But What If Addiction Isn't a Disease? Part I
I recently read Dr. Marc Lewis’s book “The Biology of Desire: Why Addiction Is Not a Disease” and found his arguments compelling and refreshing, offering a new way to understand addiction and importantly, to offer a way for those dealing with addiction to actually change their outcomes for themselves. This book is exactly what I was looking for. A bit about Marc: he’s a neuroscientist and professor of developmental psychology. Marc has also struggled with addiction himself so his contributions, both personal and professional, are significant.
As someone who struggled with problematic #alcohol use and consumption for many years, labelling my experience as a “disease” never sat well with me. The brain disease model of addiction (BDMA) is widely accepted and touted as the best way to understand, conceptualize and ultimately, treat addiction. It is endorsed by the American Medical Association, the American Society of Addiction Medicine and other giants. That said, I am pleased to report that there is a growing number of neuroscientists, psychologists and addiction & recovery specialists who are voicing not only their dissent against this model but also why the BDMA is harmful to those struggling with addiction.
Outside the BDMA, the other common understandings of addiction are that it's a choice or that addiction is a result of self-medication. So my question is: is that all we get? Is that the best we can do? And perhaps most importantly, do these options, especially the BDMA, leave us feeling #empowered, as though we have the capacity and agency to do something to change the outcome for ourselves? For me, these are crucial questions to explore if we want to create meaningful change not only in how we talk about addiction but also in how we understand it and create approaches to managing addiction that support agency and empowerment of those actually struggling with addiction.
Taking on the identity of someone who is diseased has never felt empowering to me. And if you are someone who struggles or has struggled with addiction of any kind and the BDMA serves you, all the power to you. And if like me, the BDMA does nothing to support or empower you, let’s explore this further. My goal here isn’t to convince people that there’s no value in the BDMA; my goal is to simply identify other options that might support us better.
This article is for those who seek something more than what we’ve been offered to date. As is true in my coaching practice, my goal has been and will always be to create options, show up in ways that serve others, to assist and support in their #empowerment and to help them step fully into their power. Perhaps that’s why the BDMA never sat well with me; it does the exact opposite of this.
Unlike the BDMA, which argues that changes in the brain as a result of behaviors related to addiction signal disease, Dr. Lewis proposes that addiction is essentially a bad, problematic and challenging habit, a result of normal cognitive functions being taken to the extreme. Habits are a routine or practice performed regularly and repeatedly to the point where they become an automatic response to specific situations. To explain addiction as habit and how habits form as a result of neural pathways and neuroplasticity more thoroughly, here is an excerpt:
“There’s nothing more fundamental to the human brain than changeability. Yet neuroscientists who study addiction seem to have missed the point. They put people through a number of brain scans, and when they notice changes after someone has taken a lot of cocaine or drunk a lot of booze, they say, ‘Look! The brain has changed!’
If neuroplasticity is the rule, not the exception, then they’re actually not saying much at all. The brain is supposed to change with new experiences. In fact the newer, more attractive, and more engaging something is, the more likely the brain is to change, and the more likely those changes are to condense into habits — an outcome of more frequent repetitions
People have referred to addiction as a habit throughout recent history. That’s just what it is. It’s a nasty, often relentless habit. A serious habit. An expensive habit.
Perhaps all habits, once formed, or compulsive to some degree. The brain is certainly built to make any action, repeated enough times, into a compulsion. But the emotional heart of addiction — in a word, desire — makes compulsion inevitable, because unslaked desire is the springboard to repetition, and repetition is the key to compulsion.
Like all habits, addiction quite simply grows and stabilizes, in brain tissue that is designed (by evolution) to change and stabilize. Yet addiction belongs to a subset of habits: those that are most difficult to extinguish.” - The Biology of Desire, pages 32-33.
It's important to note here that the cognitive processes used to create the habit of brushing your teeth (a behavior that has become automated over time due to repetition and the carving out of neural pathways) are the same cognitive processes that create addiction.
When we layer in the science of #habit formation, the idea of addiction as habit becomes all the more compelling. James Clear’s book “Atomic Habits” is quite helpful in this regard. He demonstrates that the science shows us that habit loops (the pathways to habit formation) are comprised of 4 stages, one following the other, starting with the cue. A cue (or multiple cues) is when something triggers your brain to initiate a behaviour. This could be a time of day, a visual cue, a sound, etc. Understanding our cues/what triggers the start of our habit loops is of paramount importance when trying to shift #habits.
The second stage in a habit loop is cravings, which are considered the motivational force behind every habit. It’s important to note that the craving is less about the habit itself and more about the change of state that it delivers. For anyone who has ever struggled with addiction, you understand the notion of craving intimately.
The third stage of the habit loop is the response, which is the actual habit. In the case of addiction, this is when you take the drink or use the drugs or eat the cake. It’s worth mentioning that the response can be either a thought or an action.
The final stage of the habit loop is the reward, which is the end goal of every habit. It’s the payoff. The reward closes the loop and completes the habit cycle, often only to begin again later.
If any of the stages of the habit loop are insufficient, the habit will not be formed. As well, if any of the stages of the habit loop are removed, the habit will not be (per)formed. It makes sense then that in the case of an already established habit, should one or more stages in the habit loop be shifted significantly or removed, that it would cause a disturbance in the execution of an existing habit. Depending on who you ask, 40-95% of our behaviours are driven by habits so if we are hoping for sustainable change, recognizing your habits and disrupting them where needed is a great way to go about this.
This is the exciting part! And this is why conceptualizing addiction as habit feels so helpful and hopeful to me. We know that habits are learned behaviours. What this also means is that they can be unlearned and re-directed. If we can bring awareness and radical honesty to our behaviours and habits, we stand a far greater chance of shifting them and creating new habits that support where we want to be. Of course, this is just the beginning of shifting out of addiction cycles of behaviour but again, it feels optimistic.