Is Addiction Really a Disease? A Challenge to Twelve-Step Programs
Addiction is everywhere, it seems, as is the devastation wrought by this disease. But does it even make sense to call it that? Modern medicine thinks it does. What used to be considered a moral deficiency is now called a biological condition, and every twelve-step program from Alcoholics Anonymous to Overeaters Anonymous is predicated on this principle. But in different cultures diseases look different and, more importantly, mean different things. I believe that in digging into the metaphoric landscape of addiction and disease in the American soil we can get at the grit of where we are in our public perception and how we got here. What follows is both an intellectual and personal unpacking of the following question: what does it mean to be an addict in America?
Let me preface this by saying that I write as someone who has struggled with these issues both as an academic and as someone who has lived in the prison of chemical dependency. I have experienced the despair of finding out I had an “incurable disease,” as well as the despair of being told it could only be arrested by a Protestant-by-proxy twelve-step program. I know as well the process through which disease-identity is cultivated within the walls of Narcotics Anonymous. I experienced firsthand how the disease of addiction is a cipher for all sorts of projections and even, to a certain extent, a symbolic transformation of the Devil himself into the language of medical discourse, echoing the ancient struggle of God, or a “Higher Power” with the Devil, or “the disease of addiction.” This crypto-Christian theology is still very much alive in the treatment of addiction. And for the still-struggling addict who doesn’t subscribe to or is alienated from the Judeo-Christian tradition, this can prove to be very problematic. And although these programs encourage each wayward addict to define his or her “Higher Power” as he or she understands Him (it can be a doorknob, a doll, or the twelve-step program itself), all of the literature and even the verbiage used within the “rooms” themselves point to a Judeo-Christian concept that turns the addict into a spiritually devastated individual who can only be saved by developing a more intimate relationship with a “Higher Power.”
The Harmful Power of Misplaced Medical Diagnoses
Like dictionaries, which jettison words every year, medicine disposes of diagnoses that are no longer tenable. Such was the case with both hysteria and homosexuality in the early and mid-twentieth century. These diseases then become historical curiosities like so many of the comically absurd laws of the nineteenth century. Obviously, homosexuality is not a disease, and it never was, regardless of what medicine thought; the experience of being gay, however, for many people was one of living in illness. For some gay people, this damaging self-conception prevented actualization of a healthy sexuality and nurturing of an authentic self. In other words, this misdiagnosis was damning. Fortunately, this particular vestige of Levitican law has been abandoned by the medical community.
The metaphor of addiction as a disease is equally damning. And yet, with some procrustean acrobatics, medicine has been able to fit chemical dependency under this rubric. After all, the life of the addict is often characterized by “disordered or incorrectly functioning systems of the body,” which are the hallmark of any disease. But again, the ways we think about disease today are neither similar to how they were a thousand years ago, nor to the way they are envisioned in holistic paradigms today. What I suggest is a radical return to the way we thought about diseases of the body and of society in antiquity: as imbalances that need to be brought into equilibrium, rather than as insidious interlopers to be destroyed. The truth is, the current medical model of addiction is fundamentally modern and just doesn’t work; what we need is a metaphoric rewrite that understands the disease of addiction not as a discrete illness circumscribed by the skin of the individually afflicted, but as a societal condition reflected in the sinews and psyches of the chemically dependent. This would require quite a transformation of the clinical dynamic, but such a transformation would open it up to a more individualized and democratic environment.
For most of America, having a disease means having a foreign body assume residence in the biological tissue, multiplying itself and attacking the surrounding healthy tissue. This idea is a direct result of the discovery of microscopy and the bacterial origin of many afflictions. The metaphor here is war, and all good doctors are on the front lines, battling leukemia, eradicating AIDS and other serious illnesses. Sometimes we cause the war ourselves and sometimes we are simply invaded. But where is the infection in addiction? To what can we actually point? Carl Jung famously diagnosed addiction in a letter to Bill Wilson as “a thirst for wholeness” and prescribed analysis, creative activity, and the formation of meaningful relationships to fill in the gaps where absence has encroached. I’m not sure about the analysis part, but as for the formation of meaningful relationships, I am 100 percent convinced.
While a minority of addicts find the idea of having an arrestable, albeit incurable, condition empowering (at least according to the twelve steps), most addicts, myself included, do not. And the monopoly of the twelve-step ideology precludes the possibility of finding out about alternative therapies such as those I will discuss. It also occludes the societal etiology and responsibility for a collective condition.
Boeving, NIcholas Grant. 2011. Is Addiction Really a Disease? A Challenge to Twelve-Step Programs. Tikkun26(4): 22.