In my previous post, ‘But What If Addiction Isn’t a Disease? Part I’, you heard about my recent reading of Dr. Marc Lewis’s impactful book called The Biology of Desire: Why Addiction Isn’t a Disease. I would highly encourage you to go back and read it if you haven’t already as it’s a great foundation for what is going to be discussed in this article, which is some of the holes in the brain disease model of addiction (BDMA).
It’s worth saying again that my intention in writing these articles is not to convince people to believe in something different; if the BDMA serves you, keep using it. These articles are to simply explore other options. I personally never resonated with the idea of being diseased because I struggled significantly with my drinking. As discussed in Part I, Dr. Lewis proposes that addiction is simply #habit, a natural, albeit extreme manifestation of normal cognitive functioning.
What I love about this concept is that habits are learned behaviours that can be unlearned, changed and adapted which means if we understand addiction as habit, we become empowered to actually create change in our lives by changing out habits, which I love. Now, let’s review some of the incongruencies of the BDMA.
First and significantly, most people who struggle(d) with #addiction don’t receive treatment (in the form of in- or out-patient care, a rehabilitation centre, addictions counselling or coaching, etc.) and still manage to recover. Let’s think about that for a second. If we were to compare addiction as a disease to cancer as a disease, would this be possible? Could most people with cancer not receive treatment and still recover? This feels highly unlikely.
For the folks who do receive treatment, they are likely to receive pharmaceuticals to reduce their withdrawal symptoms and to curb their initial cravings in the early days of their recovery but once this small window of time has closed, treatment typically moves to a non-pharmaceutical approach including things like 12-step programs, motivational interviewing, therapy, etc. The point is that when it comes to addiction, while defined as a medical disease, it’s largely and for most people not treated medically.
Another incongruency that’s worth mentioning is that within the BDMA, the foundation of this model’s argument that addiction is a disease rests on the idea that the brain undergoes change as a result of the prolonged use of substances and the repeated engagement in certain behaviours connected to one’s addiction.
What this model fails to mention is that changes in our brain are a normal #cognitive process. Our brains change in response to new experiences, stimuli and lessons. That is how our brains are intended to function. While #neuroplasticity is a relatively new concept, it’s one that is widely accepted and understood. In short, neuroplasticity is our brain’s capacity to create and reorganize synaptic connections and neural pathways. This is important to understand and appreciate because this means we literally have the capacity to change our brains. Thus, the idea that addiction is a brain disease because the brain changes in response to the use of drugs or alcohol (and associated behaviors) is insufficient as our brains change in response to new experiences and stimuli all the time.
In understanding addiction as habit, we can effectively understand addiction as one end of a spectrum. Of course, there are many other factors that contribute to whether or not someone develops an addiction including childhood upbringing and trauma, the tendency towards impulsive behaviors, one’s coping strategies and level of #resilience and so on. Brain change alone does not signal disease. Our brains are changing all the time and we have a considerable amount of control over how this change occurs.
While I have been quick to speak of some of the flaws with the BDMA, I think it’s also worth noting that one of the main benefits of the BDMA is that it promotes compassion and understanding for those who struggle with addiction and that will always be a positive thing. Unlike the understandings of addiction which argue that it’s a personal choice or a strategy used by individuals to self-medicate, the BDMA does not approach addiction from a place of blame or shame, which is to be commended. I would also argue that understanding addiction as habit and on the spectrum of cognitive functioning also allows us to infuse compassion into the equation, recognizing that the manifestation of addiction is a reflection of cognitive functions and a variety of other factors (often out of the control of the addicted individual), as listed above.
The takeaway here is this: there will always be new ways of exploring how we understand, conceptualize, talk about and manage addiction. Sometimes the dominant discourse or tools, whether it’s the BDMA or AA, just doesn’t fit for you and that’s okay. Keep searching, keep exploring and keep looking. You will find what resonates with you and most importantly, what #empowers you to create the change needed in your life to step into your personal power.