“We must choose to come out in the light and be treated with dignity and respect. So let’s stop whispering about this disease.”
– Michael Botticelli, Director of National Drug Control Policy, speaking at the UNITE to Face Addiction Rally, Washington, D.C., 10/4/15, excerpted by 60 Minutes, 12/13/15
If only addiction hadn’t been whispered about three years ago!
If I had discovered this December 28th – in 2015, not in 2012 – that I couldn’t stop drinking, thanks to extensive efforts to educate the public, I would have known that substance use disorder is a brain disease, a medical condition, and I would have started with my primary care physician for science-based, evidence-based, best practices treatment.
Michael Botticelli: We’ve learned addiction is a brain disease. This is not a moral failing. This is not about bad people who are choosing to continue to use drugs because they lack willpower. You know, we don’t expect people with cancer just to stop having cancer.
Scott Pelley: Aren’t they doing it to themselves? Isn’t a heroin addict making that choice?
Michael Botticelli: Of course not. You know, the hallmark of addiction is that it changes your brain chemistry. It actually affects that part of your brain that’s responsible for judgment.
– 60 Minutes interview on 12/13/15 with Michael Botticelli, Director of National Drug Control Policy
Almost three years ago, on December 28th of 2012, however, even though I was trained as an addictions counselor myself, I believed my own lack of oversight of my behavior had caused my addiction to alcohol. I was appalled at myself. My fundamental understanding of my personhood was shattered by my inability to insist to myself that I not drink again, and be unable to stop myself.
People suffering from addictions are not morally weak; they suffer a disease that has compromised something that the rest of us take for granted: the ability to exert will and follow through with it.
– Nora D. Volkow, M.D, Director of the National Institute on Drug Abuse (NIDA), quoted in What We Take for Granted
What we know now – that may have been known in 2012 but wasn’t widely known, and didn’t seem to be known in 2006 when I finished my degree because it wasn’t part of the curriculum – is that addiction impairs the brain’s ability to make decisions, to make judgments, to intend and to make intentions happen. What one most needs to do – decide to stop and stop – is beyond the injured brain’s ability to do.
I not only did not whisper when I realized I had a drinking problem in 2012, I did not speak at all. I told no one. In silent shame, I drove myself to a support group meeting comprised of survivors – well-meaning, amateur volunteers with a set of beliefs about what treats alcoholism.
If you had a brain disease – multiple sclerosis, Parkinson’s, Lou Gehrig’s, Alzheimer’s, for example – would you go to a support group meeting for treatment?
(Hey, WebMD, how about updating your site and adding addiction to your list of brain diseases?)
Not that there’s consensus on what constitutes effective treatment for addiction. This 2003 list of alcoholism treatments excerpted by a private company from a reputable, if dated, source (then linked disreputably by that company to its own products – good grief, how could you, people are dying out here) ranks 40+ treatment modalities. The National Institute on Drug Abuse (NIDA), has a 2012 explanation of principles of addiction treatment that does express current best practices but essentially says, “Try a bunch of stuff.” It states, “Behavioral therapies – including individual, family, or group counseling – are the most commonly used forms of drug abuse treatment.” Behavioral therapies? For a brain disease? That’s all we’ve got?!
In terms of addictions treatment, I think we’re still in the era of bloodletting. Most of our treatments are based on belief, not knowledge.
. . . . .
Where does this leave me after six years of imbibing increasing amounts of the neurotoxin alcohol, then struggling three years with abstinence in essentially an untreated, under-treated, even mal-treated state of recovery from a brain disease? And watching the terrible statistics ravage my beloved fellow brain disease sufferers who attempt against miserable odds to survive?
Enraged. Bereft. Exhausted.
And, paradoxically, thrilled. Relieved. Hopeful.
With all the unknowns, now is still the very best time in history to need help with recovery from addiction.
I appreciated hearing in yesterday’s 60 Minutes interview that Michael Botticelli and I have something in common – we both attended a support group when we realized we had a problem, continue to do so, and continue to stay abstinent. (Additionally, I have needed therapy and “a bunch of stuff.”) He and I are among the lucky 1 in 15 who have been able to support abstinence through support group attendance.
