Your Path to Recovery Begins with…DEFINING Your Journey
INTERESTING FACT #1: There is no unanimous agreement on exactly what ‘addiction’ is –its causes, its manifestations, or its solutions.
Within the Medical Model, one can find definitions for both ‘disease’ and ‘disorder’. However, there are equally valid and scientifically based arguments that contend that addiction is a Behavior –which is entirely controllable by the individual who chooses to use substances, hence the Behavioral ‘Choice’ Model.
Medical Models: Disease / Disorder
The specific differences between the ‘disease’ and the ‘disorder’ models are often blurred. However, upon analyzing existing definitions throughout the medical literature, there are some defining characteristics:
- Disease: The Disease Model implies that a part of the body has been structurally or molecularly changed in some way and there is a definite cause, disease path, and prognosis. The National Institute on Drug Abuse (NIDA), the American Society of Addiction Medicine (ASAM), and the Drug Enforcement Agency (DEA) all define addiction as a brain disease –noting changes in the structure of the brain, primarily related to neurological circuitry –which impacts how it works. The ASAM definition includes the prognosis that “without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death”.
- Disorder: The Disorder Model falls short of identifying a particular structural or molecular change in a body part or organ and relies more heavily on functional changes – adverse social consequences, increased use, inability to quit, craving or a strong desire, inability to carry out major obligations, reduction in formerly important activities, continued use despite harmful consequences, legal problems, etc. The Substance Abuse and Mental Health Services Administration (SAMHSA), The American Psychiatric Association (APA), and Wikipedia refer to individuals with a Substance Use Disorder (SUD), while The World Health Organization (WHO) describes a ‘dependence syndrome’.
‘Diagnosing’ –A Critical Component of a Medical Model
Whether a disease or a disorder, a medical or mental health condition must have a way of being diagnosed. Both The Diagnostic and Statistical Manual of Mental Disorders (DSM) –the guide used by health care professionals to diagnose mental disorders, and The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) –the system used by physicians to classify and code all diagnoses, symptoms and procedures related to hospital care –refer to impacted individuals as having a Substance Use Disorder (SUD).
INTERESTING FACT #2: The symptoms of ‘tolerance’ and ‘withdrawal’ formerly used to diagnose a Substance Use Disorder, were removed from the DSM criteria in 2013, for those substances that are legally prescribed and ‘taken as prescribed’ while under the care of a medical practitioner.
Prior to that, both ‘tolerance’ and ‘withdrawal’ were among the seven criteria used for diagnosing the ‘disorder’. So the good news is that if you were ‘addicted’ to prescribed opiates prior to 2013, and you are still taking them –you are no longer considered to be ‘addicted’!
Of further significance was the fact that in 2013, four additional criteria were added, along with a severity index –a minimum of 2-3 criteria is required for a mild SUD diagnosis, while 4-5 symptoms denote a moderate disorder, and the occurrence of 6-7 is severe. Prior to 2013, an individual exhibiting 3 or more symptoms, including ‘tolerance’ and ‘withdrawal’ (regardless of whether the substance was legal or illegal) was satisfactory for diagnosing a level of the disorder severe enough to warrant medical intervention.[ps2id id=’choicemodel’ target=”/]
Behavioral ‘Choice’ Model
The Behavioral ‘Choice’ Model is rooted in the theory that using substances is a rational choice that individuals make in response to certain benefits they get from using substances, such as coping with trauma, reducing anxiety, staving off depression, or relieving loneliness or boredom. Likewise, overcoming addiction and maintaining recovery is also a choice –entirely within the power and control of the individual using the substances. (Alexander, 2015; Heyman, 2010; Kurti and Dallery, 2012; Price et al, 2001; Robins et al, 1975; Schaler, 2002; White, 1996)
This model is promoted by Baldwin Research Institute (BRI), is the foundation of Rational Recovery (RR), and is the rationale for many drug-free recovery support options –including hypnotherapy, Addictive Voice Recognition Training, Narconon, and others. Proponents of the ‘Behavioral Choice Model’ point to research that shows that most people meeting criteria for ‘addiction’, wean themselves off substances when the benefits of NOT using the substance begin to outweigh the benefits of using it (see section on Spontaneous Remission, p. 66). BRI concludes that “after reviewing the available research from both sides of the debate, the belief in the ‘disease of addiction’, causes the disease”. (Hart, 2013; Heyman, 2010; Noe, 2016; Price et al, 2001; Peele, 1991, 2016; Regier, 2016; Szalavitz, 2016)
In a recent TED Talk, entitled Everything You Think You Know about Addiction Is Wrong, the speaker postulates that addiction occurs when individuals are unable to bond with or connect in meaningful ways to the greater society. He cites evidence that twenty percent of soldiers were regularly using opium during the Vietnam War but quickly recovered from their dependency upon returning home. He also highlights the famous Rat Park study, where a lone rat isolated in a cage will choose to drink opiate-laced water until death, while rats living in an environment where they have stimulation and social contact with other rats choose not to drink the opiate-laced water, preferring pure H2O instead –even when they have been introduced to ‘The Park’ after becoming dependent upon the opiate-laced water in the isolated environment. These rats presumably choose to wean themselves off of their opiate dependence when they are presented with a better option.
The adaptive function of addiction is often hidden. Many addicted people deny that they live in a state of dislocation because they feel ashamed of their inability to find a secure social life, a sense of who they are, some values they can believe in, a place they can call their own, or a reason to get up in the morning… They may deny their dislocation because it feels like an unbearable personal failure and they may be only dimly aware of the adaptive function of their addiction. In moments of insight, however, [they] can explain the function of their addiction with surprising candor. (Alexander, 2008, 2010)
There is a clash of values between the “addict” and society. The “addict” at the time when they are using drugs, sees the choice as worthwhile and thus is freely choosing it, exercising the acquisition of their values. Society disapproves does not see the behavior as worthwhile, and proceeds to pathologize it as an illness that must be “treated” out of the person. Thus society is forcing their values upon the “addict” because they disagree with the costs or risks the “addict” is taking on with their behavior… (Steven Slate, author of CleanSlate.org, 2013)
INTERESTING FACT #3: How you choose to define your experience with and relationship to substances is ultimately up to you.
However, the way you perceive your experience will definitely influence your treatment choices and/or recovery options. It is ultimately up to you whether you are battling ‘the disease of addiction’ or coping with a ‘substance use disorder’ or have made a ‘personal choice’ to use drugs and will make a personal choice to stop your use altogether, cut back, or use one substance but not another. It is also up to you whether you perceive your battle to be life-long or whether you identify with being in ‘long-term or short-term recovery’, or to be ‘recovered’, or to choose to reduce or moderate your use to a safe consumption level.