Common Misconceptions About Addiction
1. Addicts Have a Good Time
For people who can have a drink or two and leave it at that it’s easy to assume alcoholics have the same experience they do, just all day long. They may imagine, even envy, a carefree day of mild to moderate intoxication. In truth, addiction — having to stay drunk all the time just to feel normal, just to avoid withdrawal — is a life of daily worsening hardships involving brutal physical, emotional and psychological repercussions from which there are few respites, save unconsciousness. The old saw that addiction is slavery is true. Addicts are prisoners to continuous drug use and the terrible things they have to say and do to obtain enough to get them through every day. There are no vacations from addiction. No matter how much they deny it, every late-stage addict knows at some level that he or she can’t stop using regardless of how hard they try. In my three-year descent into deepest alcoholism, there were precious few fleeting moments of fun. Realizing you’ve lost self-control is baffling and terrifying. This horror permeates nearly every thought and action, every moment of every day. It’s a terrible life. For a more detailed description, click on The Addict Experience.
2. Addicts Are Stupid, Lazy People
People who don’t know that brain changes prompt addiction’s compulsive drug use may presume addicts are just too stupid to know better. But addicts aren’t stupid. They have something akin to selective blindness. They believe, wrongly but wholeheartedly, that they need drugs just to survive. (For more, click on Denial) It isn’t a belief they make up out of thin air, it has a biological basis. Specifically, the brain develops tolerance to drugs, which worsens over time, eventually requiring a base-level of constant intoxication to stave off the disastrous consequences of withdrawal. (For more, click on Hangover versus Withdrawal). Addicts will do crazy stupid things to avoid detoxing but they do them in service of a disease they can’t control. Addicts also aren’t lazy. They’re actually intensely motivated people, but that drive is limited to satisfying their most compelling need — getting enough drugs every day to stave off withdrawal. It’s not easy to do. In fact, it’s exhausting. You would not believe how much time and effort it takes to insure you have enough drugs to make it through today, tomorrow and the next day. Imagine for a moment that you had to buy at least a quart of alcohol every day while simultaneously concealing it from everyone around you. Every day, no days off. Also imagine you were intensely attuned to hiding how much you’re buying so you have to rotate among half-a-dozen stores. And you have to dispose of the bottles in a way that doesn’t blow your cover — alcoholics don’t use their own garbage or recycling bins, they farm out the evidence. Most addicts expend such substantial efforts feeding their addictions that when they get sober they find they have a lot of dangerous free time. One of the challenges of early sobriety is to use that time constructively rather than destructively like they used to.
3. Addicts Lack Willpower
Although it’s true that most addicts lack the willpower to overcome addiction on their own, that’s a symptom of the brain changes associated with addiction, not its cause. Addiction is a disease which, due to the progressive nature of tolerance, is characterized by accelerating compulsive drug use despite worsening personal, physical, social and psychological consequences. (For more about this, click on the Definition of Addiction). Failing to stop isn’t driven by a mere lack of willpower. It’s driven by changes to the structure and function of brain cells that have morphed into a “new normal” requiring a base-level of intoxication to function. Neuroscientists say that while people may start out using drugs to get high, tolerance leads addicts to continue to take drugs to avoid the terrible lows of withdrawal. The motivational power of the fear of detox outweighs all of the rational reasons — all willpower — that ought to convince an addict to stop but rarely can.
4. 12-Step Programs Are An Easy Con
You show up, you sit through a meeting and if you’re on probation get a card signed to prove you attended. Easy, right? It may be if you’re using AA just as a dodge to get others (family, friends, probation officers) off your back. But most aren’t like that. Most are desperate: they’ve tried everything else they could think of but have failed to solve their drug problems and are baffled. Most view 12-STep programs as the “end of the line,” their last bitter choice. Ever know anyone who thought attending AA meetings would be a fun way to spend an hour? Not likely. No one wants to be a drug addict. I entered AA suspicious of other peoples’ motives, so I was surprised to find the vast majority of members were honest people sincerely trying to follow the program to the extent they could. I shouldn’t have been surprised. Regular 12-Step attendees are intensely conscious of needing the program to stay alive: they’ve usually known many people who’ve died of the disease and have come dangerously close themselves. Desperation is a powerful motivator. They also know that if they pick up a first drink, they’re lost. So it’s no wonder most AAs take the program seriously. Their very lives hang in the balance and they know it. But desperation alone is rarely enough to succeed. 12-Step programs are simple to understand but hard to do. It’s work. Not back-breaking physical work: it’s much harder because what you have to do is retrain your mind and alter your behavior from one extreme (using as much as possible) to the other (total abstinence). Combating cravings is tremendously hard psychological effort. Sharing at meetings honestly is emotionally uncomfortable and leaves you intensely vulnerable. It doesn’t come naturally to most people and isn’t easy. But the more you practice the easier it gets.
