The Social Construction of the Disease of Addiction
Do we need to redefine addiction?
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Man this is going to gaslight some butthurt, but I am going to write it anyway!
The Disease of Addiction is as much a social construction as Race. There is an exhibit here in Pittsburgh, at the Carnegie Museum of Natural History, called RACE: Are We So Different? It extrapolates and explicates the fact that there are no genetic markers or distinct biological differences between races. There is no clear demarcation that separates white from black from Asian from Latino etc. If you want an example, we'll go with Sickle Cell Anemia. It can be found in white people or black people, or any people...as long as that person had an ancestor who lived in a region that suffered from Malaria. You see, SCA is found to be a defense against the parasitic protozoa that cause the disease. So where did race come from? What is its purpose?
Race was invented because those people who owned slaves needed a reason to go against their religious beliefs in order to perpetuate the institution. Most people already know this but it needs repeating. It was hard to go to church on Sunday and hear about loving the poor, and helping your neighbor, while having your poor neighbor in chains! In order to feel better about it, we decided that people who looked differently (read: African, Native American, etc.) were different at a biological level. There was no proof, but people needed something to explain away these atrocities so they could still be considered God-fearing, Christian people. I have nothing against Christianity (I even capitalized it!), but this is true, and it is pretty sick.
As I was reading a recent article from Maia Szalavitz on another site, I had a realization. It is true that our drug policies focus on racial and socio-cultural assumptions, but there is something eerily similar between race and how we view addiction. Just like race, we can't find a genetic or biological distinction between addict and "normie" (to borrow a term), but we sooooo badly want one. Any new evidence that might suggest a link is trumpeted as a breakthrough, even though it is always premature. Now as a person who was diagnosed with this disease, when I see this cycle, my stomach drops and my blood boils. All of my efforts today, including writing this blog, are to get people to finally see me not as a diseased person who suffers from a disability and is doomed to a lifetime of meetings and prayer, but as another human being!
Before you skip down to the comments section, let me make my point.
Let's start with a question: How is this disease diagnosed? Is there a blood test? A PET scan of the brain? Are you swabbed in the mouth for a culture? Nope. Instead, in one of the weakest moments of your life, you sit down with someone and tell them what you are experiencing. You tell them about your day-to-day life. What you do! This person then marks your experience against an arbitrary "measurement," and, of course, comes back with a "positive" (has there been anyone who went for this diagnosis and didn't receive it?). You're diseased! At this point, you are then told that you are different from everyone else, must go through treatment or die, and will have to live as an "addict/alcoholic in recovery" for the rest of your life. Well, actually, a lot of that comes later on.
What really just happened there? Were you just subjected to an objective test that can measure your "addictedness" to see if you qualify for the disease? No. I'm sorry, but no. What happened is that your experience, at that moment in time, was judged to be failing and then assumptions about biology, which have yet to be proven, were made. Your deviance from a cultural norm was measured and a theory as to why this abhorrent behavior happened was created and then placed on you. Don't worry, it happened to me too. Just like you, I was told that my "addict brain" caused me to act in a way that was deemed inappropriate and harmful, by going against cultural norms of self-soothing behavior. If only I had just eaten more Twinkies...
What is really strange is how cultural norms have changed since the invention of Disease Theory. We're at a point now where I believe almost anyone, at the right moment in time, could be diagnosed as an addict. How many people have been weekend warriors, including Thirsty Thursdays, only to find a spouse, children, and a career later on and in all that meaning, find the ability to stop? How many people go through rough patches in their lives, yet find their way around the treatment industry, and manage to fix their problems on their own? How many people smoked weed during college, or high school, but were never caught and never told about their diseased behavior? How many people have pulled themselves out of daily cocaine use, or tobacco use, and gone on to live wonderful lives? What is the real difference between these people and people like me, who "carry the disease of addiction"? Honestly, it was someone else's decision. Someone else, at that perfect moment in time, gave me my diagnosis.
That's really it, and that's why Disease Theory, like Race, is a social construction. There is no genetic or biological difference between addict and non-addict. I will make that call, even while they are still trying to prove me wrong. There is no line of demarcation between addict and non-addict, and that's why the line keeps shrinking. We can't find an honest difference. And the way it is used? At this point, I understand that those who love addicts or are working with addicts need a way to have compassion for addicts. It is hard living in (ahem!) a society and culture that views people who drink and use drugs in a negative light. There is a draw to using Disease Theory as a way of allowing for compassion. Now, it isn't the persons fault. They couldn't and can't help themselves! It allows people to continue judging other's behavior while eliminating fault and blame and allowing for socially acceptable empathy. The problem is, it takes away responsibility and efficacy from the person who is suffering. Which just so happen to be the two main ingredients in recovery...
Where do we go from here? How do we allow for people who aren't currently suffering from addiction to feel compassion for people who currently are AND allow for those suffering to hold on to their self-efficacy? We redefine addiction, phenomenologically, as a lived, and very much human, experience. It is an act of human consciousness. It is an ability, like all other human abilities. As an example of what I am saying, let's talk about an addiction that doesn't involve substances. How about food?
An addiction to food is a way of experiencing food not as a nutritional supplement delivery system and part-time good-time, but as a way of dealing with the world. It becomes a way of coping. A way of making yourself feel better. In fact, many people who are addicted to food don't know how to experience joy or sorrow without food...just like a drug addict or an alcoholic! Yet the only way a person can stop their suffering is to change their relationship with food: to change the way they experience and perceive food. You see, even though it sounds like a good idea to get rid of this ability to become addicted, we would pay a dear price for doing so.
This human ability, to become this obsessed with something, is a gift. Without it, we would not be able to attach ourselves to our lovers or our children. We wouldn't have careers, or even hobbies. Without the ability to addict ourselves to the outside world, there would be no great works of art or architecture or creativity in general. We NEED to be addicted. We are addicted to addiction! "That's cute Kevin, but it doesn't explain why addiction can hurt!"
I hear you, so to answer that, I have written a new definition of what we consider addiction. One that takes these new ideas into account: "Addiction is an obsessive relationship, and reliance upon, an external source of coping and/or emotional manipulation that leads to decreased well-being." In other words, we start using something “else” to make us feel “good” or feel “better." Eventually, we come to believe we need it to engage the world; to “walk out the door." Our “selves” become wrapped up in the relationship with the addiction. We cannot experience anything without filtering our experience through our addiction. It's not always a choice, but it is definitely an action...
So there's my point. Addiction, like race, has more to do with relationships, culture and consciousness than it does genetics and biology. Addiction is a relationship gone awry. An unhealthy, unbalanced and dependent relationship. If this is true, am I that different from anyone else? Hasn't anyone else found themselves in an unhealthy relationship that took time and work to get through and to get over? That is what I went through. A very long and very unhealthy relationship with drugs and alcohol that I had to move on from. The relationship needed to mature, to grow away from the norm I existed within. I changed, and in my change, my relationship with drugs and alcohol changed. My dependence was eliminated. I moved on.
By understanding addiction as related to relationships and identities, we can better understand how people really change their lives. How people heal. No more stigma, no more labels, no more genetics and bad neuroscience. No more DARE, no more Drug War, no more forced treatment. No more trying to convince children and teenagers of half-truths. No more failed policies. We can get to, and understand the core of the problem, while accepting that people, even addicted ones (Hell especially addicted ones!), are powerful.
Kevin Gallagher is a former frequent visitor of detoxes and emergency rooms who now works as a homeless outreach counselor while studying existential phenomenology and clinical-community psychology.