I’m not against AA

I was overjoyed to see that Salon.com published a large excerpt from the first chapter of my book. (The headline may still be on the front page!) Until I saw the title: Addiction is Not a Disease. Good so far… Then: How AA and 12-step programs erect barriers while attempting to relieve suffering. Not so good.

They got the phrasing directly out of the excerpt (i.e., the book), so I can’t fault them on that. But now I understand the double-edged buzz/sting of being taken out of context. Nice to be taken… Thanks, guys! But does it have to be out of context?

trenchtrench2There’s been enough AA bashing in the last…I have no idea how many years….to just give it a rest. Anyone knowledgeable about the addiction field knows that their success rates are far from stellar: estimated at 5-10% by Lance Dodes (an articulate critic) and other sources. Take a closer look and you’ll see that the way they estimate success is rather stringent, as it depends on total abstinence, and many of us believe that AA/12-step groups do not serve a cross-section of addicts. They serve those who are in the worst trouble. And they’re free. And they’re a support group, not a treatment organization. Etc. Etc.

It’s true that there’s been a sort of merger between 12-step programs and the disease model, mostly manifested in institutional settings such as residential rehabs. This has been going on for decades, due mostly to the influence of mainstream medicine and the coercive power of the court system. It’s exemplified by the doctrine that addicts had better follow the 12 steps in order to fight off their disease — or else. Of course I oppose this view. But it’s not the heart of AA/12-step philosophy as I understand it. Rather, it’s an unfortunate branch in the evolution of a rehab industry that often feeds off the worst of both worlds.

If you want to get an even-handed picture of the pros and cons, truths, myths, and lies about AA/12-step, I suggest you go to Anne Fletcher’s recent article: Setting the AA Record Straight.

I wanted to set my own record straight. Salon.com has a huge circulation. I respect a lot of their coverage, and I’m always up for healthy debate.

But, as my readers know, my book is about reframing addiction as a learning process, countering the dominant view of addiction as a disease, showing why this reframing is scientifically valid, showing why it makes sense in the lives of those affected, and suggesting implications for new perspectives in the science and treatment of addiction.

It’s not about AA.

 

 

 

 

44 thoughts on “I’m not against AA

  1. Shaun Shelly July 13, 2015 at 4:50 am #

    Hey Marc, I wondered what your response would be. I vacillate on this issue – it depends which day you get me on. I am currently writing a piece entitled “what I really think of 12 step programs” and it is proving quite challenging! At the end of the day (this day), I have two main contentions: 1) Twelve step programs are great if you don’t do the steps or read the literature and 2) they have no place in the treatment industry.

    While it was great to see the excerpt, I was dismayed at the comments: I tend to live in a world where most of my colleagues and associates think a lot about addiction and see it in a very nuanced way – even the disease advocates – but the comments show me that the real world is filled with a lot of reductionist thinking based on bad information. There is a lot of stupid out there – I cannot put it in kinder terms! I had to laugh at the person who went into all-out attack mode, repeatedly referring to you as “Marc with a c” !

    Anyway, I am really glad the book is getting so much press – I hope there will be a lot more, and some good commentary.

    • matt July 13, 2015 at 8:56 am #

      I couldn’t agree more Shaun. I think the landscape is changing. Most rational people see that recovery is a very nuanced and individually experienced. That’s one of the reasons groups are so helpful, because the good ones validate people’s experience, regardless of the approach. I had to go to way too many meetings in rehab and I approached the 12 Steps in order, out of order, without a sponsor, evaluated them through different lenses, blah blah blah. It wasn’t the meetings or the steps that helped. It was the people in them and their shared experience.

      My world shrunk enough through the funnel of my addiction. I don’t need it shrunk in my recovery, thank you very much. Open source sobriety.

    • Marc July 13, 2015 at 9:18 am #

      Shaun and Matt: The Stupid-with-an-S comments are common currency whenever the debate gravitates to AA/12-step, pro or con. I’ve seen this happen in dozens of forums now.

      My most respected neuroscience mentor, Don Tucker, has the best theory of the neuroscience of emotion I’ve ever found. But I once asked him to put it in a single sentence, and what he said is —

      “Emotions make you stupid.”

      The AA debate is SO repetitive and mind-numbing, because it’s SO emotional. Almost everyone on one side has been helped by AA and almost everyone on the other side has been hurt.

