subjectivism. Everyone isn’t correct, and it does matter. If you don’t care about it, then by all means, don’t come here to talk about it. I did not say you preferred the disease model – I explained why it’s silly to just take a subjectivist ‘everyone’s correct’ stance on it – by essentially presenting the idea that REALITY MATTERS.

          It matters what addiction really is. The more strongly people believe the disease rhetoric, the more likely they are to relapse – and more likely to binge. It matters.

          Your ignorance is really painful. The war on drugs is more than slogans – it is a bunch of laws and efforts aimed at putting drug dealers and drug users in jail as well. Avoiding the war on drugs is not so simple as changing the channel when a just say no commercial comes on. I mentioned it as an example of a scare tactic. Propaganda demonizing drugs, and big penalties for being caught with drugs. It’s a scare tactic. And rates of addiction have not gone down since it’s been implemented. The disease model, as you described it, is supposed to operate as a scare tactic (abstain, or you’ll drink uncontrollably until you die). I’m highlighting a commonality.

          Also “who says that anymore?”

          Are you really so obtuse?

          I said no such thing as “people should do what works best for them to stay sober…” I said:

          You should do what works best for you in your life – this may or may not include some sort of substance use.

          • allie heisenberg says

            Try to maintain the focus of what your talking about. The low success rate of the war on drugs is unrelated to the fact that fear of relaspe causes some people to abstain from drugs. Addiction is unique to the individual that experiences it and what helps one may not help another. You can scream your black and white ideas all you want if your willing them to back them up. In doing so get your information from a website that challanges , rather than cherry picks arguments

            • says

              Allie,

              What exactly are the strong points of the disease concept? I’ll be happy to argue against them. Please let me know.

              -Steven Slate [the author of this site]

  79. Jay says

    I have been clean as they call it since 2010. I had a horrendous 12 year pain pill habit. Partly due to my own ignorance on the subject. The doctors should share some of the blame also. It did alter my chemistry. I suspect that I have had a chemical deficiency in some way before the habit and conclude I still have it . This is a very complex subject. After 4 years you still do not feel as wonderful as a person who had nothing wrong (no disease) should feel. It also takes a toll on your health that seems to have some permanent effects. At least for me. When my Mom died I had become used to thinking about things regarding her. My mind would just go there sometimes forgetting she was no longer around. The dependance and addiction differences are also blurred in recovery “science.” Unhappy or depressed people are known to be more suceptible to drug use. They try to self medicate away the discomfort. This might actually be the disease but the drug use is an attempt to compensate for it? I have accepted what happened and try to give myself the best diet and excircise to promote good health. And of course concentrate on growing away from all that with more interesting activities. It is fading away. But I still remember that extra good feeling. My cure is knowing what the situation really is what it leads to the next day and the next. At this point you know you simply can’t do it. And it is wise to be careful about it for the rest of your life, if you value it like I do. Many dead friends will let you know where this goes if you don’t make the change and keep it.

    • Jay says

      Sorry I somehow missed that this was a choice vs. no choice conversation. After reading these comments I wanted to add some more. I will leave the debate to those who know more than I do. My path was rehab and then meetings. Thousands of them by now. I was glad for something, anything to be there in my situation. The 12 steps commnunity did help me with acceptance and understanding that the outside world would never be able to provide. Even when I was at my worst low self esteem moments. I did see many who were in rehab due to the courts. Avoiding jail. They they sleep and you can spot them immediately. They don’t think they should be there and have decided it will do nothing for them. Also there are people forced to go by intervention. I saw some who had already relasped before ending treatment. Just waiting to go out and start whatever again. Also the rehabs and clinics are making money on return customers. In 12 steps it is ok to relapse as long as you come back. I do not agree with that unless it has already happened. It seems to me that you should never halfway decide to do something and plan to fail if needed. The right way should be to plan to succeed. My addiction was as serious as any. I tried to quit at home many times first before going to rehab. I lost my car and had no money left to live on. Some say the relapse rate is nearly 100 percent over time. I have not relapsed. I have to be honest and consider it may be a choice I made. That others did not? I seem to be an exception. Maybe I would have done this without the 12 steps program eventually. But I still know the support does help.

      • Jay says

        Forgot this. My first sponser. I specifically chose him for one reason. Unlike the others, that he was telling how a person would, after starting off powerless, become empowered through working the process. He could quote references in the book stating so. But after four years the meetings are a mixed blessing for me. Sometimes I feel like I am being dragged back to the old feelings when I hear a new person telling their thoughts. I know exactly what that felt like. And the new person is who we are supposed to be there for. I get a lot of inspiration from the old timers. They are great. But I do not feel this powerless situation should be life long. That can’t be right. Where is the getting better in that? I admit that I will continue to go and appreciate the recovery community always.

      • says

        Thanks for your comments Jay.

        I couldn’t blame you for missing the fact that this is about whether addiction is voluntary or involuntary – because without fail, most of the commenters who disagree with me make it into a debate between being a good person or a bad person; or between hating addicts and loving addicts; or between being “morally flawed” and a victim of a disease. It is rare that they ever attempt to delve with any substance into the issue of whether people with substance use problems are free to change or not.

        Thank you for recognizing that that is what this is about.

        -steven

        • Jay says

          Sure Steven. It’s a very worthy subject. I don’t know what the answer is. After about a month of missed sleep and meals I was not able to choose anything whenever other options became available. Powerless then. But after quitting I was free to choose anything pretty much. There is a lot of pressure from the recovery community whenever you get off track in their minds. I was expected to step aside and let others decide everything for me. Which I did for a while. I wanted the full advantage of my rehab. This was the worst situation I had ever been in and I was scared. To be out of control like that. But once thats over and you study all this. Then don’t you then have to choose never to do it again? So that must not be the problem. Because any sane person would at that point agree they have to stop. So for some something more is going on. My habit was equivelent to a strong heroin addiction but I do not have -overwhelming- cravings anymore. I have changed any patterns I could that seemed risky for relapse. That’s the part I don’t understand. I’m missing something.

          Keep up the good work. Great site. – Jay

        • Ryan says

          “However, I’m not sure why you think this implies disease. It would be great if you could explain that. Because, if the thinking that leads a person to a set of choices that ends poorly is indicative of a disease, then all thinking that leads to all unfavorable outcomes is disease. Wouldn’t that be diluting the term “disease” at least a little bit?

