To Disease Or Not To Disease

That is a question…

The topic of addiction has no shortage of “experts”, many credentialed, and many not, who profer exceedingly different, and often polarizing explanations regarding causative factors. I suppose it is like any other science where you can have opposing viewpoints, and at times, one may prevail, only to be toppled at a later date by another. Or not.

As a former user of alcohol, one who was willing to conduct a lot of introspective analysis, I can honestly say “I don’t fucking know” who I agree with, and I say this having also conducted a lot of study of the literature surrounding alcohol.

I don’t want to make this about scientific papers and statistics. I’d really like to just touch on the discomfort I have when I hear someone emphatically state that they know the answer, one way or another. While I do think certain answers make us feel better, I think we can also turn them into crutches.

It seems clear that some individuals, myself included, seem to struggle with excessive consumption, while some individuals can walk away. I know that former traumatic incidences, notably in childhood, excessive violence or other forms of personal intrusion have certainly been linked to addiction. And whether or not someone argues in favor of mere “habit” versus “disease”, it does seem clear that something occurs in the brain with repeated patterns of use. Like a tune we sing 1000 times, we come to know the words of well.

Returning to the personal aspect of this — please understand these are simply emotions that I am sorting through. There are aspects of the disease model that I have a distaste for, but if I turn the prism, from another view, I can understand and accept them. Of the myriad complexities I acknowledge, I do feel that the ingredients necessary to create a perfect environment for addiction were present, in my case. Some involve a familial history of alcohol abuse. Some was excessive childhood trauma and violence. Some was being an INTJ that just didn’t really feel comfortable having to talk with other people. Top it off with decades of use, some intermittent, with some more heavy, and a definitive pattern and “habit” was set by my choices. I have no doubt that my choices created a chemical outcome in my brain and made my use increasingly easier and more “necessary”, or so it seemed.

But then there is the aspect of the disease model that leaves me a bit more empty. While I don’t feel like I have “control” over alcohol in a certain respect, i.e., I need to keep that first drink away from my lips, I likewise do not feel like I have a disease such as the asthma that I suffer, which requires daily medication. Nor do I require daily or scheduled cognitive therapy, per se. With alcohol, I need abstinence and personal work on leaving it behind me, and creating my life in a way that does not utilize the drug in circumstances where I would have previously. But I do feel like I have a choice whether or not to drink. Whereas with my asthma, I do not have a choice whether not to take daily medication. So I suppose there are some differences. Perhaps it is the acknowledgement and empowerment that I feel knowing that I indeed have a choice whether or not to take that first drink.

And if I don’t ever take that first drink again, what I am really doing is refraining from putting a poison inside my body. Not taking poison would seem to be the obvious choice. But alas…in upcoming blog pieces I would love to discuss the myriad ways in which the use of this poison is socially accepted, much as cigarettes were in prior decades. So what is a smoker who has quit smoking for over 10 years. A former smoker? A smokaholic? A recovered smoker? I think it is common knowledge that nicotine likewise has addictive properties. How about a heroin or meth addict, or someone addicted to narcotics? Do we say they forever have the disease of “addiction”? Or do we say they need to stay the hell away from drugs forever because of history and predisposition?

I did read a study that came out of Great Britain that placed alcohol as the most dangerous drug, outpacing heroin by a long shot, when it came to personal and societal impact.

By making those former statements, however, I’m not denying any validity of the disease model. Where I seem to be now is that I very much believe that I have a predisposition, with many causative factors, to alcohol abuse. If I make the conscious choice to drink, I could actually give myself many diseases, not just the process of alcoholism. I do think I have a problem with it that may be, by definition, a disease, or it may not be. I’m not entirely certain we have this sorted out.

If I go 20 years sober, like many people I know, I don’t know that I’d be comfortable just saying “I’m an alcoholic” without some clarification. It seems rather limiting a label if I move forward, alcohol free, and create a fulfilling life of health and sobriety. I would no longer be practicing the drink, and the alcoholism, but the opposite. But would I think of myself as the average Joe, or “normal” with regard to alcohol? Most certainly not. I can’t imagine not forever being wary, cautious, understanding the risks…

Would it be possible for me to go backwards? I suppose I’d hate to think that I’d dare, because I’ve seen that road and what is down it. I don’t have any desire to proceed in that direction, because of my tendencies, because of my predispositions, and because of my tolerance to the drug, that I had even before ever drinking much at all.

We certainly see a greater incidence of alcohol abuse in various demographics, and I am fully aware that I fall into a subsection of the “risk factor” arena.

Yet interestingly, I have come across writers and other people who doubt even this — whose conviction is that nobody is predisposed, that it is all a matter of choice, and of habit. This I cannot agree with either.

As I’m writing this, I’m helping clarify for myself where I currently stand, and like any really “good” opinion, it is subject to change. I would hope to continue to learn more about the topic. I’ve become quite fascinated with it, and there is a part of me that yearns to have gone into addiction medicine instead of another field. Because now, as never before, I get them. I get other addicts, no matter what their drug of choice. That was never the case previously.

To date, my favorite book, the most telling, and compassionate, encompassing read on addiction was written by Dr. Gator Mate, entitled In the Realm of Hungry Ghosts: Close Encounters with Addiction. It taught me so much regarding the physiology of the developing brain, and its response to trauma, and the relationship all of that has to addiction. I mention this because as I consider this topic while continuously interacting with people on both sides of the fence, my current take seems to fall in line with that of Dr. Mate, who said:

In the real world there is no nature vs. nurture argument, only an infinitely complex and moment-by-moment interaction between genetic and environmental effects…

In summary, I’m willing to fully admit that labels are helpful in language and communication, and for the transmission of ideas. But they can also be limiting. Some have appeal to me and some do not. Some are helpful while others are limiting. Having a “disease” does help me to understand some risk factors and complexities, while it also makes it slightly more challenging to empower myself. I need to know that I can help myself, and without a doubt, I do know that. So I’ve come to believe that there are some solid ideas on this topic, and the bottom line for me is that it doesn’t necessarily matter one way or the other whether I “disease or not disease”. What matters are the choices I make from here on out.

I’ll certainly face the challenges of changing some habits and thought processes surrounding my former drug of choice. But I’m excited about a life of sobriety, one that doesn’t shackle me the way alcohol came to do.

These are my thoughts today. Only a few days in, this go around. Feeling strong and good.