      I can see the pro’s and con’s…Shaun, you put it quite succinctly! Matt, your emphasis on “open source sobriety” is beautiful.

      What if we call an armistice? Or….Suppose they gave a war and nobody came? (slogan from my Berkeley days).

      • matt July 13, 2015 at 2:26 pm #

        If we could all keep that adage in mind, “Emotions make you stupid.” the world would be a different place. And if AA were truly a cult, its millions of members would have overthrown the government by now. There are inflexible people in every walk of life— and some of them feel very strongly about treatment modalities. But they’re not the majority.

        I just led a discussion in a detox that was split between long time 12 Steppers, people that 12-Step didn’t work for, and people who were ambivalent. Still, they were all in detox.

        We need something different than the current prescriptive, labeling, top-down treatment approaches, and Marc’s model encompasses all the existing ones because it focuses on the individual not the addiction.

        Let’s behavior model what a reasonable approach to addiction treatment looks like, with calmness and reasonableness. Let’s lose the military metaphors for debate (look how the war on drugs turned out!), and just let the evidence speak for itself. In the coming weeks, it’ll be important for us all to just keep our brains tucked in, and let the chips fall where they may, and help those people in the detox whatever their persuasion.

  2. Lovinglife52 July 13, 2015 at 5:15 am #

    I look forward to reading your new book, it looks really interesting. I am certainly not a fan of the disease theory. I am one of the many people who made use of Aa for a while and then moved on. It gave me a place to go, and a “sober community” but much of the spiritual/religious ideas did not appeal to me. I still bump into some people that I knew when I was attending and they seem to be happy and doing well in that environment. There are of course some who are affected by over zealous sponsors, and certain groups are anti medication and don’t trust doctors. I think the piece you link to by Anne Fletcher is well balanced and superiour to much of what is said about AA online. I also think that Lance Dodes makes some good points and does not go down the line that some do online, such as calling AA a cult.

    I call myself pro choice rather than anti -AA. I think it is important to look at all that is on offer and choose an appropriate solution at a particular time. AA has the advantage of having a huge network which was important for me in my early days, but as time went on, I found that I wanted to deal with self esteem issues and the Smart approach was more helpful with this, in terms of support. I had a lot of one on one treatment after about 18 months and then moved on from formal support groups. That is what worked for me, but it won’t be the best way for everyone. I have not used any formal support group for the last 7 years.

    It is hard to get the word out about alternatives to AA, but I hope things will change with the help of the internet and social media. AA is so dominant in the treatment industry and has a lot of media endorsement. I think a lot of people get support groups and treatment mixed up and this is due to the approach taken by some in the rehab industry, which is a huge money making machine. I have my own blog and the most popular section for traffic from google is about leaving AA. I don’t encourage bashing and hope people look at the alternative solutions I mention, and try them if they are attracted to them. I think there is a backlash to some of the anti-AA commenting at the moment, which actually gets in the way of reasoned discussion.

    I will put a link up to your new book when I read it and try and get something on another site I write for, addiction.com if I can. I think countering the disease model is really important if more modern appraoches to treating addiction are to become more widely accepted. I think solutions such as the Sinclair method could really help a lot of people who do not react well to an abstinant type solution for example. We should be supporting eachother in recovery not arguing!

    • matt July 15, 2015 at 10:01 am #

      Thanks, Liz. The tone of this is so balanced…It really speaks practically and articulately to the fact that there is no one size fits all in recovery, and that people don’t necessarily have to be “in recovery” for the rest of their life.

    • Marc July 13, 2015 at 9:22 am #

      Thanks, Shaun! Hadn’t seen this until now. It’s not a bad write-up. They get into some of the detail better than other reviewers. Still, I’m irked by “Dr. Marc Lewis, himself a longtime addict and professor of developmental psychology…” Sounds like a joint position I landed somewhere. I wish they’d said “one-time” addict…

      I can see that this whole process will do more to toughen my skin than 20 years of sunbathing.

      • Shaun Shelly July 13, 2015 at 2:39 pm #

        Yes Marc, I know how you feel, although I do love the label when I have been having a discussion with someone and they throw what they think is their death blow: “well you wouldn’t understand it, not having ever dealt with addiction personally!”