          Thats the point!!! Dude…..you still don’t get it. YES all thinking CAN lead to bad consequences!! If I think I’m superman and can defy gravity and jump off a building I will die. But here is the thing……. Addiction involves MORE THAN JUST “THINKING”. Furthermore….. addiction “EFFECTS” THINKING!!! It influences thinking….. it controls thinking……it forces thinking….. it determines thinking!!!! DO YOU GET IT NOW??????????????? PROBABLY NOT!!!

          But antyway…YOU JUST ADMITTED IT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

          AND I QUOTE…….

          “You are exactly correct that my mind frame – i.e. my thoughts, beliefs, ideas related to substance use, my own abilities, etc – was what kept me having problems with substance use for so long”.

          But wait a minute….. I thought you said….. Ahhhhhhhhhh

          But I thought you could just choose SLATE??????????? WHAT HAPPENED BUDDY?????????? WHAT WAS WRONG BRO?????????? Why didn’t you just make the “choice”……huh????:

          See that’s the other thing……….. No one is arguing that a person needs to change their thinking. That is part of treatment and recovery. IT’S A PROCESS SLATE…..ITS A PROCESS….I REPEAT….ITS A PROCESS!!!! You can’t tell “EVERYONE” TO EMPLOY “IMMEDIATELY” WHAT TOOK YOU 5 YEARS (ALLEGEDLY) TO DISCOVER AND APPLY. That’s the whole problem with your reasoning. This is why the term “disease” is used. It’s used because a person is “AFFLICTED” and many aspects of their life have to go through a transformation. And in most cases…(dare I even say YOU) it takes TIME and treatment. You didn’t simply make the “choice” to stop and move on with your life did you?……….. You didn’t have ALL the answers and you needed treatment just like everyone else. Again, you need to allow the addict to deal with ALL the elements of what they are going through. And teach them the “truth” that they have a problem that is more than just “will power”. Bro….. this is why so much research has been done on the brain and behavior and the “disease” model makes more sense. Just like any other “disease”…….. it takes “treatment” + “time”……to find a cure!!! The “choice to quit” is one thing…… but the ability to make that choice and follow through is what addicts struggle with. And it’s because they are suffering with the “disease of addiction” or “chemical dependency”. Your whole argument that it’s “just like any other thinking flaw” is not justified. It actually is flawed on so many levels. If that were true…. I could accuse you of suffering with the disease of “pride”. And quite frankly, there can be an argument made that we all have certain “human drives” and tendencies that can ALL lead to bad behavior and consequences. But again….the reason addiction is a “disease” is because of HOW the drugs and alcohol change (hijack if you will) our brain and cause us to REPEAT the behavior. It’s fine Slate to instruct that our thinking needs to change….but you can’t change our thinking until the brain’s chemistry has returned to functioning normally, we begin to replace the behavior with NEW ones and like you said….we begin to implement new thoughts, beliefs and gain new direction and purpose. But I’m sorry there is a lot more to it than just “a thought”. That is why the term “disease” is used.

          By the way….. what the hell is your beef with it anyway? Why do you have such an axe to grind with a “WORD”? An idea? A scientifically accepted model….with Tons of evidence? The model fits and you know it…so why don’t you just leave it. What are you trying to prove anyway?

          RYAN

          • says

            When did I tell everyone in the world with a substance use to just get up and quit today with no process of thought whatsoever going into it? That would be absurd, and it’s not what I’m advocating. It’s a big life change, and there is a lot of thought that goes into it – and you can’t just run through all those thoughts lightning speed in an instant upon someone else’s command and then arrive at the choice to quit. That’s not what I am suggesting.

            Nevertheless, it is a choice. All those thoughts and beliefs that add up to the preference for heavy substance use over all other things – are held voluntarily by the individual, can only be re-examined by the individual voluntarily, and can only be changed voluntarily by the individual. Choice, choice, choice.

            I’ve never denied that all of that is a process. But it’s a conscious volitional process – it’s not a matter that starts by re-arranging some neurons. It starts by choosing to consider new perspectives on what you think and believe.

            You can shout that:

            addiction “EFFECTS” THINKING!!! It influences thinking….. it controls thinking……it forces thinking….. it determines thinking!!!! DO YOU GET IT NOW??????????????? PROBABLY NOT!!!

            all you want, but you need to define what addiction is and how exactly it controls you, if you want to be taken seriously. That’s a large claim, and the burden of proof is on you with that. There is literally no published proof that some physical abnormality of the brain causes a preference for drug taking. None. I even recently added a quote from a 2013 paper by Gene Heyman PhD in which he says just that:

            There are no published studies that establish a causal link between drug-induced neural adaptations and compulsive drug use or even a correlation between drug-induced neural changes and an increase in preference for an addictive drug. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644798/

            If you’ve got the proof of a causal link, I’d love to see it. If you have more baseless assertions though, I don’t care to hear them and I will no longer respond to them.

            You ask:

            Why do you have such an axe to grind with a “WORD”? An idea? A scientifically accepted model….with Tons of evidence? The model fits and you know it…so why don’t you just leave it. What are you trying to prove anyway?

            The disease model is misinformation. If people believe it, they are more likely to “relapse”; more likely to binge; less likely to change long term; more likely to have this problem last longer in their lives than it would if they would just start seeing it as a freely chosen behavior based on freely chosen thoughts and beliefs that they can freely choose to reevaluate, rethink, etc and find better choices for themselves. I’m trying to prove that people are free because it is the truth, and truth will help people to get the best results for themselves. Misinformation hurts people.

            -Steven Slate

            • Ryan says

              “All those thoughts and beliefs that add up to the preference for heavy substance use over all other things – are held voluntarily by the individual, can only be re-examined by the individual voluntarily, and can only be changed voluntarily by the individual. Choice, choice, choice”.

              Your stupid stupid stupid…..

              Held “voluntarily” huh?? Where is your scientific evidence of that slate?? Your saying that a heroin addict each day needing their fix to feel better is voluntarily sticking the needle in their arm for the millionth time when he “COULD” OR “SHOULD” be tossing the needle in the trash instead. Research as well as experience shows the exact OPPOSITE!!! You didn’t read a damn thing I wrote did you!! Shocking!! People in the throes of addiction are NOT VOLUNTARILY THINKING THE WAY THEY ARE!!! They are thinking based on the condition their body and brain is in. Ever see a crack addict “fiend” for dope ALL DAY LONG…. MORNING…NOON …AND NIGHT?? Their like Robots dude!!!

