Is Addiction a Disease? Or a Choice?
Addiction is not a disease! It is actually a completely reversible condition. To see this, let us examine what a disease is, and then look at whether the addictive behavior qualifies as such. The Webster dictionary defines a disease in two ways. First, it is a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors. Second, it is any harmful, depraved, or morbid condition, as of the mind or society. It is the second definition that allows the inclusion of addiction as a disease. However, when we use the word disease, we think of the former. We search for the disordered part and, if we do not find it, we presume it exists. Is addiction a depraved or morbid condition? Nobody wants that label. Is it a disorder of some part of the body? No one has found that. All present arguments are presumptive. I would like to propose an alternative consideration.
First, however, let us look at the existing alternatives and their limitations. Generally, it is assumed that the only alternative to considering it as a disease is to consider it a choice. If we do that, and consider it a choice, we can see that the choice becomes a depraved or harmful act, making it also a disease, this time of the mind. The first available alternative, therefore, is that it is a disease of the body; the second is that it is a disease of the mind. Therefore, the argument of whether or not it is a disease can be condensed to that of whether it is a disease of the mind or of the body. A disease of the mind has its limitations in that it is inaccessible and thus untreatable. It is a disorder of who you are. By inference, it cannot be treated without also changing who you are. Of course, to change who you are so that you become a better person is quite attractive and admirable. But then, the previous existent is not a disease of the present one. It is a different or less developed existent. What we would have done would be to enhance the self, that is, take the self to higher ground. That is not the curing of a disease but the building of the personality. So to consider it a disease of the mind is the condemnation of the person`s ability to be whole, and thus an insult to the person. Nobody, therefore, wants to believe they have a disease of the mind. So they prefer to choose a disease of the body.
I agree that relegating addiction to be a disease of the body is a much more humane consideration than making it a choice that becomes a disease of the mind. But this also confers a huge problem. A disease of the body is a progressive or chronic condition unless it is found and treated or accepted as a permanent disfigurement. May I explain this? When an organ system or structure of the body is disordered and incorrectly functioning, it distorts not only the total function of the body, but also the function of other organ systems that are associated with it. A diseased kidney, for example, can cause severe high blood pressure that, in turn, causes heart disease. Secondly, unless treated, the disease progresses within the system it is affecting causing more of it to be diseased. Thirdly, if a diseased organ or structure cannot be repaired, the person is condemned to live with a disorder that compromises the full quality of life. Thus, it is insufficient to accept the presence of a disease unless we also are able to define and treat the disordered structure or system, or accept its chronicity.
It may appear from this argument that the person with an addiction is doomed. He is either diseased in the body in a place or form that cannot be identified and so treated, or he is diseased in the mind, an existent that defines the very nature of the person but cannot be accessed and so treated. Since neither is palatable, may I now propose an alternative option for consideration? This is that the addiction is not a disease, nor is it a choice, but it is an effect. The effect of addiction is the apparent distortion of either the body`s function as a result of the presence of a foreign substance (drugs, alcohol) or the distortion of social responsibility as a result of the participation in an activity (gambling, shopping, sex). This effect is a natural one. When anyone uses a substance or activity that alters either physiology or accountability, the alteration is a temporary state that exists while and because the substance or activity is present. As a simplistic explanation, I wish to compare it with tachycardia or increased heart rate. A heart rate of, let`s say 150 beats per minute is abnormal under normal conditions. However, if we are running a marathon, it is an unpreventable and desirable effect. And it stays while the body`s metabolism is high. The choice is to run, the effect is the tachycardia. In a similar way, the use of a substance or the indulgence in an activity can so distort the body`s function that it then requires a continuation of that substance or activity for it to function comfortably. We see this often in, for example, cocaine use. The presence of the substance takes over a normal function of the body so that, the deactivation of the substance by the body`s enzymes causes a temporary inability of the body to continue its normal function. This is not a disease but a temporary lapse in body function that can resume in short order. But its discomfort evokes a need to maintain the function by the temporary reintroduction of the substance. In other words, the substance takes over a particular function of the body. When it is removed, the body is left without a natural function of that part for a short time until it recovers. This transitional period introduces so much discomfort that the person who cannot deal with such discomfort naturally will be inclined to resort to a boost with the substance that caused the distortion in the first place. This can happen to anyone. It is a natural physiological fact. It is not the addiction. There is another factor at play. I alluded to it by referring to the possibility that the person may not have the internal resources to deal with the temporary shutdown of that part of body function. But we will get into that later.
Look at it. In this example, there is no disease process going on. It is only the temporary effect of the substance taking over a natural function, and the temporary dysfunction that exists while the transition back to the natural function of the body is taking place. The renewed use of the substance is again a rational decision to maintain body function albeit from an artificial source just to avoid the discomfort of the transition. Thus we see that the use is a rational decision. The continuation of use is also a rational decision directed at an immediate and realistic need. The addictive behavior is the repetition of the effect. To say that it is a rational decision, therefore, does not relegate it to being the disease of mind because a rational decision is neither a depraved act nor a morbid condition. A rational decision is directed at solving an existing problem with an immediate if not always highly appropriate solution. It is, however, a solution that is most appropriate within the limitations of the person`s understanding or capability at that time. What we have deduced is that there is a problem behind the addictive act. The act is only an effect, a temporary one that can be repeated while it is the most appropriate solution for an underlying need.