        For obvious reasons I kind of identify with Adi Jaffe (his Alternatives Rehab with Marc [with a c!] Kern is onto a good thing) and I like this TEDucla talk of his: https://www.youtube.com/watch?v=A9xFJ_hqzDQ

      • Shaun Shelly July 13, 2015 at 3:55 pm #

        Marc, the last couple of paragraphs of this are particularly brilliant and pertinent to my setting. I think that this highlights much of the local context around drug use. One of the (many) great evils of apartheid was that it robbed people of a narrative. I think of populations who were forcibly removed just as these narratives were developing. The ability to see a viable future outside the drug and gang culture has been severely limited by the fog of political expedience and the inability to address the core issues. Instead we focus on metrics – such as arrest rates – that will ensure that the future of young people is pre-ordained – drugs, prisons, gangs.

        As you have previously said, we need to build a scaffold to help support that image of future self.

  3. Gary July 13, 2015 at 8:15 am #

    It’s interesting the various views of A.A. and persceptions held by many, yet, in my own opinion, A.A., for me, is “Speechless”. What actually gives light and/or life to A.A. is each and every individual. Though I wasn’t fond of each layer I took what I needed and let go of the things I didn’t need. Life itself is much the same in that we give light and life to the meaning of things. In many ways, our minds have been conditioned to like or dislike things, points of view etc…, holding on at times with all our might to the illusion of truth.

    Sometimes belief becomes a thief especially when a person feels they are “absolutely right” because then there is no room, perhaps, for alternatives and the ego is unwilling to see other possibilities.

    A.A. actually helped me to re-engage back into community with folks of similiar inetrests. However, after a numbers of years of attending A.A. meetings I felt the core meaning of the program was to continually grow beyond it’s structures and thus I haven’t attended a meeting now for around ten years. However, I am forever grateful to have been rooted in A.A. in the beginning of my journey of Discovery.

    Remember!!! it’s not that ones’ job may be the crushing of stones, attending an A.A. meeting or referred to the best “evidence based” scientific addiction treatment facility in the world but it’s to find “meaning” which makes all of the difference in the world.!~

    Intellect and/or “brains” can actually get in the way of understanding the true nature of life and living. Many people operate on ego and intellect alone and perhaps are afraid to think that life and living may be in fact quite simple. The measure of a good, honest, authentic, loving life is to understand how we are all connected by the vibration and beat of our hearts and not the brain.

    “Peace”!~

    • Nancy July 13, 2015 at 10:13 am #

      Thank you for these thoughtful and fair minded words.

  4. matt July 13, 2015 at 8:36 am #

    Well… you know what they say,”There is no bad publicity.” That might be the “disease” of some of these sensationalist blogs. But frankly, I think it’s ultimately a good thing. The body of the text is so balanced, it will leave anyone who knows anything about the field scratching their head.

    It’ll get the discussion going. It may be at loggerheads, but it’ll get it going, with everyone blazing their true colors. And you will have plenty of opportunities to establish what context your views are situated in.

  5. William Abbott July 13, 2015 at 8:41 am #

    The NY Post has a good discussion/overview of the book — and is not an AA bash

    http://nypost.com/2015/07/12/addiction-is-not-a-disease-and-were-treating-drug-and-alcohol-addicts-wrong/

    Although many including me criticize AA but more accurately the 12 steps approach is because of their idea of having ( sic) to declare yourself powerless and.. that you need to call upon a higher power in order to recover. . Even that might be ok if you want to ask for outside help from a deity ( God as you understand him) but the concept excludes the most important player in the game– YOu!!

    This is self defeating in my way of thinking.. and the way out of this mess if you have it it to find ways enable or re-enable self-empowerment which then lead to the learning to make better choices

    Recovery in my view is about Re – learning

    • Marc July 13, 2015 at 9:30 am #

      I think most of us — I for sure — agree with you on that. If those guys could find a good urban dictionary they might encounter a lot less opposition. Instead of “powerless” maybe something like “self-reflective”…? doesn’t quite have the same punch, though, does it.