              Of course everyone should make the choice to stop using drugs….and ultimately (if they don’t die first) everyone will have had initially “made that choice” at some point, sought treatment and eventually recovered. But it is still a disease they must make the “choice” to heal and cure.

              “The disease model is misinformation. If people believe it, they are more likely to “relapse”;” Oh yeah…where is your proof of that?? You got ant stats to back that absurd claim up? In my experience (and most of the REAL world of medicine any behavioral psychology)….when an addict is told that they have a medical and psychological condition that needs to be treated… they don’t feel so bad about “themselves” and they tend to approach treatment from ALL angles. Telling an addict…that “they simply don’t think right” hurts their self esteem and makes them believe that they have character flaws or they are weak or unintelligent.

              Dude….your lost!!! I’m Done!!!

              Good luck with your little “ego” driven quest to do whatever the F%^&* you think your doing!!!!

              • Katherine says

                So much hate, it’s sad really. I feel refreshed after reading the author’s words of truth. Several years ago when my husband, who was too young to die, did, my world was turned upside down. I turned to consuming excessive amounts of alcohol and “zoning” out from the pain and everything else in my life. After two years of this hell and every day saying to myself, “tomorrow I will not drink”, while cursing my throbbing head, sore muscles and God for causing this pain and agony on me. One morning looking blurry eyed and groaning over having to drive my precious daughter to school so early, snapping at her and loathing myself again, I vowed no more! I exercised “my choice” to stop hurting myself once and for all. To say it was easy and that day was the last drop I swallowed, oh if only it were so easy. Yet, two years later, clear eyed, clean and sober and loving myself each day I wake up feeling stronger than the next day. I have always had an addictive personality whether it was drinking, diving, running, I had to be the best at it and I was the best alcoholic on the block! Is having a competitive or addictive personality a disease? I think not. We make choices every day of our lives, have another piece of cake, have an affair with that cute little blond, have another drink, our choice or decisions, our destinies.

                • Ryan says

                  The reason why it is termed a “disease” is illustrated by exactly what you stated………”I turned to consuming excessive amounts of alcohol and “zoning” out from the pain and everything else in my life”. Why did you do this Katherine? Why didn’t you make the choice to quit while you were in the throws of this state? Why not after a week? A month? 87.5 days? You then say…….”After two years of this hell and every day saying to myself, “tomorrow I will not drink”, while cursing my throbbing head, sore muscles and God for causing this pain and agony on me. One morning looking blurry eyed and groaning over having to drive my precious daughter to school so early, snapping at her and loathing myself again, I vowed no more”! REALLY? What took you so long????????????? Why two years of this “HELL”?????// See that is the point……..you were “caught up” in the “GRIP” of addiction!!! This is simply why it is deemed a disease. Why do you people not get this?????? Mind boggling!!! Of course at some point you made the choice and everyone does (unless they die first) to quit….but you still admit that you DID NOT QUIT COLD TURKEY AND THAT IT TOOK TWO YEARS TO RECOVER. Thats another component that justifies the disease model is the fact that we need treatment and various forms of assistance to recover fully. Again………………………………………….DISEASE….DISEASE…..DISEASE!!!! And what’s even more crazy….is that you admit that you have an “addictive personality”………..NO…you just happened to “SUCCUMB” to the “POWER” that drugs and alcohol have…..like most people do. THAT’S THE DISEASE!!! It changes you…physiologically and mentally until you are “powerless” to control it. Have you ever been around a crack addict or heroin addict and witnessed them crave the drug 24/7? Robots!!!! And why do you think you stated that over and over and over again for 2 years you vowed to quit time and time again but were unable to????? Again….that’s the disease aspect of it. And lastly, why do you people attempt to equate choices made (diving, running, eating cake etc…) while in a normal (non inebriated state) as being the same as choices made while under the throws of addiction where you are intoxicated and your mind is altered 24/7. Amazing!!! P.S….no hate here hun….just stating my opinion. God Bless…..

          • Kevin B says

            Ryan,

            Another defensive lunatic, who I hope was under the influence of drugs and alcohol when they wrote this belligerent streak of verbal diarrhea because if this was composed by a sober person, then we are clearly confronted with a lost cause. I’ll say it a million times, it took a series of POOR CHOICES to produce the hopeless state you describe, Ryan. No matter how you spin it, it started with a series of choices, and, therefore, it all comes back to choice. You’re defensive posts suggest you have trouble facing facts, but allow me enlighten you on the fact that all the bad things you did, all the people you hurt, and all the things that still make you cringe were a product of your own choices. Does this mean you’re eternally evil? Of course not. But have the decency and courage to stop blaming you’re disease for your errors in judgment. It’s like a fat person blaming the spoon for their obesity.

  80. Joe says

    I don’t even think my response will be read based on all the previous responses. What I love and what I believe based on my own addictions is that some May need the structure of a 12 step program and some May need to classify this as a disease.. The brain and body is plastic. There are many studies that support adaptation in neurotransmitter due to chronic use of any drug. Studies that support the heart protects itself to infarction with chronic users. Unfortunately, there are users that exceed their bodies abilities to absorb the assault. This will never be a deterrent. No addict thinks it will be them that dies from overdose even though every addict has cruised er’s or fire stations thinking a fatal reaction was around the corner. What I LOVED about this article was truth in the amazing ability for our brains to correct even many years of damage. I believe that many addicts fall into the belief that changes have occurred from their behavior that will result in lasting irrefutable changes.. That is not the case. I used cocaine for over 10 years after 20 years of abstinence. Non of it had to do with brain changes.. It was my choice. When I was done.. I was done.. I encourage those to realize you can just stop. It’s not an act of god or a decision that requires you to right all ur wrongs. Sometimes it just becomes a habit.. Move on..

  81. John Tale says

    If addiction ran in the genes then every human right now should be an alcoholic, considering how much people drank in the 1500s through 1800s.

    People are more likely to become alcoholics when their parents were. The fact is, when AA meetings tell people it’s in the family, it vindicates alcoholics by letting them blame the fathers they hated so much.