5. Alcoholics Anonymous is a Cult
I was suspicious of AA at first because I thought it bore all the hallmarks of a cult. I’d studied Chinese Communism in college and had read Mao’s Little Red Book (in Chinese). Though I was impressed by what he’d done to improve the lot of China’s peasants, I was repelled by his personality cult. Moreover, I came to believe that ideologues, who chose doctrine over reality when they clashed, were idiots. The day before I was taken to rehab one of my closest friends confronted me, yet again, about my drinking problem. She said she’d drop everything and take me to an AA meeting. I refused. Then she handed me a mini-copy of AA’s Big Book and begged me to read it. My immediate reaction was that it was Mao’s cult all over again, just with a different supreme leader and a different color book. I put it aside un-read. I expected brainwashing (before I realized it might be a good remedy for a brain disease). I believed I’d have to exchange my innate skepticism for a dogmatic explanation of everything, forever relieving me of the burden of having to think. I saw evidence of this in the first meetings I went to, from the group-speak about “working a program” to AA “book-study meetings” where they treated the Big Book like a sacred text. Ubiquitous posters with slogans accompanied a form of public self-criticism in what they called “sharing.” It looked like a cult to me. In my less judgmental moments, I might have allowed that AA was a relatively benevolent cult. But a cult was still a cult. And I’d never join one. This was just one more thing I was wrong about. AA urges you to use what you find beneficial in the program and ignore what isn’t. The Steps are suggestions, not commandments. As was pointed out to me in rehab, AA’s Fourth Tradition states that “Each group should be autonomous except in matters affecting other groups or AA as a whole.” What kind of a cult grants each group complete autonomy, my counselors asked? My experience belied my expectation. I have found AA to be a loving, tolerant, open-minded, democratic community. It’s no cult.
6. Forced Treatment Fails
Addicts Have to Want Help Addicts don’t have to want help in order for treatment to work. In fact, most addicts are in denial and don’t think they need it. What’s required is that they become willing during treatment. I was typical. I was forced into rehab against my wishes and resistant for the first third of my stay. But immersion in a therapeutic community eventually whittled away my objections. As my doctor wrote in my chart, “Something happened to him between day 7 and 10 of his treatment. He came in very angry and very defiant and then became a little compliant and then he actually started to take to the program like a duck to water.” What happened was that I became willing because of the love and care I was given. In years of volunteering at my rehab, I saw this happen over and over. Take a drug addict, remove the drugs, care for him in a therapeutic setting, and even the most resistant can become willing. That doesn’t mean they’ll succeed, but it’s a start.
7. Quitting Occasionally Means You Can’t Be Addicted
On entering rehab it was easy to dismiss the First Step of Alcoholic’s Anonymous, which told me I’d lost control over my drinking (even while it was impossible to completely ignore how unmanageable my life had become, the Step’s second part). I thought I still had control because I was able to quit, sometimes for weeks at a time. This attitude is dangerously wrong. The key question isn’t “Can you quit?” it’s “What happens if you start using again?” If you revert right back to abuse or if it takes only a short time to do so, quitting is the illusion of control. This is particularly true when successive detoxes get worse and the amount of sober time before using again shrinks. Instead of evidence of control, it’s an indication of addiction. So the important question isn’t whether one can quit intermittently, it’s whether one loses control over drinking or using drugs once it starts.
8. Punishment Is the Best Model to Make People Stop Using Drugs
Threats of punishment like arrest and incarceration, hazards rational people would avoid, are largely useless in getting addicts to quit. That’s because it’s a disease in which the emotional motivational need for drugs far outweighs the threat of the negative consequences of drug use. This has a biological basis: the balance between the brain’s competing emotional and rational systems is altered by drug abuse, resulting in over-valuing the short-term emotional payoff of continued drug use at the expense of longer-term rationality (Click on How Tolerance Develops). As Dr. Alan Leshner, at the time the Director of the National Institute on Drug Abuse, wrote in a 1997 issue of Science Magazine, “If the brain is the core of the problem, attending to the brain needs to be a core part of the solution. Understanding that addiction is … a consequence of fundamental changes in brain function means that a major goal of treatment must be either to reverse or to compensate for those brain changes.” Criminal-justice strategies to curb addiction “are missing at least half of the issue,” wrote Leshner. Incarceration disregards the essence of addiction: “If they [addicts] have a brain disease, imprisoning them without treatment is futile.”1 For every recovering addict that I’ve known, except two or three who were able to get sober on their own, the key to sobriety has been immersion in a therapeutic community. And, as I know from 20 years in law-enforcement, county jails and state and federal prisons are the opposite of therapeutic communities.
