What's Wrong with Treating the "Disease" of Addiction?

Elsewhere I talk about the flawed science behind the disease model of addiction. Here I'm interested in the net effect it's had on addiction treatment. Addicts need empowerment and self-direction in order to change. But the medicalization of addiction turns them into patients: obedient, passive, and powerless.

Religion and Addiction: Void-Fillers?

When addicts face the prospect of permanent abstinence, they stare into a frightening abyss. But that's not so different from the experience of religious people who are losing their faith. For both, the neural circuitry of desire has been harnessed to a fundamental need for connection. And that's a terrible thing to lose.

What if Addiction is the Only Game in Town?

Giving up booze or drugs, getting sober, might sound like a good idea. Unless there's nothing else available to provide you with meaning and warmth. Without those alternatives, getting straight is like looking into a dust-storm. There's nothing to see except greyness and formlessness -- and that can be terrifying.

When All Our Dreams Come True

The warmth and closeness that come our way during the holidays can cast a long shadow: loss, loneliness, and alienation. That makes Christmas a difficult time for ex- and recovering addicts. Because drugs and other addictions promise to fill the hole.

The Key to Quitting: Self-Trust Part 2, Delay Discounting

Delay discounting is the tendency to overvalue immediate rewards at the expense of long-term benefits, and addicts are particularly prone. Their messed-up dopamine system makes their drug, drink or behavior of choice seem way too attractive. To overcome delay discounting, addicts need to find a future self they can rely on.

The Key to Quitting: Self-Trust Part 1, Ego Depletion

Self-trust is extremely difficult for addicts to find, but when they find it, they also find a pivot point in their battle against addiction. Self-control works very differently when you talk to yourself like a coach instead of a critic.

When the Thrill is Gone: Reward Deficiency Syndrome

Different brains have different quantities of receptors -- such as receptors for neurotransmitters like dopamine. If you were born with, or acquired, a disappointing crop of dopamine receptors, then it might be harder to feel the thrill of being alive. That's where drugs, booze, gambling, and binge-eating come in handy.

Running on Empty: Eating Disorders as Addictions

Are eating disorders a type of behavioral addiction? Might they even constitute a special case of substance addiction? After all, food is a substance you put inside you to make yourself feel better. As far as your brain is concerned, it's the context that makes the difference between consumption and addiction.

The Common Denominator of All Addictions

Substance addictions and behavioral addictions are defined by compulsion—an urge that's very hard to turn off. So is obsessive-compulsive disorder (OCD). In fact, addictions and OCD appear to be members of the same family, whose characteristics include brain mechanisms underlying conditioned responses to recurring stimuli and the breakdown of cognitive control.

Behavioral Addictions vs. Substance Addictions

All addictions—whether to drugs, alcohol, food, gambling, or internet games—have a lot in common. They not only feel the same to the person who can't seem to stop, but there's not much difference in what's happening in the brain.

Addicts Don't Have a Monopoly on Craving, Say the Buddhists

Buddhism teaches us that giving into craving just reinforces the cycle of human suffering, and nowhere is this more apparent than in addiction. Neuroscience research provides a complementary message: the brain has to work extra hard NOT to do what's right in front of you. The take-home message? It's probably worth the effort.

Real Recovery is Always Developmental!

Maybe some 12-step groups promote a static state of anxiety to ward off addictive impulses. But for people to recover thoroughly, to move on from being an addict, stasis won't do. Real recovery must be a developmental process, whereby synaptic re-wiring and personal growth change the way you think and act.

Does 12-step Treatment Work by Inducing PTSD?

Nobody really knows how the 12-step approach works. But some who've tried AA or NA don't like the price they end up paying. Like PTSD sufferers, group members may stay clean by remaining anxious and vigilant — too scared to go backward and too stuck to move forward.

Narcotics Anonymous Groups Give Out Opioids

You probably didn't think it was possible. It's scandalous! Providing opioids for the very people trying so desperately to get off them? But there have to be neurochemicals in the milk of human kindness, or our brains wouldn't get the point of connecting with other people.

A 12-Step Rest Stop for Heroin Addicts

I'd become quite skeptical about the 12-step monopoly of the addiction field, based on gruesome personal stories and reportedly poor success rates. But joining a meeting of Narcotics Anonymous (in the north of England) brought on some new insights.

The Hourglass Shape of Addiction

Many kinds of people, with different genes, families, and personalities, can become addicts. But as addicts we think, feel, and act very much the same. Only once on the road to recovery do our lives begin to fan out again, taking on the individuality they once had.

How I Quit

What's called "spontaneous recovery" isn't usually spontaneous at all. It often follows years of failed efforts and increasing self-disgust, depression, and terror. At least that was the case for me.

Self-Medication or Self-Destruction?

While early trauma may fertilize the soil for addiction, it's clear that addiction itself is traumatic. After a while, the psychic pain elicited by the addiction can dwarf historical factors and require more and more self-medication—a vicious circle that seems to lie at the heart of the problem.

Addiction as Self-Medication

If drugs, booze, binging or gambling soothe an overactive amygdala, then addiction is neither a disease nor a "free" choice. It's a form of emotion-regulation that speaks directly to the brain.

Part III: This is your Brain on Choice

Brains do most of their work unconsciously and rapidly, connecting inputs to outputs at many levels before the moment of choice arrives. That's why good choices require good habits. And good habits can be practiced and improved, so that we choose well when temptation strikes.

Addiction as Choice: Part II

When subjectivity and science join forces, we begin to see choice as a fragile vessel on a roiling sea of psychological processes already in action. In fact, choice is never free of the mother of all psychological processes—habit.

Addiction: A Matter of Choice?

Free choice is never really free, but it takes a good long look at the neurochemistry of motivation to understand why.

A Brain's-Eye View of Addiction as a "Disease"

Addiction really does change the brain -- the dopamine system in particular. But so do other things we find very attractive. Where and how do we draw the line?

Defining Addiction: Disease, Choice, or Self-Medication?

The war of definitions has reached critical proportions. It's time for neuroscience to step in and clear things up.

A Genetic Blueprint for Addiction?

There are genetic components to personality traits, like impulsivity, and impulsive people take more risks. But experience is the final arbiter of the pathway to addiction.

Disease, Disorder, or Neurodiversity: The Case of ADHD

The migration route of a wonky gene reveals something surprising about the libelous label "psychological disorder." Context makes all the difference.

Addiction: Disease or Not?

I've been pretty convinced that the disease metaphor does nothing for our understanding of addiction. But now I'm not so sure.

Psychedelics Let the World In

But instead of turning on, tuning in, and dropping out, the chemicals we prefer today help us turn off, tune out, and drop in—into a solipsistic safety zone, protected from too much reality.

The Pivot Point: Once More With Feeling

You've been craving and craving, for hours, maybe for days, and now you finally allow yourself to get the thing you've been craving. Dopamine feels like desperate desire when the goal is out of reach. But it feels like a headlong rush when you're suddenly "allowed" to go get it.