      • William Abbott July 14, 2015 at 8:01 am #

        One of the biggest problems as I see it is, they are adamant about changing the thing

        Ive heard that the big book and essentials of the program , the 12 steps, are inviolate .. I think we have progressed at least a littlle since 1935 or whenever is was written

  6. Richard Hollett July 13, 2015 at 1:13 pm #

    Hey Marc,

    I applaud your commitment to elevate world dialogue and understanding about addiction. Nothing meaningful comes out of a resistance-free situation. In other words, if you met little or no resistance (backlash) for your rather brilliant writing (and thinking) then that would be an indication that it wasn’t so brilliant – or wasn’t so vital to begin with. People are allowed – and should be encouraged – to question, debate, challenge, etc. The only means to truly accept and implement an elevated truth is to wrestle with it – not just blindly accept it. I think we can all relate to that. So my point is, interpret the debate and “mudslinging” for what it is – an opportunity for amuch needed dialogue where sooooo many people – worldwide I might add – will evolve – personally as someone who struggles with addiction – and professionally for someone who “treats’ people for addiction – and even for folks who simply observe addiction. It’s all good. I promise. 🙂

    • Marc July 20, 2015 at 9:15 am #

      What good advice, Richard! I’ve been told that before, but I need all the reminders I can get. I’m angst prone. Of the 300 comments following that article, about half are negative.

      But of course you’re right. You don’t make waves by slipping a mildly worded variant of something into the clattering chaos of public debate. So I do sometimes say things that I know will be provocative and challenging in a provocative and challenging way….absolutely on purpose. And then I feel like running for cover.

      I’ll get over it. Good advice!

  7. Jon S July 13, 2015 at 2:12 pm #

    Thanks for introducing a note of sanity into the AA debate. I quit AA a year or so ago after 14 years as a 12 step fundamentalist. I now believe that while AA is helpful in separating the alcoholic from what ails them, it’s not a sound route to long term mental health. Today I’m an AA critic, but I abhor the language and rhetoric of the “haters”, as it has no place in a the ongoing search for a science- and reason-based alternatives to AA. Everyone’s so invested in recovery it’s hard to find a balanced approach. This blog, and the interesting comments sections, are one of the few places you can find such calm and ordered discussion.
    “Leaving AA, Staying Sober” at http://jonsleeper.wordpress.com

    • William Abbott July 14, 2015 at 8:04 am #

      Oh this is soooo true.. One way not to change peoples minds is by destructive criticism

  8. Paul S. Meade, MD July 13, 2015 at 4:46 pm #

    I plan on reading your new book as soon as finish “Memoirs of an Addicted Brain”. I participate in AA meetings and actually chair a morning meeting twice a week. I’m an atheist and still “tolerate” the God-speak that can permeate the meetings. I have found many of the principles of AA helpful in my recovery but I put a twist on them that I don’t hesitate to explain to others. I find if you apply the steps as you would apply CBT or REBT the result is that you can succeed. But as some of the previous posters have mentioned and as I glean from your writings, to recover from any addiction you have to want to recover.

    Also while alcoholism may not be a disease some of our underlying mental perturbations (I won’t call them “diseases”) make us prone to drink or self medicate.

    Sometimes it is hard escaping trying to escape.

    • matt July 13, 2015 at 6:45 pm #

      Yes. “Sometimes it is hard escaping trying to escape.”
      But that’s what we have to do if we’re ever going to be who we really are.

      I totally agree with you. It’s about attitude, not algorithms. The serenity prayer is pure CBT: accept what or who you can’t do anything about, change what you can do something about, and recognize which is which.

      • matt July 13, 2015 at 6:48 pm #

        …and move on!

        • Paul S. Meade, MD July 14, 2015 at 9:05 am #

          Couldn’t agree more!

  9. KC July 13, 2015 at 9:15 pm #

    I am firmly against recommending anyone any AA/NA group on the continental US. Still.
    I am also against recommending someone to a Scientology group as well.

    Recommending anything, drugs or groups, which is not empirically- nor fact-based is unethical, my personal opinion.

    If I were King of the World, I would not make any rules or regulations to this effect. But I would suggest anyone who would recommend either of the above “do 90 mtgs in 90 days and then report back.” Especially in regard to fundamentalist, back to basic groups.

    And more importantly newly sober women should attend only women’s groups. Not matter what.

    My experience with XA, throughout US was 7 years, minimum 3 mtgs a week.

    Great news, the book is rolling out well. Can’t wait to get my hands on a copy. Also, AS REMINDER TO ALL:

    Put in a request to your local library to buy a copy of Dr Marc’s new book, you never know who’s life you might make a bit better!