Therefore, the alternative condition I wish to propose is that an addiction is a repeated effect on a person as a result of a reasoned decision to participate in an act. This is not choice. Choice suggests that the person has access to other options but chooses the inappropriate one. This proposal suggests that the person does not have sufficient other options. Therefore, choice does not apply. It may even be the only option the person has, not just the most immediately effective. The reasoned decision is directed at resolving another issue that is related to the person`s essence or self. The disorder, therefore, if it can even be considered a disorder, lies in the severity of the underlying condition to be resolved and the depth of capability of the person to access solutions. This makes the understanding of an addiction appear to be a complex issue, one that seems too difficult to consider easily. After all, if we can relegate it to being a disease, even one whose location or source we do not understand, it appears easier for us to digest and accept. Yet, when we think of it, this argument that the addiction is the repetitive attempt to address an unresolved need, we will be able to concoct an even easier solution that will then be more permanent and effective. Let us start by redefining our position.
We are proposing that addiction is neither a disease nor a voluntary act. Rather, it is an effect, a complex manifestation of a voluntary act. A voluntary act is initiated to achieve an end. This includes the act of using a substance, indulging in a pleasure, or participating in a game of chance. There is an objective, and thus, a voluntary act. The act cannot be the addiction. The addiction, the repetitive act, is the reliance on a limited depth of natural options and the understanding that confers it. It is the void that must repeatedly be filled through participation in an artificial distraction that itself offers only short-lived release that then becomes the appearance of the addiction.
The addiction is an apparently irrational repetition of an act that appears to have no real objective but a fleeting pleasure that is often unattainable. Since all using are voluntary acts, they require permission from the person to himself, to consider or participate in the act. The using becomes repetitive according to the level of permission a person gives himself. Such permission can be determined by the desire to reach the objective countered by the discipline of the person to use that or another method to reach the objective.
If there is great desire or desperation to reach the objective, in one case the attainment of pleasure – contentment, freedom, or power, and in another case, the release from displeasure – the permission can be great. If there are few options for reaching this objective or insufficient discipline or time to build options, permission is even greater. Therefore, the disease of addiction does not lie in the using but in the frequency or ease with which permission to use is taken. Of course, in the case of substance use, the ease of permission can also be affected by the presence of the substance as it can both increase the desire for the artificial control of body function and reduce the access of the user to other options they may actually have.
Therefore we cannot treat addiction simply as the decay of the moral fortitude of the person any more than we can treat it as a disease that takes away their volition. Instead, we have to consider the two counteracting forces that drive the self-permission. On the one hand, is that person experiencing such severe discomfort in life that even a large range of natural options is insufficient to allow them to achieve the immediate objective? Is the person so devoid of options that even a simple discomfort appears to be too severe for their natural abilities thus requiring the decision to consider other artificial options that will help resolve the simple discomfort immediately? Why does this imbalance exist? It is the existence of this imbalance and its severity that determines the rational decisions to participate repetitively in an act that provides short-term resolution. That it also expands the gap of this imbalance cannot be considered in the immediate need for assistance in the resolution of the imbalance, especially if it is severe.
Thus, we can see that an addictive condition is set up when there is too much discomfort and too few natural options for resolving that discomfort or reaching an acceptable level of comfort. This is the addictive process, not the act that we have observed to be an effect. There is no disease here. There is only an imbalance between the person`s developed abilities and the severity of the personal discomfort or need for comfort. Of course the severity of discomfort can result from a true disease. Cancer can be so painful that the use of morphine to a level that would otherwise be considered an addictive level is justified. On the other hand, the hidden pain of a migraine can also demand such artificial assists, but because of its invisibility, cannot always be justified. Although, in these cases, the reliance on the substance to do a job it is doing more strongly than can the natural body`s defences can be severe, it is not considered an addiction. More often, whenever we cannot often identify the depth of personal pain the individual is experiencing, we see the participation as inappropriate and, therefore, addictive. Similarly, we cannot see the limitations of options the person has. We may even see their use of artificial assists as addictive when they are simply responding to their responsibility to manage and are using assists to enable them to reach the solutions that are otherwise unavailable. In the first case, one can visualize Edith Piaff`s famous statement to her doctor about why she uses so much morphine. She told him that it was the only way she could get her body to shut up. In the second case, we can visualize Billie Holiday who needed heroin to help her extend her reach to perform unnatural hours on the road. Of course, the combination of both factors is most often the case.
This recognition of addiction as neither a physical disease nor a moral depravity allows us to consider the relative imbalance between the enormity of the discomfort and the paucity of natural resources for resolving it. We know that the discomfort is directly related to the paucity of personal resources, even when the person sees only the unfairness of an imposition, the internal feeling of emptiness, or the opposite, which is the desire for relief or a pleasure that is rarely experienced. These factors will visit everyone. The person who can deal with them naturally is not the one who does not experience them; it is the one who can manage or resolve them using personal or natural resources. Therefore, we can see that the existence of the need, or even the void when the need is extreme, is only related to the level of personal resources and beyond that, personal resourcefulness that the person has available to them. Once we can see this, we also can see the addictive effect, or more so the addictive need can easily be addressed, not just by shutting out the effect or relegating it to being a disease in its own right, but by accepting and looking for the paucity of resources belonging to the person to allow them to resolve the issue naturally. When that is discovered, it is easy to build, help the person build, and show them how to continue to develop independently the natural resources on which they can rely.
Unless we can see that the appearance is only the effect and look to address the cause, which is the void, we too will be treating addiction in an addictive manner. We too will be using only a different approach just as repeatedly to quell the effect that cannot go away while the underlying void remains unaltered.