    Yet, most drugs weren’t around before the 1950s. The 20th century invented over a million drugs, some of course just variations of others. How did these drugs run in our genes all of a sudden? Why is cocaine entwined in an African person’s? Why would a family who knew nobody among them to ever have touched a drug suddenly see their teenagers using all kinds of hard shit?

    Hmm, obviously, then, addiction is not genetic. The reason the family’s newest generation is using chemical substances is because most places in the world are now flooded with drugs. Humans have always strived to attain a higher reality away from the relative hell that is their lives. So drugs are the easiest way to break away from one’s emotional agony and boredom.

    Second, addiction is a habit, only made tougher by a need to normalize one’s feelings/body by using regularly to avoid withdrawal symptoms. We take drugs (every one who has ever tried something or uses even rarely) to cope/escape reality. That is that.

    Third, if addiction really was a disease, especially a progressive one, then why do addicts not consume themselves to death? If a heroin addict was given thousands of pounds of heroin, there would be quite a lot left, and the heroin user would probably still be using it a year after if an immediate overdose didn’t kill him/her first.

    Addicts should be getting worse every single day, because that’s what diseases do when untreated. Unfortunately, for that line of thinking, many addicts maintain a constant level of use year in and year out. Some alcoholics can use two pints, the exact quantity taken by the average Russian every day, while others take in an extremely deadly amount around half a gallon of hard liquor. Same applies to every other drug addiction, opiates, meth, speed, marijuana, whatever.

    The disease nonsense was that from the start, conjured up by a primitive doctor of the 1930s. It will gradually die away from here. Don’t waste your time arguing with those who’d rather be coddled over and not have to admit responsibility.

    The theory will die, and drug addictions will continue to spread.

  82. Kevin B says

    To Parker and the other cowardly, hostile defenders of the disease theory, which, conveniently excuses you from all wrongdoing in the past, please put down your guns and listen for one second. As this comment below shows:

    Anyone who thinks disease is a choice and not a disease is an idiot and obviously not a true addict. I would have never done the things i’ve done had I had a CHOICE.. THE ONLY CHOICE I HAD WAS CHOOSING TO DO THAT FIRST DRUG AT TWELVE YEARS OLD THAT SHIFTED MY BRAIN TO THE FRONTAL CORTEX TO THE MID WHICH MADE ME A DRUG ADDICT.

    At one point, you, admittedly, had a choice. No one is disputing the fact that, once physically addicted, a person looses a large degree of choice in the fight against taking the next drug, but you’re completely overlooking the fact that it took a series of choices to get you to the point of chemical dependency. I don’t imagine too many people wake up one day with an insatiable desire to shoot drugs into their veins at the risk of jail, destroyed relationships, financial ruin, etc…and it’s hardly plausible that one use of even the strongest drugs could immediately trigger cravings and withdrawal symptoms. One gentlemen made a comment to the tune of “walk one day in the shoes of a junkie and tell me it’s a choice”…once again sir, you didn’t magically become a junkie as would be the case if addiction were a disease, you made a series of un coerced choices that landed you in the junkie shoes you reference. As an ex cocaine and alcohol abuser, I know what it’s like to crave and disregard the feelings of loved ones for my own selfish needs. Some of the things I’ve done make me cringe, but I’ll be damned before I dodge responsibility by claiming I never had a choice. Maybe I had little choice by the end, but this was a result of choices I had already made. I hate to be offensive, but to all those shamelessly attributing their past mistakes to a disease they couldn’t control, be a man, and accept the fact that some of your past choices had undesirable consequences. Thankfully, this doesn’t mean you’re forever an evil person, especially if you’re cleaning up now. Only, man to man, don’t be a complete coward and suggest to a bunch of people who’ve been right where you were that you had no choice in the matter. This wouldn’t pass the scrutiny of a three year old.

    • ryan says

      Thanks for the kind words jerk!!! Look smart guy…..OF COURSE CHOICES WERE MADE TO BECOME AN ADDICT!!!!! The thing is that once addiction takes a hold and your brain becomes changed chemically and physiologically…..the “disease” condition becomes set it. It is “THEN” when “CHOICE” becomes nearly impossible. Dude take your tired arrogant talking in circles ass somewhere else!!! NO ONE EVER SAID THAT CHOICES WERE NEVER MADE YOU MORON!!! BUT THE “CONDITION” OF CHEMICAL DEPENDENCY IS WHAT IS REFEREED TO AS THE “DISEASE OF ADDICTION”. MAKING THE INITIAL CHOICES TO TRY DRUGS OR ALCOHOL IS NOT THE DISEASE DUDE!!! IT’S “AFTER”CONTINUAL USE THAT THE DISEASE MANIFESTS!!!!!!!!!!!! KEEP YOUR SHALLOW OPINION IF YOU CHOOSE BUT STOP BAD-MOUTHING THOSE WHO HOLD TO THE SCIENTIFICALLY HELD MODEL.

      • Kevin B says

        Ryan,

        It’s clear that you are still restless, irritable, and discontent. So I’m a jerk, a moron, shallow, and arrogant for having a different opinion? Ryan, be honest with the community, how much cocaine have you ingested tonight? No “serene” grown man would throw a cyber tantrum like that sober. I gave you the rope to hang yourself with, and, predictably, you reacted like an immature lunatic on a forum intended for mature debate. My point is proven and I genuinely don’t want you to have an aneurism, so I will refrain from further conversation with you in the future. I’m sorry that abstaining from substances did nothing for your peace of mind, and that you lack any semblance of spirituality. Thankfully, you can soon go hold hands with other like minded grown men and complain about how unfair your life is. Peace, god bless.

