When we launched our blog in the Spring of 2017, one of the first issues we tackled was the disease model of addiction. Addiction is a brain disease. It’s a scientifically proven fact. Until the science is accepted and the asinine debate is permanently laid to rest, the stigma around addiction will continue to block suffering human beings from desperately needed compassion.
Dr. Gabor Maté’s groundbreaking book – In the Realm of Hungry Ghosts – explains the chronic and progressive deterioration of the diseased brain: “The drug-addicted brain doesn’t [look the same when imaged by scans]. A diminished volume of gray matter has been shown in heroin addicts and alcoholics. [These] same addicts showed impaired functioning of their prefrontal cortex, the “executive” part of the human brain…Such changes are sometimes reversible but can last for a long time and may even be lifelong…. Since the brain determines the way we act, these biological changes lead to altered behaviors. [The] functions that become pathological are the person’s emotional life, thought processes, and behavior” (150-155). In a nutshell, Dr. Maté is saying that when one’s brain literally loses brain matter, one’s ability to make sound decisions is drastically diminished.
The problem with the disease model, however, is that it only provides an explanation of the biological mechanisms. It sheds no light on the preexisting factors that make a person susceptible to addiction, and can only be understood, therefore, as an oversimplified interpretation of addictive processes. Leaning too heavily on the disease model can do more harm than good; it ignores crucial components that are invaluable to healing.
What Causes Addiction?
According to Dr. Maté, three components create the perfect substance misuse storm: “a susceptible organism; a drug with addictive potential; and stress” (147). Maté posits that “emotional isolation, powerlessness, and stress are exactly the conditions that promote the neurobiology of addiction in human beings” (145). Two well known studies – Rat Park and an analysis of addiction post Vietnam – contribute to Maté’s conclusions. Research demonstrates that rats who are subjected to captivity and stress are more likely to engage in addictive behaviors. “The Vietnam veterans study pointed to a similar conclusion: under certain conditions of stress many people can be made susceptible to addiction”. Scientists noticed that many soldiers ceased to use heroin once they were removed from the war zone. “The ones who persisted in heroin addiction back home were, for the most part, those with histories of unstable childhood and previous drug use problems. Lack of meaning, not simply the dangers and privations of war, was the major source of the stress that triggered their flight to oblivion” (146).
Based on these findings, one can infer that environment – as well as trauma, social connection, and a sense of meaning – are all incredibly important elements of the overall addictive process picture. However, these elements are often overshadowed by biological considerations…which can lead to biased solutions.
The Healing Benefits of “Digging Deep”
In recovery settings, you’ll hear a lot of talk about “doing the work”. Often, this phrase sends a shudder down the spine of beginners. “The work” entails confronting painful emotions, challenging the false narratives that drive dysfunctional behaviors, and learning to trust others – sometimes for the first time. The process of allowing oneself to become vulnerable is an uncomfortable, if not excruciating, experience. So why bother exerting the effort?
If Dr. Maté and other addiction experts are correct, “the work” is critical to maintaining long-term recovery. It’s not only a matter of allowing the brain to heal, but also of addressing environment, trauma, social connection, and purpose. At the end of the day, the rewards one receives from enduring discomfort far outweigh the sacrifices. Sustainable recovery is the overarching benefit of many positive gains, including the following:
- Learning to Feel – As a treatment provider, one of the chief concerns we hear from our clients is: “I don’t know how to feel anymore”. A driving force behind addictive behavior is the avoidance of feelings, particularly pain. In recovery, “the work” necessitates touching feelings one hasn’t touched before; namely, the pain one has been avoiding. The benefit of venturing into painful territory is that we are able to process and release those uncomfortable emotions. Once the pain has been confronted and properly managed, it ceases to provoke relapse. The other benefit is that once we have learned how to cope with and process painful emotions, we are also able to enjoy feelings on the opposite end of the spectrum, such as peace, contentment, and joy. There is no longer a need to seek out substances to manufacture positive emotional experiences. It’s important to note that confronting unpleasant feelings isn’t a one time ordeal; it is critical to teach healthy coping skills that can be utilized when future painful emotions surface.
- Rewriting Our Stories – The stories we tell ourselves aren’t always true; perhaps we tell ourselves “no one expects anything of me, so I’m going to fail,” or “my parents abandoned me, so I am worthless and unlovable,” or “no one talks about their feelings on the street, so I am weak if I talk about them”. The mind is so powerful that it can create a false reality – and a large part of that reality is driven by mindsets that were created in the past. The truth is that everyone is worthy and lovable, and everyone is capable of change. Part of digging deep and doing “the work” is about exploring the past and becoming aware of those false stories. When awareness has been established, one can “rewrite the story”. For example, one might say: “The streets made me tough and I am a survivor. But being vulnerable is a different kind of strength. My willingness to be honest and vulnerable is also courageous”. As our stories are rewritten, those false old narratives no longer drive us in the direction of relapse.
- Overcoming the Fear of Judgement – Arguably the most important part of therapy – and recovery – is truly being seen by another person. As addicts, our instinct is to hide. Not unlike a child retreating under the blankets, we comfort ourselves with that idea that when the outside world can’t see us, we can’t see ourselves. Our lack of genuine connection blinds and cripples us. Relationships, therefore, are the most important part of healing. Many people resist entering (or reentering) the therapeutic process because they “don’t want to tell their story again”. This resistance is less a disinclination to recount the past, and more a thinly veiled fear of being judged. Allowing one’s self to be seen by the world means forcing one’s self to confront the truth of one’s reality. Often, we don’t want to look at ourselves. However, letting another person into our interior world is the only way to overcome our fear, learn how to manage our emotions, and rewrite our false stories. Forming a safe connection also teaches us how to trust. Above all, it demonstrates that these connections are possible without the buffer of drugs. In the absence of healthy relationships, it is difficult to move forward in the recovery process. Recovering individuals require sources of both unconditional love and accountability.
If you want to promote addiction recovery, the best thing you can do is to educate others that addiction is a complex and multilayered affliction with no simple solution. Part of ending the opioid epidemic does, indeed, involve an acceptance of the brain disease model, but it also requires an examination of the environments that create susceptibility. In order to move forward, we need to find ways to reduce trauma exposure (or increase access to interventions) and to cultivate and maximize positive relationships and community connections. Just as addiction treatment often utilizes a holistic approach, so, too, must we as concerned community members.
If you are struggling with a drug or alcohol problem – and looking for support to “dig deep” in the interest of your own healing – please call (888) 649-1149.
Autumn Khavari/ Contributor
Jennifer Harrington/ Contributor