There are lots of articles being published this month about recovery. It is, after all, National Recovery Month. I am pleased to note that this is called National Recovery Month and not something like National Addiction Awareness Month- which focuses on the illness, not on the healing. And so to my topic. Do we have a disease, or an illness or an injury? What does recovery mean?
I have “alerts” set up in my email account to advise me when articles pop up about addiction, relapse, recovery, and all of these combined with YOGA (of course). I get a lot of publicity fluff articles about treatment centers and other corporate PR material. I get some good information as well. I also get controversial articles – the most recent one in support of the point of view that addiction is not a disease; “This Neuroscientist Argues That Addiction Is Not a Disease and Rehab Is Bullshit” – Marc Lewis.
Already you might feel compelled to accept the article based on the headline because the author is a neuroscientist. I also have to go by what I have learned and other points of view. I have my own gut feelings; I have my personal opinions and I am not a scientist of any kind.
I did feel compelled to read his article. As a person in recovery he comes to the topic with some experience. Where do experience and science overlap? Where do they diverge? Lewis tells us. He addresses the science pertaining to his opinions in a straightforward manner. Here are some of his points.
Addiction is a learned behavior. I get that. Our brain, designed for pleasure in healthy ways, gets hijacked by the quick, easy and repeatable jacking up by drugs, nicotine, alcohol and exciting effects of sex, gambling, porn and other edgy behaviors including media/internet addiction. We can learn the heck out of these, and use them to the point of delirium and death.
There is no single genetic condition related to addiction. However, there are numerous personality traits “like impulsivity”. Well, even though complex many other scientific authors find that the groups of genetic traits are similar enough, and trace through herited factors enough to call addiction “strongly influenced by inherited functional variations” (HHS 2009). So there is no exact single addiction gene; there is a complex combination of inheritable proclivities that collude to make one more than less likely to become addicted to a substance or a behavior.
The author states that making addiction a disease is harmful to recovery, and that “defining addicts as patients makes them passive”. I hear his point about addicts being patients but I don’t think that makes them passive. As we are learning responsibility for our sobriety, I think that passivity is not even on the table. In terms of the medical profession I, myself, have been more often in the position of educator rather than student as the doctors and nurses I have seen have not known much about disease. I did not feel like a victim; I did not feel passive. I worked for psychiatrists for years and they had no concept about addiction, disease or not. They were focused on prescribing for the co-occurring mental disorder and had no clue about treating the addiction. Maybe I just haven’t met the right group of medical professionals.
Active addiction has a life cycle. He writes that there are median lengths of time that one will be in active addiction per substance. The maturing of the brain has an influence on when we will hit our bottom as well. His point is that the median (a range) run for an alcoholic is 13-15 years from the point you first start drinking. There may be documentable cycles for other drugs as well. I am confused. Does this mean wait for fifteen years and you will hit your bottom? Don’t try to sober up sooner as the cycle of addiction hasn’t run its course? (I have issue with this point of view- and would say that more study needs to be done. This is a shaky scientific point to hang your hat on, in my opinion.)
Finally he comes down on the rehab industry. I use both words advisedly. I am concerned about treatment centers and facilities myself. He maintains the the current state of this often unregulated industry is a sham, does little to prepare one for recovery and, in fact, may be designed for people to return, rather than get well. That is a pretty gloomy (or paranoid) outlook as I think most people working in the recovery field have the very best hopes for their clients.) I am not sure that we have a handle on what works and why. Community is important. Reframing our (the addict’s) life outlook is important. Acquiring coping skills and tools to address life as it comes at us is very important. Practicing (yes, learning) new ways to find happiness, pleasure and contentment is critical. Many of us would agree that longer term live in care would be much wiser, and a full on aftercare program would be so very useful. If indeed this is a learned behavior – and if we practice this addictive behavior for fifteen years- we need at least a tenth that long to practice and acquire new habits of healthy living.
I love the twelve steps. They are my home and home base. I come back to the rooms because I love the people and I understand our willingness to get well, and the importance of being there for the new comer. There are lots of programs now, and I don’t want to be myopic or defensive. I think that treatment centers can offer more than just one process when we look beneath the surface and find out what the steps, what the **** in refuge recovery, the statements of commitment in other recovery groups, are getting at. Yes, some treatment centers have become complacent and rely on the 12 Step meetings to carry the message and provide only safety, meals and routine. For some that is enough.
I am a yogi. I think that body mind and spirit need to be healed. Other tools aside from reading, talking and listening, need to be employed to heal. Breath work, meditation and intentional physical movements are critical, in my opinion, to heal and integrate us.