        • Ryan says

          You end that arrogant self-righteous ATTACK with……….Peace, god bless!!! Your laughable!!! P.S….your “opinion” is NOT PROVEN!!! And to accuse someone of being high just because I tell it like it is (YOU ARE A MORON)…..is also laughable. You didn’t read a FUCKING thing I said…..all you can do is defend your bullshit with attacks. You are shallow because you cant even acknowledge the endless amount or research and science backing the disease model. Also, we who hold to the model have every right to adhere to it and just because we blast back at ego-maniac PUNKS LIKE YOU……………all you can come back with is “how much cocaine have you smoked today”. And then you play the “mature adult forum” card. What a fucking loser you are!!!!!!!!!!!!!!!!!! You are a pathetic jerk because you have NO IDEA who I am how “spiritual” I am and you make accusations with NO PROOF OR EVIDENCE…………………and lastly you are a hypocrite…….claiming to be spiritual while doing nothing but spewing insults!! People like you SUCK!!! You have NO FUCKING CLUE WHAT I WENT THROUGH AS AN ADDICT OR MILLIONS OF OTHERS WHO SUFFER OR ANYTHING ABOUT IT!!! AND YOU HAVE THE NERVE TO TELL ME AND APPARENTLY EVERY ONE ELSE THAT WE “CHOSE” TO HURT OUR FAMILIES….ETC…………..YEAH LIKE I WOKE UP EVERY DAY CONSCIOUSLY SAYING TO MYSELF….”I THINK I WANT TO HURT THE ONES I LOVE TODAY…..YA KNOW FUCK EM…..I WANT TO GET HIGH”. AND I MADE THAT “CONSCIOUS” “CHOICE” “DECISION” EVERY DAY FOR OVER A DECADE!!! I THOROUGHLY THOUGHT IT OUT IN DETAIL EVERY TIME…..RIGHT BUB??????? AGAIN………………YOU ARE A FUCKING IDIOT!!!~!

          • Kevin B says

            Ryan,

            If I even closely resemble the litany of unprovoked insults you launched at me, why are you concerned about the opinions I’m suggesting? Ryan…you are categorically insane, sober or otherwise. Want proof? Read your own hysterical, effeminate post:

            You have NO FUCKING CLUE WHAT I WENT THROUGH AS AN ADDICT OR MILLIONS OF OTHERS WHO SUFFER OR ANYTHING ABOUT IT!!! AND YOU HAVE THE NERVE TO TELL ME AND APPARENTLY EVERY ONE ELSE THAT WE “CHOSE” TO HURT OUR FAMILIES….ETC…………..YEAH LIKE I WOKE UP EVERY DAY CONSCIOUSLY SAYING TO MYSELF….”I THINK I WANT TO HURT THE ONES I LOVE TODAY…..YA KNOW FUCK EM…..I WANT TO GET HIGH”. AND I MADE THAT “CONSCIOUS” “CHOICE” “DECISION” EVERY DAY FOR OVER A DECADE!!! I THOROUGHLY THOUGHT IT OUT IN DETAIL EVERY TIME…..RIGHT BUB??????? AGAIN………………YOU ARE A FUCKING IDIOT!!

            You are right on one thing…you didn’t wake up consciously considering whether you would hurt a loved one because you didn’t give a damn. Me a punk…interesting. I’m not the one blaming an unproven disease for the sins of my past so I can feel better about the fact that I’m am ignorant, useless, crybaby with a backbone made of swiss cheese. Ryan, I would never mention this, but, since you have called me an idiot so many times, I guess it’s worth mentioning that I made a 1540 on my SAT, have an MBA, and am about to start my second non-profit organization devoted to those suffering from substance abuse. You wouldn’t understand spirituality if it shook your hand and told you to keep coming back because it will work if you work it, and I can only pray that my harsh responses will jolt you into real action.

            I do know what you went through, I’ve had upwards of ten friends or family members die as a direct result of drug/alcohol abuse, and how fucking dare you claim to know who is an addict and who isn’t…You chose to hurt yourself and your family, but keep lying to yourself if that’s what gets you through. You’re a coward of the worst degree…one that can’t even look himself in the mirror.

            PS Yes, I attacked Dr. K’s article based on grammar. Those of us who are educated tend to believe that the manner of delivery can be equally as important as the content. Have fun being a finger pointing female today, Ryan. I’m about ready for a beer.

            • Ryan says

              Blah Blah Blah dee dah!!! LMFAO………………. “I scored a 1,345,000,856 on my SAT”……………… Your still a F@#$%$^%^& LOSER!!!! There…. was that better for ya!!! What a Chode………..

              Boy…… don’t we all love “know-it-alls”….EHH

            • Ryan says

              By the way………..if addiction was simply a matter of choice…….why did all these friends and family of yours not make the choice to quit before addiction took their lives?? I’m guessing they didn’t make the “choice” to die did they?? They were suffering from a debilitating “disease”…..that’s why. And you say I lie to myself?? LOL………..Dude……………..if everyone could simply “choose” to quit….there wouldn’t be anyone using until it killed them now would there? And there would be no need for treatment centers either….now would there?

              • Kevin B says

                I would absolutely love to see you make comments about my dead friends and family members to my face Ryan. Go ahead and get down on your knees and thank god for the fact that we live in a nation of laws where spineless punks like you can spout off at the mouth with no recourse.

            • Ryan says

              “You wouldn’t understand spirituality if it shook your hand and told you to keep coming back because it will work if you work it, and I can only pray that my harsh responses will jolt you into real action”.

              P.S…..You do know that this is a completely irrational run on sentence don’t you?

              Oh and there is no need for the comma after “it” because you use “and” right afterward…..

              Just saying…..since you are so into grammar and such…..

              LOL

        • Ryan says

          I just read your response to Dr k above…..and all you did was attack his grammar????????? Spelling????? And “were you on LSD” when you wrote this???? Wow….no wonder you have nothing meaningful to say………….YOUR A TIRED BROKEN RECORD!! What a joke you are Bub…………and you actually think you are intelligent. Ask any psychologist what it means when someone finds the “tiniest” little things to insult someone with. That’s right………..you guessed it….”immature” and “insecure”!!! In other words…………….LOST!!!!

    • Matt says

      Hi Steve,

      I guess it’s been awhile…I like the new digs. Pretty slick. Who is this new guy Kevin B? He is fun to read! Well, that’s it for me now…I guess???

      Love,
      Matt

  83. Michael V. says

    For me, the uncertain relationship between freedom and choice is at the heart of whether anyone, addict or not, can just choose to change. “In Freedom Evolves,” (2004), Daniel Dennett does a reasonable job of covering the idea that our perception of choosing freely (whether or not we actually are) may be an evolutionary necessity which allows the Self to take ownership of its actions. Older studies by Benjamin Libet indicate that conscious awareness of an action may come after the electrical impulse governing that action has already been unleashed—although whether this is an artifact of the experimental conditions is still uncertain.