    KC

    • Marc July 20, 2015 at 9:09 am #

      Point taken, KC. People usually make recommendations based almost solely on their own experience. Which doesn’t offer much assurance, people being so fundamentally different from each other, but it may be the best we have to go on. Well, it sounds like you’re also making recommendations based on your experiences. I’d take your advice…not to take anyone’s advice…on such a personal matter…at least until I checked out my options pretty thoroughly.

      Thanks for the call to arms. It sure does help sell books!

  10. David Heggestad July 17, 2015 at 10:55 pm #

    Interesting thoughts around AA and glad you responded to Salon.com putting you on one side or another.

    I have many thoughts on that but instead wish to ask a related question:

    on page 25 you write “Brain change underlies religious conversion…”. What exactly happens in the brain in a conversion experience? Relating to AA, the literature refers to two types of “spiritual awakening” (vis a vis James)–sudden and gradual, the latter being of the “educational variety”.

    What brain changes happens in each? But I am particularly interested in the sudden conversion where the obsession for alcohol is suddenly dispelled.

    I love your book! I read Memoirs and was thoroughly engaged; I had ordered several other books later, but only when I received it yesterday realized it was another work of yours.

    It must have grabbed my attention because the Marc with a ‘c’ jumped off the cover!

    Hah!

    David

    • Marc July 20, 2015 at 9:04 am #

      Those are such hard questions! Can we save them for another time? See below for more thoughts about spirituality. In the passage you refer to, I’m using religious conversion as an example of a belief switch, which I see as rapid learning….much as in addiction. I’ve seen data showing that religious conversion is one of the few experiences that can radically alter the personality. But clearly so can addiction. So there are lots of parallels one can draw. Just not today.

      So glad you like the book!

  11. Jim maguire July 18, 2015 at 9:06 pm #

    Marc and fellow bloggers, Marc as you know ( my history) I got sober in AA 33 years ago. While I’m not an AA Natzi and I believe there are many ways to get sober,
    I can truthfully say I love AA. I was a heroin addict for about five years ,went to a one year residential ( self help concept ) , got my drinking privilege we I left and ten years later got in trouble with alcohol . What a surprise !
    AA told me be honest,talk about your feelings , work the steps,go to meetings and don’t drink. I said ok and the rest is history . I have an awesome life ,am respected for who I am , raised a family ,grew a business and have or had all the accoutrements of life that I wanted.
    My question to EVERYONE is ; is it necessary to be honest, to share your feelings and have a “spiritual centeredness ” ( I’m Agnostic ,go easy) to stop addiction ? I thought so and although I question everything I never questioned that.Now after reading your book ,you bastard , I question that! Your getting me to think and I don’t have that many brain cells left .
    I feel good about myself ,because I have integrity , empathy , compassion ,work hard etc..( and I’m humble 😆) So would I be sober if I still lied, cheated on my wife ,stole from anyone I could . I know this is really an unanswerable question pertaining to me ,what I’m trying to ask is this “recipe for sobriety” necessary on a universal level ?
    Have at it !!! Jim

    • matt July 19, 2015 at 11:55 am #

      I like you, Jim. You don’t just ask all the right questions. You ask ALL the questions! And the answer is in you. You don’t have to be honest to anybody but yourself. If you read your post over, it seems like you answered your own question. You are sober now because you feel good about yourself– because you have integrity, empathy, compassion, work hard, etc… You are sober now because you are happy. Not bliss ninny happy, skipping along through life with a stupid grin on your face all the time. Happy in that you’re secure in who you are. When you make a decision it’s because Jim Maguire made it. There is no universal “recipe for sobriety.” It took a while to get all the ingredients right for yours, but it sounds like it tastes pretty good to you now.

      That’s what I think Marc’s model is saying. One has to reconnect that reward center in the brain to some other reward that is meaningful and takes the place the addictive behavior once held in your life.

      • Jim Maguire July 20, 2015 at 7:54 pm #

        On the money ,my friend .As I was writing that last post I started to think and look at what I was saying . You summed up what I just couldn’t get my hands around . And I agree with your happy ,” not bliss ninny happy” ,your right and hilarious . I always say to my wife , Im not Mary f..in Poppins . Jim

    • David Heggestad July 19, 2015 at 6:06 pm #

      I love AA also. I was at a speaker meeting last night where the speaker shared her story–experience strength and hope (past, present and future). There was a young woman who was three days clean and sober who halfway through the speakers share, was weeping.

