Despite significant advances in neuroscience with insight into how the brain works, many people still have difficulty accepting that addiction is a disease. The problem seems to be one of accountability. If I believe that addiction is a choice I can remain dispassionate to those afflicted with it. The American Medical Association has recognized alcoholism as a disease since 1956. Addiction meets the criteria of disease in that it is progressive, chronic, and potentially fatal.
There is no simple explanation to what makes an addict, but research suggests it is a combination of “nature and nurture”. Mark Schenker PhD calls it a “multilayered phenomenon” which includes a genetic predisposition “potential” interacting with psychological factors and social conditioning.
The problem with the “choice” theory of addiction is that it is not supportable with medical facts. Kevin McCauley can speak to this much more eloquently than I can, but the bottom line is this. Addiction does not take place in the part of the brain associated with executive functions such as reason, logic, morality, values, etc. (prefrontal cortex). Science has known this since the Olds experiments in the 1960’s. Addiction takes place in the mid-brain which is a much more primitive part of the brain that simply responds to stimuli. Over time the reward centers of the brain are conditioned by drugs and alcohol to equate usage with survival.
This is the reason that complete abstinence is the only solution for addicts. As AA puts it “a pickle cannot return to being a cucumber.” Once the threshold into addiction is crossed, any ingestion of drugs or alcohol will set in motion the phenomenon of craving and begin the addictive cycle. Another medical fact is that brain spect scans of addicts show that the prefrontal cortex is largely inactive during active addiction.
To complicate matters further, the prefrontal cortex continues to develop in humans into mid-twenties. Therefore, young people who abuse drugs or alcohol may be stunting the part of the brain which controls self-regulation and impulse control. These are the very things which would enable a person to consider the consequences of actions and refrain from using in the first place.
At Temet Nosce we believe in a holistic approach to recovering from addiction. I believe that addiction begins as a maladaptive attempt to try and feel better. Typically addicts start using in an effort to find relief from physical or mental suffering. Because of this identifying “core issues” is key. I have worked with many addicts who got sober in twelve step recovery, but continue to relapse over mood instability or lack of coping skills. A holistic approach to recovery addresses physical, mental and spiritual needs.