I am a person with a health condition that’s commonly termed “addiction.” The primary symptom of addiction is continuing to use substances despite negative consequences. Why my behavior includes, or included, continued use is due to complex changes in my individual brain.
While some accuse me of making a “choice” to use, or selfishness for “liking to get high,” or of having moral or criminal problems, addiction research does not support these beliefs. My original use may have been of my own volition, but with repeated, extensive use over time, my brain learned to use nearly automatically. Because alterations occurred in the organ of the brain, this condition is alternately termed a “disease,” a “medical illness,” a “brain disorder,” a “health problem,” and a “health condition.”
My brain may have been predisposed to developing addiction from trauma, mental illness, neurodevelopmental challenges – such as ADHD and autism – and/or conditions in my environment, such as abuse or poverty. Unfortunate brain changes resulting from addiction may have affected my judgment, decision-making, learning, memory, and self-control.
I have reasons for using alcohol and/or other drugs. You may or may not approve of my reasons, but they are meaningful to me, often because substances help me with emotional or physical distress.
Please don’t equate my use of alcohol and other drugs with “abuse,” nor with the term’s inferred – and stigmatizing – sexual and physical violation. Humans have used substances for 10,000+ years. If we count caffeine, nicotine, and alcohol, nearly all Americans are drug users. If we count being overweight or obese, more than two thirds of Americans have trouble limiting their intake of substances. Neither I, nor they, are substance “abusers.”
This is subtle but I need you to hear me: Substances are not the problem. Problems are the problem. Substances can solve problems – that’s why we use some substances as medicines. Substances can help people feel good, feel better, or do better.
My intention was to use alcohol and other drugs for my reasons and without harm to myself or to you. The majority of people who take or use substances do not become dependent upon them, i.e. experience physical symptoms without the substances, or become addicted to them, i.e. persist with using them despite adverse consequences. I expected to be like most people. I did not mean for this health condition to occur, nor do I choose or want it to continue. I deeply regret any hurt or hardship my having this condition has caused you.
Abstinence is not the solution to the problem of addiction. When I abstain, whether through my own attempt or mandated by authorities, I am under the neurobiological force of addiction, possibly under the physical force of dependence, and under the mental and physical forces of unmet purposes that substances served. These forces interact and magnify, causing anguish that’s nearly unbearable. This is why I continue to use, or return to use – what you call “relapse.” You perceive my return to use as evidence of self-indulgence, of lack of self-discipline. I experience my return to use as self-mercy.
If you want to help me recover from this health condition, we need to focus on what might be termed “the unbearability.” First, you can help me protect my health and safety if I’m still using by connecting me with harm reduction resources. Second, please get me medical care. Extensively-researched medications exist to ease the neurobiological, physical, and mental burdens of this illness. A physical exam and lab work can help detect other conditions that may be weighing down my system.
If I’m newly attempting to cut down or abstain, or am mandated to abstain, I don’t feel very good. Abstinence from some substances puts me in mortal danger. In an emergency, help me get to medical professionals. With urgency, help me make appointments and help me get to them. If I can trust you and you are a safe person for me, I might even ask you to go into appointments with me to help ask important questions and to take mental or written notes on the guidance I receive.
If there are policies or laws in the way of me getting medical care, I either can’t or dare not advocate for myself. I usually don’t have adequate resources to hire legal representation. And if I speak up, I risk punishment from authorities or shunning by society. Protest injustice on my behalf and on behalf of others denied health care for health conditions.
According to research, sometimes medications and medical care are all I need to achieve stability from this health condition. What was unbearable may now be bearable. If I’ve received medical care and am still suffering, I may benefit from counseling. Research suggests individual counseling if I can get it, and skills-focused (not general) group counseling if individual counseling isn’t available, I can’t afford it, or I find working together with others helpful to me.
Since addiction is a brain condition, counseling can’t specifically and directly treat areas of the brain affected by addiction. I need counseling that takes into account the workings of my brain, not my personal, moral, or spiritual selfhood. I may or may not choose to look at those subjects in the future. Right now, I need assistance with using my own mind as a tool to work with having this health condition.
Given what neuroscience research has revealed about addiction, the essence of effective counseling for addiction builds toward this: If I can become aware that I am feeling emotions, and name them, that simple act of consciousness activates both the “heart” and “mind” functions of my brain. I now have access to the innate essence of both – termed “Wise Mind” in dialectical behavior therapy, or, more generally, “inner wisdom.” From my inner wisdom’s state of attention, awareness, functionality, and self-kindness, I can learn and apply myriad skills that may help me consider what might be helpful for me to say or do next – or not say or not do.
If I’ve received medical care, then counseling, and I am still troubled, I may need what’s termed “support.” If you can help me figure out what’s working for me, and what’s not, and help me access resources to increase what’s working and decrease what’s not, that, too, lightens the load of what has been unbearable.
For some, addiction is a chronic condition. My condition is in remission now, but if a flare-up happens, I would welcome your help in getting evidence-based care.
You will have to fight for me. Even professionals who should know better – the science is right here for all to see – will call me an “alcoholic,” scorn my “choice” to drink again, and admonish me to “become a better person” to make my alcoholism go away. You will have to fight to keep misinformation and mistreatment from breaking my heart, my mind, my life.
I am a person. I am not an osteopororitic because I have been diagnosed with osteoporosis. I am a person in which a troubling health condition has occurred.
I am a person with addiction. Addiction is a health condition that responds to evidence-based treatment. I do not and cannot speak for all people with addiction, but my lived experience matters. In America today, evidence-based treatment for addiction is hard to get. When I am unwell, I am your sister citizen, at your mercy. I ask for your help in continuing to receive evidence-based treatment for addiction. I ask for your help in getting evidence-based treatment to persons who have what I have.
Maia Szalavitz and Keith Brown contributed to this article.
This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.