    An honest debate about whether addiction is voluntary or involuntary prompts all of us to re-evaluate how much any of our actions are voluntary or involuntary, which may be why we react with such vigor when our viewpoints on this subject are challenged. Addiction is a wagging finger that mocks our humanity. Regardless of the certainty displayed by many on this topic, it is far from a settled issue. A few pieces of kindling to throw onto the fire:

    “The person who asserts his freedom by saying ‘I determine what I do next,’ is speaking in and from a current situation: the ‘I’ who thus seems to have an option is the product of a history from which it is not free, and in fact determines what it will do now.” B. F. Skinner, About Behaviorism. 1976

    “I say, do not choose, but that is a figure of speech by which I would distinguish what is commonly called choice among men, and which is a partial act, the choice of the hands, of the eyes, of the appetites, and not a whole act of man.” Ralph Waldo Emerson, 1847

    “But what we ordinarily mean by choice is not freedom. Choices are usually decisions motivated by pleasure and pain, and the divided mind acts with the sole purpose of getting ‘I’ into pleasure and out of pain.” Alan Watts, 1951

    “Neither blindness nor ignorance corrupts people and governments. They soon realize the path they have taken is leading them. But there is an impulse within them, favored by their natures and reinforced by their habits, which they do not resist; it continues to propel them forward as long as they have a remnant of strength. He who overcomes himself is divine. Most see their ruin before their eyes; but they go on into it. Leopold von Ranke

    “Freedom is not a reaction; freedom is not a choice. It is man’s pretense that because he has choice he is free. Freedom is pure observation without direction, without fear of punishment and reward. Freedom is without motive; freedom is not at the end of the evolution of man but lies in the first step of his existence. In observation one begins to discover the lack of freedom. Freedom is found in the choiceless awareness of our daily existence and activity.” J. Krishnamurti, 1980

    • Ryan says

      Author….Ryan

      Michael….thank you for shedding some light on the reality that much of our behavior is involuntary and that the reality of actually being able to choose moment to moment is really impossible since we are perpetually moving forward in the realm of time and space and hindered by limited ability. It clearly is impossible with our limited minds to consciously “decide” or “choose” everything we think and in turn act at every possible moment. Much of our existence is driven by habitual processes. And this is why the state of severe addiction is clearly a case of involuntary action. A severe addict cannot simply “choose” to halt the momentum of the path they are on anymore than a driver of a car can stop the vehicle that the brakes have gone out on. Sure…the thought can “occur” to them that this “pattern” of behavior needs to stop and that something needs to be done to “change” their present forward momentum in a different direction. And this usually means seeking treatment in which the persons brain can begin to function in a different way. And this is why the disease model fits. An addicts brain becomes driven and controlled by a developed “condition” that directs thoughts and behavior “in a specific direction”…..continual use!! Ultimately….a “choice” is made to quit using….but most of the time…..a “process” of change will need to occur in order to cause our momentum to go in a different direction. If some people are able to quit cold turkey….more power to them, but to then in turn claim that “EVERYONE” should be able to accomplish this same momentum shift immediately just simply does not make any sense what so ever. The addict is still suffering from a “DISEASE” (perpetual involuntary condition) no matter how one is able to accomplish lasting change. And even then…..as you have pointed out…..much of our ability to choose is limited.

      • Michael V. says

        Ryan…Your thoughtful response is much appreciated, although I suspect that an opponent of the disease model could find something in my post to support their position also. Tabling that debate for now, your multiple uses of the word “momentum” with regard to choice were quite intriguing, and could serve as a key clarifying concept if we can tether it to a measurable, biochemical quantity. The idea would go like this: stripped down to our volitional skeletons, human beings choose, experience and remember the results of those choices, and then choose again. Choices accumulate; memories accumulate. Do addicts remember differently than non-addicts? —And how does the accumulation effect how each chooses?

        I checked my files (I have been fortunate enough to serve as an R &D Chemist, Biologist, and Scientific Historian for the last 25 years) and found research starting around 2002-2003 and continuing to this day that suggests that learning & memory and drug addiction are modulated by the same neurotrophic factors, share certain intracellular signaling “cascades,” and depend on activating the same transcription factors. The “cascades” in particular may indicate a real “biochemical momentum” associated with addiction and memory. A better understanding of these molecular and cellular adaptations could lead to novel interventions that improve memory and combat addiction in humans. Imagine discovering that addiction is actually a severe learning disorder!

        My personal preference is to call addiction a Disorder of the Volitional Self, even MORE serious than what we would normally call a disease. But that is just my preference. In a landmark 1980 compendium, “Theories on Drug Abuse,” the National Institute on Drug Abuse compiled 43(!) etiologically distinct explanations of addiction from a variety of sources. There is a lot of room on the field between the opposing goalposts of “choice” & “disease.” Clarifying concepts like “momentum” and “memory” can go a long way towards reminding us that we are on the same field.

        • Ryan says

          I am not a scholar or scientist by any stretch….in fact I am a humble garage door repair man and construction worker….so I am not in the same league as you are when it comes to research and scientific knowledge. All I DO know however, is my own experience combined with my witness of other addicts as well as what I have learned and it has led me to unequivocally assert that addiction when it is in full blown mode so to speak is a “condition” that completely “paralyzes” its victims. I cant tell you how many times (hundreds) that I told myself that “I need to stop”…”God why?”…”I can’t do this anymore” etc…..to find myself back downtown the next moment. It then turned into “I CAN’T STOP”….”I need help BADLY”. But the state of mind that developed over time that began to seemingly take over control of my every thought and action is the state that causes us to experience what feels like a perpetual and hopeless disease. These yahoos on this site want to split hairs and claim that in order for a condition to be deemed a disease it must be “cellular” or organic or something that afflicts us with out any doing on our part. But the problem with that is that there is plenty of scientific evidence as well as experiential proof to show that an addict in the throws of severe addiction has marked changes in the brain as well as chemical imbalances occurring. So why cant this be termed a disease??? In my opinion….the writer of this site and others who think they are so intelligent and are in FULL control of their thoughts and lives and want to push their “choice” BS…. are simply ego-maniacs who have ZERO humility or compassion for others who are legitimately suffering from a hopeless situation in many cases. People need help….they need treatment…they need love and support. They don’t need ASSHOLES like these self-righteous “KNOW-IT-ALLS” telling people they are weak and should be able to simply make better “choices”. I finally got clean…….but it took several years of struggling!!! And it was not as simple as making a choice to quit and that was it!!! It took a series of events to start that ball of change rolling…..and it then took a lot of hard work to reverse the “momentum” that had taken over. By the grace of God….I was able to recover. But there was a DEFINITE AFFLICTION….CONDITION….”DISEASE”………….whatever you want to call it ……..that had deeply set in!!! And this is the reality of addiction. It is a medical, physiological as well as a psychological issue!! It is not a philosophical one!!!! God Bless