      The whole group wrapped themselves around that young woman after the meeting and, as we hear so often, she wept because she heard her story, she identified, and she no longer felt alone.

      When I got home I re-read the Big Book. It amazes me that a bunch of low-bottom drunks in the 30’s could capture addiction so accurately–especially describing the ‘real alcoholic, one who has moved from impulse to compulsion.
      As I read it, I laughed because so much of it could be translated into neural language and so much parallels what Marc so eloquently describes in both of his books.

      That is the ‘descriptive’ part of the literature; the ‘prescriptive’ I am sure has pros and cons.

      If we rewrote the book and the steps with much of what we know now, perhaps the second step would not read “Came to believe a power greater than ourselves could restore us to sanity” but something like “Came to believe that the PFC could be reactivated and perspective restored.”

      In any event, I remain open to everything that might help me remain sober. As the book says, “more shall be revealed.”

      David

      • Marc July 20, 2015 at 8:50 am #

        Nice way of putting it, David. I applaud your neural reinterpretation of Step 2. Maybe that should be somebody’s next book — but probably not mine. Thanks for helping heal the rift.

    • Marc July 20, 2015 at 8:59 am #

      Hi Jim. I think your story is one of my favourites. As Matt says, you seem like a poster child for the central place of integrity and self-acceptance in recovery. If that’s not spiritual, I don’t know what is.

      In his recent book, Sam Harris says that the origins of the word spirituality have nothing to do with religion. Rather, it’s about being centered and clear-sighted, having the capacity to see what’s real instead of just the cartoons constantly showing on the inside of your cranium. Something like that.

      When I meditate — if it’s a good day — I get a sense of warmth and self-acceptance that makes me feel I am at home in myself. I started meditating (just now and then, not daily) when I quit drugs thirty-something years ago. If it wasn’t for that feeling (or even just knowing that the feeling is around here somewhere), I don’t know if I could have made it.

    • Richard Hollett July 20, 2015 at 11:08 am #

      Jim, I love your post – or better said, I love the openness and wisdom that is so plainly conveyed in your post. I personally believe that being honest with oneself – which is so often evidenced by being honest with others – is vital for a fulfilling, successful life, regardless of one’s specific struggles. Addiction is one of many, many human struggles.. The same is true for a “spiritual centeredness”, which can be experienced and expressed in countless ways. You and I have had the “privilege” of having struggled with addiction. Those struggles very powerfully informed us that things weren’t working out so well for us – that something was “off”, to say the least. Ultimately, our struggles were the very thing that led us to discover some beautiful truths about life – that we may very well have not otherwise known. Those truths pointed us toward tools, beliefs, experiences etc., that prompted some profound changes in our lives that guided us toward personal fulfillment and multiple successes. .AA never felt compatible to me, so I chose an alternate path. However, you and I seem to have encountered very similar truths – about human connection, integrity, love, family, openness, spirituality, dedication, commitment, and so on. I often say that while there are certain universal truths that ultimately guide us, there are as many paths to those truths as there are people on this planet. You and I took different paths that led to truths that in my eyes, seem identical.

      I have no clue if what I say here will help you with your question, but I hope it somehow validates the fact that you clearly chose the perfect path for yourself. In just a few short paragraphs, you make it impossible for any sound-minded person to doubt that.

      By the way, you have a ton more brain cells in tact than you give yourself credit for.

      Richard

      • matt July 21, 2015 at 9:19 am #

        Yes. Thank you, Richard.

        I’ve said it before and I’ll say it again. Not that it’s a recommended method, but once we get through addiction and out the other side to a better life, we learn something pivotal about ourselves and our brains that people who have never experienced this difficulty will ever know. And it’s important to remember and value the experience as such.

  12. dustman July 23, 2015 at 8:30 am #

    I’m new to this blog and find it very interesting to read. I would like to comment, although my thoughts are just coming from a first gut feeling, so I must be oversimplifying things. But by reading Marcs ideas and the ideas of Ms Volkow I get the feeling both are very closely related in a pure scientific way. If I’m right, both share the same basic concept that addiction is a result of a deviation of brain processes towards a direction where external and internal information is processed in a way that leads to the addictive behaviour. This deviant process is a learning proces as Marc states, ms Volkow describes it as maladaptive (or something like that) but I don’t think there is a fundamental difference of viewpoint here. Whether you define the state of being someone with an addiction as a learned bad behaviour or a disease are for me two sides of the same coin because both contribute in an overall understanding of the process, and for me they never seem contradictionary.