Lewis is partly right. Our response to this tragic epidemic needs to be better. Our treatment opportunities need to be stronger. However divisiveness, even semantic, will not help community building. Rather than “this / OR that”, how about “this AND that”. So not to focus on it being a disease / not a disease -let’s agree that it is a brain injury that requires healing- and practice of any healing modality, done in community with others, will help the brain recover.
I agree with Lewis that “Isolation is really bad for you and it’s the underlining factor of addiction.” Work together to improve rehabilitation, find more options for those still suffering and whether or not the life span of an active addiction is seven or seventeen years, let’s recover together.
10 Comments
How absolutely wonderful to read this piece ,thank u
I prefer dis-ease, myself
I get it – I kind of think both- dis- ease in body mind and spirit and the disease that contributed to the injury. Thanks for your feedback!
You are welcome – it is a topic that is going to be discussed widely for some time. Be well
Extraodinary article – important message – I love your insights and your yoga recovery class – you are such a gift in our lives – a spontaneous gift from the universe to the recovery nation that never stops giving…
Re-read – yes there are common traits to people in recovery – that is a fact – but there are also many common parenting deficiencies – I think much of codependence and self-esteem challenges, criticism and judgement in parenting in nearly universal in recovery – so I do not believe there is any inherent genetic or biological reality in addiction – if so, believe me big pharma is going to find that gene and peddle some magical cure. I agree that the disease concept is medically fraudulent and the rehab industry gleefully takes billions from insurance and govt and in many cases, the success rate is dismal. I feel telling someone struggling in addiction that they have incurable disease, stigmatizes and creates relapse. I believe that recovery happens and does not require life-long attachment to groups to avoid relapse. Community and love are universal needs for a healthy life – such as good food and exercise – but that is not unique to people in recovery.
I wonder if we or the neuroscientist would call Type 2 Diabetes, a disease or dis-ease?
We don’t question once the patient is end stage and needs dialysis or when they need pills or medicine to maintain their sugars in a normal range to prevent the real consequences of nephropathy, neuropathy, blindness, amputation, cardiovascular complications and death.
And yet that disease is virtually non existent in places like Rural India. When that Asian Indian moves to NYC, diabetic rates surge to 40%.
Still nobody questions the disease label.
Why then do we fight this for addiction?
Why then the need for a “-” to feel better about it?
For 14 years, I struggled to call myself an alcoholic but certainly knew I had a drinking problem. I would admit that porn was an issue, every guy watched it.
Those type 2 diabetics can reverse their disease if caught earlier enough by choosing a better diet and exercise – blood sugars stabilize and need for medication and constant monitoring end. And yet these people can face the same challenge if they revert back to the way they ate or acted before.
Why are we so hung up on this? Is it because it is a mental health issue? And God forbid we have a mental health disease.
Today I am less worked up about this – I accept the notion that Addiction is a Disease. A disease of choice. I accept the medicine I need to take – meetings, journalling, step work, surrender, and reaching out – as those things that will help me have a better quality of life. And I know full well when I am well that healthy choices will continue to dictate the direction of my health.
As for the medical model – certainly better than the criminal model or the ” you are on your own – too bad you made bad choices model”. I am grateful for my 8 weeks in Rehab.
Improving the results for the type 2 diabetic and the addict comes down to acceptance and action. Hopefully before it is too late.
I feel using the “recovery” is a mistake. By definition recovery it tells we are returning to a former state. If I recover from
a condition I have been restored the pre condition state.
The alcoholic must do more or he will drink again.
Through AA and the 12 steps, a sponsee and meetings of group and belief in a higher power (no necessarilily a deity)
he or she can be restored to sobriety.. it requires a different view of the second step . It requires saying that the power in the second is truth itself.
Now the question is —-what is your source of truth? The answer? Sooner or later the answer is — The word of God.
Now I have walked into the third step and my spiritual life ca begin . I have been transformed!!!!
Interesting ! I have not heard that point of view. I use recover in the sense of being “restored” which the steps suggest I will be. Thank you for writing!
Yes, restore and recover are somewhat synonimous but the newcomer
has not yet gotten past the first – has not gotten to third and his
Introduction to a diety. The second step shoud not be “diety” step
It shoud be the step that introduces him to the the necassiity of
Truth being the basis of his life from this point. The sponsors next
poilnt is 1. Truth must become the cornerstone of your life including
What you told yourself in the first step.!!!!
What you will base your life on.
THE TRANSFORMTION HAS BEGUN!!!!!
Truth has become his first higher power. Now he can meet his Diety who