          • Michael V. says

            Ryan… I am not sure whether or not your comment was directed at me, but I would never tell an addict that they “should be able to simply make better choices.” I would also never tell them that they have a disease that robs them of their ability to choose. Framing the discussion as simply “choice” vs “disease”—and that is nothing new in the history of addiction—is a wobbly dichotomy that leaves out alternative explanations that might better account for why an addict’s ability to choose “appears,” for them, to disappear. You actually said it: “the state that causes us to experience what feels like a perpetual and hopeless disease.”

            So why can’t we call it a disease? Because the ways things appear to us, the way we feel things, are not necessarily the way they exist—and that applies equally to the extremes of full agency and total helplessness, the extreme explanations of choice & disease. For me, it is not a settled issue, so I continue to look for better models to explain the reality of addiction. As a human being I tend to look for comforting explanations that reinforce my pre-existing worldview. As a scientist, I look forward to those paradigm-shifting moments when my worldview is turned upside down. Hopefully, my internal dichotomy never blinds me to the immediate suffering of those who do not have the luxury engaging in philosophical discussions.

          • Kevin B says

            Ryan,

            I’m 100% stooping to your level, but, ironically, I have lost choice in the matter…at this point, I’m addicted to fundamentally dismantling anything that comes out of your mouth.

            Your quote:
            In my opinion….the writer of this site and others who think they are so intelligent and are in FULL control of their thoughts and lives and want to push their “choice” BS…. are simply ego-maniacs who have ZERO humility or compassion for others who are legitimately suffering from a hopeless situation in many cases. People need help….they need treatment…they need love and support. They don’t need ASSHOLES like these self-righteous “KNOW-IT-ALLS” telling people they are weak and should be able to simply make better “choices”

            There are so many problems in this comment, but I’ll try to address the most glaring items succinctly.

            1) You describe the situation as hopeless, though people recover from addiction every day. If an undesirable situation can be bested, it cannot be described as hopeless. A hopeless situation is one without an answer or a way out, so that terminology is illogical. Let’s meet in the middle…it’s a difficult situation.

            2) To your point about people needing love and support, are we supposed to believe that a person as angry and unstable as you is capable of being loving or supportive? If you were my last line of defense in a desperate situation, I’d prefer a handgun and a bottle of scotch.

            3) No one arguing the choice model has ever even remotely insinuated that struggling addicts are “weak”. This is just a bold faced lie.

            4) The people you are unnecessarily bashing in this piece are only guilty of having a different opinion than you on a debatable issue. So because I happen to believe that, in the absence of true physical addiction (a state of mind and body that is the product of a series of poor choices), we always have a choice, I’m an ego maniac, know it all asshole with no humility or compassion?!?! That’s quite a leap. I believe it’s empowering and encouraging to know that each of us can chose to engage in behaviors that are destructive or beneficial. As for humility, doesn’t it stand to reason that a person who owns up to the misdeeds of their past instead of blaming a condition they couldn’t help should be considered more humble, more mature, more responsible? Just because I feel that substance abuse and everything that comes with it boils down to a series of bad choices doesn’t mean I’m numb to the suffering of people in that struggle. Nor does it mean that I’m judging them…how could I, I’ve been there. I take responsibility for the sins of my past, and I try to do better moving forward…please explain how this mindset is arrogant, cruel, egotistical, and/or apathetic to the suffering of those around me.

            One final item, stop putting God bless at the end of your belligerent posts. God doesn’t bless unproductive, maniacal outbursts of anger, and, more importantly, you’re pissing on the core nature of spirituality.

          • matt says

            good onya Ryan,

            to the rest, after you have had some real life experience with addiction maybe a good decade of heroin use, then by all means offer an opinion about choice.

            • says

              I, the author of this article, have the experience of using heroin from the ages of 18-26 years old – spending five of those years sincerely feeling “addicted” and out of control. Is that good enough? Is 8 years of use, and 5 years of struggle enough? Is it enough that I went homeless for a few months, was arrested many times, and spent a month in jail for shoplifting to support my drug use enough? What’s enough? When I do I get to give my opinion? Are several stints in treatment and several years in 12 step programs enough? What do I have to do for my opinion to be valid?

              My opinion is that all substance use is fully freely chosen, and that the mindset that creates the desire to use is freely chosen, and can be freely abandoned.

              -Steven Slate

    • says

      It’s too bad so many of the determinists hang there argument on those experiments by Libet, since they’ve been seriously challenged in the past few years. It appears that we’re just finding background noise in that experiment – that there is a constant wave of readiness potential going up and down, and indeed it is there often, and yet not followed by a flick of the wrist. Too bad.

      Here’s a quote I’m fond of:

      “It should be noted in passing that to elude a self-negating predicament, proponents of nonagentic theories implicitly exempt themselves from their theories of how other folks behave. For example, Skinner argued that humans are shaped and controlled by environmental forces under the illusion that they influence events. But he exhorted people to become operant agents shaping their society by applying his operant-conditioning methods. Radical post- modernists, who emphasize fragmentation and relativity, argue authoritatively for the correctness of their view that there is no one correct view. Elimina- tive physicalists contend that people’s behavior is orchestrated unconsciously by their neural networks while mistakenly believing that they are exercising control. But eliminativists do not portray their own cherished treatises as the product of automatic writing by their neural network under illusory personal authorship.”

      -Albert Bandura

      That last sentence is the best. I hope Nora Volkow reads it someday, and seriously ponders that idea.

      • Michael V. says

        Steve:

        This is not a reply to your post; I just positioned it here to address you directly.

