Is Addiction Really a Disease? A Challenge to Twelve-Step Programs

Cigarette Brain

Can metaphors make us sick? Do we harm ourselves by imagining addiction as a foreign body assuming permanent residence in our biological tissue? Credit: Sayaka Merriam.

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.

rod of asclepius

The medical establishment has persuaded many that chemical dependency fits under the rubric of disease. But what if we instead saw addiction as "a societal condition reflected in the sinews and psyches of the chemically dependent"? Credit: Laura Beckman (

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.


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Nicholas Boeving is an independent scholar whose research interests include the psychology of religion, new religious movements, and comparative addictionology. He would like to thank Ann Gleig and Claire Villareal for their support and insight in the process of writing this article.

Source Citation

Boeving, NIcholas Grant. 2011. Is Addiction Really a Disease? A Challenge to Twelve-Step Programs. Tikkun26(4): 22.

tags: Culture, Health, Spirituality   
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10 Responses to Is Addiction Really a Disease? A Challenge to Twelve-Step Programs

  1. Pingback: Saving Addicts « The Revealer

  2. Larry Sparks September 25, 2011 at 7:46 am

    All addition is a question of folks trying to live up to unsustainable backward values of this soiety, (which ignores the sustenance of life)that no one can live up to. Instead of a systemic failure with dehumanizing values, folks see it as a personal failure leading to a process of self abuse. Change your thinking with a
    (hope sharing and caring) alternative vision you change the world. No one is ignoring the biological basis questionis: what is the trigger/choices that sets it in motion. peace larry

    • Jeff Beck July 13, 2014 at 9:45 am

      Using the paradigm of addiction as a disease, you could say exactly the same thing about learning being a disease. Addiction tends to be frontal-lobe stuff, learned behaviors, the treatment for addiction is not too terribly effective looking at the overall statistics. We could certainly do a lot better in the coming decades in terms of helping individuals addicted to drugs instead of joining a strange cult (12 steps), or accepting a lot of pseudoscience as gospel. Thanks for the great read, good article!

  3. libramoon September 25, 2011 at 6:10 pm

    We seem to have developed an erroneous mindset that mistakes fighting symptoms for curing the cause. In the case of our relationship to “drugs,” the problem is not in the substances, or the people who seek benefit from their use, but the intensive, deceptive marketing of panacea. People thus become conditioned to believe not only that medicines will cure, but that we are dependent upon them, powerless. A more useful paradigm would be to see these not as authoritative, but as tools. We do the work, use our own power to heal, grow stronger, face and overcome our issues and ills. In a great variety of cases, various tools can help us — allies, not tyrannical powers.

  4. Gabrielle Pullen December 7, 2011 at 9:36 am

    Thank you for putting this out there, a shift is due, I agree. For myself, I do believe that the idea that addiction is a disease that I could put in remission with the help of a relationship to a Higher Power saved my life. It was an entry point of understanding that I could use to do whatever it took no matter how unsavory the task. At the time, prayer and self inquiry were extremely unsavory to me. But as years passed, I became unsatisfied with the model from the point of view that you point out, that it is full of the language of conquest. Furthermore, as I learned about meditation, (which could be construed as listening), I become turned off by the idea of prayer (it seemed too simplistic to think that God is some guy in charge who really has time to listen to the pathetic requests of all these ‘sinners’). Eventually, my search for the means to stay out of addiction in ways congruent with what felt right to me brought me to some powerful practices that are all related to ways to create a shift in perception, a shift in consciousness. So, while I am grateful to 12 step programs for helping me re-establish a relationship with spirit, I think they are currently a useful model for beginners on the path, but no, they do not satisfy the long-terms needs of the person in recovery for a way to make such a radical change in self image that addiction is no longer an issue.

  5. Philip Paris, M.D. January 25, 2012 at 10:10 pm

    While “addiction may be everywhere” your article fails to draw any distinctions between addictive substance. I sympathize with your critique of 12 step programs,but you do not mention addictions which are effectively treated with medication. Heroin addiction is the major example, as methadone treatment allows most addicts to regain felings of normality. Recovery from heroin addiction is not amenable to approaches of altruism or ease of alignment. Any such approach leads to total frustration and is really not acceptable in our modern world.

  6. Johnny March 14, 2012 at 9:41 am

    I enjoyed reading this. There is a shift and the people are waking up.
    Be well,

  7. Johnny The Healer August 29, 2012 at 10:29 am

    Heorin can be treated without methadone or suboxone. Brain damage from alcohol drugs or prescription meds can be reversed. I am doing it everyday here in my center. I applaud those got clean with AA 12 step rehabs, but back off and let those who it has failed have a real chance at total healing. And for Gods Sake stop labeling people as incurably diseased and powerless. We are powerful and can do anything we put our mind to. Just read my story on my site.
    God Bless

  8. Ibogaine November 30, 2012 at 1:27 pm

    Addiction is not a disease if it was or is it can be arrested and reversed! I can attest that a treatment that ends addictions to drugs is out there, It changed my life………. Google “Pouyan Method”

  9. Adrian December 19, 2013 at 4:16 pm

    Helping people with addictions is a challenge. The more “weapons in the attack” on addiction, the higher the likelihood of success. The good news is that new treatments such as ibogaine are helping win the war for recovery. Ibogaine is the newest and most effective treatment for addiction since the start of AA in the 1930′s. Ibogaine is legal in Canada, Mexico, Costa Rica and many other countries. It is very effective at eliminating withdrawal and cravings especially for addictions to opiates such as heroin and oxycontin. It’s made from the root of a plant in Africa, and is a powerful and effect drug in the war on addiction. Look into it; you’ll be glad you did. It gives opiate addicts a fresh start.

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