I dedicate my voice and my work as an addictions counselor and as a person in recovery to learning other ways for the 14 out of 15 who also need help with this dangerous, destructive brain disease of addiction.
The opinions expressed here are mine and do not necessarily reflect the positions of my associates, clients, employers, friends or relatives.
Nice job! Firmly and passionately stated, well-organized and thought-provoking. By clicking on the link to the Dodes book I reread some of his ideas that you condensed from his manuscript – the belief that 12-step meetings are just about the ONLY solution available at this time and also the almost universal endorsement of expensive rehabs that themselves focus on 12-Step programs as the pivotal treatment model, the same treatment one can find in church basements for free. I also recall agreeing with him about the time duration spent in rehab. Why 30 days, he asks? Is THAT the magic number? Did this number originate from scientific evidence-based research or is this the the limit of insurance coverage?
I admire your pursuit of other treatment modalities and methods here in the NRV and your insistence that there just has to be something else to help the 90% for whom 12-step programs have been ineffective to recovery from addiction.
While pondering the Boticelli piece I began to wonder about specific situations, such as the following.
– Drunk driving, especially when the loss of human life is a factor: treatment or incarceration?
– What about selling drugs (to support one’s addiction) near schools?
– What about domestic battery and assault and abuse, exacerbated by drugs and alcohol? Jail or treatment?
In order to satisfy society’s demand for punishment, is it possible to convert the white-collar country club “prisons” into some kind of transitional treatment facility. Society is no doubt not ready to let bygones be bygones and perhaps this incarceration/treatment model might appease them while offering the addict some hope for recovery.
As for myself, I admittedly have a conflicted view of the “disease” model of alcoholism advocated by AA. If it is indeed a “disease,” with medical symptoms, why then all this talk of a “spiritual” solution? I do hope that if I someday suffer a heart attack the cardiologists have something more constructive up their sleeves than hauling off the gurney to get on my knees and pray. I understand the “disease” model helps ward off the shame and guilt so many addicts/alcoholics feel but I also believe that in many cases it absolves the addict of any negative consequences, of any malfeasance. That being said, I know from my experience that once I am drinking, that there is most definitely a physical component, as well as a mental obsession that essentially does make me powerless, takes away the ability to choose. I am simply a slave to the drink at this point and yes, all of my limited energies are focused on drinking and ensuring that my alcohol supply is sufficient to stave off physical withdrawal symptoms. I act against my core beliefs – I lie to loved ones, I bargain with them, I have little regard for anyone or anything as long as I have enough booze to keep from severe withdrawal symptoms (DTs, seizures, convulsions). I definitely can feel actual physical and mental effects and if alcohol is unavailable, my mind and body exhibit grievous and dangerous symptoms that need to be medically treated or I face the risk of a potentially fatal reaction. A spiritual solution does not mitigate these grave medical concerns. However, once safely detoxed from alcohol I do feel that I bear the brunt of the responsibility to”treat” my brain disease, knowing full well that there is a part of my brain that wants to kill me. But let me be clear. As a recovering alcoholic I am not powerless. Yes, continued use despite the adverse consequences is, while insane, not as simple as drawing a line in the sand and convincing oneself that this line shall not be crossed.
While science has recently identified with greater clarity the effect of addiction on our poor brains, science has NOT identified a one-stop solution shop.
Like you articulated clearly in your piece, we must have a treatment plan comprised of various parts AND that these plans must be individually tailored. So I imagine 10 people in your group and each one of those ten requires a uniquely specific treatment for him/her! And at this time, whether CBT, or SMART recovery or AA/NA or other faith-based alternatives, all that is really being offered is Talk Therapy in some guise or another. Yes, I do know there are anti-craving meds available but what about the vast amount of addicts where “the disease” is but a symptom of serious mental trauma. Simply taking a pill (currently unavailable) to cure addiction just won’t deal with the mental anguish that precipitates the use of drugs and alcohol to find relief, to self-medicate oneself to alleviate despair and hopelessness.