    On another level (not the scientific, but the emotional value) disease and ‘bad habit’ are two very different concepts. While disease is related with doctors prescribing medication (from their ivory tower), working on a ‘bad habit’ directly implies the person who is addicted should become empowered and in charge of themselves and their process of recovery.
    So what my first impression was, is that the discussion on disease-not disease on a scientific level is actually not that much of discussion. The discussion whether in a broader context the term disease or learned behaviour should be used is difficult, because both has its own advantages. The ‘disease concept’ is easy to explain to people without any knowledge about addiction and can shift their mindsets from seeing someone with an addiction as a lazy junk towards someone who is in need of recovery and should be given the (opportunity to take) time and tools for it. I think this has paved the way to investments in scientific research and is therefore (still) of great importance. The great disavantages of calling it a disease is that treatment providers (and maybe even people with an addiction themselves) are going to believe in too simple solutions. No curing pill exists for this ‘disease’. And it could lead to narrow-focussing on addiction related terms like craving, while indeed addiction is a learned ‘concept’ with not only shifts in behaviour (like drug-seeking) but also lots of others cognitions within te person.
    While the ‘learning concept’ is very helpfull for the well-informed person with an addiction as well as treatment providers, for the broad public it could be a too sophisticated idea to comprehend right away (if it is a learning problem why not send them to evening school on their own costs…).

    So in the end my gut feeling is that both terms inbroader context have their own pros and cons and thus their own place and should be held – in the right context- in the minds of persons with addiction as well as the people from which they seek help and guidance.

    I apologize if these thoughts are an open door (or totally wrong 🙂 ), and apologize for my Englisch (i’m dutch…)

    • Tim Greenwood September 30, 2015 at 4:52 am #

      Important thoughts and input on the challenge of moving from a disease model to a “maladaptive learning” model of addiction. Think these discussions are so important. I appreciate the “disease model” for its ability to make others more compassionate but also recognize the problem of its disempowering those seeking relief or recovery. Maybe addiction is a “disability”. Maybe we need more teaching at an early age about human tendencies toward addiction and the tools that are available along the way to protect oneself or recover. Our young people need to be taught all the forces of addiction – advertising, media, branding, stimulants, etc that exist around them and allow them them to reflect on choices that lead toward freedom versus the ones that lead to less freedom and attachment. The Buddha identified craving and desire thousands of years ago as the root of suffering. The seeds are in our nature.

  13. Truthfulone July 24, 2015 at 12:38 am #

    Addiction is a disease of the brain and very much physical too. I believe AA can help some those that want to be helped, but it is risky business for those that have not detoxed properly. The man that wrote that book, has he ever been an addict? I find just because he is an MD or a scientist, he can refute all he wants–but if this was just emotional or sheer will-power and not a progressive actual disease than addicts could stop like we stop drinking soda. I fought to stop benzo’s. Although, I have been sober for years, they can’t be around me or I will take them. It is a disease that never goes away. It is manageable and if it does not get treated, it kills you.

  14. rehab houston July 31, 2015 at 6:09 am #

    Its a good post about Drug Addiction. Its really very informative . We should stay away about it and if we will not do that this addiction will influence on us.

  15. Claudia August 5, 2015 at 11:16 am #

    Very interesting post and I definitely agree with much of what you say. However, what has to be ditched is the current arrogant image that AA is the one and only way to solve an alcohol problem.This post really reminded me of a book I read recently called “Addiction is the Symptom” by Dr Rosemary Brown(http://addiction-is-the-symptom.com/). It is amazing that after all my years of programs, counseling and books that there is a new concept still to be discovered. This book truly showed me that the tried and true 12 step program is, in fact, incomplete. Emotional “freedom” and independence is so crucial to the healing process, and reading this book has given me insight and tools necessary to find that freedom within myself. It is nice to read material from someone who is not only an expert in the subject, but has faced many of the same trials as I have, it makes the advice more “real” for lack of a better word. This book is a very helpful tool and I highly recommend it to everyone

