Addiction is a disease where the patient controls the outcomes
By Michael Campbell
In 1956 the American Medical Association declared that alcoholism is a disease. The definition was enlarged over the years to include drugs and by 1991, when the AMA expanded the classification of alcoholism to both its medical and psychiatric sections; the disease was generally described as “addiction.” However, decades later, the debate over “what is addiction” continues, because it is a disease like no other.
The addicted person sometimes takes comfort in being able to rationalize their poor behavior by explaining that they have a disease. But few people will fall for this “get out of jail free” justification. It is hard to compassionately embrace the concept of sickness when someone intentionally lies, manipulates and acts in a selfish manner. The symptoms of addiction do not look like other diseases, which usually have obvious physical signs. Instead, addiction’s trademark qualities are denial, rationalization and minimization.
The addict and alcoholic will also bristle at the disease concept because they want to be “normal.” A chronic, incurable disease declares that they will never be able to live life completely free of their addiction. Recovery demands that they tend to their disease, constantly working to keep their thoughts and behaviors from leading them back into the patterns of addictive behavior. Many addicted people resist the thought that they must continually manage their disease, as does the patient with diabetes.
But perhaps the greatest challenge to the understanding of addiction as a disease is that healing demands the patient’s willingness and active participation. If I have an infection, the prescribed antibiotics will address the problem, regardless of my thoughts and wishes. The surgery to remove an inflamed appendix will provide rapid resolution to what could be a life-threating problem. The patient cannot prolong appendicitis by their actions. But addiction is different. Wellness requires an act of will. The only way to beat addiction is because you want to.
At St. Joseph Institute our primary criteria for admission is the declaration by the patient that they want to get well. We ask a number of questions to assess their motivation and the reason for seeking treatment. Admission is denied if the motivation is all external – perhaps a court mandate or a spouse’s edict. Outcome studies confirm over and over that success is directly related to the internal motivation of the addicted person. Recovery requires change, and determination to learn how to live and think differently. This rarely occurs without a strong “inner desire” to break free from drugs and alcohol and embrace a new life.
I remember a young man who came into treatment pleading for help to leave his addiction behind. Throughout the program he was compliant and followed the rules without objection. But his counselor detected that it was all a façade. Something was providing motivation for treatment, and it was not a deep felt desire to live without his drug of choice. The answer became clear when his father picked him up at discharge in a shiny new truck – his reward for attending rehab. Not surprisingly, he started taking drugs soon after dropping dad off at home and picking up his former “using friends” in the new ride.
While interventions make for dramatic television, they do not necessarily represent a good beginning for treatment. The website for the American Psychological Association cites a study claiming that the success rate for the traditional method of “Johnson interventions” is only 23%. This is not surprising. Recovery requires much more than surrender to the pressure from family and friends. It happens when an individual makes a determined effort, driven by an inner drive to change and live life differently.
Should addiction be reclassified as something other than a disease? I think not. Research confirms the heritability, etiology and pathophysiology that meet the criteria for disease classification. However, as healthcare providers we must understand that our ability to ensure recovery is limited. We have few and very imperfect means of treatment that override the desires of the patient (e.g. methadone and Suboxone.) The healing we seek is ultimately in the hands of the patient. Only they have the ability to take what we offer in terms of knowledge, techniques, tools and treatment, and apply it in their lives to achieve wellness. From a medical perspective this is frustrating because we seek outcomes that the patient does not limit or control. But with addiction, that may never be possible.
Michael Campbell is Co-Founder and President of St. Joseph Institute, a leading rehab facility located near State College, PA.