Ask an Expert: Is Addiction A Chronic, Progressing Disease?

By Lance Dodes 02/05/15
Today's question is on whether addiction is a curable disease or terminal illness.

I have been sober from opiates for 4 years. I have been really struggling lately. The problem I run into is I am constantly worried about relapse. I went to a rehab that taught addiction is a chronic, progressive, and fatal disease?  I was reluctant to believe this. They told me things like, "If you do not go to NA, you will eventually run out and get anything you can like a dog running through traffic not worrying about consequences.” So the last few years this has really been sinking in my head.

I wake up every day like this is the day I may relapse because I still refuse to go to NA. It’s like I obsess over it. I am even obsessed with drinking relapse now even though I never had a problem with alcohol. So I guess my question is that Is it definite addiction is a chronic and progressing disease. My counselor told me my thoughts will get so bad that I will eventually break down and relapse. So my head uses this against me or was he right maybe this is just how my addictive mind works. I think it is pretty horrible that they try to set people up for failure in rehabs like this.  Does this theory hold a lot of water? You would think after 4 years things would get better but not worse.  Please Help. - Trey


Lance Dodes: It is a myth that addiction is inevitably a "chronic, progressive, and fatal disease." The spontaneous remission rate (the rate at which people stop their addictive behavior without any treatment at all) is around 8% per year for alcoholism, for example.  Even people who are unable to abstain often have long periods of abstinence, and most do not die from their addiction. as we demonstrate in our new book The Sober Truth. We might forgive people for using scare tactics, such as what you were told, if it helped. But we have thousands of years of evidence that telling people they are going to die from their addiction does not make them stop. 

Instead of repeating this myth, we should be helping people to understand their compulsion to drink, take drugs, gamble, and so on, so they can be empowered over the addiction, rather than feel the addiction is a "disease" that controls them and will kill them.

It is also a myth that leaving 12-step meetings means that you are doomed. Far from being doomed if you drop out of programs that don't work for you, you are giving yourself the chance to try something that might help you. There are many non-12-step ways to approach addiction, including groups such as Smart Recovery, LifeRing, and the HAMS network. For people who tend to be introspective, I have found that understanding the way addictions work psychologically can be extremely helpful. (For more information, see the links below to The Heart of Addiction and Breaking Addiction).

The bottom line is that you are right that you are being set up for failure by 12-step people who tell you that you must do things their way or you will die. It just isn't so.



Lance Dodes, MD, has been Director of the substance abuse treatment unit of Harvard’s McLean Hospital, Director of the alcoholism treatment unit at Spaulding Rehabilitation Hospital and Director of the Boston Center for Problem Gambling. His books, The Heart of AddictionBreaking Addiction: A 7-Step Handbook for Ending Any Addiction and The Sober Truth, have been described as revolutionary advances in understanding how addictions work.    Full Bio.

Please read our comment policy. - The Fix