Why Addiction is Not a Disease
Written by Kathleen Cogan, M.A.
There is not a person alive that addiction does not touch. You, a friend, a colleague or a family member may be struggling with alcohol and drug use, or a compulsive coping mechanism. Because ultimately, that is what addiction is: a compulsive coping mechanism or pattern of behavior linked to emotional and psychological distress. Whether someone becomes addicted to an eating disorder or oxydin, there is a short-term benefit for the person. I would argue this short-term benefit is relief from some kind of pain or anxiety.
Marc Lewis’ work in Biology of Desire normalizes addiction by arguing the brain is not diseased if addiction is present, it is doing what the brain has trained itself to do: create patterns of repetition for efficiency. This definition allows for other maladaptive behaviors to be viewed in some ways as an addiction. We all have patterns we repeat; some are healthier than others and sometimes those patterns become destructive, leading to unintended consequences. Addiction is something all brains have the potential to develop, rather than only those with a “disease.” As a counselor this re-frame is critical in helping to reduce help to reduce the client’s shame around their addictions. When shame is reduced, healing can begin, and new patterns of relating to others and the self can emerge.
This definition and Lewis’ working model for addictions increases our capability as practitioners to work with more people and to work deeper with client’s suffering. Maybe the drug and alcohol addiction is the most pressing, urgent addiction, but are there others, similarly less insidious addictions the client battles with? Can those be addressed alongside the primary addiction? These are the kinds of questions I ask myself when working with individuals with substance abuse issues. This practically means that I view addiction through these patterns whether it be maladaptive sexual behaviors, excessive gambling or forms of self-harm, like eating disorders.
Additionally, this re-frame allow space for the client’s unique story and experience to emerge. While the pattern of behavior may be similar to others, everyone’s reason for their behaviors is unique. As Lewis’ writes: “Addiction is a house with many doors. However, it is approached, and however it is eventually left, addiction is a condition of recurrent desire for a single goal…” (Lewis, 2015).
This desire for a single goal has overridden all other desires when addiction is present. If Lewis is correct in that “addiction always satisfies an emotional need” then the heart of any treatment must be uncovering what the unmet emotional need is (Lewis, 2015). Lewis’ Addictions are formed in the brain through repetition. It is from this repetition that neural pathways become solidified and habits form. However, the habit that turns into addiction is characterized by an intense desire and a single attention target. This means that uncovering the unmet need will take time and, in some ways, might seem in conflict with addiction. Are clients resistant if their goal is to simply stop using?
Approaching addiction with the above frame and lens will aid in my ability to get into my client’s world to form a strong therapeutic alliance and relationship. That will then allow me to identify their blind spots. With new awareness a new self is then able to emerge. A self that is able to satisfy their emotional needs without drugs, alcohol, maladaptive sexual behaviors, binge eating or any other destructive repetitive behavior that has formed.
While the disease model may work to keep others sober, I wonder who we are missing and who might be empowered through this new understanding of addiction. As a counselor, I certainly have a new understanding of addiction and desire and am hopeful of the effect of this model in treatment.
If you think you’d benefit from addiction counseling, contact our office today.
References
Lewis, M. (2015). The biology of desire. Why addiction is not a disease. New York: Public
Affairs.