  16. Ira Gnesin August 11, 2015 at 7:09 am #

    Hi Marc,

    I’ve been following your wise words for a while now and first came across your book memoirs of an addicted brain in a treatment center. i’ve always been an addict of the variety that sort more understanding about addiction. simply throwing my life and understanding at the mercy of the disease model and 12 steps was never enough for me. Probably dates back to pre-drug use, always been a seeker, on a search to find some understanding in a complex world of misunderstood people. I haven’t been around long enough nor do i have the experience or PHD behind me to fully grasp alot of what happens in the brain. I get most of the more “layman’s” terms used to describe what happens when a drug or a drink is introduced into my brain.
    I guess the topic is about AA and not about me, so ill continue on.
    I do alot of research and follow alot of the leaders in the field, whether its for the disease model or against, i really enjoy the internal mental debates i get into with myself in the search to understand what this is all about.(sounds a bit looney saying it out aloud)
    I’m a member of a 12 step fellowship and i really believe there is value in what happens in those meetings. As its been spoken about before in this thread i won’t over indulge in the power of an alcoholic not feeling alone, separated from society and shamed for being a drunk, hopeless and broken. I know its a trending topic at the moment and probably a bit over done but Johann Hari’s TED TALK has some real value when it came to speaking about connection. From what i understand there is a chemical reaction in the brain when connection is felt with another person and that probably explains why connection plays a part in replacing(and i say that with reservation) the relationship with the drug of choice. I also agree that treatment centers have leaked into fellowship meetings and have built up another level to the disease model. The only time i can find the word disease in the Big Book is when its referred to as a spiritual disease.

    BB How It Works, p.64

    From it stem all forms of spiritual disease, for we have been not only mentally and physically ill, we have been spiritually sick.

    Taken out of context like that what we miss is, they referring to resentment being a key feature if not the key feature in our “spiritual malady”. They follow on to say that once we sort out the spiritual problem, the mind and body will follow.

    So often in a meeting people say they referring to the Big Book and then they throw around what they have heard in treatment centers. I say, if you can’t find it in the book, it’s not from AA. The message that was trying to be passed down to generations in my humble opinion has been distorted and or watered down. I really do engage in the spiritual side of the program and believe it be life saving. I also really believe in the power of the steps and what they can do to a broken, misunderstood junkie like myself. Whether understanding myself better makes staying clean and sober easier ? I dont know.
    Is the rigorous process that is step 4 the real crux of “cleaning house”, dispelling resentment, guilt, shame and secrets necessary to find a healthy functional life ?
    Again i don’t know.

    What i do know and this is purely my experience, the spiritual side to this healing process that so many of us fortunate people are on is vital. Without some sense of spirit in my life, i feel different and not the good type of different. I believe there are things going on in the rooms that are far above our understanding, this includes in the brain and in science. Im open to learn and change but one thing remains…today i’m clean and sober and AA has played a large part in that.

    peace all

    p.s thanks Marc

    • Marc August 15, 2015 at 3:26 am #

      Hi Too much to respond to, but you’re right that AA did not generally define addiction as a disease. Rather, the marriage between AA methods and treatment centre policies and politics helped that definition become entrenched. I agree with you that there is good in AA. Absolutely. Especially in the interpersonal caring and connection. And yes, the loss of that connection with others leaves a gap for addiction to plant itself. Congrats on you recovery.

  17. Philip September 22, 2015 at 1:39 pm #

    Today while browsing the internet I came across your name. I looked up a short bio on you and many quotes they used definitely hit home. I am 30yrs old, and have struggled with using both stimulants and depressants for ten plus years. I have tried everything under the sun, but nothing worked!! To make a long story short a year ago I got on a methadone program. Along with my methadone dose the clinic requires once a week group theropy and individual theropy. I would love if you could give me a response regarding your thoughts on methadone and the impact it may or may not have on the brain. My biggest fear is that I will NEVER EVER EVER be able to get off this medication because it has worked (scared of being a slave to this both mentally and physically). My track record shows constant use of drugs or alcohol daily. Consequences always follow lol. After this I will be searching Amazon.com and purchasing your book and am excited to read about the “disease” debate. The bio stated that you went to H.S. in Massachusetts. That was the deal breaker. As a Bostonian pride in deep from education to healthcare, but now kids are overdosing and parents are buying coffins instead of first cars. Marc Thank You for giving a shit and hope to hear back. Best Wishes Philip

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