Survey after survey has shown that the general public overwhelmingly believes that addiction is a disease, addicts are powerless over it, it’s a result of some sort of spiritual or moral issue, it’s hereditary, and the only hope the addict has of ever being free of it is for he or she to commit themselves to treatment, and resign themselves to life-long participation in some sort of 12-step or other semi-religious organization. None of this is true, of course, which I will address in chapter three, but for now, let’s look at these false beliefs from the standpoint of what we know today about the nature of addiction and how we become addicted.
Firstly, consider that those false beliefs stem mainly from a book that was published in 1939, called “Alcoholics Anonymous,” which became the foundation of the drug and alcohol treatment industry, and the source of most of the public’s knowledge about addiction. Not a single word or phrase in the operative portion of this book has been modified or updated in the slightest since its initial publication, seventy-plus-years-ago, in spite of all we have learned about addiction, especially in the last half-century. For its part, the addiction research community has hardly gone out-of-its-way to change public opinion either, partially because of a reluctance to challenge the established treatment industry, and partially, I suspect, due to their lack of access to the public-at-large. That last is truly unfortunate, because the truth of the nature of addiction, revealed by the available studies and research paint an entirely different picture than the one the public, and even most addicts, currently believe.
Addiction is an extremely complicated Biological, Psychological, Neurological, and social disorder, with no single cause. We are not addicts because we are weak, immoral, or fated to be so. We are addicts mostly because we learned to be, not because of any spiritual shortcoming. We became addicted because of a combination of genetics, experience, personality, opportunity, and outlook.
Family, twin, and adoption studies have demonstrated that genes contribute to the development of alcoholism and drug abuse with heritability estimates ranging between 50 and 60 percent. That’s a pretty good percentage, but it’s not exactly destiny either. Specifically, the genes most associated with alcohol dependence are those that encode the enzymes that metabolize alcohol, and certain drugs. Other suspects include genes that alter some of the functions of chemicals called “Neurotransmitters,” such as dopamine, which mediate and influence transmission of signals in the brain. This could lead, for instance, to an individual being more susceptible to stress, or other environmental stimulants than other individuals. There is no particular gene that has been firmly linked to any particular drug or alcohol addiction, but although there have been some strong correlations discovered between some genetic configurations, and certain manifestations of drug and alcohol abuse, as we will see in the next chapter, genetics are only one piece of the puzzle.
Addiction is not driven by the drug itself, or the effect it has on a person’s brain chemistry, it’s driven by the emotional and psychological needs it fulfills for the user. These needs are determined, not from genetics, but from the persons environment, their perceptions of the world, and most importantly, their beliefs about themselves. If a person has a poor self-image, for whatever reason, and believes they’re a “screw-up” who will “never amount to anything,” and is subsequently exposed to a drug that reverses all that, makes them feel ten-feet-tall, bulletproof, and “one of the gang” for the first time in their life, who wouldn’t want to repeat the experience? Who wouldn’t want their social anxieties to disappear?
Because of this combination of factors, using did things for us that drugs don’t necessarily do for others. The effects they initially had on us provided the positive reinforcement that encouraged further use. This further use resulted in the eventual development of physical tolerance, where ever larger doses of the drug were required to achieve the effects we sought. At some point, if we continued to use, positive reinforcement turned to negative reinforcement – we still sought the effect of the drug, but our using was driven more by nearly irresistible cravings and avoidance of the effects of withdrawal than by the positive effects of using.
This was our learning process. Regardless of the particular drug, the process – and the end result – was the same. We will find in the next chapter, that as we were learning to use, we were strengthening certain neural pathways in our brains, while we were growing new ones, thereby reinforcing and changing our thinking, beliefs, and perceptions of the world around us. As we continued down the path, our craving for the drug became wired into the most primitive parts of our brain, until it reached the point where the “thinking” portion of our brains couldn’t distinguish between the drug-related “gotta have it’s,” and our primal drives for reproduction, food, and survival itself. When we reached this point, using was no longer a choice, something we had conscious control over, but an almost “hard-wired” response to how we learned to perceive the world outside, and our beliefs about it.
I don’t mean to present this as though we were, in any way, helpless “victims” of genetics, personality, upbringing, or anything else, because we were not! At any point along the path we could have chosen, as the vast majority do, to quit using, or at least abusing, drugs or alcohol. The fact that some of us do not doesn’t indicate weakness or immorality, it simply means that for whatever reason, we saw our using not as a problem, but as a solution – the best one we had available – to help us cope with the world as we saw it! Fortunately for us, that was the problem – and it also contains the seeds of our solution.