Is Addiction a Disease?
A great deal of time, energy and research has been given to the concept of addiction as a disease. Just about every treatment provider talks about a genetic pre-disposition to addiction, but I’ve never heard anyone identify a particular genetic mutation responsible for addiction. In contrast, genetic mutations linked to higher risk for diseases like breast and ovarian cancer, have been identified.
Further, if the genetic pre-disposition for, say, breast cancer or diabetes exists in an individual, it does not guarantee that individual will end up with that disease. Neither does the absence of that specific disposition make us immune.
Addiction and brain chemistry
If we examine the neural pathways for addiction, it turns out they are the same as the neural pathways for substance abuse. Anyone who abuses drugs or alcohol, whether or not they become addicted, builds those neural pathways. The neural pathways do not identify what makes the addict different from the normal person. That is still a mystery to be solved.
The book Alcoholics Anonymous, published in 1939, calls alcoholism an allergy. And yes, in regard to some people reacting differently to alcohol than others, that’s a good description. But it doesn’t tell the whole story or fit the medical definition of allergy.
Much has been talked about in regard to brain chemistry and addiction. Still, we have not definitively figured out why most people can use alcohol, prescription drugs and even other harder drugs and not become addicted while a smaller percentage become addicts that develop acute living problems from using. This is why a misguided argument for addiction as a moral dilemma still exists.
Alcoholics Anonymous, also known as the Big Book, has a wonderful section describing different types of drinkers. One is the person who drinks a lot and never suffers any living problems. Another is the problem drinker who drinks too much, gets in trouble and then facing difficult consequences or proper motivation is able to abstain or even moderate going forward. The book (and the program of AA) is focused on a third type of drinker: The one who just can’t or won’t stop, even though it’s obvious—sometimes even to him or her—that alcohol is causing severe living problems.
I am one of those people. My story clearly tells me that any time I put a mind- or mood-altering substance in my body, I cannot predict if and when I will stop, and starting makes me want more!
Addiction and trauma
Some people in the addiction treatment community are asking the right questions and providing what could be the right answers. The psychiatrist Bessel van der Kolk and others are looking at the effects of Adverse Childhood Experience or ACE, as a recent study by Kaiser Permanenté calls it. Van der Kolk notes that hundreds of soldiers experience the same thing in combat and only a small minority of them end up with a diagnosis of PTSD. He suggests the difference is their being “set up” by adverse childhood experience such as neglect, physical or emotional abuse or growing up in an extremely dysfunctional family as the difference.
Canadian physician Gabor Maté has made great strides in treating acute addiction by looking at ACE. He makes the point that up to 20 percent of Vietnam War veterans used heroin while in-country. Only a small percentage came home as practicing addicts. The others were done with the drug when they were done with the experience. Maté goes as far as relating the “chemical hook” of physical dependence to ACE—a thought I’m not quite on board with.
Look at the vast majority of individuals who receive prescription opioid pain medication who do not end up doctor shopping or buying street drugs—and look at the small percentage who do. What is the difference? I know a woman who was on pain medication for an extended period of time after a hip replacement. When she stopped the prescription she had “the worst flu ever.” I knew, and didn’t tell her, that she experienced opiate withdrawal. The point is that she never once considered finding more to avoid the discomfort of withdrawal.
All of these illustrate the difference that is still a mystery: the difference between the addict and the normal person.
Watch the video on YouTube with Nadine Burke Harris. She uses research to suggest—dare I say to prove—that Adverse Childhood Experience is responsible for much more than behavioral issues. Instead of declaring war on drugs, let’s declare war on Adverse Childhood Experience. Or as my associate Rob Rodriguez says, “Let’s get beyond the propensity to declare war and declare peace on our children.”
One school district, one church congregation, one community at a time, I believe this is the way to win our battle with the scourge we call addiction: by learning how to become more resilient adults who then raise resilient children.
There is a lot of negative connotation about the word addict. We have tried calling it many things. Chemical dependency was popular for a while. The current label is SUD, substance use disorder. None of these labels have served us well. Even the term SUD diverts us from recognizing the difference between addicts and normal people that could make all the difference in the world in finding an effective solution. To me, the labels, what we call it mean little in formulating a solution. A more trauma-informed and trauma-responsive solution is to look at how we raise our children.