Concerns about the Disease Model and
Diagnosis in the Treatment of Addictive
Behavior
Diagnosis in the Treatment of Addictive
Behavior
Intoxication temporarily limits a person's ability to function and
relieves them temporarily of their responsibility to do whatever it is
they'd be doing if they were not impaired.
This is a great part of the appeal of substance use. Once consumed,
there is no going back until the effects of the substance wears off. A
person's spouse cannot bring them back, a person's boss cannot
bring them back, a person's conscience cannot bring them back, a
person cannot will themselves back. Even God cannot bring them
back.
This is the best of both worlds. First, there is the power of autonomy
this allows. The substance user is the only active agent in deciding
whether to consume the substance. Not shame, not wisdom, not
sanction, not even jail can prevent a substance user from using if they
decide to use.
Then, there is the surrender of power. Once ingested, the substance
is the agent in control and even the substance user cannot undo this.
Being responsible in this life is a heavy burden. Being relieved of
responsibility can be a wonderful experience.
Let's look at what we do when we give a person a psychiatric
diagnosis. Let's look at the mixed message we send to an addict
when we reward their addiction to irresponsibility by absolving them
of responsibility.
Prior to a diagnosis, an individual may actually be engaging in a
process of self examination. They may be wondering:
Do I have a problem/ do I not have a problem?
Should I change my behavior/ should I not change my behavior?
Is there a pattern/ is there not a pattern?
And they may decide they don't want to think about it anymore
because it is too uncomfortable to think about, and they may instead,
seek their drug of choice in order to gain temporary relief from the
burden of responsibility that awareness of choice imposes.
When this pattern is observed by a diagnostician, the substance user
is further relieved of the responsibility for their behavioral choices.
The diagnostician tells them that the addiction is not their fault. The
diagnostician tells them they have a "disease." The kicker, however,
is that the "cure" is nevertheless "personal responsibility."
I suggest we skip the counterproductive collusion with the addict's
addictive behavior and that we do this by refusing to give the addict a
diagnosis. There is nothing at its core that is unique to the addiction
to substances.
Addiction is a universal and common problem which is never
resolved completely.
It is not just the substance user who must embrace the colloquialism
"once an addict, always an addict." Everyone has a tendency to be
short-sighted, to seek immediate gratification, to believe that if a little
is good, a lot must be better, to seek relief from pressure, to seek
oblivion, to do so repeatedly, to seek to lower expectations, to
engage in repetitive behavior, to reduce novelty, to conserve energy.
To do otherwise requires constant attention, intention, awareness,
mindfulness, engagement, wakefulness. This will be true as long as
we are alive. Life requires this. This is what life is. Life requires
participation. There is no "cure" but death and so, in a way, the
"cure" for addiction is a good dose of whatever one is addicted to.
The cure for alcoholism is alcohol. It is death. It is a disease. It is a
diagnosis. It is being relieved of responsibility.
For an alcoholic, the problem is not the alcohol. The problem is
being sober. The problem is life.
relieves them temporarily of their responsibility to do whatever it is
they'd be doing if they were not impaired.
This is a great part of the appeal of substance use. Once consumed,
there is no going back until the effects of the substance wears off. A
person's spouse cannot bring them back, a person's boss cannot
bring them back, a person's conscience cannot bring them back, a
person cannot will themselves back. Even God cannot bring them
back.
This is the best of both worlds. First, there is the power of autonomy
this allows. The substance user is the only active agent in deciding
whether to consume the substance. Not shame, not wisdom, not
sanction, not even jail can prevent a substance user from using if they
decide to use.
Then, there is the surrender of power. Once ingested, the substance
is the agent in control and even the substance user cannot undo this.
Being responsible in this life is a heavy burden. Being relieved of
responsibility can be a wonderful experience.
Let's look at what we do when we give a person a psychiatric
diagnosis. Let's look at the mixed message we send to an addict
when we reward their addiction to irresponsibility by absolving them
of responsibility.
Prior to a diagnosis, an individual may actually be engaging in a
process of self examination. They may be wondering:
Do I have a problem/ do I not have a problem?
Should I change my behavior/ should I not change my behavior?
Is there a pattern/ is there not a pattern?
And they may decide they don't want to think about it anymore
because it is too uncomfortable to think about, and they may instead,
seek their drug of choice in order to gain temporary relief from the
burden of responsibility that awareness of choice imposes.
When this pattern is observed by a diagnostician, the substance user
is further relieved of the responsibility for their behavioral choices.
The diagnostician tells them that the addiction is not their fault. The
diagnostician tells them they have a "disease." The kicker, however,
is that the "cure" is nevertheless "personal responsibility."
I suggest we skip the counterproductive collusion with the addict's
addictive behavior and that we do this by refusing to give the addict a
diagnosis. There is nothing at its core that is unique to the addiction
to substances.
Addiction is a universal and common problem which is never
resolved completely.
It is not just the substance user who must embrace the colloquialism
"once an addict, always an addict." Everyone has a tendency to be
short-sighted, to seek immediate gratification, to believe that if a little
is good, a lot must be better, to seek relief from pressure, to seek
oblivion, to do so repeatedly, to seek to lower expectations, to
engage in repetitive behavior, to reduce novelty, to conserve energy.
To do otherwise requires constant attention, intention, awareness,
mindfulness, engagement, wakefulness. This will be true as long as
we are alive. Life requires this. This is what life is. Life requires
participation. There is no "cure" but death and so, in a way, the
"cure" for addiction is a good dose of whatever one is addicted to.
The cure for alcoholism is alcohol. It is death. It is a disease. It is a
diagnosis. It is being relieved of responsibility.
For an alcoholic, the problem is not the alcohol. The problem is
being sober. The problem is life.
There are certain medical
interventions which are
generally reserved for life
threatening interventions.
Stomachs can be pumped or
substances called antagonists
can be given to counteract
the effects of a substance.
Again this is the exception to
the rule and I do not believe
it detracts from the point I
am making here.
interventions which are
generally reserved for life
threatening interventions.
Stomachs can be pumped or
substances called antagonists
can be given to counteract
the effects of a substance.
Again this is the exception to
the rule and I do not believe
it detracts from the point I
am making here.
Understanding addictive
behavior is essential to the
human psyche and the
human condition. This is a
philosophy prominent in the
basic tenets of Buddhism.
behavior is essential to the
human psyche and the
human condition. This is a
philosophy prominent in the
basic tenets of Buddhism.
Christian Wolff, MA, Licensed Psychologist Associate
Copyright, 2003
Copyright, 2003
| CHRISTIAN WOLFF, MA Licensed Psychologist Associate/Consultant 820 NW 21st Avenue, Suite B . Portland. Oregon . 97209 . 503-284-4501 . christian@christianwolff.com |
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