        First of all, I applaud your site and defend your right to run it any way you want – not that you need my applause and support. As someone who has been fighting the good fight against the “Addiction Industry – AA -disease” juggernaut for thirty years, I know how difficult and thankless a task it can be. Someday I would very much like to start a meaningful exchange on what strategies and tactics you think work best in this ongoing battle, and which strategies and tactics just backfire.

        But for now my question is this: is it really serving any purpose posting Ryan’s rants? (his last one included the word “chode” – I had to look it up!) I can respect a no censorship policy, but sometimes we need to protect people from their own lunacy.

        Anyway, its more of a rhetorical question tacked on to my much overdue kudos to you for being in the game and not standing on the sidelines.

        Sincerely,
        Michael V.

        • Kevin B says

          Michael,

          Having been on the receiving end of numerous insults and rants from our boy Ryan, I have to say that I support his continued participation and I have actually learned a lot from him. His childishness and obsession with capital letters aside, he embodies the dry drunk concept, and, though annoying at times, his behavior serves as a daily reminder of how not to be. Ironically, he has a spot on my grateful list…despite all my faults, I’m grateful that I’m not as bad off as him. I imagine his day today will look something like this…wake up, be really mad, eat breakfast, be really mad, go to an aa meeting, be really mad and confused, then spend the rest of the day being mad, insecure and scared until bed time. Personally, I’d rather go ahead and get drunk than live like that, but, assuming he has been sober while composing his comments, I can’t imagine how hysterical, irrational, emotional, and needy that dude would be drunk.

          I feel a tinge of guilt for being so harsh, but I’ve determined that, at the end of the day, Ryan is a net negative for the world at large. Put differently, the sum of his words, actions, interactions, etc…will result in the world being just a little bit worse. The vast majority of moronic behavior falls on a very simple spectrum…asshole or dumbass? The asshole knowingly cuts you off and feels absolutely no remorse…the dumbass cuts you off unintentionally and doesn’t even realize he’s done anything wrong. Occasionally, someone comes along that is both simple minded and cruel hearted. It’s never too late, but, as of today, that person is you Ryan. Respond however you see fit, but you know I’m right. All I have done is give my opinion on a site designed for mature debate. You, on the other hand, have insulted anyone who doesn’t agree with you, and have shamelessly exposed yourself for the simple minded coward that you are.

          Anyways….I’m about to go check on the ladies I work with who have recovered from years of homelessness, addiction, incarceration, and all other forms of abuse. Then I’m going to puff some weed, watch the UGA game, and decide whether or not I want to go out and get laid tonight. Have a good one Ryan.

  84. donjuan says

    I’m in total agreement of the creator of this website…i see someone like him as using tough love to help people in a dysfunctional recovery culture….he will get mocked..bashed..accused of anything from triggering..or killing people who die from their addiction. it’s pretty simple for me to see..on websites like this that are for free thought and aren’t AA based or disease model based…the AA disease camp will feel the need to come out squash an opposing view..in a disrespectful way.. If their program or philosophy was so good they would never feel the need to do that..in the way that they do..I’ve done the research myself and this man Slate..is correct..it’s amazing it’s like he is stuck inside my head…i drank to give myself liver damage….got sober..did my own research for 2 years..keep in mind i have a good BS detector…the vast majority of people grow out of addiction…some small percentage feel they have a lifelong disease that they are powerless too….our recovery culuture and business caters to those people and controls them…they really think..they are the only “real addicts” recoveryism becomes their life….In my experience substance is the not the real problem for people in “long term” recovery and I’m glad someone is brave enough to tell it like it is..

    thank you for your courage and honesty

    • Ryan says

      Addiction is not a “lifelong disease”………..it is a temporary one. The disease model applies to a person who is in the throws of addiction (currently using) because of the chemical imbalance in the brain and so forth. Once a person has recovered completely and in not using any longer….the disease is cured. Wow people!!! Get with reality……..Slate is NOT correct in his assertion that addiction is merely a matter of choices. Come on….you really think that is all addiction boils down to?????????? You people crack me up!!!

      • donjuan says

        So are you saying addiction is a lifelong disease or not? your post wasn’t clear..well I think it’s neither because it’s not in any way a disease..and it’s definatley not lifelong. I knew the truth about this phenomena “addiction” long before i found this website. Slate didn’t change my mind but I do agree with him. i base my conclusions on logic..statistics and social science…thats all we really have with addiction. the science of genetics..brain scans..neurotransmitters contrary to published articles in the New York Times or what Nora Volka says conclude absolutely nothing about addiction..the are useless,,bugus…made up conclusions..I also don’t base my assertions of addiction on “feelings” like I really feel alcoholism runs in my family..or I feel I’m powerless to alcohol..I certainly don’t use the “feelings” of the small minortiy that addiction is a lifelong disease as a fact..even if they are screaming at me using profanities

  85. donjuan says

    somebody asked on an earlier post that if there is somebody who was abusing alcohol..that now can moderate…

    well I am such a person…i drank because I liked getting drunk for 3 years very hard…up to 40 drinks a day or night. I developed a fatty liver and decided to stop…my physical withdrawal was almost nothing…gone after a couple of days….after a year my liver has completely healed….alcohol is not an issue for me…i can stop after 2 drinks. I could back when i was boozin too..i just didn’t want to…telling someone you are moderating in the recovery community is extremely taboo..I never tell anybody…I did once and they accused me of such horrible things…and even blamed me for putting peoples lives at risk….this is my life..they can stay home and drink tea….if i want to go play some cards..drink some beer..or go dancing and have a few..that is my business…I could care less what any disease model 12-stepper thinks…..btw i never once had a “craving” for alcohol….is that like a craving to get laid or more like a bacon cheeseburger craving?

    the recovery community will change…the BS is getting called out now

    • Kevin B says

      Donjuan,

      Me too. I used to abuse alcohol when I was also using cocaine, but, since quitting the coke, I’ve been able to moderate. I know three other people who share my experience, as in, went to rehab at one point, were told that they were a powerless addict whose only chance for a functional life rested in aa rooms. For some, this is the case…for others, it isn’t…it’s quite simple.

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  1. [...] the Times piece brings out, at issue is whether drug addiction is a disease (involuntary) or a choice (voluntary), and the kind of help that’s appropriate depending on your [...]

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