The sun has reached its apex for the day and I’m at the ‘nooner’. Now, depending on which dictionary you prefer that could mean that I am: (a) having a midday sexual encounter, (b) getting jingled at the pub, or (c) attending a lunch-time Narcotics Anonymous (NA) meeting. I don’t know why it can’t be all of those things, and I’m not ruling out at least one (you’ll have to guess), but the correct answer is (c), I’m at NA.
Why am I here? Not in the existential sense either, like literally, why am I at this NA meeting? It doesn’t really work. It’s been almost 14 years, and like they say in Alcoholics Anonymous (AA), isn’t the definition of insanity “doing the same thing over and over again and expecting different results”? Forgive me for being flippant but I’m a little bit disenchanted, I could be having sex!, but instead I’m stuck here, kneeled at the pew of my “powerlessness” over addiction.
NA knows why I am here. We all read the laminated oracle reprinted from the little white book of Narcotics Anonymous at the start of each meeting. I’m here because “before coming to the fellowship I could not manage my life”, along with my “inability to accept personal responsibility”, and “incapacity to face life on life’s terms”. Apparently I “suffer from a disease from which there is no known cure” and my only hope of recovery is that it be “arrested at some point”; as relief from the power of addiction is outside the realm of the natural world, and only God has the antidote.
In all fairness, my life was/is un-manageable and there were certainly times where the finger I was sticking up at the rest of the world should have been pointed directly back at yours truly, but this business about suffering from “a disease from which there is no known cure”? Come on!
In my last post I said that I would be exploring Marc Lewis’s refutation of the disease model of addiction which he expounds in his highly praised book The Biology of Desire: Why Addiction Is Not A Disease. I also said that I found Lewis’s assessment of addiction revelatory. I might have chosen a less biblical descriptor for his insight, but the apocalypse of addiction is upon me and I couldn’t help but receive the divine inspiration of a formerly addicted neuroscientist with over 50 peer-reviewed scientific articles who has been practicing psychology and teaching/doing research since 1989. Key word, formerly addicted!
I won’t simply regurgitate the introduction and first chapter of his book as I highly suggest you read it yourself, but his argument goes something like this. The disease model of addiction is, if anything, convenient. It’s a convenient way of explaining a complex problem that is driven by some combination of biological, neurological, psychological, and social-cultural processes. While Marc Lewis devotes the bulk of his attention to the brain science of addiction, what he does not do is divorce this from what he describes as the brains “natural partners”: psychology and personal experience. Meaning that in order for us to truly understand the nature of addiction would require multiple levels of analysis, including the complex sociocultural processes that we are subjected to as modern humans in the most highly technological stage of late capitalism (Gabor Maté, Bruce Alexander, and Johan Hari have all written books that will provide some nuance). But I digress—the main point is that the disease model which has been claimed as the property of the medical community (and as the means of production for the Treatment Centre Industrial Complex that has been built up around the lives of the addicted) is a convenient way of interpreting the changes to the brain which occur with chronic substance use. It’s also a convenient way to make sense of compulsive drug seeking and chronic relapse, despite the harmful consequences. It’s convenient for the medical community, the psychiatric community, and the addiction research community because, if addiction is a disease that means they can claim authority for its research and treatment, which is worth billions of dollar. I’m so surprised!
Politics aside, the disease model is also a convenient way of shielding the afflicted from the stigma and guilt of being addicted. As Lewis describes in his book, and as I experience each and every time I plant my ass in the chair at an NA or AA meeting, suffering from a disease from which there is no known cure that you were powerless against is certainly easier to contend with then the condescending eyes of a society who defines you as a moral failure. While having a disease may seem more appealing than being a dreg of society, it also doesn’t mean that you will stay clean. In fact, Lewis references one study which found that internalising the disease model of addiction is actually a pre-treatment predictor of relapse into substance use in the six months following treatment. It also ignores the empirical fact that millions of people simply stop using substances without internalising the disease model of addiction or the “benefit” of an intervention from the medical community. Isn’t that miraculous?
I can hear the AA literati’s reciting the Big Book of Alcoholics Anonymous ad nauseum. I’m just “looking for excuses”. I’m probably one of those “unfortunates” who is unwilling to “completely give myself” to their simple program, “constitutionally incapable of being honest with myself”. My only saving grace being the fact that I am “not at fault” because I was “born this way”.
It precisely the fact that I am constitutionally incapable of being dishonest with myself that I reject the disease model of addiction and find Marc Lewis’s position persuading. The changes which occur in the brain with persistent substance use are not evidence of a chronic, relapsing brain disease, but aren’t all that different from changes which occur in the brain with any other form of learning and development, like when you fall in love (or become a Trump supporter). If addiction is a disease then so is affection (and the 62,984,828 Americans who voted for Trump suffer from an incurable malady).
So, why am I here? I’m here at this NA meeting because there is honestly nowhere else to go where I can find a community of people with the common experience of addiction. I’m here because the only de jure requirement for membership is the desire to stop using substances and like many of the former addicts whom Marc Lewis interviewed as part of the research for his book, I look at it as one stop along the way on the journey towards finding myself. Like the woman described as Nathalie in Lewis’s book, I have to find a self before I can find self-control. Which means that NA cannot tell me why I am here, only I can. If a Nietzsche quote can do any justice to Marc Lewis’s work I think it would be his famous aphorism, off cited by the likes of holocaust survivor and psychiatrist Victor Frankl, that those who have a ‘why’ to live can bear almost any ‘how.’The disease model of addiction confiscates the opportunity for those with a problematic relationship to substances from figuring that out for themselves. Like Lewis charges in his book, whether the medical, psychiatric, treatment centre, or twelve step community, they all seem to know what the problem is, and they’re the ones to fix it. I’d rather be like Nathalie and take responsibility for myself.
Now if you will excuse me I have got a mid-day sexual encounter to attend. Next blog post I will look more deeply at what Lewis describes as the intersection of experience and biology as well as the strategies for becoming an addict in the past tense, which were found to be useful to those he interviewed on their path to recovery development.