On the Nature and Treatment of Addiction

Are we turning a corner on how we think of addiction? Not so fast.

Posted Dec 10, 2014

As someone who has questioned our view of addiction—how we define and treat it—over the past five decades, often for Psychology Today, I look to the future as both a perilous, and a promising, journey around four critical issues.

I.  Addiction Isn't About Drugs

It was in 1974 that I first wrote about addiction for Psychology Today: "Love Can Be an Addiction" actually predated my book with Archie Brodsky, Love and Addiction, by almost a year.  We said that addiction was only incidentally associated with drugs, that no chemical unlocked the key to addiction.  Rather, addiction was something that took on a central place in a person's life as their main source of satisfaction.  An addiction could be any form of powerful experience—so long as it was destructive.

In 1974, addiction meant heroin (the subtitle of our article was "Interpersonal Heroin"). To speak of smoking as addictive was to be beyond the pale, let alone to believe that things other than drugs can cause addiction. That is no longer true.  The current psychiatric diagnostic manual, DSM-5—which I wrote about in PT magazine in 2010, several years before its release—not only recognizes comparably severe disorders for any type of drug, it for the first time identified a non-drug addiction, gambling. 

We can bet our lives that other activities will officially be labeled "addictive" in the years to come.  And none are more likely to be so designated than sex and love.  Indeed, I present evidence that both sex and love are far more powerful than drugs, more powerfully addictive in the first place, harder to overcome in their withdrawal throes.

It is necessary to disabuse ourselves of the idea of addiction as a chemical side effect of some substances.  This misstates the reality of addiction, both in making drugs (and alcohol) larger than life, and because it misses the picture on problems that more commonly befall us.  Virtually no one commits suicide due to withdrawal from tobacco, alcohol, or heroin.  But suicide—and murder—are frequent results of the end of addictive relationships.

II.  Recovery Is NOT Abstinence

America has created two neologisms—"recovery" and "sobriety"—both of which are taken to mean abstinence.  Neither term is accurate.  Sobriety is not abstinence: the word literally means not being intoxicated or, in its broad sense, taking a serious approach to life.  Recovery does not mean avoiding a substance forever.  It means regaining a foothold in life by finding purpose and meaning. This meaning of recovery is now recognized by the U.S. Alcohol, Drug Abuse, and Mental Health Administration.

ADAMHA's new recovery is built on four pillars: health, home, purpose, and community.  As my 2014 book with Ilse Thompson, Recover! Stop Thinking Like an Addict, puts it: "You can't build your life around nothingness, an empty core.  Rather, it is the strength of your life foundation that guarantees not only your longevity, happiness, and fulfillment, but your resistance to addiction."

The acceptance of anything but abstinence as a path to recovery—of even considering how to improve your life in the absence of a wish or ability to abstain—has been a long-running passion play in America.  My 1984 Psychology Today article, "Through a Glass Darkly," which dealt with what is now recognized as the Sobells' classic study of controlled drinking therapy, on which the recovery movement launched an all-out attack, was among the most controversial in PT's history.

III. Recovery Is the Most Natural Path—Even On Your Own

Our concept of addiction as a disease is predicated on the idea that, if we are addicted, we are permanently afflicted.  Our condition can only grow worse unless we abstain, join AA, or get some—as yet undeveloped and unknown—brain fix.

Or so the disease theory claims.  Nothing can be further from the truth.  Natural recovery is, by far, the typical outcome for addictions, as I wrote first for American Health magazine in 1983, and updated in my article in Psychology Today magazine in 2004: "The Surprising Truth About Addiction": "More people quit addictions than maintain them, and they do so on their own."  Unfortunately, even as the government's own research shows that natural recovery is the rule, it refuses to acknowledge this truth.

The persistence of the idea that addiction is an irreversible personal characteristic shows how this belief is wired into our culture—even as it is not a truth about us as individuals. It is so much better to realize that the force is with you as you work to regain your balance during an addiction—all odds are that you will succeed.  Yet, this empowering message is being hidden from you, while you are sold the bill of goods that you must be a lifetime patient or support group member.

IV.  The 21st Century Is About Drugs—and How We Deal with Them

We now recognize that addiction is not a characteristic of drugs, that other powerful activities and involvements can be addictive, that recovery is built on moving forward with your life, and that natural recovery is typical. All of these are being combined with the growing recognition that drugs are a normal part of life, as marijuana legalization has become the hottest political movement in America. 

Taken together, these developments would seem to indicate that we are embarking on a new era of understanding and dealing with addiction in America.  To complete this picture, many are coming to see the harmful effects of the label "addict." As Meghan Ralston, of the Drug Policy Alliance, put it in a viral blogpost: "For many people, myself included, the word 'addict' is incredibly harmful and offensive."

Yet, despite these advances, we are in the middle of a trend carrying us powerfully in the opposite direction.  The neuroscience research industry, the pharmaceutical industry, and a treatment industry clinging to the tried-and-found-wanting Minnesota Model are expanding worldwide, countering a movement to regain sanity in the addiction field. This sanity requires that we return power over ourselves to ourselves.

Listen to Stanton's interview with Drug Policy Alliance, "Reconsidering Addiction and Addiction Treatment."

Stanton Peele, a columnist for Substance.com, has been at the cutting-edge of addiction theory and practice, including uncovering natural recovery, identifying addiction as being not essentially linked to drugs, and focusing on social forces and individual choice in addiction since writing (with Archie Brodsky) Love and Addiction in 1975. He has since written numerous other books and developed the online Life Process Program. His latest book, with Ilse Thompson, is Recover! Stop Thinking Like an Addict. His website is Peele.net.