An addiction by any other name….
Addiction is a disease. At least that’s what we hear in 12-step groups and from the medical community. Actually, in 12-step groups you’ll often hear the older claim that addiction is not just a disease, but more specifically, an allergy This medicalized way of understanding addiction has played an important role in changing the way society in general, and the addict him or herself, reacts to addiction. By changing the way we understand addiction, formerly seeing it as absolute proof of a weak character at best and utter moral depravity at worst, to seeing it as an affliction comparable to cancer (or hayfever, using the allergy model) the addict is seen as someone that can be allowed to reintegrate into society at large as a patient, and not expelled as an unredeemable wretch.
Thus, one cannot deny that medicalizing the understanding of addiction has been of substantial benefit for the addict, his or her family and friends, and our communities in general. It has relieved the suffering of many and given hope to many more. But, as much as this way of understanding has aided us, it is not without its deficiencies, and understanding these deficiencies is one way we can move to a deeper and more complete recovery.
The Deficiencies of the Disease Model
Again, the disease model has been useful in alleviating the moral condemnation that was often dispensed on addicts. But for the addict him/herself, if not properly understood, this model can create a false sense of understanding, it can invite a victim mentality, and ultimately it can impede growth.
It creates a false sense of understanding by handing each of us a set of ready-made terms and concepts. These terms and concepts have been predigested by our culture and appear familiar to us because everyone has had experience with disease or allergies. One can easily think of the situation where one friend says to another, “I’m allergic to cats.” The second friend will often feel he has an understanding of his friends affliction, and would never question that understanding.
However, if pressed, more often than not, the friends’ understanding is superficial. He might believe (correctly or not) that the other person sneezes around cats and have absolutely no appreciation for the workings of the immune system or of histamine reactions.
In most day-to-day circumstances this superficial understanding is sufficient for those around the allergic person. It’s as simple as keeping him or her away from cats (or vice versa). But, for the allergic person, staying away from cats may not be sufficient because cats are not in and of themselves are not the true problem. The problem for an allergic person is a specific allergen. Likewise, for the addict the problem is not the intoxicant itself, but something underlying the addiction. Thus, to simply propagate that addiction is a disease or allergy may leave the addict believing that he or she understands the problem and how to avoid it.
In Buddhist terms this underlying problem is attachment. The craving for drugs, alcohol or whatever is sought by the addict, is not ultimately a craving for that one simple thing. It is a craving for an end to suffering, for permanence, and for a satisfaction complete and unending. In simplest of terms, the “allergen” is not the alcohol or drug, but it is suffering itself. Thus, while the allergic individual might deal with the allergy by simply avoiding the cat, the addict cannot simply avoid their allergen, suffering (Duhka).
Another effect of the familiarity evoked by the disease model is that it also risks inviting a victim mentality in the addict. The great comedian Mitch Hedberg had a joke to the effect that alcoholism is a disease, but it’s the only disease you can be yelled at for. I always found this joke not only to have a kernel of truth in it, but that it also reveals a particular danger of the disease model. Essentially, by seeing it as a disease the addict is invited to think of it like just any other disease. Further, if it is a disease, and most diseases come upon us through not fault of our own, addiction is actually thrust on us, and we are merely a puppet of cruel fate (or perhaps cruel genetics).
Thus, when the addict says “I have a disease,” he or she may impliedly be saying “I am a victim of something outside of me,” and thus any solution or cure must be applied to me from outside. In Buddhist terms, however, we see that this is not the case. The “allergen” may be suffering, but the problem is within each of us. The problem is our denial that the suffering is itself impermanent, and that our views, intentions, and mindfulness (amongst the other parts of the eightfold path) are not appropriate.
I do understand that the foregoing “deficiency” may be controversial. Many a 12-stepper will testify that the solution does lie outside of themselves (the higher power), and that it is only by accepting that it lies outside of themselves that they can be reborn. But the problem is one of degree. The common attitude about medical treatment is that a person merely submits to treatment, rarely questioning, and even more rarely actively working out a treatment plan or program.
The ultimate effect of this mistaken attitude is that the addict can become ensnared in this model, unable to grow spiritual, or grow in recovery. If addiction is cause by something outside me, and the prescription for a cure is applied from outside me, the self is frozen. The self is enshrined as an object apart from the world, a victim of the world, and at the mercy of the world. The self cannot grow. At best the self can only be grown.
A Buddhist response to this may be that this deficiency can be overcome by understanding that the suffering that is the allergen for all addiction cannot be avoided but that it is impermanent. Further, far from the situation being one of the self tossed about by the world, the addict may grow to apprehend the true nature of his or her own suffering, with compassion and empathy see that this suffering is shared by all living creature, and learn to extend lovingkindness (metta) to all who suffer, including the addict himself. Therein is the possibility of growth, and therein lies the possibility of recovery.