The two competing views of addiction that dominate our current landscape are the neurobiological and life-meaning models. Aren't these two visions incompatible (I think they are)? And which will end up dominating the 21st Century, since both are ascending now.
The Stanton Peele Addiction Website, March 29, 2011. This blog post also appeared on Stanton's Addiction in Society blog at PsychologyToday.com.
Addiction Wars: Meaning and Purpose v. Disease
People like to speak of "paradigms" vis-à-vis Kuhn's The Structure of Scientific Revolutions, where one scientific paradigm creeps up on and overtakes another, as it provides an unambiguously superior account of reality.
I never got Kuhn's shtik. In my field -- addiction -- right now two incompatible views are in ascendance -- the "scientific" medical model; the mindfulness, life-meaning model.
The desire to resolve addiction into a single biological mechanism has never been stronger. Starting in the 1980s, every few years Newsweek and Time alternated cover stories on the neurochemistry and mechanics of addiction, replete with brain diagrams and optimistic predictions.
Here are their most recent variants:
Newsweek's cover story, "The Hunt for an Addiction Vaccine ," reports, "this emerging paradigm treats addiction as a chronic, relapsing brain disorder to be managed with all the tools at medicine's disposal. The addict's brain is malfunctioning, as surely as the pancreas in someone with diabetes." "We are making unprecedented advances in understanding the biology of addiction," says an addiction expert.
Hard on to the Newsweek article, Time magazine, in its "A Drug to End Drug Addiction," asks, "What if science made a pill to protect us from addiction — keeping us from smoking cigarettes, getting fat or abusing drugs and alcohol? According to encouraging results from several lines of study, it seems that day may be closer than we thought. . . . (According to one addiction expert) the 21st century war against drug abuse can be waged as successfully as last century's global fight against infectious diseases."
Fabulous! Really. The Newsweek article behind the cover is titled, "What Addicts Need." What do addicts need, really, to overcome addiction? A medication? A vaccination? A replacement chemical? A blocking agent?
Many people who deal with addicts express their views on this question. It is the central question in addiction treatment. Since I first wrote about addiction in 1975, in Love and Addiction, I recognized that people overcome addiction out of purpose-based motivation -- they quit when they recognize how their habit violates who they were, what they want to be, where they want to go in life.
Here is some of what I said there:
Overcoming addiction is as much a matter of encouraging positive involvements with one's environment as it is of withdrawing oneself from addictive attachments. . . . Let us go directly to the deeper aim of eliminating addictive tendencies through having a life that is complete and satisfying. . . . I am not interested in remedying our defects so much as in realizing our ideals. . . . We can remedy an addiction only through working hard at learning to do something well, something which is important to us and to other people.
And when I began to write self-help/clinical manuals, beginning in 1991 with The Truth About Addiction and Recovery, I emphasized meaning (in line with my 1985 book, The Meaning of Addiction). It was the centerpiece of my Life Process Program. Here is how I expressed this view in a later book, 7 Tools to Beat Addiction, in my summary chapter entitled, "Higher Goals: Pursuing and Accomplshing Things of Value."
Goals are important advantages for overcoming addictions. You will not usually be sufficiently motivated to give up an addiction or habit simply because it is bad for you or because others want you to stop. But when a habit or addiction interferes with accomplishing a goal you want to attain, or something larger you are committed to, you are more inclined to quit. Thus instead of focusing on what you need to quit or escape from, it is critical to focus on what you want to achieve. Giving up your addiction then becomes a necessary step on the road to getting where you wish to go.
Hopelessly outdated, I know. But, all of the sudden, this week I was reminded that these ideas are alive and well, even outside of my own feverish mind.
I do a weekly commentary every Thursday evening on "Addiction Treatments that Work " on Internet Radio. Last week, host Ken Anderson interviewed Henry Steinberger , a long-time addiction psychologist who is on the board of SMART Recovery. What struck me in Henry's presentation was this statement:
Not to feel cravings, not to feel urges. I don't know anybody who can do that. The long-term approach to changing one's emotions, is to accept your emotions and don't let them deter you from what you really value in life. I think of it as like being on a bus: You need to stay on your bus journey to where you're trying to go. You say to yourself "I'm going to continue to pursue what I value, despite cravings, or anxiety, or depression." At the end of your life, you want your epitaph to read: "He pursued what he valued; his life meant something; he stood up for what he thought was important."
And then, to go to the opposite extreme, I looked into the new recovery Web magazine, The Fix. There I found John Crepsac, an NFL substance counselor, who answered this question: "What's the Major Factor that Stands in the Way of People's Recovery." Crepsac answered :
It is a lack of purpose and meaning in people's life. When they lack that sense of purpose, addiction seems like a really good proposition. It gives them a sense of meaning, of purpose, of identity - although not one that is positive or sustainable. The challenge of recovery is to find meaning.
Crepsac is about as far away from Steinberger and me as you can get (he immediately suggested finding meaning in 12-step fellowships). Except, isn't it funny that we three, from such diverse backgrounds and given our divergent belief systems, each of us having worked decades in the field, have all arrived at the same position?
Time and Newsweek references:
Interlandi J: What Addicts Need . Newsweek February 23, 2008.
Hylton H: A Drug to End Drug Addiction . Time Magazine Jan. 09, 2008.